“Imagine that it is 2013, and a new President is sitting in the Oval Office... Imagine that he (or she) was elected on a platform of cutting taxes, rolling back the Obama administration's increased spending, and reforming the Medicaid and Medicare entitlement programs... To make things even more interesting, let's imagine that [although]... expansion of health insurance coverage [was] enacted into law... most of the cost controls were stripped out or weakened as a result of political opposition. Health care spending has continued to rise at breakneck rates, and the Medicare trust fund is about to run out of money.
What is a new President to do?
Because the most promising approaches to gradually ‘bend the cost curve’ - comparative effectiveness research, coverage of evidence-based preventive services, advance care planning, reductions in regional variations in the quality and cost of care, and the public option - were left out of the health reform law... the only cost-cutters left are hugely unpopular ones. Increase the age of eligibility and slash Medicare benefits? Means-test Medicare to exclude the rich? Slash payments to doctors and hospitals? Go back on your campaign promise and raise Medicare payroll taxes? Or let Medicare go broke?”
The above comes from a post I wrote in November, 2009, four months prior to the Affordable Care Act becoming law. I bring it up again because here we are, less than a year from the presidential election, and in my view, things are turning out just as I had feared. Critics of the ACA, mostly from the right, are doing everything they can to discredit even the most modest programs to lower health care costs, while at the same time deriding “ObamaCare” for not controlling costs! The result may be that a new President—are you listening, President Romney, Santorum, Gingrich, Huntsman or Perry?—may have nothing left in the tool kit to tackle health care spending, other than shifting costs onto patients and cutting their benefits. Let’s say that President Obama is re-elected; he too may find that the most effective tools to lower health care spending have been damaged by the political effort to turn the public against them.
Case in point: Grace-Marie Turner’s breathtaking distortion that Washington is funding research on the effectiveness of different medical treatments for the purpose of “setting up the systems to direct doctors to practice Washington-approved medicine.” (Turner is the Executive Director of the Galen Institute, which describes itself as “a non-profit public policy research organization devoted exclusively to advancing free-market ideas in health policy.”)
Independent fact-check organizations long ago discredited the idea that CER “is being used to build a ‘scientific’ case for government rationing of health care” as Turner claims. In August 2009, the Pulitzer Prize winning “PolitiFact” said that a similar claim by [now Speaker of the House] Rep. John Boehner was false, pointing out that “it's a stretch to call giving patients better information about which treatments and drugs are most effective ‘rationing.’ In fact, given specific language in the bill to the contrary, we think it’s outright wrong... to claim the research findings would be used by the government to ration care.” (The law says that “Nothing in this section shall be construed to permit the Commission or the Center to mandate coverage, reimbursement, or other policies for any public or private payer.”) Factcheck.org, a project of the Annenberg Public Policy Center, also said that it is “false” to say that CER will allow government to “decide what care I get (a.k.a. they won’t give grandma a hip replacement).” Yet this doesn’t stop the Grace-Marie Turners of the world from repeating this discredited claim over and over again, probably because they know that scaring people into believing that the government will ration their care is the most effective way to undermine support for health reform, facts be damned.
It is this type of shamelessly cynical attack that former CMS administrator Don Berwick decried in uncensored remarks delivered a few days after leaving government:
Cynicism diverts energy from the great moral test. It toys with deception, and deception destroys. Let me give you an example: the outrageous rhetoric about “death panels”– the claim, nonsense, fabricated out of nothing but fear and lies, that some plot is afoot to, literally, kill patients under the guise of end-of-life care. That is hogwash. It is purveyed by cynics; it employs deception; and it destroys hope. It is beyond cruelty to have subjected our elders, especially, to groundless fear in the pure service of political agendas…
And, while we are at it, what about “rationing?” The distorted and demagogic use of that term is another travesty in our public debate. In some way, the whole idea of improvement – the whole, wonderful idea that brings us –thousands – together this very afternoon – is that rationing – denying care to anyone who needs it is not necessary. That is, it is not necessary if, and only if, we work tirelessly and always to improve the way we try to meet that need.
The true rationers are those who impede improvement, who stand in the way of change, and who thereby force choices that we can avoid through better care. It boggles my mind that the same people who cry “foul” about rationing an instant later argue to reduce health care benefits for the needy, to defund crucial programs of care and prevention, and to shift thousands of dollars of annual costs to people – elders, the poor, the disabled – who are least able to bear them.
The fact is that the next president, whether it is in 2013 or 2017, will have to deal with the fact that health care costs are rising at an unsustainable rate—and this will be true, regardless of whether the Affordable Care Act survives or not. Empowering doctors and patients by giving them information about what treatments work well, and what doesn’t, is the kind of program that conservatives should embrace, because “markets” don’t work if people do not have the information needed to make a comparative choice. Helping patients make their own decisions about how they want to be treated when their life is coming to an end is good and compassionate care, not a government death panel. But the unrelentingly cynical attacks on such common sense ideas to help improve care and reduce costs may actually work in persuading the public to reject them, leaving the new president with nothing in the tool box other than cutting benefits and raising taxes.
Today’s questions: What is your take on the continuing claims that comparative effectiveness research equals government rationing? And what will this mean for the ability of the next president to lead a discussion on controlling health care costs?