Health reformers shy from proposals that would limit treatment options

Jul 8 2009

In a story headlined 'In Retooled Health-Care System, Who Will Say No?' the Washington Post reports: "Although Obama and his advisers have held up providers' spending patterns as the crux of the crisis, proposals in Washington go only so far in addressing the thorniest questions about who gets what care."

Two topics under discussion broach the subject: comparative effectiveness research, a method that "weighs the risks and benefits of different types of treatment for the same illness," and Medicare payment reforms that would "emphasize the overall quality of care over the quantity of treatments."

However, those ideas take second chair to cost-cutting measures like creating a new public plan to compete with private insurers, or simply slashing Medicare rates, in part because reforms that directly address what treatments physicians provide are also perceived to limit patients' access to care. "In a country where 'rationing' is a dirty word, who will say no," the Post writes. "The question permeates all levels of medicine."

For instance, "reformers are clearly spooked by the notion that they could be accused of denying, for example, hip surgery to an 80-year-old," the Post reports. Industry representatives have praised comparative effectiveness research, but also "demanded" that cost not be considered in any analysis.

Experts who support the research, and who support using it to limit less effective, more costly treatments, a step Congress has refrained from taking, argue that the data could be used to more gently encourage better choices, too. "If doctors were to demonstrate to heart disease patients how few advantages coronary artery bypass graft surgery has over less expensive treatments, for example, many patients probably would not elect to undergo the surgery."

However, "All signs in Washington suggest that cost considerations will be kept at arm's length as health-care legislation moves forward," despite the argument that the researches' advocates make: the American health system already rations care based on whether or not an individual has insurance (MacGillis, 7/8).

Even some people who do have insurance believe their treatment options would be limited by costs. "Fewer than half of all Americans trust that their health insurance plans would pay for the full costs of cancer treatment and nearly two-thirds falsely believe Medicare would not pay anything, according to a survey [by the Community Oncology Alliance] released on Wednesday," Reuters/Boston Globe reports.

The survey suggests "Americans are both worried and misinformed about the state of the U.S. healthcare system and changes that might be made as Congress and the White House work to reform the system" (Fox, 7/8).