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Topics: Veterans Affairs

Bedside rationing is coming with Obamacare but doctors can stop it

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Opinion,Op-Eds,Obamacare,Veterans Affairs,Health Care,Medicare and Medicaid,Veterans

National uproar over the Veterans Affairs scandal should refocus the nation's attention to the issue of health care rationing.

Under VA care, 40 patients died while waiting for treatment at a Phoenix, Ariz., facility. Not only is that the tip of the iceberg in terms of what government-run health care means for patients, it should also sound the alarm about the newest tactic for rationing care, bedside rationing.

In an effort to bend the health care cost curve, oncology doctors may soon be encouraged to do the government’s and insurers’ bidding in rationing high-cost health care treatments and procedures.

So, instead of relying on your physician for their expertise and guidance in one of the biggest challenges a person might face in their lifetime – a battle against cancer – patients might instead have to worry whether their doctor is Marcus Welby or the Grim Reaper.

An effort is underway to redefine the physician’s role in health care as a servant both to society and the patient.

This was being promoted at the recent American Society of Clinical Oncology (ASCO) 50th anniversary meeting in Chicago.

The organization is crafting a drug-rating system based on the value of drug treatments for advanced cancer based on benefits, side effects, and price.

Rather than base a course of treatment on the individual patient and their particular needs and preferences as determined by the physician, decisions could be determined by an algorithm.

A dual obligation could potentially force doctors to sacrifice patient care at the altar of “the greater good.”

By moving rationing decisions to the bedside, rationing decisions will be deflecting away from government payers and insurers -- making rationing decisions less visible to public discussion and public scrutiny since they won't be explicitly-stated policy, such as prescription drug formulary list or pre-authorization for certain treatments.

The lessons of government-imposed health care rationing both in the United States and around the world are well-documented.

But it was perhaps laid out best by former Clinton Labor Secretary Robert Reich. In a hypothetical speech of what a political candidate "should" say about government-run health care, Reich said:

"And by the way, we are going to have to — if you're very old, we're not going to give you all that technology and all those drugs for the last couple of years of your life to keep you maybe going for another couple of months. It's too expensive, so we're going to let you die."

One can easily imagine this approach being replicated across medical specialties, starting with the higher-cost specialties, such as oncology, and working its way down year-after-year when these efforts at cost-containment also fail.

That is why the question of who rations is critical. Rationing does take place in health care, as it does in every other commodity or product that is in limited supply, such as cell phones, clothes, and food.

In the case of insurers participating in the Affordable Care Act, for example, health insurers are actively rationing access to health care providers such as hospitals and physicians. In that way, the insurers are rationing on the federal government's behalf.

The nature of rationing in health care is very different from most products since rationing in health care is often done in a covert manner — secret wait lists at VA hospitals are just one example.

Rather than allow nameless, faceless bureaucrats or their co-conspirators to ration patient care, physicians and consumers should support health care approaches that allow patients to select the health coverage from the broadest array of options that best meet their own individual needs and preferences.

One such approach is offering high-deductible catastrophic coverage combined with a health savings account.

Others include block-granting Medicaid to facilitate sliding-scale premiums for the purchase of private coverage with a health savings account, and providing equitable tax treatment for both large HSAs and individuals purchasing health care on their own.

These measures would go a long way to putting patients back in charge of rationing their own care.

The much-feared death panel could be even more frightening than previously imagined — taking the form of bedside rationing, leaving patients without an advocate in the health care system.

Physicians are now at an important juncture. They can either stop this proposal in its tracks, rescuing the profession from those who wish to deflect blame and scrutiny for denying care, or further compromise their fidelity to their patients.

Naomi Lopez Bauman is director of health policy at the Illinois Policy Institute.

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