Once upon a time there was a grandmother who lived with her
son and his family. As she aged, her coordination deteriorated, and she began to spill things at the table, sometimes breaking dishes in the process.
Her son decided that she should no longer be allowed to use the family’s
china or eat at the family table with the lovely white table cloth, so he gave
her a small wooden bowl and a separate wooden tray for her meals.
The grandson, observing the change, asked why Grandmomma no
longer ate with the family. He was told that she was now too old to be trusted with anything nice.
The folks designing the federal health care reform must be
friends with that son.
They are proposing to cut Medicare reimbursement to doctors by 20%, making it even more difficult for seniors to get access to consistent and personal medical care. When doctors can not recover their costs for treating their Medicare patients, they must limit the number of senior patients they can treat. This is de facto rationing.
The federal stimulus bill created, and funded, a Federal Coordinating
Council for Comparative Effectiveness Research. This organization is charged with deciding what treatments the government’s health care plan will pay for.
The Council is to apply two standards in making that decision.
The first standard is based on research, meaning that only treatments with "proven effectiveness" will be allowed. If only proven treatments
are allowed, how do new treatments get developed? If a doctor determines that the particular needs of the patient require a treatment that is unusual, will the treatment be permitted?
Right now nearly 90% of the chemo-therapy being administered in America is using a combination of drugs that are combined in off-label ways. That means that physicians are exercising their professional judgment to build cancer treatment packages that blend medicines to get a result that is different from the original intent of the drug. And patients get better. If doctors were limited to the labeled use of those drugs, all of those cancer treatments would stop. What happens to the patients currently receiving those treatments?
The second standard is based on a cost/benefit analysis. This means that the cost of a proposed medical treatment will be divided by the number of years the patient will benefit from that treatment. So if a 10 year old breaks a hip, the cost of the treatment would be divided by the 62 future years of life that child is expected to have. If a 65 year old breaks a hip, the cost would
be divided by the 7 future years of expected life. The child’s treatment would be deemed cost-effective and allowed, but the senior’s care would not.
This system hurts everybody.
The harm to the patients is obvious.
But just as destructive is the harm to the families of those denied
medical treatment. Families who will lose loved ones to diseases like cancer earlier than necessary. Families that will have to care for infirm
and hurting seniors years before they should. Families in which grandchildren will lose their grandparents before they ever get the chance to know and love them.
In our story, the grandchild reminded the father of the dignity of Grandmomma’s life. The question is, will we remind the government of the same thing?