Comparative Effectiveness Research will NOT Ration care

[JohnWxy]

I posted about the Republicans success at putting an amendment into the Health care bill being marked up by the Energy and Commerce committee. (http://www.democraticunderground.com/discuss/duboard.php?az=view_all&address=103x467866 ) The Republicans are spouting typical bullshit that using Comparative Effectiveness Research will lead to rationing of health care (likeit isn't being rationed for profit enhancement reasons right now!)

This is of course, bullshit.


http://wonkroom.thinkprogress.org/2009/06/19/republicans-offer-redundant-cer-amendments/

The government (is not going to mandate) that doctors adopt the results of CER and it is not rationing care. Each patient has his or her unique needs and the ultimate decision for how to proceed should be left to the doctor and the patient. Currently, approximately one-third of all treatments have never been proven to produce better outcomes; CER would provide doctors with unbiased information about the most effective treatments, help doctors and patients make better informed decisions, and improve the quality of care.

Moreover, far from establishing one-size-fits all medicine or dictating treatments, properly conducted CER will actually promote faster adoption of personalized care. As Alan Garber of Stanford and Sean Tunis of the Center for Medical Technology Policy point out, “far from impeding personalized medicine, CER offers a way to hasten the discovery of the best approaches to personalization, providing more and better information with which to craft a management strategy for each individual patient.” The new CER council and CMS seek to preserve a personalized approach — that is, allow doctors to make decisions based on a patient’s history and individual needs — while eliminating truly ineffective treatments.

CER results are rarely black and white and no one study should serve as a final word on a coverage decision. But given the amount of unnecessary, redundant and ultimately harmful treatments, the government has an interest in informing health care providers about best practices– and this is what the legislation does and our doctors want. More efficient medicine is better medicine, and anyone who wants to prevent the system from wasting money is in the pockets of the medical industrial complex that is getting rich while we get sick.

[jody]

1. You may be right but Obama acknowledged the need for rationing in his comment below.

President Obama's Grandmother and the Ethics of Health Care Reform

So now she’s in the hospital, and the doctor says, Look, you’ve got about — maybe you have three months, maybe you have six months, maybe you have nine months to live. Because of the weakness of your heart, if you have an operation on your hip there are certain risks that — you know, your heart can’t take it. On the other hand, if you just sit there with your hip like this, you’re just going to waste away and your quality of life will be terrible.

* * * * * * * * *

I don’t know how much that hip replacement cost. I would have paid out of pocket for that hip replacement just because she’s my grandmother. Whether, sort of in the aggregate, society making those decisions to give my grandmother, or everybody else’s aging grandparents or parents, a hip replacement when they’re terminally ill is a sustainable model, is a very difficult question. If somebody told me that my grandmother couldn’t have a hip replacement and she had to lie there in misery in the waning days of her life — that would be pretty upsetting.

...I think that there is going to have to be a conversation that is guided by doctors, scientists, ethicists. And then there is going to have to be a very difficult democratic conversation that takes place. It is very difficult to imagine the country making those decisions just through the normal political channels. And that’s part of why you have to have some independent group that can give you guidance. It’s not determinative, but I think has to be able to give you some guidance. And that’s part of what I suspect you’ll see emerging out of the various health care conversations that are taking place on the Hill right now.

The President has done two key things here. First, he has started to discuss resource allocation and rationing in down-to-earth, personal terms. The question of whether to do a hip replacement is a truly challenging clinical as well as ethical decision. This wasn't a situation of "flogging" his grandmother with a chemotherapy that offered a small chance of minor extension of life but at the cost of major side effects and high expenditures. If the President's grandmother had nine months of life in store and the hip replacement went well, the operation could have contributed to a significant improvement in quality of life for many months, but her heart condition and the cancer made the procedure riskier. What to do was a tough question.

[JohnWxy]

2. "acknowledged the need for rationing" premises it is somethiing TO BE CONSIDERED as if it is not

being done now.

