Universal health care, Medicare and rationing

by James Hubbard, M.D., M.P.H.

Health-care rationing is coming, but what form will it take?  Limiting by age?  Predicted life expectancy?  And who will make these decisions?

Two recent medical review studies give us a glimpse into the future.One was a few months back, which caused the medical powers-that-be to recommend it wasn’t worth the expense to screen for prostate cancer after age 75.  The thinking is the cancer is slow growing and you will probably die of something else while going through the misery (and expense) of treatment.  So why bother?

Okay that’s a little blunt, but you get the idea.  Health-care money is tight and older people are not cooperating by dying off young.  In fact there is just going to be more and more of us, and we are getting healthier by the day.  The prostrate screening is really not such a bad idea as long as the patient and doctor have the final say, but there are plenty of vibrant men well over 80 who might disagree.

Next step is Medicare will decide not to pay for certain screenings and treatments.  They already don’t on experimental procedures (unless a congressmen decides to make them in individual cases).  Public policy wonks look at populations, not individuals.  They look at how much it costs in dollars per benefit to the public.  If there is only so much money to go around and there has to be a choice between paying for a test which costs a million dollars to save one patient life versus one which cost one a thousand dollars per patient saved, guess which one wins?  That’s okay unless you are the one in the first category.

The second review is in the new Annals of Internal Medicine.  The investigators found around 45 percent of elderly VA patients were being screened for colon cancer in some form or fashion (colonoscopy, x-rays or fecal blood test).  This is below the average for younger ages, even though the older are at increased risk for the cancer.

Then they divided the patients into those who had chronic disease with a life expectancy less than five years and those who were expected to live more than five years.  They found the percentage who were getting screened for cancer was the same in both groups.

Their conclusion was we should start paying more attention to target screening for those with longer life expectancies and less to those with shorter.

Despite what politicians say, if we reign in health care costs dramatically we are going to have to make some hard decisions, and you know the policy makers read (probably encourage) these medical review studies.
It will be a certainty, if the government pays, they will have control.  I just hope they leave the patient and doctor a little breathing room (pun intended).

The decisions the government is making on health care will affect us all directly.  Stay informed with facts, not soundbites, decide what you can live with or without and make your opinion known.

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5 Responses to “Universal health care, Medicare and rationing”

  1. jhubbard Says:

    Dr. Kevin Liu left a comment on my Facebook page questioning the fact that younger people were screened more often than 45 percent. After rereading the study I may have misread. In its summary, it states 46-47 percent of the 75 year old group were screened and that percentage went down with age and morbidity to as low as 41 percent.

    Thanks Dr. Liu

  2. Sagan Says:

    Sighs. We need to invest more into health care.

    Sagans last blog post..The Slow Food Movement

  3. Steve Parker, M.D. Says:

    One form of “breathing room” would be to leave us the option as private individuals to pay for something out-of-pocket when the government program won’t cover it. Some socialized medicine systems allow that, others don’t.

    -Steve

    Steve Parker, M.D.s last blog post..Glycemic Index and Chronic Disease Risk (Mostly in Women)

  4. FatFighterTV Says:

    When will we find a solution? It seems like the healthcare problems will never end. All I want is for insurance companies to help sick patients. Well, that’s not all I want, but that’s a big one. :)

    FatFighterTVs last blog post..News Nugget: Just a swish of a sports drink can boost workout

  5. ocbody.com doc Says:

    Universal health care will come with a loss of control that Americans will probably resent. When the government says it’s not covered and you can’t have it, people will get angry. Of course by then there will be little they can do about it.

    ocbody.com docs last blog post..Christie Brinkley: Good Genes or Good Docs?

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