Americans want Congress to pass meaningful legislation to reduce
health costs, improve access to needed care, expand coverage and shore
up the unstable Medicare program.
Controlling rising costs remains the top priority on the health reform
agenda. Rising health costs make health insurance coverage unaffordable
for millions of Americans. Others face massive increases in
co-payments, premiums and deductibles. Nevertheless, solutions to these
problems must first allow Americans to maintain their existing private
Medical decisions should remain in the hands of patients and
physicians, not federal bureaucrats. Patients need useful, reliable
information about cost and quality to make informed decisions. We can
eliminate waste by giving physicians better informationabout available
resources used by their peers.
As a heart surgeon in Southwest Louisiana, I saw this firsthand when we
posted price comparisons for medical stents at the hospital for
surgeons to review. Doctors took note, and use of the more expensive
and less effective devices decreased. Physicians and patients can be
empowered to lower costs without harsh limits from Washington, D.C.
As the national economy struggles, families and employers worry about
maintaining current coverage levels while remaining competitive.
Employer mandates and penalties merely lead to job cuts and stifle job
creation in our economy. We must work toward solutions that provide
universal access and make American businesses and entrepreneurs more
Health costs can be lowered by introducing competition and disease
prevention. Under current law, people are restricted from purchasing
insurance across state lines, a significant burden to lowering costs
and increasing private coverage options for small businesses. In
addition, prevention allows patients to stay out of the hospital and
increases their quality of life.
One central health reform fight will be focused on Medicare coverage
decisions. Private insurers tend to follow Medicare decisions to deny
coverage for new treatments. More than 44 million Americans currently
receive health coverage under the program, whose costs are
skyrocketing. One dangerous cost-saving proposal, cost-effectiveness
analysis, could prevent millions of patients from receiving medically
necessary care when the government deems it too costly.
Office of Management and Budget Director Peter Orszag previously urged
Congress to consider denying coverage for “more effective but more
expensive services” in Medicare. He said “determining which treatment
was most cost effective for a given population would involve placing a
dollar value on an additional year of life.” Daniel Callahan of the
Hastings Center, a health care foundation, correctly points out,
“Effective control [by government] will force patients to give up
treatments they may need.”
Medicare must reduce costs by eliminating waste, fraud and abuse.
Republicans believe the program can improve quality while respecting
the doctor-patient relationship. A growing number of organizations,
including AARP, the Congressional Black Caucus and the New Democrats,
oppose Medicare depriving patients of needed care solely because of
However, the economic stimulus package and omnibus bill provided a
combined total of $1.15 billion for cost-effectiveness analysis. Before
Washington sets research priorities for this funding, surely medical
societies should be allowed to survey their physician members? Ranking
the most frequent challenges encountered by doctors for comparing
treatments provides practical benefits for patients.
The conference agreement on the stimulus excluded language from the
Senate bill preventing Medicare from using this data to “withhold
coverage.” As a result, nothing in the new law prevents Medicare from
using cost alone to deny coverage for medically necessary care.
I recently wrote a bipartisan letter, signed by 45 of my colleagues,
asking the president to establish reasonable patient protections. The
letter calls for more transparency and reliance on clinical expertise
during Medicare coverage decisions to ensure the availability of
medically necessary treatment options. Common-sense protections are
needed for groups that respond differently to various treatments such
as women and minorities.
Orszag and other advocates of cost-effectiveness analysis cannot afford
to forget the value of personalized medicine. We can save money by
making our health care system more accountable and cost effective,
while providing higher quality care. Blanket coverage denials on
effective treatments might initially save money but force patients to
suffer needlessly and lead to higher costs in the end.
Rather than sweeping coverage denials, lawmakers can lower Medicare
costs with risk-adjusted pay-for-performance tools based on medical
societies’ clinical guidelines informed by comparative effectiveness
research. When I practiced medicine, surgery for severe ulcers was
common. The invasive surgery removed portions of the stomach, but today
the procedure is rare following the approval of the drug cimetidine.
That was three decades ago, and the originally expensive drug now
results in significant savings, which might have been lost if cost
alone was considered.
For far too long, Republicans failed to talk about our health care
ideas. But the American people deserve to hear viable alternatives.
Republicans believe providing access to a doctor to every American and
lowering costs on patients and taxpayers is achievable. Our health care
system needs reform, but along with that reform comes a responsibility
for Congress to be open and transparent. Working together, an
unprecedented opportunity exists to develop meaningful reform, not
simply more government bureaucracy.
Rep. Charles Boustany (R-La.) was a heart surgeon before being elected
to Congress. He serves on the House Ways and Means Committee and is the
ranking member on the Subcommittee on Oversight.