Medicare’s dilemma grows: How far to go in coverage
By Julie Appleby
USA Today
4/21/2005
…an ongoing dilemma for Medicare: whether to pay for a treatment when data on its effectiveness are uncertain or show it to be of limited value. The program… will increasingly face such debates as medical technology advances, baby boomers retire and Medicare confronts vast deficits.
“The question is, are we willing to pay for treatments that have a small chance at success?” says Peter Neumann, associate professor of health policy at the Harvard School of Public Health. “It’s true that we are a wealthy country, but whether we admit it or not, there are limits.”
Should Medicare cover every new $20,000-a month cancer drug? If a treatment is found for Alzheimer’s disease, will it go only to those diagnosed with the disease, or will patients who have normal age-associated memory lapses also be covered? Can the U.S. afford to put a pacemaker or other cardiac device into every patient with heart problems?
Medicare and other insurers are aiming to develop a better understanding of treatment outcomes by studying the results. Medicare, for example, has recently approved some new technologies but will track the patients – either by requiring them to be in clinical trials or by using a databank where medical information can be compiled – to see how well they do.
But cost isn’t the only factor in Medicare’s growing push to gather more data on effectiveness. The head of Medicare, Mark McClellan, says better evidence can help Medicare avoid treatments that don’t work or are dangerous.
“Why shouldn’t a patient who is very desperate say, ‘I’m willing to take a risk of dying from this technology, because I have little to lose’?” asks Princeton economist Uwe Reinhardt. While Medicare and other insurers should not pay for every treatment, regardless of its value, he says that some provision should be made to allow for innovation and experimentation.
http://www.usatoday.com/money/industries/health/2005-04-20-medicare-cover_x.htm
Comment: A common criticism of the Medicare program is that there are excessive delays in approving coverage of new technological advances. But we should keep in mind that new technology has contributed significantly to the continuing escalation of health care costs. So it seems that the Centers for Medicare and Medicaid Services is acting responsibly in requiring adequate evidence that new technology is providing reasonable value for the taxpayer.
It is entirely appropriate to limit coverage of unproven new technology to an experimental protocol until there are adequate data to warrant coverage for everyone.
As patients, each of us may want unlimited access to new, unproven, high tech care, but, as taxpayers, we should be assured that our health care spending on others is responsible.