Rationing is occurring right now. INsurance companies decide who gets coverage and what procedures they will cover in order to keep profits strong.

Wendell potter formerly of CIGNA explained on the Bill MOyer's journal that insurance companies are interested in keeping profits high to keep there share price strong.


Bill asked him what insurance companies do to keep costs down (and profits up):
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WENDELL POTTER: Rescission is one thing. Denying claims is another. Being, you know, really careful as they review claims, particularly for things like liver transplants, to make sure, from their point of view, that it really is medically necessary and not experimental. That's one thing. And that was that issue in the Nataline Sarkisyan case.

But another way is to purge employer accounts, that-- if a small business has an employee, for example, who suddenly has have a lot of treatment, or is in an accident. And medical bills are piling up, and this employee is filing claims with the insurance company. That'll be noticed by the insurance company.

And when that business is up for renewal, and it typically is up, once a year, up for renewal, the underwriters will look at that. And they'll say, "We need to jack up the rates here, because the experience was," when I say experience, the claim experience, the number of claims filed was more than we anticipated. So we need to jack up the price. Jack up the premiums. Often they'll do this, knowing that the employer will have no alternative but to leave. And that happens all the time.

They'll resort to things like the rescissions that we saw earlier. Or dumping, actually dumping employer groups from the rolls. So the more of my premium that goes to my health claims, pays for my medical coverage, the less money the company makes.
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Yes, we have rationing right now, who gets coverage and what procedures are covered is decided by insurance company execs to maintain profits.


You can watch the video here: http://www.pbs.org/moyers/journal/07102009/profile.html"> Wendell Potter on Profits Before Patients


It's fun to hear how insurance companies ration to preserve and grow profits. In fact those of us who have health care insurance now, - some portion of us will lose it in the future because of the cost growth. Won't that be fun?

[jody]

3. Your OP subject "Comparative Effectiveness Research will NOT Ration care" contradicts Obama's stated

position.

[JohnWxy]

4. you want to provide a link. Rationing is happening right now. It's done by insurance

companinies to preserve profits.

I don't know what the statistics are but insurance companies make a practice of dumping the people who are the sickest and denying treatments as "experimental". The result is people who thought they had insurance find out they don't just when the need it. Here's a short article on the case of Nataline Sarkisyan:

Family of 17-year-old Nataline Sarkisyan has filed a claim against Cigna insurance company. The company initially refused to pay for a life saving liver transplant for Nataline. Four medical experts from Mattel Children’s Hospital at UCLA Medical Center continuously appealed to the insurance carrier claiming they believed the transplant to be beneficial for the 17 year-old girl. Cigna kept arguing the procedure was experimental and continuously denied the claim. The insurance company eventually approved the transplant after Sarkisyan’s family held a rally outside Cigna’s Los Angeles office.

........Nataline Sarkisyan died hours after the approval was granted.

[jody]

5. I provided a link in #1. Have a great evening and goodbye. n/t

[JohnWxy]

6. Rationaing is going on right now, by the health insurers to preserve and protect profit.

If you are up to it (wouldn't want to shake you preconcieved notions) watch Wendell Potter formerly of CIGNA talk about how insurers dump people and companies (who provide group coverage to employees0 when they get too expensive.

Watch it. Its fun to listen about Sarcasian who fought their insurer to get a liver transplant approved for their daughter. CIGNA was refusing to pay. they said the treatment was 'experimental'. Eventually, because they made their battle public, the insurer approved the treatment. Sarcasian died hours before the approval.



http://www.pbs.org/moyers/journal/07102009/transcript2.html


WENDELL POTTER: Well, there's a measure of profitability that investors look to, and it's called a medical loss ratio. And it's unique to the health insurance industry. And by medical loss ratio, I mean that it's a measure that tells investors or anyone else how much of a premium dollar is used by the insurance company to actually pay medical claims. And that has been shrinking, over the years, since the industry's been dominated by, or become dominated by for-profit insurance companies. Back in the early '90s, or back during the time that the Clinton plan was being debated, 95 cents out of every dollar was sent, you know, on average was used by the insurance companies to pay claims. Last year, it was down to just slightly above 80 percent.

