Thursday, July 2, 2009

Healthcare rationing is in the works and saving money can mean getting rid of the sicker, quicker.

http://tinyurl.com/m3sa9u
Government Health Plans Always Ration Care Europe offers a glimpse of the future if President Obama and congressional Democrats have their way. By SCOTT GOTTLIEBOnly by expanding government control of health care can we bring down its cost. That's the faulty premise ... claimed cost control depends on politically safe ideas such as preventive care or the adoption of electronic health records. And neither ...will do much to reduce spending.****it comes as a surprise to many that Medicare de-emphasizes preventive care. Screening tests or checkups are excluded. The vaunted low administrative costs are due to Medicare automating bill payment, rejecting what the program says, paying what they want, and brooking no palaver about whether or how much. If you don't accept customer complaints, you don't need to staff a customer service department. ****...(when these) fail to produce savings, government will turn to a less appealing ...tool to cut costs: the regulation of access to drugs and medical services. Medicare is already going down this path. What will be new about government-run health care is the instrument of regulatory control. There will be an omnipotent federal health board. ...bill released by the Senate Health, Education, Labor and Pensions (HELP) Committee. The bill calls for a "Medical Advisory Council" to determine what medical products and services are "essential benefits" and those that shouldn't be covered by a public insurance plan.The Senate ...turns to a "Federal Health Board" to compare similar medical treatments in order to steer reimbursement to lower-cost options. Senate Finance also proposes a "sustainability commission" charged with finding automatic cuts to Medicare spending that would then pass Congress by a simple up or down vote....an independent "advisory committee" that will "recommend a benefit package based on standards set in the law." I...help develop treatment protocols based on government-directed research.... Under the HELP committee's plan, the health board's recommendations would be binding ... Obama objects when people use the word "rationing" in regards to government-run health care. But rationing is inevitable ...Like Medicare's recent decisions to curtail the use of virtual colonoscopies, certain wound-healing devices, and even a branded asthma drug, the board's decisions will be one-size-fits-all restrictions. Such restrictions don't respect variation in preferences and disease, which make costly products suitable for some even if they are wasteful when prescribed to everyone.****Medicine, if not this administration, is moving in the direction of "customized" prescription and procedure since patients are unique and some respond better to some protocols and others to different ones.It only appears to be wasteful to have multiple drugs directed at the same disease: they all have different efficacy and different side effects, depending on the individual. That's the fundamental difference between nationalized healthcare and private: emphasis on the collective or average in the former case, on the individual in the latter.****
...policy makers know they'll need to ration care but want to absolve themselves of responsibility. ...tipped their hand on this goal by proposing to make recommendations of the current Medicare Payment Advisory Committee (MedPAC) legally binding rather than mere advice to Congress.......an omnipotent board that makes unpopular decisions on access and price isn't a new construct. It's a European import. In countries such as France and Germany, layers of bureaucracy like health boards have been specifically engineered to delay the adoption of new medical products and services, thus lowering spending.
In France, assessment of medical products is done by the Committee for the Evaluation of Medicines. Reimbursement rates are set by the National Union of Sickness Insurance Funds, a group that also negotiates pay to doctors.
In Germany, the Federal Joint Committee regulates reimbursement and restrictions on prescribing, while the Institute for Quality and Efficiency in Healthcare does formal cost-effectiveness analysis. The Social Insurance Organization, technically a part of the Federal Joint Committee, is in charge of setting prices through a defined formula that monitors doctors' prescribing behavior and sets their practice budgets. In the past 12 months, the 15 medical products and services that cleared this process spent an average 35 months under review. (The shortest review was 19 months, the longest 51.)
In short, other countries where government plays a large role in health care aren't shy about rationing. Mr. Obama's budget director has acknowledged that rationing reduces costs. Peter Orszag told Congress last year when he headed the Congressional Budget Office that spending can be "moderated" if "diffusion of existing costly services were slowed."****"Hinder adoption of new techniques and medications."****
Medicare can already be painstakingly slow. Appealing to it takes patients an average 21 months according to a 2003 Government Accountability Office report (17 months involve administrative processing). Layers of commissions and health boards would delay access still further.****This must account in large measure for the vaunted "low overhead" costs of Medicare. If you don't give a damn about appeals, you don't need a customer service department. Delaying appeal of denials of service has another advantage: by the time Medicare gets around to the matter (even assuming it is willing to act affirmatively on an appeal against its own denial ), the patient has likely died and so no longer needs the service. Medicare can do such cute things as: last October, Medicare stopped paying for complications arising from certain infections and coditions that result from hospital care and are "reasonably preventable."Presumably, the idea is to pressure hospitals into take more actions for safety's sake. HOWEVER, how is a lay patient to know that an infection is clearly hospital-CAUSED (like MRSA, for example ) and something that just "might be?" Only a government bureaucracy would crassly kick the can down the road of the chain of responsibility. Medicare has many other ways of pressuring hospitals to take precautions against MRSA and other hospital-acquired diseases.Of course, private insurers are following.****
When asked to judge the constitutionality of the Senate HELP committee proposal, there's a reason why the nonpartisan Congressional Research Service said that the proposed Medical Advisory Council "raises potentially significant constitutional concerns." Our Founders thought politicians should be accountable when it comes to citizens' right to life, liberty and the pursuit of heart surgery. Dr. Gottlieb, a physician and resident fellow at the American Enterprise Institute, is a former senior official at the Centers for Medicare and Medicaid Services.

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