Friday, March 12, 2010
The lights must dim around Google's data-storage centers every time someone does a search for "government bureaucrat coming between you and your doctor." Foes of the Democrats' health-reform proposals have been chanting this on the hour for a year -- with a surge after Democrats put money for "comparative effectiveness research" in the stimulus bill.
This involves comparing treatments for the same condition to find which works best. The reform-killers insist that "government-run" health care would use these findings to tell doctors what to do, largely in the name of saving money. The stimulus legislation clearly states that cost may not be a factor in determining best practices -- the studies would highlight the most successful treatments, not the cheapest ones. But hey, demagogues have never been sticklers for facts.
Those who care to move this conversation to a more grownup level will note a recent article buried in The Wall Street Journal. Its headline was, "Insurer Plays Judge on Cancer Care."
The piece notes that the giant insurer UnitedHealthcare "has started sending doctors individualized reports assessing their treatment of breast, lung and colorectal cancer patients." The company hopes that by showing doctors "how their treatments might vary from medical protocol," they will "reduce unnecessary care that doesn't improve health and raises health-care costs." Sounds like the government's comparative effectiveness research, except with money a factor.
Now let's move this discussion to a higher plane still. Money (SET ITAL) should (END ITAL) be a factor. One can't blame insurers for wanting physicians to use better or just-as-good treatments that will save them money. We love our doctors, of course, but some are not up-to-date or direct patients toward things they have investments in or are looking to enhance their incomes through excessive treatment.
But why has the idea of letting the government do what private insurers do to save taxpayers money become such a hysterical hot button? Because the medical industry can more easily bully politicians than they can insurance companies. They do this through campaign contributions and ads directed at an unsophisticated public. (People in the business know the score.)
By the way, many insurers have long monitored how doctors treat their patients in a variety of diseases. For example, industry giant WellPoint rewards doctors for using certain technologies and prescribing generic drugs.
What makes UnitedHealthcare's new program controversial is its application to cancer. Protocols are harder to apply to cancers, which can take on many forms and vary a great deal from patient to patient.
Yes, there are gray areas. For instance, some cheaper drugs may do as good a job as high-priced fancy ones, but produce more side effects, such as causing sleepiness.
Another example: Testing for prostate cancer has sent countless older American men into debilitating treatments when they were all but certain to die of something else first. Suppose a 75-year-old with a high P.S.A. score demands full-court surgery, and his doctor is happy to operate. If the insurance company tells the man, "Pay for it yourself," is it denying care?
These gray areas must be addressed by all insurers, whether government or private. Resources are not unlimited. The difference, however, is that government doesn't have to make a profit. Its bureaucrats get their middle-class salaries no matter how they decide. The private insurers must find millions extra to enrich their executives, pay back investors and advertise their wares.
The powers in Washington have clearly decided to keep most working Americans in the hands of private insurance companies. But the public should labor under no illusions that because evolving legislation has diminished the government's role in containing costs, no one is going to come between patients and their doctors. That's pure fantasy.
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