This week's policy "must-reads"

We're starting a new feature here at Policy Blog. Every Friday (or as often as we can remember) we'll share a handful of recent reports, news articles and blog postings that we think raise interesting or provocative public policy questions. Please share your thoughts about any of these pieces.

Here is this week's offering:

Misfortune teller: A statistics professor says he can predict crime before it occurs.

Gambling revenue promises rarely met: How well do predictions of state gambling revenues match up to reality?

Why does manufacturing matter? A new report by the Brookings Institution suggests manufacturing policy should strengthen four key areas.

The geography of government benefits: Courtesy of the New York Times, see the share of Americans' income that comes from government benefit programs like Medicare, Medicaid, Social Security, veterans' benefits and food stamps. The map may surprise you.

Evaluating teachers: Bill Gates weighs in on a hot topic for education assessment: whether publishing evaluation reports of individual teachers is a good idea or not.

Comments

[Andrew Sanborn]

Conventional Wisdom: Top-notch health care depends on preserving a diversity of options and patient choice.

The Contrarian: Elizabeth DeVita-Raeburn says we need fewer choices and more evidence.

Americans have always valued the right to make their own choices, especially about health care. So it is not surprising that federal health-care reform, popularly known as Obamacare, has sparked fears that the wise counsel of doctors could be replaced by the rubber stamps of government bureaucrats. The common belief is that only doctors truly know what works and what doesn’t.

But the argument falls apart because most doctors lack the evidence to compare various treatments in any absolute way. In 2009 the nongovernmental Institute of Medicine (IOM) released a list of 100 disorders, including lower back pain, atrial fibrillation, and early prostate cancer, that it says require research analyzing which treatments work best for different groups of patients.

Having lots of treatment options is useless if we have no way to intelligently choose between them. That is exactly what we need to remedy in our health-care system: Instead of offering a vast array of choices, we must eliminate options that are needlessly risky and expensive by providing more proof of what works best.
The government has pledged $500 million annually, beginning in 2014, to do exactly that. Comparing various treatments and supporting the most effective won’t ruthlessly eliminate patient choice. It will help patients and doctors make better treatment decisions. It may end up limiting choice but only by removing the wrong options.

Case in point: a 2007 study in The New England Journal of Medicine comparing the long-term effectiveness of treatments for heart-related chest pain. It found that angioplasty, a surgical procedure to open clogged arteries, was no more effective than medication—a far cheaper, less invasive alternative. “It was a gorgeous study,” says Harold Sox, an internist who cochaired the IOM report and was not involved in the study. Similar research has recently sorted out treatments for spinal fractures and heart disease.

Funding more of these studies, guided by the IOM recommendations, is critical for strengthening American health care. Patients may like having many choices, but they will love knowing the right one.