If you didn't want Obama to fire Peter Orszag already,** you might after reading Jerome Groopman's piece in the New York Review of Books . Groopman notes that "comparative effectiveness" research on which treatments work and which don't--research Orszag would back up with financial incentives and other semi-coercive measures, and which he and Obama think will cut costs --is often a four card flush:

Over the past decade, federal "choice architects"—i.e., doctors and other experts acting for the government and making use of research on comparative effectiveness—have repeatedly identified "best practices," only to have them shown to be ineffective or even deleterious.

Plus, declaring one course of action a "best practice" often involves a value judgment that experts aren't in a much beter position to make than individual physicians or patients. When a federal panel recommended against mammograms for women in their forties--allegedly without considering cost--it implicitly decided that the anxiety and pain of false positives (resulting in biopsies and sometimes surgery) outweighed the saving of nearly 12,000 lives over 10 years. Maybe that's not an unreasonable weighing--seems crazy to me, and Groopman doesn't buy it--but it's not a "scientific" finding to be imposed through financial penalties.

P.S.: Obama, who (Groopman notes) consistently portrays "comparative effectiveness as equivalent to cost effectiveness," either a) has an average President's shallow understanding of the subject, or else b)  is conveniently trying to make "bending the cost curve" look painless (by pretending cost-cutting will never require denying treatments that have some benefit).  ... Or else c) he knows that if he knew more--enough to second-guess Orszag--he couldn't do the pretending, so he doesn't want to know more. (And Ron Brownstein and Dave Leonhardt love his position the way it is! ) (C) would be my guess.

P.P.S.: I think Groopman pretty clearly demonstrates why Bob Wright was wrong, so wrong, in our latest bloggingheads debate about what was and wasn't in the health care bill. But at least Wright wasn't smug about it. Oh wait, he was! ...

**--The latest humiliation to the Obama/Orszag/Pelosi/Reid health care effort: Dems are apparently floating the idea that the ban on excluding pre-existing conditions will apply only to children (who are of course the least likely to have them). That would be a pathetically small achievement designed mainly to preserve the careers of Dem Congresspersons by allowing them to hype a tiny, face-saving accomplishment. Kabuki wins! Or, as Charlie Peters calls it, Washington Make-Believe. ... 11:40 P.M.

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