In case you haven't heard, there's a debate about health care reform going on - today we find out that a campaign promise, no fines if you choose not to use government health care, is off the table if you are middle class.   That's only going to aggravate the situation.  What is needed is some clear thinking and some science-based evidence, but you won't find it in Washington.  Heck, you won't even find it in medicine.

The downside to insurance over the last few decades is that people have misunderstood what the word 'insurance' means.   There have been lawsuits (at least in my decade in California, your state may vary) about things like breast implant coverage.   Insurance was originally intended to be for serious things but people increasingly want everything covered - no surprise costs have skyrocketed and insurers look for people to deny.

And doctors aren't helping.   A recent survey by Lake Research in California showed 88 percent of people believe scientific evidence for treatments is important but lumbar fusion surgeries for simple back pain (the kind not caused by accident or injury) went up 500% between 1993 and 2003 despite no evidence that it works and in many cases made the pain worse - doctors and surgeons ignore the science-based evidence.   If an insurance company objects to this expensive, invasive surgery based on science-based evidence we get commercials extolling that 'doctors should make these decisions, not insurance companies' and then we all get premium raises with no actual benefit to patients.

And people need to realize more access to a cheap hospital stay may not be the best idea.   190,000 people die in hospitals each year, not from what they were admitted for but from infections and avoidable medical errors.   That's over 20X as many people who die from guns and more deaths than breast cancer, car accidents and AIDS - combined.

Can we blame doctors?   Maybe a little, because a lot of information is provided to doctors by pharmaceutical marketing departments, so if you are newly convinced your son is at risk of cervical cancer if he doesn't get an HPV vaccine at a cost of billions of dollars, you can thank advertising.

80% of people believe it is a serious problem when doctors provide unnecessary care and 79% think it's a serious problem when they don't get necessary care.   90% want to know if there is no scientific evidence to support a treatment.

Part of the reason why the president's health care reform plan, which was once a slam dunk and is now on the verge of failing, is political.    When Republicans had the White House and Congress the concern was they would implement their policies - when Obama got elected the first thing Congress did was tell him they weren't going to rubber stamp his agenda.

Another part of the reason it is teetering on failure is that the financial cost was known before there was a plan - 5 competing proposals for health care reform is not reassuring to people.   

The good news; 2 of the plans being floated have provisions for research that would compare the effectiveness of different treatments.  Yes, science-based evidence for medicine instead of personal belief, tradition and pharmaceutical marketing.   They all carry bloated infrastructure costs in order to actually disseminate that information but at least the information patients receive will have science behind it.  

The September 2nd poll was conducted by the Campaign for Effective Patient Care - like everyone else, they claim to be 'nonpartisan' but they are funded by AARP, the California Association of Physician Groups and Blue Shield of California.  So their nonpartisan status can be calibrated by whether or not you agree with them, like most things in politics.