Medicare’s “global budget” & bureaucratic medical decisions
November 19th, 2009 | by Brian Schwartz |From the Wall Street Journal:
Democrats are quietly attempting to impose a “global budget” on Medicare, with radical implications for U.S. medicine. …
If Democrats impose such a commission nationwide, it would constitute a radical change in U.S. health care. The reason that physician discretion—not Washington’s cost-minded judgments—is at the core of medicine is that usually there are no “right” answers. …
The only way to take the politics out of health care is to give individuals more power to control medical dollars. And the first step should be not to create even more government spending commitments. The core problem with government-run health care is that it doesn’t make decisions in the best interests of patients, but in the best interests of government.
More excerpts:
The commission is mandated to go after “sources of excess cost growth,” meaning treatments that are too expensive or whose coverage will boost spending. If researchers find a pricey treatment for Alzheimer’s in 2020, that might be banned because it would add new costs and bust the global budget. Or it might decide that “Maybe you’re better off not having the surgery, but taking the painkiller,” as President Obama put it in June.In other words, the Medicare commission would come to function much like the National Institute for Health and Clinical Excellence, which rations care in England. Or a similar Washington state board created in 2003 to control costs. Its handiwork isn’t pretty.
The Washington commission, called the Health Technology Assessment… consider[s] the clinical effectiveness but above all the cost of medical procedures and technologies. If they decide something isn’t worth the money, then Olympia won’t cover it for some 750,000 Medicaid patients, public employees and prisoners.
So far, the commission has banned knee arthroscopy for osteoarthritis, discography for chronic back pain, and implantable infusion pumps for pain not related to cancer. This year, it is targeting such frivolous luxuries as knee replacements, spinal cord stimulation, a specialized autism therapy and MRIs of the abdomen, pelvis or breasts for cancer. …
Currently, the commission is pushing through the most restrictive payment policy in the nation for drug-eluting cardiac stents—simply because bare metal stents are cheaper, even as they result in worse outcomes. If a patient is wheeled into the operating room with chest pains in an emergency, doctors will first have to determine if he’s covered by a state plan, then the diameter of his blood vessels and his diabetic condition to decide on the appropriate stent. If they don’t, Washington will not reimburse them for “inappropriate care.”
Read The Rationing Commission: Meet the unelected body that will dictate future medical decisions.
(Via John Goodman)
tags: capitation, global budget, Medicare access, Obama Care, physicians, rationing health care, Washington
