Liberals’ Latest Deficit Proposal: Reducing Access to Treatments
Earlier this week the Center for American Progress released a series of proposals it alleges could save Medicare “$100 billion or more in a decade.” Among the ideas is a proposal to reduce access to costly treatments: “Medicare should not pay extra for technologies that are more expensive but no more effective than other available technologies. If a treatment has a less costly alternative that produces the same clinical outcomes, Medicare should reimburse only the price of the less costly alternative.” While such a proposal to grant Medicare “least costly alternative” authority – so named because Medicare would only pay an amount equal to the cheapest treatment option – may sound reasonable, a Congressional Budget Office document from 2008 highlighted potential drawbacks:
An argument against the option is that differences do exist between products in terms of how they are derived and produced….Those differences may warrant a clinical judgment on the part of physicians to prescribe one product rather than another. The LCA policy could therefore impose a financial penalty on physicians who used a more costly alternative on the basis of their clinical judgment and expertise.
In other words, under the CAP proposal, each individual patient may respond differently to a particular treatment, but Medicare would impose a one-size-fits-all reimbursement policy that only pays an amount equal to the cheapest drug. This proposal would likely have its biggest negative impacts on discrete sub-groups – potentially including racial and ethnic populations – that may respond differently to a particular drug or therapy than the majority of the population, but would have to pay more to find a treatment that worked for them.
It’s also worth noting that one of the co-authors of the CAP proposal is former Obama Administration official Zeke Emanuel. Emanuel, of course, offered the infamous chart for prioritizing scarce medical resources in a journal article in which Emanuel admitted that his system “discriminates against older people….[However,] age, like income, is a ‘non-medical criterion’ inappropriate for allocation of medical resources.”
Given all this, some may find it a bit ironic that liberals are protesting proposed reductions in Medicare benefits as part of deficit reduction talks, because that’s exactly what CAP is proposing – a major reduction in Medicare beneficiaries’ access to treatments, based solely on cost, that could hurt vulnerable sub-groups hardest.