Lawmakers Must Alter Health Care Costs without Harming Care


By Dr. Donald J. Palmisano and Dr. Peter Lavine

The talk in America of late has focused on our country’s need to address its long-term fiscal issues and reduce our bloated deficit. Most Americans understand that we, as a nation, must start getting our fiscal house in order now, before it’s too late.

This is especially true in health care, where rising costs are expected to bankrupt our nation’s Medicare program by 2024, according to Medicare’s trustees. President Obama acknowledges this, and has stated that we cannot ignore the daunting “long-term health care cost-curve” that has been bending skyward for too many years now and presents what may be America’s most important and difficult cost-cutting challenge.

But it is important that lawmakers and all Americans calling for immediate cost-cutting solutions remember that we need to make smart changes, not necessarily easy ones. This is especially true in the health care.where hasty cuts could cost patients their health, or even their lives.

Bending the health care cost-curve down without diminishing the quality and accessibility of medical care for patients can and must be done. A few basic starting points could be fixing our broken medical malpractice system so doctors can spend their valuable time and resources caring for patients instead of facilitating needless paperwork, or allowing patient and doctors to privately contract regardless of what government programs pay, allowing market forces to naturally drive down health care costs around the country.

It is becoming clear however, that rationing health care to cut costs is on the table for lawmakers, as was revealed by the inclusion of a provision in the Patient Protection and Affordable Care Act called the Independent Payment and Advisory Board (IPAB).

The IPAB is a 15 member panel of unelected bureaucrats who will be empowered to slash Medicare funds by billions of dollars every year when spending exceeds targeted growth rates. But funding for our nation’s already cash-strapped Medicare program was cut by over $500 billion in order to pay for the Affordable Care Act and allowing IPAB to cut additional billions will further decrease quality of care and endanger patients’ access to that care altogether.

Despite this, President Obama has stood behind IPAB and recently called for the strengthening of the board.

We wonder what “strengthening” a board that already has the unprecedented power to cut billions of dollars from Medicare every year could mean. Hopefully Congress will do the right thing and eliminate IPAB so patients never have to find out.

And while IPAB could most certainly harm patients, it is not the only board created by the Affordable Care Act that could be used to cut costs at their expense. The law also created the Patient Centered Outcomes and Research Institute (PCORI), whose board of governors will set priorities in comparative effectiveness research (CER) and communicate results to the public. Although PCORI was created, in part, as a check against the government’s potential use of CER data to prevent coverage of certain medical treatments, we must be watchful, as CER has been used to prevent coverage in England. The same could happen here in the United States. PCORI met this week in Washington, D.C. to discuss next steps in CER and receive public input, and we were glad to see a number of patients and patient advocacy groups make their voices heard on why CER can never be used to deny patients care.

It is essential that PCORI recognize the importance of individualized health care. Each patient treated is different. What works for one patient may not work for another. If correctly designed and implemented, CER can be a vital tool to aid doctors and patients. It is our hope that PCORI continues to seek input from stakeholders across the spectrum of the health care industry. It is imperative that these conversations remain open and transparent. Specifically, PCORI must solicit input from the Medical Specialty Societies. The Medical Specialty Societies are the best vehicle to develop treatment guidelines for physicians in each of the medical specialties. In this regard, PCORI and CER should work in tandem with these leading authorities on health care by providing Specialty Societies with additional tools to make treatment recommendations to physicians in each specialty. As such, PCORI and CER should be used as a valuable adjunct to physicians as they provide medical care to patients, but it should never be used to mandate care or restrict the deliver of care by a physician.

America’s health care financing system is in need of reform, but we must remember that harming patients during our worthy efforts to address our nation’s important fiscal issues would be unnecessary, counterproductive, and downright dangerous.

We can, and must do better in the United States of America.

About the authors:
Donald J. Palmisano, MD, president of the American Medical Association from 2003-2004, is spokesman for the Coalition to Protect Patients' Rights, a group of more than 10,000 physicians; Peter E. Lavine, MD, Orthopedic Surgeon, president of the Medical Society of the District of Columbia in 2004 & 2009, and Delegate to American Medical Association


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