FORUM,The COLUMBUS DISPATCH
Best-for-less plan would cut medical bills
FROMA HARROP
About 10 years ago, a radiation treatment for prostate cancer came on line. A course of “intensity-modulated radiation therapy” cost Medicare about $42,000. The older radiation therapy cost $10,000. Hospitals bought the new machines and stopped using the traditional method. This tacked another $1.5 billion per year to Medicare spending on prostate cancer alone.
Did the fancy new machines do a better job than the old ones? Medicare did not inquire. It just paid. Amazing. A new McClatchy/Marist poll has 80 percent of Americans opposing cuts in Medicare and Medicaid spending to reduce deficits. Well, that 80 percent doesn’t quite understand Medicare’s reimbursement system and how crazy it is.
Forget the GOP plan to squeeze Medicare spending by moving to a voucher system. First, look at the existing setup. For most any treatment deemed “reasonable and necessary,” Medicare pays the cost plus some profit. This has turned the program into a brainless check-writing machine for the medical-industrial complex.
Not long ago, an article in Health Affairs used the above prostate cancer example to show the ludicrous way Medicare pays for things. “Coverage is determined without any requirement for evidence demonstrating that the service in question is equally or more effective than other available options,” writes Steven Pearson, president of the Institute for Technology Assessment in Boston, and Peter Bach, a critical-care physician at Memorial Sloan-Kettering Cancer Center in New York.
Enter “comparative effectiveness research” — perhaps the most boring term in public policy today, but essential to containing the explosively rising costs of Medicare, Medicaid and private health coverage. (I suggest “best for less” as a catchier name.) Comparative-effectiveness research studies different treatments for the same condition and identifies those that do the job with the fewest side effects. Medical economists generally agree that our system groans with pricey treatments that provide outcomes no better — and sometimes worse — than cheaper alternatives.
The 2009 stimulus bill and the health-reform legislation contained spending for this research, which Republicans and some Democrats fought tooth and nail. They expressed concern that it would discourage medical innovation. Their unstated worry was that taxpayers would become resistant to sending big checks to equipment makers and other medical providers for bells, whistles and exotic names that add nothing to the quality of care.
Much of political Washington has a vested interest in the vested interests. Pearson and Bach have come up with an intriguing way to use comparative-effectiveness research without stifling the development of improved technology. They would use this research to have Medicare pay the same thing for services that provide equivalent results. But it would reimburse new technologies at the higher rates for, say, three years. If they prove to be superior, then Medicare continues to pay more for them.
What the 80 percent of Americans who oppose spending cuts on the government health plans really want is the assurance that they can get state-of-the-art medical care when they need it. Responsible leaders must impress upon them that enormous savings can be found in Medicare without reducing quality one iota.
Furthermore, the perverse incentives in our reimbursement system encourage too much care, which itself can hurt patients. There’s no need for a radical voucher plan that saves money by sending the elderly to private insurers, then curbing payments to the insurers.
The government can continue picking up the bills if Medicare starts considering value received for the checks it writes. Patients would be happy. Taxpayers would be happy. Some vested interests would not be happy, and they have lots to spend on scaring the public. The question at the end of the day is: Who matters more to our politicians?
Froma Harrop writes for Creators Syndicate. fharrop@projo.com
There is a lot of flexibility in the brilliant foundations of government our founding fathers put in place. Over a couple of hundred years, a forward thinking president here and there established additional functions for the betterment of the people – always with “for the greatest good of all the people” in mind. And it has worked beautifully. Social Security was such an achievement and eventually Medicare. Both have been hugely successful and totally loved by our people.
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That is not to say it is universally admired. By now, we all know about or have heard of the disturbing rumbling of the few who would destroy our way of life, our form of governing – - whose desire it is to shrink government to “kill the beast” so to speak. Since November’s election, it has become evident how well planned it all has been. Many with open eyes saw it coming and witnessed the “new wave” of dictatorial leadership, the stripping down of individual rights. It feels like all hell has broken loose. Many are loosing faith that any in Washington or in state capitols know what they are doing or can do anything to set us right again. Unrest and broken lives are everywhere. People by the millions feel they have been lied to. It even seems that mother nature is very unhappy about stuff and has had enough! Earth may be trying to slough off the pesky annoyances who have invaded her like fleas on a dog. Can’t claim we didn’t know what we were doing. Science has been telling us right along. Greed is one hell-of-a-thing.
