Monday, November 08, 2010

Rationing Health Care

There's a rather curious editorial in today's Los Angeles Times. I gather that the "center-left" editorial board was attempting to plump for more scientifically based decisions on health care, especially when it comes to expensive screening tests which may or may not be reliable, but the editorial itself is rather unclear, and therefore unhelpful.

The editorial was written against the backdrop of the failure of the federal government's Preventive Services Task Force to meet as planned November 1 and 2. This group of 15 primary care physicians has as its task the development of recommendations for which tests should be used by doctors and which should not. One of the members of the task force suggests the meeting was cancelled because it was too close to the elections, which, if true, is shameful and more evidence of politics trumping science.

Among the topics the task force was assigned were the usefulness of routine mammograms for women and the current testing done to screen for prostate cancer for men. The report on mammography was met with howls of protest, even though nothing in the report suggested that mammograms would be banned outright. The report on prostate cancer screening is still not out, and presumably was at least one of the topics on the agenda for the November meeting.

The failure of the task force to meet implies that the administration didn't want to give the Republicans yet another talking point on government intrusion into our lives. "Rationing Health Care" is right up there with "Death Panels" when it comes to red meat being tossed to the Republican base. It is at this point that the editorial does make some sense:

These episodes illustrate what may be the biggest challenge facing policymakers as they try to restrain the healthcare costs that are consuming so much of the country's resources. Americans have a hard time accepting limits on their access to care, even if the treatment or drug is shown to be ineffective. They're much more willing to put up with rationing by income, which the current system imposes by allowing wealthier people to buy more and better care, than accept even the whiff of rationing by the government.

Bear in mind that the task force doesn't try to determine whether screening saves money in the long run for patients, or even whether a particular test works better than other, less expensive methods. "Cost just isn't a consideration when the task force deliberates," Dr. Ned Calonge told the Washington Post last year. The panel simply tries to judge whether a prevention technique is medically effective. Nevertheless, a common, misguided criticism of the task force in the wake of the mammogram decision was that it was trying to cut costs, not improve medicine.
[Emphasis added]

The Preventive Services Task Force could play a valuable role in containing health costs if it identifies medical tests which are simply ineffective on a scientific basis. If, however, the task force is going to be shackled by political considerations, then its existence is a waste of the doctors' time and taxpayers' money.

I just wish the editorial would have been a little clearer and a little more forceful in pointing that out.



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