Really depends on where you put the center, of course.

David Cutler, Obama's health care expert, is, I'm afaid, not left-of-center, but right of center.

I've read his book and interviewed him. And while he's a perfectly nice person (as is Obama, no doubt), for a long time Cutler's positions have supported the for-profit corporate interests that are making billions on our current health system--and that don't want to see change that would, in any way, cut into those profits. "Universal access" is okay if it would bring them more customers. But they don't want to see reform that calls for higher quality at lower prices.

Culter argues that our sprailing health care costs aren't such a big problem. (In other words, drug-makers don't charge too much. Device-makers don't charge too much.) We're getting good value for our dollar, he says. He ignores the waste in the system--the fact that according to other healthcare eeconomists, $1 out of $3 of our healthcare dollars is wasted on unncessary tests and procedures, unproven treatments, ineffective, sometimes riksy drugs and devices that have been "fast-tracked" through the FDA.

Matthew Holt, of thehealthcareblog.com, sums up how Cutler's writings support the medical-industrial complex:
"industry is totally happy to use Cutler's arguments -- very much out of context -- to praise ex-post all manner of technologies, procedures and services that they’ve foisted on the American patient and taxpayer. The ink was barely dry on the editions of the New England Journal [where Cutler published an article saying that we're getting great value for our health care dollars], when Advamed, an umbrella group for all kinds of medical technology companies, was out with its press release. Its chief lackey, one Stephen J. Ubi, was certainly not looking this gift horse in the mouth:
"When health care dollars go toward procedures and products that make a difference, that's when our health care system is at its most effective," Ubl said." etc. etc.

I'd add this to what Holt says: The NEJMM article that Cutler co-authored argued that if you look at spending and health trends from 1960 to 2000 we've been getting a real bang for our buck. That's true --if you go back to 1960. We had huge medical breakthroughs in thesixties, the seventies, and even the eighties.

The problem is that if you look at say, 1996 to 2006--you find that in recent years, we've reached a point of diminishing returns in many, many areas.

One of Cutler's big examples is how much progress we've made in treating heart disease. But recent research shows that in recent years, we've been doing way too many anigioplasties (using over-priced coated stents that have been hyped by the device industry, with help from the main-stream media). Many patients would have been better off with less agressive, less expensive treatment. We're actually hurting patients by over-treating them. This is true in many other areas as well--prostate cancer, for example.

Holt concludes: "But given that Cutler won’t call a spade a spade, on the “value” issue, the overall ramification of the work he is doing . . . is that the real debate about how to fix our financing system and deliver some type of cost-effective medical care in this country is getting pushed to the sidelines. That of course is just how the industry wants it."

Cutler knows this, of course. I'm not at all clear as to why he ignores the waste. But it may be his sense as a centrist economist that what's good for American business. is more business. Growth is always good.

But what's good for America's health is not always more healthcare. While some people in this country (the uninsured, the underinsured and many on Medicaid), get too little care others (the well-insured and many on Medicare) are getting too much care in the form of all of those pricey, not fully-tested, drugs, treatments and devices.

No Democratic President is going to be able to get "his" health care program, or just about any other program thru Congress intact. Democrats just don't do things that way. For that reason I don't expect or want Obama to develop a complete health care policy package and campaign on it. What I do want is assurance that he understands the importance of changing how we deliver health care in our country, and assurance that he will work to make the necessary changes. I have received those assurances.

Getting from here to there, where we have a single payer health care system will require a substantial majority in Congress to buy into the need and the importance of filling the need, plus a president who is not in the pocket of the health insurance and drug industries. Obama will be that president.

Hoppy in Sacramento

John--
I would like to think--and hope--that Obama has been relatively slow to put forward a proposal because he is thoughtful and realizes just how complicated health care reform is.
I'm not sure I want him to put forward a 55-page, 302 point plan. But I would like to see him begin a thoughtful national discussion about what is wrong what our health care system--and what needs to be fixed.
It's not just that we lack univeral access--costs are too high, and quality is not high enough.
It would be great if Obama could help people begin to understand that quality and lower costs go hand-in-hand. An efficient health care system that provides the right care to the right patient at the right time is less expensive than a profit-driven system that over-medicates and over-treats well-insured patients. The waste in our health care system isn't just a waste of money--it's "hazardous waste" that threatens our health.
If you're interested, here's a link to an article that I've written about this problem http://dartmed.dartmouth.edu/spring07/html/atlas.php.

" If you're interested, here's a link to an article that I've written about this problem." Good article.  It boils down to a sentence about fee per service. And it's just the sort of thing that a naive person would assume an insurer would curtail to maximize profits.  Sometimes I think anti-libertarians should carry a rubber stamp that says in red caps "market failure" and use it liberally. 

John 

http://www.haberarts.com/

A zero it is. It wasn't political commentary at all. It was a post intended only to enflame the reader and detract from any discussions. In other words a pure troll post, whether or not the author is a troll. The only alternative explanation is that the poster actually believes that Obama's supporters are all Black Panthers and similar people, which is again a trollish attitude totally out of place in a discussion about a serious subject - the presidency of the United States. I stand by the zero.

Hoppy in Sacramento

Your comment in no way deserved a zero. I have been thinking about the one I gave a zero to. I'm willing to accept that it was intended as satire, even though the satire was so subtle as to be nearly indetectable. I think when we do a comment like that, intending it as satire, we need to add something that makes it obvious that satire was the intent. I shall change my zero rating.

Hoppy in Sacramento

I do agree, a text-based medium certainly makes the nuance often needed for communication a difficult thing.