Medical Experts Highlight Chief Flaw of Dems’ Health Reforms

The New York Times today points out the chief flaw in the sweeping health reform bills passed by Congress last week: Health care spending might be unsustainable, it might be threatening to bankrupt the entire country, but there’s very little in the legislation that tackles the public’s severe overuse of medical services, estimated to constitute as much as a third of all health care costs.

[The legislation] is important, medical experts say, because it opens the door to medical care for millions of people who were shut out because they could not afford insurance or because they had pre-existing conditions or had reached lifetime caps on insurance payments. But controlling overuse is not its focus.

The reason is clear. While the reforms include additional funding for comparative effectiveness studies — research that tests different treatments for the same ailment to discover which work best on which patients — charges of rationing prevented lawmakers from stipulating that the more ineffective treatments be weeded out.

The argument of those rationing critics goes something like this: Even if a pill or test or procedure is found to be ineffective in 99 cases out of 100, it should remain available for that 1 percent of patients that respond to it. And that means that insurers (both public and private) will still have to cover it in all cases, even when there’s no health benefit at all.

“The minute you attack overutilization you will be called a Nazi before the day is out,” Uwe E. Reinhardt, a health economist at Princeton University, told the Times.

As proof of that, look no further than the outcry — and quick congressional intervention — that accompanied last fall’s scaled-back mammogram recommendations by an independent panel of preventive care experts.

The issue has split some of the most powerful members of the medical-industrial complex, with insurers in support of stronger links between effectiveness and coverage (i.e., they don’t want to be obligated to cover treatments with little medical value) and the pharmaceutical and medical device industries very much opposed (because they don’t want any restrictions on coverage of their products, even the ineffective ones.)

It’s a thorny issue, for sure. If you or a loved one is in that anomalous 1 percent of patients that responds to a drug, you don’t want anyone telling you it’s unavailable. Yet health care spending was $2.5 trillion last year, representing roughly 17.3 percent of the nation’s economy. And that figure is projected to jump to $4.5 trillion in just 10 years, representing 19.3 percent of projected GDP in 2019.

Robert D. Truog, a medical ethics professor at Harvard Medical School, told the Times that something has to give. “The point is that as long as a health care system has anything less than an infinite budget, there is a need to decide which types of health care will be funded and which will not.”

Congress, though, has so far declined to do so.