Americans want Congress to pass meaningful legislation to reducehealth costs, improve access to needed care, expand coverage and shoreup the unstable Medicare program.
Controlling rising costs remains the top priority on the health reformagenda. Rising health costs make health insurance coverage unaffordablefor millions of Americans. Others face massive increases inco-payments, premiums and deductibles. Nevertheless, solutions to theseproblems must first allow Americans to maintain their existing privatecoverage.
Medical decisions should remain in the hands of patients andphysicians, not federal bureaucrats. Patients need useful, reliableinformation about cost and quality to make informed decisions. We caneliminate waste by giving physicians better informationabout availableresources used by their peers.
As a heart surgeon in Southwest Louisiana, I saw this firsthand when weposted price comparisons for medical stents at the hospital forsurgeons to review. Doctors took note, and use of the more expensiveand less effective devices decreased. Physicians and patients can beempowered to lower costs without harsh limits from Washington, D.C.
As the national economy struggles, families and employers worry aboutmaintaining current coverage levels while remaining competitive.Employer mandates and penalties merely lead to job cuts and stifle jobcreation in our economy. We must work toward solutions that provideuniversal access and make American businesses and entrepreneurs morecompetitive.
Health costs can be lowered by introducing competition and diseaseprevention. Under current law, people are restricted from purchasinginsurance across state lines, a significant burden to lowering costsand increasing private coverage options for small businesses. Inaddition, prevention allows patients to stay out of the hospital andincreases their quality of life.
One central health reform fight will be focused on Medicare coveragedecisions. Private insurers tend to follow Medicare decisions to denycoverage for new treatments. More than 44 million Americans currentlyreceive health coverage under the program, whose costs areskyrocketing. One dangerous cost-saving proposal, cost-effectivenessanalysis, could prevent millions of patients from receiving medicallynecessary care when the government deems it too costly.
Office of Management and Budget Director Peter Orszag previously urgedCongress to consider denying coverage for “more effective but moreexpensive services” in Medicare. He said “determining which treatmentwas most cost effective for a given population would involve placing adollar value on an additional year of life.” Daniel Callahan of theHastings Center, a health care foundation, correctly points out,“Effective control [by government] will force patients to give uptreatments they may need.”
Medicare must reduce costs by eliminating waste, fraud and abuse.Republicans believe the program can improve quality while respectingthe 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 ofcosts.
However, the economic stimulus package and omnibus bill provided acombined total of $1.15 billion for cost-effectiveness analysis. BeforeWashington sets research priorities for this funding, surely medicalsocieties should be allowed to survey their physician members? Rankingthe most frequent challenges encountered by doctors for comparingtreatments provides practical benefits for patients.
The conference agreement on the stimulus excluded language from theSenate bill preventing Medicare from using this data to “withholdcoverage.” As a result, nothing in the new law prevents Medicare fromusing 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. Theletter calls for more transparency and reliance on clinical expertiseduring Medicare coverage decisions to ensure the availability ofmedically necessary treatment options. Common-sense protections areneeded for groups that respond differently to various treatments suchas women and minorities.
Orszag and other advocates of cost-effectiveness analysis cannot affordto forget the value of personalized medicine. We can save money bymaking our health care system more accountable and cost effective,while providing higher quality care. Blanket coverage denials oneffective treatments might initially save money but force patients tosuffer needlessly and lead to higher costs in the end.
Rather than sweeping coverage denials, lawmakers can lower Medicarecosts with risk-adjusted pay-for-performance tools based on medicalsocieties’ clinical guidelines informed by comparative effectivenessresearch. When I practiced medicine, surgery for severe ulcers wascommon. The invasive surgery removed portions of the stomach, but todaythe procedure is rare following the approval of the drug cimetidine.That was three decades ago, and the originally expensive drug nowresults in significant savings, which might have been lost if costalone was considered.
For far too long, Republicans failed to talk about our health careideas. But the American people deserve to hear viable alternatives.Republicans believe providing access to a doctor to every American andlowering costs on patients and taxpayers is achievable. Our health caresystem needs reform, but along with that reform comes a responsibilityfor Congress to be open and transparent. Working together, anunprecedented opportunity exists to develop meaningful reform, notsimply more government bureaucracy.
Rep. Charles Boustany (R-La.) was a heart surgeon before being electedto Congress. He serves on the House Ways and Means Committee and is theranking member on the Subcommittee on Oversight.