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Enuff! This post is about trying to get a handle on Medicare. We can do it. What we will NOT DO is abolish programs which have been a blessing without which many would have needlessly suffered and perished. In this, we know that our president will not let us down. Many of us are sensing that the time has come when push has finally led to shove. No More! Ain’t gonna happen.
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From Washington we can expect and demand courageous action which is both equitable and fair. Pharmaceutical medication MUST be dealt with and RE-ESTABLISHED through negotiated pricing so that we pay no more for our meds than any other people on the planet. Just do it. Break rules if you have to or break heads – get it done.
Stop treating BIG PhRMA like the Gods they think they are. They do not belong on any political boards or governing office posts. They do not belong in the FDA; they should not dictate how medical schools are run nor should they be allowed to OWN them. If they wish to bless them with money (you know – endow them) great, but no strings of any sort. It is way past time to treat them like any other company – - they are after all just a business out to make profit. They need no breaks or special attention of any kind. Most of all, NO SPECIAL TAX BREAKS .
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As for the citizenry, we can contribute much. Government should not dictate what people will eat or should eat or not eat. It is expected that scientific guideline be offered and shared but the so-called pyramid thing is such a joke that almost nobody pays it any mind. Government does not honor the sciences and the advancements in knowledge being made on an almost daily regularity. Instead, are influenced by CORPORATE interests. (all that $ flowing in) Doctors who should be knowledgeable with regard to nutrition, are not. There is so little mention of it in med school it amounts to hours or days (compare that to the study of drugs) The public is on its own for more than 50 – 60 years. Sad.
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So what else can my fellow Americans and I do to help. We all need to get real about expectations. Getting medical care for sickness and accidents is a given and the humane thing to do and expect. It is extravagant however to expect body part replacements. It is extravagant to expect “heroic measures” be used on seriously ill and advanced age people simply because families aren’t prepared to let them go. We all hear of massive cost factors in the last year or so of life and it is not good for anyone – the patient or the families or Medicare’s checkbook. Hospice is so much kinder than hospital care. America needs to deal with death and dying much, much better. Attitudinal upgrades might be in order. No question it is a time of loss for those left behind. . .this is simply something we all must deal with. But it should not be the ‘horror’ so many seem to feel it is. To many an oldster, the closer one gets to it, the more welcome it seems. Kinda like being pregnant for some (like me). I was scared to death of the childbirth thing itself. Maybe it was all the horror stories my mother recounted about us both almost dying at my birth. Still, the day was coming, I could hardly get around anymore – so uncomfortable and then the last few weeks it was OMG lets just get this over with! So you lean into it gladly.
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As in the article above, I don’t think the population is expecting all the bells and whistles that medicine is capable of coming up with. When we hurt, we need to be fixed. It is not the patient demanding the latest whatever, it is the medical establishment. I did a post March 24 called 50 yr old drug/new Windfall. It irritated me so, as it was just this. They had this concoction which had been in use for about 50 years. Pharmacist would mix it up on demand. About $10 This was to help women keep from aborting or losing their baby. Go read it if you like, can’t remember the details. But FDA or someone gave this company the rights to produce the stuff so that it would be available when needed. But they put a stop to pharmacist being able to make it any longer. And the new price on the outright gift to the company was now about $1,500 for each weekly shot which came up around an additional $30,000 to have their baby. I wish it was Love that makes the world go around, but it seems to me to be Greed
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Golly, it’s going on 4 in the morning, again. I get carried away at the computer, so nice and quiet, vibration is delicious. . not that I enjoy my blog or anything. . .but folks I gotta go to bed. (And I was just getting started. . .) nite Jan
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