Comments on: An Argument for Pilot Programs http://healthblog.ncpa.org/an-argument-for-pilot-programs/ Health Care Policy and Reform Insights | NCPA Wed, 16 May 2012 20:29:55 +0000 hourly 1 http://wordpress.org/?v=3.3.2 By: Michael Kirsch, M.D. http://healthblog.ncpa.org/an-argument-for-pilot-programs/comment-page-1/#comment-50439 Michael Kirsch, M.D. Sat, 12 Dec 2009 19:21:54 +0000 http://www.john-goodman-blog.com/?p=7482#comment-50439 Too many pilot programs are not done as an honest experiments. They are done as stalling maneuvers, to avoid doing what should be done. If the pilot approach is optimal, let Speaker Pelosi raise taxes in her district alone as a 'pilot program'. Then, after a few years, we can evaluate the benefits before making the project a national effort. www.MDWhistleblower.blogspot.com Too many pilot programs are not done as an honest experiments. They are done as stalling maneuvers, to avoid doing what should be done. If the pilot approach is optimal, let Speaker Pelosi raise taxes in her district alone as a ‘pilot program’. Then, after a few years, we can evaluate the benefits before making the project a national effort. http://www.MDWhistleblower.blogspot.com

]]> By: Linda Gorman http://healthblog.ncpa.org/an-argument-for-pilot-programs/comment-page-1/#comment-50424 Linda Gorman Fri, 11 Dec 2009 22:47:40 +0000 http://www.john-goodman-blog.com/?p=7482#comment-50424 All proposals like this do is turn health care into education. We have paid for innumerable pilot programs in education. Curricula are studied and changed year in and year out. Fads come and go. Models of excellence created by them? None. Improvements in education occur when private individuals come up with new models that succeed or fail in the educational marketplace. This includes charter schools that have to succeed by pulling kids away from existing public schools, new homeschooling curricula, and new models of adult education. All proposals like this do is turn health care into education. We have paid for innumerable pilot programs in education. Curricula are studied and changed year in and year out. Fads come and go.

Models of excellence created by them? None.

Improvements in education occur when private individuals come up with new models that succeed or fail in the educational marketplace. This includes charter schools that have to succeed by pulling kids away from existing public schools, new homeschooling curricula, and new models of adult education.

]]> By: John Goodman http://healthblog.ncpa.org/an-argument-for-pilot-programs/comment-page-1/#comment-50423 John Goodman Fri, 11 Dec 2009 22:39:15 +0000 http://www.john-goodman-blog.com/?p=7482#comment-50423 John Stuart Mill: The indented material is from Gawande. The nonindented comments are mine. I think it is reasonably clear that Gwande supports the pilot programs approach to reform in the bill and I do not. John Stuart Mill: The indented material is from Gawande. The nonindented comments are mine. I think it is reasonably clear that Gwande supports the pilot programs approach to reform in the bill and I do not.

]]> By: Dan S http://healthblog.ncpa.org/an-argument-for-pilot-programs/comment-page-1/#comment-50420 Dan S Fri, 11 Dec 2009 22:28:00 +0000 http://www.john-goodman-blog.com/?p=7482#comment-50420 The New Yorker has always been a world leader in publishing fiction. Non-fiction is another matter. I read the Gawande piece until I couldn't control my nausea any longer. To compare a commodity production business like agriculture with a professional service business like medicine is the ultimate apples and oranges fallacy. Do we need "pilot programs" to re-structure the legal profession? It's not a big stretch to make the argument in education, but that is still a by-rote kind of operation and, let's face it, kids can be home schooled with excellent results. Corporate wonks are always wanting to make medicine just like a widget factory, but the widgets we are striving to help behave the way they want to when they leave the office, we can't throw away defective or old models and we can't replace parts of an airplane when it's at 35,000 feet without suffering a crash. The New Yorker has always been a world leader in publishing fiction. Non-fiction is another matter. I read the Gawande piece until I couldn’t control my nausea any longer. To compare a commodity production business like agriculture with a professional service business like medicine is the ultimate apples and oranges fallacy. Do we need “pilot programs” to re-structure the legal profession? It’s not a big stretch to make the argument in education, but that is still a by-rote kind of operation and, let’s face it, kids can be home schooled with excellent results. Corporate wonks are always wanting to make medicine just like a widget factory, but the widgets we are striving to help behave the way they want to when they leave the office, we can’t throw away defective or old models and we can’t replace parts of an airplane when it’s at 35,000 feet without suffering a crash.

