I'm not as sanguine as some about a council of federal employees who will determine which medical treatments are more effective. I understand something must be done about medical costs, but from the time I read plans for bringing the costs of chronic illnesses under control on both Clinton and Obama's websites, I've wondered if this isn't doublespeak for take-it-or-leave-it medicine.
Having been a professor of preventive medicine for many years and having had both cancer and Parkinson's disease, at first I felt it somewhat self-serving to write about this. My husband reminded me that it's self-serving for people to write about social security because they'll one day receive it. So here are a few cautionary thoughts.
When I heard David Axelrod speaking of the planned medical council on Meet The Press, his tone and words were not reassuring. He said "I think most Americans want us to do something about that," referring to medical treatment inefficiencies. I doubt very much that most Americans have a clear picture of what this council could mean for their future medical care. He added that the "council is going to be looking at best practices, at, at, at what, what is working and what isn't and, and making recommendations about how we proceed, particularly within the, the, the federal system."
I understand that David Axelrod is personally familiar with how difficult finding a cure for diseases can be and that is reassuring. But there are still dangers lurking here. One of them is that "best practices" can be seen as falling along a straight line or a within range. The former is dangerous.
Researchers are often quite distant from the patients they study. And many prefer it that way. If we are going to have a council of researchers who keep at arms' length from patients, who seek answers only or primarily for those whose symptoms fall neatly under the inner regions of the bell curve, the many diseases about which medical experts know very little (orphan diseases) and the patients who do not respond predictably will likely, as outliers, suffer unnecessarily.
My political antennae sense some potential seight of hand here. The intentions are likely good. But I've seen and served on research boards and bodies and I wouldn't want most of them deciding my children's future medical care options. Whenever patients are not part of the equation, because they muddle things, the results are skewed. And having spent years working with doctors as a researcher and partner in my own health care and that of those I love, I'm sensitive to the strong views held by many with the loudest voices.
Medicine is a very inexact science. No council can change that fact. It could easily become a smokescreen for clearing a treatment path down the center of major illnesses putting lives in jeopardy that might be saved with some common sense and flexibility. As annoying as patients themselves can be to researchers, if their voices are not heard even a well-meaning council will bring more harm than good.
Medical costs must come down. But as we've learned with business bailouts, better to do it right early on, to anticipate abuse, than to be digging our way out of a mess for years to come.
Dr. Reardon also blogs at bardscove.
So we should just continue to leave it up to insurance companies?
I commend to you and your readers the excellent post by Dr. Howard Dean in today's Huffington Post -- http://www.huffingtonpost.com/howard-dean/the-far-rights-all-out-of_b_167628.html -- he points out the way in which the right has taken this issue and blown it all out of proportion.
For many who are intimately and constantly involved with the current state of US healthcare as patients, this looks to be a promising progression away from insurance profit-based healthcare decisions.
As many have pointed out of late, the depth of polarization in US politics is nearing the point that bi-partisan agreement on crucial issues is highly unlikely, and as a result much needed legislation is rejected or politically mutated to the point of uselessness.
All of that said, you [or anyone else] will likely not be afforded the luxury of a viable middle ground from which to broker more realistic and practical approaches; you, and the rest of us, will simply have to choose to change the system, or let stand as is.
I think you know how the majority of us feel about that.
Since people respond differently to treatment (I can take an aspirin for aches and pains, but my husband is deathly allergic to aspirin), so we don't want the government saying what medications will be authorized for payment for specific diseases. Our physicians who have been highly trained, and who know us and our conditions really are the ones who need to make these decisions, not an employee of the government, and not an insurance company whose CEO makes an ob.scene salary, and who have come up w/ mandates for how health care is to be provided (or it won't be paid for).
