Rationing Health Care

The Los Angeles Times has a good article this morning on the cancer screening debate, and the costs related to over-screening. Read it.

It got me thinking about the health care debate, the power of media, and how to lower the cost of health care. When people talk about the varying health care plans, one thing that comes across is that insurers shouldn’t ration treatment. In other words, we shouldn’t be told not to have a treatment because it is too expensive or not effective. We shouldn’t be told not to have a treatment because it is an overly expensive way of telling us nothing. We should have the right to choose our care. I agree with that, to a point, but I can also see that it is also a way for those paid by a fee for each service to continue making money, and for the insurers, be they government or private, to keep paying out and raising premiums. The media has a large role in this: medical shows routinely do test after test after test after test (after test after test, if you have Dr. House), without thought to the cost or the efficacy of the tests. The hospital dramas and the medical reality shows emphasize the importance of testing for that rare disease: what you have is never the obvious answer, can never be treated by the generic, can never be found by the simple test.

Our society overreacts to everything. Just as we feel that children shouldn’t run and play and explore unspervised because of that one child predator, we feel that we should do whatever is possible to extend a life. Damn the cost. Thus we’ll pay (or our insurers will pay) thousands each year for maintenance drugs to add an extra year to a life. From an overall societal view, can we afford this? What is this doing to our society?

And yet… we object to professionals telling us: you may not need that test. Perhaps we shouldn’t screen so often. Perhaps the cost of treating one additional cancer is less than the cost of all the false alarms and surgerys.

Where do we find that balance? How do we find the balance between the individual who wants to live as long as they can (a sentiment I can really understand), and the societal bodies that pay for the excess tests, the maintenance drugs, the surgical costs to investigate test findings, the late in life tumors from the extra radiation from the tests? Why would it be wrong for an insurer to ask, “Are you sure you need that test?” Why would it be wrong for them to pay less for something of questionable efficacy unless you can demonstrate that it works? Where is the line we should draw between the cost savings from this approach, and an individual’s right to have the care they want.

I don’t know the answer here. But as the recent mammogram controvery has demonstrated, this may be the third rail of health care.