]]> By: Devon Herrick http://healthblog.ncpa.org/an-argument-for-pilot-programs/comment-page-1/#comment-50418 Devon Herrick Fri, 11 Dec 2009 22:00:25 +0000 http://www.john-goodman-blog.com/?p=7482#comment-50418 Gawande makes some interesting points, but he's ignoring the fact that small farmers operate in a (nearly) perfectly competitive business. Therefore, they have an incentive to boost productivity and efficiency because the result is higher profit. The health care marketplace is not competitive. In health care, there is no incentive to boost efficiency when becoming more efficient actually costs the provider money. Because providers are paid by task, inefficiency often pays better if by being inefficient we mean ordering unnecessary tests and marginal treatments. Gawande makes some interesting points, but he’s ignoring the fact that small farmers operate in a (nearly) perfectly competitive business. Therefore, they have an incentive to boost productivity and efficiency because the result is higher profit. The health care marketplace is not competitive. In health care, there is no incentive to boost efficiency when becoming more efficient actually costs the provider money. Because providers are paid by task, inefficiency often pays better if by being inefficient we mean ordering unnecessary tests and marginal treatments.

]]> By: John Stuart Mill http://healthblog.ncpa.org/an-argument-for-pilot-programs/comment-page-1/#comment-50414 John Stuart Mill Fri, 11 Dec 2009 20:09:50 +0000 http://www.john-goodman-blog.com/?p=7482#comment-50414 This is a dishonest post. It gives the impression Gawande is critical of the proposed healthcare legislation when, in fact, he thinks it is absolutely right-on. Gawande's point is that pilot programs are preferable to a "master plan" because they enable us to learn by trial-and error. In his long piece, he argues that is how U.S. agricultural production became the envy of the world. This is a dishonest post. It gives the impression Gawande is critical of the proposed healthcare legislation when, in fact, he thinks it is absolutely right-on.

Gawande’s point is that pilot programs are preferable to a “master plan” because they enable us to learn by trial-and error. In his long piece, he argues that is how U.S. agricultural production became the envy of the world.

]]> By: Larry C. http://healthblog.ncpa.org/an-argument-for-pilot-programs/comment-page-1/#comment-50412 Larry C. Fri, 11 Dec 2009 19:01:34 +0000 http://www.john-goodman-blog.com/?p=7482#comment-50412 Agree with Ken. Pilot progams are no substitute for real markets. Agree with Ken. Pilot progams are no substitute for real markets.

]]> By: Ken http://healthblog.ncpa.org/an-argument-for-pilot-programs/comment-page-1/#comment-50411 Ken Fri, 11 Dec 2009 18:58:09 +0000 http://www.john-goodman-blog.com/?p=7482#comment-50411 I like your last line. There is no way we are going to get meaningful reform with pilot programs. I like your last line. There is no way we are going to get meaningful reform with pilot programs.

]]> By: Michael Kirsch, M.D. http://healthblog.ncpa.org/an-argument-for-pilot-programs/comment-page-1/#comment-50410 Michael Kirsch, M.D. Fri, 11 Dec 2009 18:49:09 +0000 http://www.john-goodman-blog.com/?p=7482#comment-50410 Speaker Pelosi has proposed some toothless 'pilot programs' to pursue tort reform. This will have the same fate as you suggested in your post. Interestingly, her view of tort reform, which is written in the House legislation is that caps against non-economic damages cannot be addressed nor can attorneys' fees be adjusted. Sounds like landmark legislation. www.MDWhistleblower.blogspot.com Speaker Pelosi has proposed some toothless ‘pilot programs’ to pursue tort reform. This will have the same fate as you suggested in your post. Interestingly, her view of tort reform, which is written in the House legislation is that caps against non-economic damages cannot be addressed nor can attorneys’ fees be adjusted. Sounds like landmark legislation. http://www.MDWhistleblower.blogspot.com

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