Report compares reform estimates, finds huge savings
Filed under: Government, Health care reform, Hot Health Headline, Studies
A report from the health reform-focused Commonwealth Fund compares costs over the next decade for numerous reform options, using estimates from the Office of Management and Budget (for the president’s reform proposal and stimulus), the Congressional Budget Office and a Commonwealth-commissioned Lewin Group report titled “The Path to a High Performance Health U.S. Health System.”
Estimates vary widely between the three efforts, with the Lewin Group (which has some ties to the insurance industry) generally giving the rosiest predictions. The federal reports generally focus exclusively on government savings, while the Lewin study often also lists the savings incurred by the system as a whole. The comparisons are particularly interesting, with some estimates looking remarkably divergent. For example, for a hospital pay-for-performance system, the OMB estimates a $12 billion savings, the CBO says $3 billion and the Lewin Group says the government will save $43 billion with the system as a whole saving $55 billion.
Hastings Center debuts ‘Health Care Cost Monitor’
Filed under: Health care reform, Health journalism, Health policy
The Hastings Center, an independent bioethics think tank, has launched the ‘Health Care Cost Monitor,’ a blog aimed at covering the “crisis” of rising health care costs with “care, depth, and nuance.”
Daniel Callahan, co-founder, senior research scholar and president emeritus of The Hastings Center, NAS Institute of Medicine member and author will edit the blog. According to the Center, “other regular American and international contributors to the blog will include Henry Aaron, Eric Cassell, Anthony Culyer (UK), Muriel Gillick, Hans Maarse (Netherlands), Theodore Marmor, James Morone, Jonathan Oberlander, Steven Pearson, Louise Russell, Richard Saltman, Mark Schlesinger, Peter Ubel, and Joseph White.”
Here’s a look at the blog’s posts so far. Already, it has established itself as a bit more nuanced and deliberative than most blogs, with the result that it’s also quite a bit longer in form.
Speaking Truth to Evasion
Callahan argues that cost controls invite evasion, and declares that health care cost may be a more important issue than universal coverage, primarily because costs are one of the biggest obstacles to such proposals. He writes that an effective cost control plan would probably have to include some form of rationing, a practice that invites the sort of ethical dilemmas in which his Center specializes. In that vein, Callahan makes his editorial position clear: “We think it important to get a reform plan in place that will stand the test of time, one that has built cost control into it from the start, and that the public is fully informed about that necessity.”
Ending the Cost Insanity: Some First Steps
Senior Brookings fellow Henry J. Aaron dismantles the health care industry’s much-publicized pledge to cut $2 trillion in spending in the next decade, saying that the U.S. system is constructed to be “as immune as possible to health discipline” and detailing just why that is the case. He then shows why the tax burden of a universal system would be unbearable without cost reductions, and outlines a possible solution including comparative effectiveness research and spending constraints and bargaining power for government health care entities.
Debate roils over effectiveness, ‘rationing’
Filed under: Health care reform, Health policy, Hot Health Headline
The Kansas Health Institute’s Dave Ranney attempts to illuminate and explain the fears that research into the comparative effectiveness of health care will lead to a “rationing” system that forces patients toward the cheapest options. Ranney interviewed prominent Kansas sources on all sides of the debate.
U.S. Sen. Pat Roberts, R-Kan., expressed his reservations about the possible consequences of seemingly-innocuous research into comparative effectiveness.
Roberts warned that there’s little to stop the federal government from using the research to figure out which medications or treatments achieve similar results for less cost. When that happens, he said, it won’t be long before Medicare starts cutting costs by steering doctors toward the cheaper alternatives and rationed or cookie-cutter treatments heedless of individual results.
And where Medicare goes, the nation’s health insurers will soon follow.
“This is very dangerous territory,” Roberts said.
In response to Sen. Roberts, Ranney quoted a health policy expert who said such theories are “fear mongering, it’s raising the specter of socialism, it’s telling people they’re going to have some fuzzy-headed bureaucrat telling them what to do, denying them choice.”
Ranney includes the answers that Kansas governor and HHS nominee Kathleen Sebelius gave to similar questions posed by the Senate Finance Committee.
Effectiveness debate over virtual colonscopies
Officials are considering whether or not Medicare will cover virtual colonoscopies, a technology that, while cheaper and far less invasive, may also be less reliable. Los Angeles Times reporter Noam N. Levey looked at how the debate over colorectal screening illuminates the difficulties inherent in the larger discussion about the Obama administration’s push for efficient health-care spending.
According to Levey, “Colorectal cancer is highly treatable if detected early, but it remains the nation’s second deadliest cancer, in large part because half of adults over 50 do not get screened.” Levey reported that patients avoid screening primarily because they wish to avoid the sedation or discomfort that accompany the procedure.
Doctors and researchers do not yet agree on the effectiveness of virtual scanning, and it still requires unpleasant preparations like colon-cleansing and the insertion of air into the intestine. Nonetheless, it promises to offer a relatively enticing alternative to the traditional colonoscopy.
Some studies have indicated that the procedure can detect most polyps as well as traditional colonoscopy. But others have suggested it is not be as good at detecting some smaller polyps.
Disputes over the cost-effectiveness of virtual colonoscopy further complicated the analysis.
The agency’s extensive year-long review of the efficacy of virtual colonoscopy shows just how much budgetary pressure Medicare is under during a period of increased scrutiny and reform.
Medicare, which will spend more than $500 billion this year, is under increasing pressure to contain spending that many experts say threatens the whole federal budget.
Of particular concern has been the rising cost of scans. Medicare spent more than $14 billion on imaging in 2006, double what it spent six years earlier, according to a 2008 report by the Government Accountability Office.
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