In Delivering Care, More Isn't Always Better, Experts Say
Tuesday, September 29, 2009
A dirty word in health-care reform is "rationing," a term that conjures up the image of faceless government bureaucrats denying lifesaving therapies in the name of cutting costs.
But what if the real issue is not the specter of future rationing, but the haphazard, even illogical, way in which care is delivered today?
Medical professionals say the fundamental problem in the nation's health-care system is the widespread misuse and overuse of tests, treatments and drugs that drive up prices, have little value to patients, and can pose serious risks. The question, they say, is not whether there will be rationing, but rather what will be rationed, and when and how.
"More is not necessarily better," said Bernard Rosof, chairman of the board of directors of New York's Huntington Hospital and a board member of the independent National Quality Forum. "In many cases, less is better."
When the Senate Finance Committee resumes its consideration of health-care legislation Tuesday, the lawmakers will be wading into one of the most complex, emotionally charged aspects of today's $2.4 trillion system. Democrats, feeling politically singed by this summer's talk of "death panels," are struggling to explain how a bill that would take hundreds of billions of dollars out of the system would not affect care.
Republicans, sensing a political opening, intend to highlight provisions they say could lead to the denial of medical services, or rationing.
"We don't want to turn health care over to a bunch of bureaucrats in Washington, who then will determine what kind of health care we have," committee member Orrin G. Hatch (R-Utah) said recently. "And you know that rationing is going to happen."
Critics of the Democrats' bill cite places, such as Canada and Europe, where government experts prioritize the delivery of medical services. Wait times, particularly for specialists, may stretch for weeks or months under such a system, they fear.
"Here in the States, we get access to new drugs and medical devices," said Canadian-born Sally C. Pipes, president of the market-oriented Pacific Research Institute. "I have friends in Vancouver who can't get colonoscopies; they wait six or seven months."
Others, however, see problems of misalignment in the American system, fueled by industry advertising, physician fears about malpractice lawsuits and a culture that craves the latest, greatest everything. The situation here, they argue, is that there is not enough care for some, and too much for others.
Often, people with generous insurance plans can run up large bills and face life-threatening complications from unnecessary care: back surgeries that result in wound infections, when physical therapy might have been a more effective treatment; imaging scans that expose patients to radiation; medication-caused side effects that must be treated.
As much as $850 billion spent on medical care each year "can be eliminated without reducing the quality of care," according to a 2008 report by the New England Healthcare Institute. That is enough money to extend insurance coverage to more than 30 million people, according to the Congressional Budget Office.