Now, as to our highly trained docs, there are docs and then there are other docs, and you know that. If the guidance is as to efficacy, what would be wrong with that? Right now an attractive, well dressed young female detail person in a some male docs' offices could get them to prescribe her company's brand of meds, regardles of its merit. Is that a better system than to have a panel advise on expected outcomes?
at least with the government I can call congressmen and write letters. I have cronic and a rare expensive illness and I have to read constantly to keep up and make sure my doctors are not just giving me the treatment they get the least flack from insurance to prescribe wether it works well or not
I love it when a generic works it costs me less but I want to keep working and side effects can push me out of work
I am going broke from co pays that make it much more expensive for me to treat cronic and rare disorders then a car accident and surgery. i have a good job and average insurance coverage but I may have to go bankrupt from medical costs and I still can't afford my medicine all the time or go to the doctor at the end of a month, and forget about the dental care I need I cant afford it even with insurance i spend too much on co pays to keep up with anything else I need
given a few protections I'll take the government over private insurance anyday heck I'd save money with medicare prescription coverage at least there is a limit on how much you have to spend
This is a partisan strategy designed to spread cynicism and fear throughout the public, in this proposal the medical council will not in any way granted the authority to disparage, deny, or determine what treatments MD's must or rather should be utilizing for their patients. This council's intention is a worthy and necessary goal, independant statistical analysis of efficacy and results data, which is available but not required for MD's to utilize in their own independant decision making process. The individuals on this council will not be politicians, or pharma lobbys they will be medical professionals with the experience and forsight to work within a framework which fully acknowledges and considers the variable nature of treatments on various demographics, but for you to suggest that any individual MD with limited access to the entire scope of demographic groups, is in any position to access trends over the entire population without this tool, then I have a road in Alaska to sell. Yeah, of course he could read every medical research journal he could find, but if a program such as this worked in conjunction with research institutions and CRO's across the world, the comprehensive insight gained would be invaulable.
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ENJOY!!
Sense it is a given that someone, somewhere will have to make such decisions in ANY system, do you really want the motivation of DENYING you coverage for profit to be the basis on which these decisions are made?
That's how they are made now, and it is NOT a reasonable way to approach healthcare.
Second, since the Federal medical insurance program called Medicare currently spends around 3 cents out of every dollar for administrative costs, which is compared to the BEST in the industry being more than 15 cents, and the average of 30 cents, and the worst spending more than 50 cents out of every dollar!!!
No matter what they may say, physicians cannot help being influenced in their decisions by how much they will get paid for them. Not their fault, it is human nature. I have several personal examples of this, one of which was an unnecessary overnight in the hospital so a referring doc could see me in person and get paid.
You imply -- by the employing the generic term "federal employees" -- that the proposed council would consist of ex-IRS agents, DMV workers and TSA security guards. To the contrary, a committee of highly qualified medical experts would review all the known research on treatment protocols for various illnesses and medical conditions, and determine which treatments, under what conditions, have the best chance of a positive outcome. We know that the corporate medical establishment has a greater concern for the most profit -- hence the marketing of new drugs and procedures which maximize income, not patient outcomes. Insurance companies will often deny care based on cost-benefit statistics related to company profits, not patient need.
I would put my trust in honest, well trained scientists and physicians well before the myriad levels of insurance company bureaucracy that are designed to discourage patient advocacy and reject expensive treatment.
Also, the Federal Council Senor Axelrod and Dr Reardon refer to is modeled after a U.K. board discussed in Sen. Daschle’s book. This board approves or rejects treatments using a formula that divides the cost of the treatment by the number of years the patient is likely to benefit. Treatments for younger patients are more often approved than treatments for diseases that affect the elderly, such as osteoporosis. So tell your parents to keep in good health.
In 2006, a U.K. health board decreed that elderly patients with macular degeneration had to wait until they went blind in one eye before they could get a costly new drug to save the other eye. It took almost three years of public protests before the board reversed its decision.
If the Obama administration’s economic stimulus bill passes the Senate in its current form, seniors in the U.S. will face similar rationing. Defenders of the system say that individuals benefit in younger years and sacrifice later.
