Con­sumer-driven chaos

Lack of money is one way to drive down costs in the sys­tem

Modern Healthcare - - Opinions Editorials -

Notes on the news: Last April, we sug­gested that the na­tion might soon em­brace what’s eu­phemisti­cally called con­sumer-driven health­care—not out of de­sign but by de­fault. At the time, re­ports of pa­tients for­go­ing care be­cause of the eco­nomic down­turn be­gan trick­ling out. Hospi­tal pa­tient rev­enue had de­clined as states slashed spending and in­sured pa­tients de­layed elec­tive care. A Kaiser Fam­ily Foun­da­tion poll showed that more than half of Amer­i­cans said their house­holds cut back on health­care be­cause of cost con­cerns dur­ing the pre­ced­ing 12 months.

Now comes word from CMS economists and statis­ti­cians that health­care spending growth in 2008 slowed to 4.4% from 6% the prior year (Jan. 11, p. 6). That’s the weak­est growth in nearly 50 years. This de­cline wasn’t due to ef­fi­ciency caused by Six Sigma or lean man­age­ment or any other busi­ness fad. The CMS re­port said the Great Re­ces­sion, which be­gan in De­cem­ber 2007, caused peo­ple who lost their jobs to lose cov­er­age, and the down­turn strained state, busi­ness and house­hold bud­gets.

The re­sults could have been lower, but the fed­eral gov­ern­ment pumped in money through Medi­care and Med­i­caid.

Pro­po­nents of the con­sumer-driven phi­los­o­phy have long ar­gued that health­care spending would de­cline if peo­ple had to fi­nance more of their own care and watch their pen­nies. Turns out their pre­dic­tion came true—just not the way it was sup­posed to hap­pen.

One of the myths Amer­i­can politi­cians love to per­pet­u­ate is that there is no health­care ra­tioning here. In fact, we do it ev­ery day. Your em­ployer, or in­sur­ance com­pany, Medi­care, Med­i­caid, mil­i­tary care, etc., de­cides what it will cover and what it won’t. If you are among the mil­lions who don’t qual­ify in those cat­e­gories, you get what you can af­ford. That puts us in the same ra­tioning league as Third World na­tions, where “con­sumer-driven care” reigns.

There cer­tainly will be no ra­tioning of mam­mog­ra­phy. You’ll re­call that the U.S. Pre­ven­tive Ser­vices Task Force late last year rec­om­mended that women without a spe­cial need, such as a fam­ily his­tory of can­cer, forgo screen­ing in their 40s and get tested once ev­ery two years start­ing at age 50. The ad­vi­sory panel said there were dan­gers as­so­ci­ated with more fre­quent screen­ing, in­clud­ing ex­ces­sive ra­di­a­tion, false-pos­i­tives, costs to the pa­tient and un­nec­es­sary anx­i­ety.

A pha­lanx of physi­cians (notably ra­di­ol­o­gists) and pa­tient ad­vo­cacy groups swiftly at­tacked the rec­om­men­da­tions, con­tend­ing they amounted to a death sen­tence for women. Repub­li­can health­care re­form op­po­nents de­nounced it as the van­guard of a larger ra­tioning cam­paign to be un­leashed once leg­is­la­tion is passed. The Obama ad­min­is­tra­tion rushed to re­as­sure every­one that noth­ing some panel of ex­perts said would change the way we do med­i­cal busi­ness in this coun­try.

Politi­cians are now try­ing to in­sert pro­vi­sions into the fi­nal re­form bill that would re­quire cov­er­age for more mam­mo­grams.

If their ef­forts are suc­cess­ful and the bill passes, Amer­i­can women will be guar­an­teed ac­cess to un­nec­es­sary and ex­pen­sive tests that might do more harm than good.

That is, of course, if they are in­sured or have enough money to pay out of pocket. Here is an in­stance in which a lack of fi­nan­cial re­sources could ac­tu­ally save some women some grief.

Maybe there is a small up­side to “con­sumer-driven” care.

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