Tuesday, August 11, 2009

This Health Care Reform Debate is Really Starting to Scare Me—What if We Were Having a Real One?

The recent stridency of this health care debate has led me to wonder what if the Democrats were proposing real health care reform?

The Democratic health care bills are hardly more than expansions of the health insurance entitlement paid for by largely insignificant cuts to existing spending and lots of new taxes. Any provider cuts to Medicare are so small they will be easily cost shifted to the private sector.

These Democratic bills are not health care reform. Nothing in them would "bend any curves" or make our system more sustainable. They are clearly not the systemic health care reform we need. At the end of the day our federal deficits, for example, are projected to be just where they would have been.

So, if these people out to scare folks more than conduct a rational debate can get away with it over such minor changes to the American health care system can you imagine the things they would be saying about real health care reform?

George Lundberg has a great post over at The Health Care Blog in which he suggests a number of meaningful changes to how care is delivered—by eliminating waste not medical necessity. Here is a portion of his post:
Currently several House and Senate bills include various proposals to lower costs. But they are tepid at best, in danger of being bought out by special interests at worst.

So, what can we in the USA do RIGHT NOW to begin to cut health care costs?

An alliance of informed patients and physicians can widely apply recently learned comparative effectiveness science to big ticket items, saving vast sums while improving quality of care.

  1. Intensive medical therapy should be substituted for coronary artery bypass grafting (currently around 500,000 procedures annually) for many patients with established coronary artery disease, saving many billions of dollars annually.

  2. The same for invasive angioplasty and stenting (currently around 1,000,000 procedures per year) saving tens of billions of dollars annually.

  3. Most non-indicated PSA screening for prostate cancer should be stopped. Radical surgery as the usual treatment for most prostate cancers should cease since it causes more harm than good. Billions saved here.

  4. Screening mammography in women under 50 who have no clinical indication should be stopped and for those over 50 sharply curtailed, since it now seems to lead to at least as much harm as good. More billions saved.

  5. CAT scans and MRIs are impressive art forms and can be useful clinically. However, their use is unnecessary much of the time to guide correct therapeutic decisions. Such expensive diagnostic tests should not be paid for on a case by case basis but grouped along with other diagnostic tests, by some capitated or packaged method that is use-neutral. More billions saved.

  6. We must stop paying huge sums to clinical oncologists and their institutions for administering chemotherapeutic false hope, along with real suffering from adverse effects, to patients with widespread metastatic cancer. More billions saved.

  7. Death, which comes to us all, should be as dignified and free from pain and suffering as possible. We should stop paying physicians and institutions to prolong dying with false hope, bravado, and intensive therapy which only adds to their profit margin. Such behavior is almost unthinkable and yet is commonplace. More billions saved.
Can you imagine what these people would be saying about George's ideas?
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