Does anyone really doubt that the government will use rationing to control medical “costs”. Here is a timely example just within the last two weeks of CMS (Centers for Medicare and Medicaid Services) denying a modern, alternative procedure for the detection of colon cancer. Death due to colon cancer, a leading cause of cancer death, can be prevented with early detection. Virtual coloscopy offers patients and doctors and option to traditional edoscopic methods which for various reasons may be less desireable for individual patients. Additionally, it is well known that traditional endoscopic colonocopy has a fairly high failure rate at detecting lesions in the right or ascending colon and cecum, due to difficulty in visulization at this level. Why is CMS against an alternative? Certainly the adminitrative team at CMS along with its advisory panel can all afford an option like this. However, they are willing to deny Medicare beneficiaries this option since it “might not apply as the study group mean age was 58 years”. You mean the older you get the more you like have a snake like tube many feet in length inserted into your rectum, under sedation? Hardly. This is about choice. Giveing Medicare beneficiaries and their doctors THE CHOICE. There is no argument that traditonal colonoscopy has advantages (such as direct visualization and the ability to take a biopsy), but there are advantages to virtual colonoscopy as well. One has to wonder if CMS read the government’s own web site (see below from the NIH- National Institutes of Health). Finally, CBS News (see link below) reported that many states fail in their efforts to screen for colon cancer due to insurance variations in coverage. They can now add CMS to that list. Is it hard to imagine that President Obama’s Compartive Effectiveness “Politburo” will not do the same and likely more: limit choice, ration care and remove options and choice from American’s and their physicians . . . jomaxx
Medicare tentatively decides not to pay for virtual colonoscopies
Medicare has tentatively decided not to pay for virtual colonoscopies, dealing a setback to a technique that some medical experts recommend as a more tolerable alternative to conventional colonoscopy in screening for colon cancer. In an online statement, CMS said that there was insufficient evidence to conclude that virtual colonoscopy [also known as CT colonography] improves outcomes in Medicare beneficiaries. In its analysis, Medicare said many studies supporting virtual colonoscopy were done in people with a mean age around 58, so results might not fully apply to Medicare’s older population.
Read more @ Medicare Blow to Virtual Colonoscopies @ http://www.nytimes.com/2009/02/13/health/policy/13colon.html?scp=1&sq=%2b%22cancer+screening%22&st=nyt
Virtual Colonoscopy
Virtual colonoscopy is a procedure used to look for signs of pre-cancerous growths, called polyps; cancer; and other diseases of the large intestine. Images of the large intestine are taken using computerized tomography (CT) or, less often, magnetic resonance imaging (MRI). A computer puts the images together to create an animated, three-dimensional view of the inside of the large intestine.
How is virtual colonoscopy different from conventional colonoscopy?
The main difference between virtual and conventional colonoscopy is how the doctor sees inside the colon. Conventional colonoscopy uses a long, lighted, flexible tube called a colonoscope to view the inside of the colon, whereas virtual colonoscopy uses CT or MRI.
What are the advantages of virtual colonoscopy?
Virtual colonoscopy does not require the insertion of a colonoscope into the entire length of the colon. Instead, a thin tube is inserted through the anus and into the rectum to expand the large intestine with air.
No sedation is needed. A patient can return to usual activities or go home after the procedure without the aid of another person.
Virtual colonoscopy provides clearer, more detailed images than a conventional x ray using a barium enema—sometimes called a lower GI series.
Virtual colonoscopy takes less time than either conventional colonoscopy or a lower GI series.
Virtual colonoscopy can see inside a colon that is narrowed due to inflammation or the presence of an abnormal growth.
Read more @ http://digestive.niddk.nih.gov/ddiseases/pubs/virtualcolonoscopy/#advantages
Colon Cancer State Rankings Colorectal cancer is the second leading cause of cancer deaths for men and women in this country, killing nearly 50,000 people annually. But when detected early, it can be successfully treated the vast majority of the time. The results of the 2009 Colorectal Cancer Screening Legislation Report Card were recently released. CBS News medical correspondent Dr. Jon LaPook reports that for the first time since it was first issued six years ago, the report shows that more states have received an A than a failing grade for their colon cancer screening laws. Twenty-one states, plus D.C., got an A, and 19 have gotten an F . . . Read more @ http://www.cbsnews.com/stories/2009/03/05/eveningnews/main4847055.shtml
“Rationing” is an odious word, especially when it suggest some malevolent intent, which I sense is suggested here between the lines. I read closely looking for clues about costs. All I found was “…the adminitrative (sic) team at CMS along with its advisory panel can all afford an option like this” which suggests that this wonderful, humane, state of science procedure is also expensive.
Rationing is never about choice. Rationing is about scarcity. It might be a scarcity of availability, a scarcity of money, or (my guess) both. I’m sure that in time with more production the economy of scale will make this procedure both widely available and less costly. At that time I’m sure CMS will look more favorably on its use and appropriateness for Medicare beneficiaries.
I am not persuaded by “rationing” arguments. The multi-tiered system now in place rations health care according to means and/or membership in certain categories (seniors, military families and dependents, veterans, government employees, Native Americans, medicare clients, and those with company-paid benefits (either at work or in pensioned retirement). Excluded from these options are the unemployed, those denied insurance by chronic or pre-existing conditions, and a large population living at the subsistence level for whom health care is limited to emergencies and whatever crumbs fall through the cracks.
Rationing is already in place.
John, thanks again for a thoughtful response. I agree that rationing is odious – the fact of it, not just the word. Malevolent . . . perhaps . . . slip shod and without concern, yes. If you truly understand how procedures are dealt with you would more than likely agree with me. First, this procedure is FDA approved, widely used, paid for by many private insurers and is a respected option (as noted, the NIH’s own website says so). Second, approval for payment by CMS will not increase costs. When approvals of this type are made, they are almost always budget neutral initially, meaning that other procedures are “re-balanced” in terms of their payment so that there is no net increase in CMS expenditures. Third, we do not currently have rationing. We have issues of access. They are quite different. Rationing is an imposed order by a hierarchy of individuals who may or may not be accountable or representative of the population, generally working out of a centralized authority or bureau. Lack of access speaks to specific issues regarding health delivery, which we are addressing here, most notably, access to health insurance. In terms of your outline of those excluded I would offer the following: unemployed persons have access to Cobra coverage – which may be financially burdensome, but the access is there; those denied insurance as you note, we have advocated for vigorously . . . and yet the President has done nothing to address this simple fix in the system; lastly, those living at the “subsistence” level should quite easily qualify for Medicaid in almost all states, so they should have health insurance with access. If we stick to facts, there are solutions for each and every item . . . ideology regarding health care is ill suited to a positive outcome that maintains what is best about our system and expands upon it. . . obi jo