Perhaps aware that US doctors order 5 times more MRIs than their German counterparts, or that billions of dollars are spent each year on cancer drugs that extend life by about a month, a Colorado neurologist posed this question to the Big O during a recent forum, covered by the Washington Post:
"Mr. President," he said, "what can you do to convince the American public that there actually are limits to what we can pay for with our American health-care system? And if there are going to be limits, who…is going to enforce the rules for a system like that?"
President Obama said it was the "right question," and then punted it like Ray Guy on fourth down.
The Big O and Congress have chosen to direct their cost-cutting efforts on the creation of a public insurance plan that would compete with Big Insurance, scythe-like cuts in payments from Medicare and Medicaid to providers, and an $80 billion loophole-closer on payments to Big Pharma.
In so doing, they have delegated the most central question —who gets what care?—to a so-far poorly defined $1.1 billion plan tucked into ARRA that would fund comparative effectiveness research.
And those with vested interests in the results of that research are hell-bent on de-clawing the initiative altogether.
In recent months for example, a federal panel has held several hearings on how to spend the $1.1 billion. At each one, reps from providers, Big Pharma, device companies and even patient groups demanded that cost should not factor into topic selection for the research studies, let alone any final recommendations that might result from the research.
Carolyn Clancy, director of the Agency for Healthcare Research and Quality, recently told the Post that the case had, in fact, been closed: the emphasis, she said, will be on clinical outcomes and that’s it.
"The questions of who gets what, these difficult choices . . . really are not posed in the current health reform legislation," said Drew Altman, president of the Kaiser Family Foundation. "The challenge," he said, "is us, the American people: We want the latest and the best, and we want it now."
Glenn Laffel MD, PhD, Sr. VP, Clinical Affairs
