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