So, investors want that to keep shrinking. And if they see that an insurance company has not done what they think meets their expectations with the medical loss ratio, they'll punish them. Investors will start leaving in droves.

I've seen a company stock price fall 20 percent in a single day, when it did not meet Wall Street's expectations with this medical loss ratio.

For example, if one company's medical loss ratio was 77.9 percent, for example, in one quarter, and the next quarter, it was 78.2 percent. It seems like a small movement. But investors will think that's ridiculous. And it's horrible.


~~
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BILL MOYERS: And they do what to make sure that they keep diminishing the medical loss ratio (i.e. hold down costs to keep profits strong_JW)?

WENDELL POTTER: Rescission is one thing. Denying claims is another. Being, you know, really careful as they review claims, particularly for things like liver transplants, to make sure, from their point of view, that it really is medically necessary and not experimental. That's one thing. And that was that issue in the Nataline Sarkisyan case.

But another way is to purge employer accounts, that-- if a small business has an employee, for example, who suddenly has have a lot of treatment, or is in an accident. And medical bills are piling up, and this employee is filing claims with the insurance company. That'll be noticed by the insurance company.

And when that business is up for renewal, and it typically is up, once a year, up for renewal, the underwriters will look at that. And they'll say, "We need to jack up the rates here, because the experience was," when I say experience, the claim experience, the number of claims filed was more than we anticipated. So we need to jack up the price. Jack up the premiums. Often they'll do this, knowing that the employer will have no alternative but to leave. And that happens all the time.

They'll resort to things like the rescissions that we saw earlier. Or dumping, actually dumping employer groups from the rolls. So the more of my premium that goes to my health claims, pays for my medical coverage, the less money the company makes.

(more)
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You can watch the video here: http://www.pbs.org/moyers/journal/07102009/watch2.html


Potter also talks about the Nataline Sarkysian case. Her Doctors recommended she get a liver transplant. Cigna denied it saying it was "experimental". Nataline's parents went public with there dispute with Cigna and eventually Cigna changed their position and approved the operation. Hour after that approval Nataline was dead.

Nataline Sarkisyan Dies and Cigna Saves Money

"This is just another example of how insurance companies routinely withhold needed coverage that sustains or prolongs life. This is why the system needs to change. We should no longer tolerate a system that allows bean counters to decide what treatments should be covered. No matter what lawsuits come, this horrendous loss of life occured because the system is broken."



So you think there is no rationing going on now? Maybe you'd like to explain that to the parents of Nataline Sarcysian.

.... Oh, and have a nice day.

[JohnWxy]

7. Insurance companies ration health care right now - to keep profits up:

Former insurance exec's testimony on Insurance industry's rescission practices to maintain profits.


Rationing is not merely a matter of discussion, it is done right now by the health care insurance companies - to maintina their profits:



http://voices.washingtonpost.com/ezra-klein/Potter%20Commerce%20Committee%20written%20testimony%20-%2020090624-%20FINAL.pdf


"To help meet Wall Street’s relentless profit expectations, insurers routinely dump policyholders who are less profitable or who get sick. Insurers have several ways to cull the sick from their rolls. One is policy rescission. They look carefully to see if a sick policyholder may have omitted a minor illness, a pre-existing condition, when applying for coverage, and then they use that as justification to cancel the policy, even if the enrollee has never missed a premium payment. Asked directly about this practice just last week in the House Energy and Commerce Committee, executives of three of the nation’s largest health insurers refused to end the practice of cancelling policies for sick enrollees. Why? Because dumping a small number of enrollees can have a big effect on the bottom line."


..... and you thought rationing wasn't going on right now.