Note to the GOP: Insurers Currently Ration Care

As lawmakers continue to weigh in on last night’s health reform speech from President Obama, Rep. Eric Cantor (R-Va.), the House minority whip, went on “Good Morning America” today with one of the more common GOP criticisms. Obama, Cantor said, wasn’t specific enough about his plans to convince Republicans that he isn’t really hatching a government takeover of the nation’s health care system. “We really need to start with some guarantees,” he said.

There need to be some guarantees that the government is not going to take away the health care decision-making from a patient and their doctor. I think we need to start with the guarantee that there won’t be any government rationing or discrimination of any kind.

The reference here is not only to the public option, but also to the Democrats’ plan to provide more funding for so-called comparative effectiveness studies — research to compare the various treatments commonly prescribed for the same ailment in order to get a better sense of which work best. Doctors and other providers could then access the results to inform their medical decision-making. The initiative is designed to weed out the estimated 30 percent of all health care spending that results in no benefit to the patient.

But Republicans and many health-related industries, including drug makers, fear that the research would ultimately lead both public and private insurers to deny payments for certain treatments, using the studies as justification. Hence the GOP accusation that the Democrats strategy would ration care.

Sen. Charles Grassley (R-Iowa), the senior Republican on the Senate Finance Committee, articulated the concern during a health reform hearing in March. “I support making sure that patients and doctors have up-to-date and effective information,” Grassley said. “But I would doubt support for reforms that allow some government bureaucrat to interfere with a doctor’s ability to practice medicine.”

Unmentioned in these arguments is that there are already bureaucrats who interfere with a doctor’s ability to practice medicine. They’re called insurance companies, and any doctor will tell you that they have a long track record of denying claims for treatments the doctor deemed necessary to help the patient. Indeed, a recent California study found that the state’s six largest insurers denied more than 20 percent of all claims over the past seven years.

This makes sense. The more claims the companies deny, the fewer payments they have to send out the door. And the fewer payments out the door, the more money these for-profit, shareholder-bound companies pull in.

It’s a dynamic that’s not lost on Obama, who was quick to point out last night that “insurance companies are not only encouraged to find reasons to drop the seriously ill, they are rewarded for it.”

Not that doctors shouldn’t be monitored for the care they deliver in expectation of being paid by a third party — particularly under the fee-for-service system of care under which many insurance plans (including Medicare) operate. That is, if you could mail away coupons and get big checks in return, you’d likely mail a lot of coupons. Someone needs to be at the receiving end of those claims to screen for their legitimacy. The disagreement is over who that someone should be.

Most Republicans trust the profit-driven insurers; most Democrats would prefer a government-run plan. But both sides could benefit by conceding that the debate is not about whether there should be someone between patients and doctors dictating care, but rather who should fill that role.