Here's the problem with health care today. In my former job, I worked for a small firm here in town. My health care was a POS plan through Carefirst. I was paying nearly $800 a month for healthcare which is outrageous. Here are some of the problems with that figure. The $800 a month represents about 40% of the overall cost which my former employer picked up the other 60%. 32% of the $800 figure at Carefirst goes to deal with administrative costs, mainly regulations.
The other problem with health care in America today? my company which is based in VA can't get an out of state quote on health care say in Oklahoma. What I paid is based on the average male in VA. Say the companies in the U.S. were allowed to go outside its borders and get health rates based in another state, maybe across the country? Say the rate was $200 a month based out of Okla? That would bring rates down and make the current system more affordable But the Government won't do that.
They want to create a whole other bureaucracy to redo Health Care. We have Medicare already, but Medicare is so far in the hole, when the Feds bailout Medicare it is going to make this current situation look like a joke.
I think that for the system to really meet the needs of the nation, truly radical reform is necessary. I think truly radical reform will require the elimination of 'cost' as a factor in the debate. While I can make many economic arguments for why single payer government health care, for instance, would cost everyone less than the current system, the cost is not the real problem of the debate.
The real issue is the existence of an industry that makes a great deal of money, employs quite a few people, and wishes to protect its own existence. 'Cost' is simply a tool in its efforts to do so.
I don't think government bureaucrats should make medical decisions anymore than insurance bureaucrats and consider the change from one to the other relatively meaningless. I would prefer to see doctors and patients making decisions based on medical need.
americans need to demand this. no one should be denied health treatment because they have been ill in the past or have a current disease. its wrong.
I'd rather that truly scientific studies [even those conducted by the government] decide what works and what doesn't.
I'm retired, so I have time on my hands. Next time YOUR child needs care LET ME decide whether it is appropriate. After all I don't work for the government, and at least I'm not trying to save your employers money.
Besides, what this is about is information. Good information is needed for a free market, remember? Doctors need good information to decide about treatment, remember? I remember Newt G saying people wanted choice. Fine. That requires very good information. The more the better and it won't come from the companies.
30 Plus yrs ago when I was in x-ray Insurance Companies outlined DRG payments. Essentially saying what they would pay hospitals for X problem. The incetive was to get you in and out fast. Then they had hospital consortium buying groups to make hospitals profitabe and buy out Doctor's practices and control their productivity. Then They increase premiums,cut back on approvals,deny care for pre existing conditions or some other reason like it does not fit their protocol. As far as I understand this problem Insurance companies are deciding who gets what based on their rules. THIS MUST CHANGE.
Thank you for your response. I would love to see the Doctors and caregivers be the people who call the shots concerning our care. I believe that has not been the case for many yrs. Insurance and Pharma Companies spend millions on Lobbyists and millions on denying care. So much $ is wasted in this system while our Healthcare deteriorates as compared to other industrialized Countries. Yes, we have some of the best facilities and Doctors in the World,but overall care has decreased and quality decreased while costs have gone through the roof.(16 percent of GDP or more)
Should it be such a "for profit" endeavor? I believe in free markets and capitolism,but when the bottom line becomes more important than the care something must change.
The idea of medical insurance, or any insurance for that matter, is to pool resources such that the capital outlay of any individual does not exceed an overall average amount. In other words, some people pay more for what they use, some pay less.
This pool of resources comes with a significant overhead to pay CEOs and stockholders, so the premium is driven up significantly to support the bureaucracy and the profit margins of big business. Consistent with the business model, of which Ms Reardon is a professor, minimizing costs to maximize profit is ALWAYS a primary issue. Profit, however, needs to be eliminated from the equation if any healthcare is to reach excellence.
Fixing healthcare cannot be done without the cost of the bureaucracy, but it can be done without corporate jets, CEO salaries, and year-end bonuses: it's called government sponsored national healthcare.
If healthcare was really a "market economy" driven by "supply and demand," one could claim socialism; however, when a pharmaceutical company can raise the price of its product to meet revenue goals without incurring a change in demand, this is not free enterprise, it's a monopoly.
(BTW, pharmaceutical companies do set prices based on projected revenues.)