The latest “stimulus package” has passed both chambers of Congress and is being signed by the President. Although we all heard promises of how Washington would be different with more public input and transparency, the bill’s 1100+ pages were not even printed before it was voted on. So we, the public who were assured that this administration would give us the chance to participate in policy debates meaningfully, will not even be able to read the bill’s language until it is too late.
Some provisions of the legislation, however, are beginning to reach the eyes and ears of those interested. Among those provisions is a re-vamping of our health care system. Essentially, the federal government will establish a Council which will decide which treatments are approved for which patients under which circumstances, based on a cost-effectiveness model.
Currently, treatments are approved if they are safe and effective. Physicians have the ability to determine treatments or diagnostic procedures for each of their patients. Patients can move among several physicians to get multiple opinions before making a decision. And while insurance company policies are certainly a part of the decision-making process, there is wiggle room for doctor and patient.
In the new health care reform, the Federal Council will be making those health care decisions. Their cost-effectiveness model means that the cost of the treatment will be divided by the number of years that the patient will benefit from the treatment. The resulting quotient will be the number that is used to determine whether the treatment is approved or not. And, like golf, lower numbers are better.
For example, the treatment for a 10-year-old with a bone disease will cost $10,000. That cost will be divided by 62, which is the number of years remaining in an average life expectancy of 72. So the cost effectiveness number is $161.29. Now let’s look at a woman of 62 who is suffering from osteoporosis. For the purpose of comparison, we will assume that the cost for treatment is the same $10,000. But this time, the divisor will be 10, since the woman has already lived for 62 of the average life expectancy years. This cost effectiveness number is $1,000.
In fact, every treatment or diagnosis for a senior citizen will have a significantly higher cost-effectiveness marker than every treatment for younger people. And in the interest of keeping the cost of health care down, procedures with high cost-effectiveness markers are more likely to be disapproved. So we are about to tell the generation that defeated Hitler that their health care is “too costly”.
The other significant, but so far mostly unnoticed, word in that formula is the word “benefit”. In prior incarnations of universal health care, individuals with disabilities were defined as unable to “benefit” from health care since treating an intestinal disorder would not result in any improvement in the underlying disability.
This is not a new system. When a farmer has a sick cow, he calls the veterinarian. The vet looks at the cow and tells the farmer what diagnostic procedures may be necessary, what treatment options are available, and what the total cost is likely to be. The farmer then decides if “Old Bessie” will be able to produce enough for the farm to make it worth his while to pay for the treatment. If so, the farmer will say yes, and the vet will proceed. If not, the farmer says no thank you, and Bessie is not treated.
The new health care reform is bringing the standards used in veterinary medicine into human health care –- and we are the cows.