Op-Eds

Give patients control of health care

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Washington, June 20, 2011 | comments

Trustees of the Social Security and Medicare trust funds released a report on the two programs’ financial status and news was not good: Medicare is likely to go bankrupt by 2024 —five years earlier than last year’s estimate.

This threatens senior care. At this rate, Medicare will not be available for future generations.

However, we can act now to save Medicare, improve quality of care — and keep Washington bureaucrats out of patients’ medical decisions.

Fixing Medicare should not compromise patient care. The president’s health care bill created the controversial Independent Payment Advisory Board. This panel of unelected bureaucrats, whose sole purpose is to decide whether to offer Medicare benefits based on a budget, could lead to government rationing of care.

With Medicare’s worsening outlook, President Barack Obama is now trying to double down on his health care plan — and allow the board to ration even more care.

I have introduced bipartisan legislation to abolish the IPAB, with more than 120 cosponsors to date. By passing our bill, Democrats and Republicans can declare with a unified voice that charging unelected bureaucrats with patient care decisions is unacceptable. We must preserve Medicare by giving patients the power to control their health care.

The IPAB is duplicitous for many reasons. It shifts health care decision-making power away from the patient. It’s devised to operate without transparency or accountability, bypassing all congressional oversight. It places the focus on slashing Medicare costs, rather than on improving the quality of care.

Under the IPAB, 15 unelected bureaucrats decide what constitutes “necessary care.” The IPAB is likely to create a “one size fits all” solution when it comes to medical care.

As a physician, I can tell you firsthand how dangerous this can be. In medicine, every case is unique — and must be treated that way.

In addition, the board’s recommendations can develop Medicare policies and decisions without any transparency, oversight or debate. If Congress fails to change the IPAB’s recommendations, they go into effect. It’s important to note that Congress can only change where to cut – it cannot decide that cuts are too drastic. This could lead to denial of care.

For comparison, consider what has happened with Medicare physician payments. In 1997, Congress passed a formula called the sustainable growth rate — setting physician fees under Medicare. The formula works similarly to the IPAB: If physician payments exceed a targeted spending level, the per-procedure payment is cut to bring the spending levels back in line with the target.

The formula was developed to ensure that physicians receive adequate payment for their work — because they could just do more procedures. Instead, physicians have gotten a decade-plus of proposed cuts that they have had to ask Congress to stave off. A 21 percent cut recently went into effect for less than a month. So these cuts aren’t an idle threat.

The IPAB would effectively eliminate Congress’ ability to work with Centers for Medicare and Medicaid Services to create and implement demonstration and pilot projects designed to evaluate new and advanced polices — like home care for the elderly, less invasive surgical procedures, collaborative efforts between hospitals and physicians and programs designed to eliminate fraud and abuse.

The United Kingdom’s medical panel has a comparable board called National Institute for Health and Clinical Excellence. Obama borrowed from this model when creating the IPAB.

NICE recently denied use of several new drugs used to treat chronic leukemia patients. Its board’s reasoning was: “When we recommend the use of very expensive treatments, we need to be confident that they bring sufficient benefit to justify their cost.”

While the president claims his board will help reduce the deficit, the latest decision by NICE in Britain illustrates the likely way such deficit savings could be achieved: rationing care.

It’s easy for a board to deny funding for care. But what if you’re the patient with leukemia, or a doctor trying to offer the best care? NICE’s decision ignores quality of care if the treatment is deemed too expensive by the medical board’s standard.

Decisions like these are what the IPAB will have the authority to make. This cannot be allowed to happen.

The good news is that, under current law, the Congressional Budget Office has estimated that the board won’t yield any savings over the next 10 years. But that will surely change if the president has his way.

Read more at http://www.politico.com/news/stories/0611/57220.html

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