WSJ needs to ration its nonsense

An editorial in yesterday’s Wall Street Journal explains how health care in the United States was all puppies and rainbows until the election of President Barack Obama and the invention of health care “rationing.”

The specific subject of the editorial was the declaration by Medicare that for now it will only pay for real, not virtual, colonoscopies.

You have to hand it to the WSJ, it does a great job of sticking to the health reform talking points pushed by Republican spinmeister Frank Luntz. Luntz suggests that his minions repeat the line that one size does not fit all in health care. That is critical. The WSJ editorial would make him proud with this line: “The problem is that what ‘works best’ isn’t the same for everyone.”

Another winner, according to Luntz, is arguing that if health reform triumphs then the government — nooo, not the government! — will set standards of care. The WSJ dutifully follows along with this line: “Washington’s utilitarian judgments about costs would reshape the practice of medicine.” Yikes, we don’t want utility.

And don’t forget to mention, Luntz warns, “It could lead to the government rationing care, making people stand in line and denying treatments like they do in other countries with national healthcare.” What is the WSJ version of this argument? “This is a preview of how health care will be rationed when Democrats get their way.”

Aside from just repeating the lines fed to it by a conservative public relations flak, there are at least two other problems with the WSJ editorial against Medicare paying for things that cost tons of money are aren’t particularly effective.

First, many of the people who would buy into any public Medicare-like program would likely not have insurance now. That means no virtual colonoscopies and no real colonoscopies. We currently ration care based on who has insurance and who does not.

Second, the WSJ does not offer any alternative to the current Medicare system. Should Medicare pay for everything regardless of effectiveness? Should Medicare just leave it up to doctors to decide what it should pay for? Given the wide variation in physician prescribing habits I don’t think that’s a good idea. Also, Medicare not paying for stuff is not something created by the Obama administration. Insurance, including Medicare, has never paid for every treatment. That includes, by the way, private insurance.

So let’s the cut the silliness. And if you’re going to use simplistic scare tactics at least get some original talking points. The Luntz lines were tired even before they were leaked.


  1. IBXer

    May 21, 2009 at 10:32 am

    “Yikes, we don’t want utility.”

    You do realize that one of the guiding principals of utilitarianism is that it is necessary to sacrfice the needs of the few for the needs of the many, right?

    It’s called rationing. Not based on the needs of the patient, but on the needs of the politicians to keep prices low and keep voters happy.

  2. Emily5131

    May 21, 2009 at 10:58 am

    It seems the recent decision by CMS to deny reimbursement of CT Colonoscopy for lack of evidence did not look at “ALL” of the facts, evidence, and costs related to colon cancer. It is easy to overlook some of the data out there and then claim lack of evidence.

    Below are some pertinent facts relating to colon cancer that somehow did not appear in the 30 page decision by CMS to deny coverage:

    Fact: 50,000 people are dying from colon cancer each year in the US.
    Fact: Another 150,000 new cases are being reported each year.
    Fact: Sadly, all of this is from a cancer that is more than 90% preventable by early screening.
    Fact: CMS and other healthcare providers are paying billions of dollars for the treatment of colon cancer each year.
    Fact: Optical colonoscopy is the only procedure where polyps (that can become a cancer) can be removed.
    Fact: Any screening method is only effective when it is used.
    Fact: More than 50% of the screening age population is simply not getting screened using the optical colonoscopy.
    Fact: There is evidence that optical colonoscopy for screening is underutilized by CMS recipients – published papers.
    Fact: The GI community currently does not have the capacity to meet the needs of the screening population (generally those over the age of 50).
    Fact: CMS pays for screening tests with lower sensitivity, such as the barium enema or flexible sigmoidoscopy. The flexible sigmoidoscopy is equated to having a mammography test of one breast.
    Fact: There is evidence that CTC is cost-effective for screening.
    Fact: CTC screening programs over the past 5 years have shown as much as 70% increase in colon cancer screening compliance.

    For those who use the argument that if you have a polyp you need to go for an optical colonoscopy to get it removed anyway: Yes, that is true for medically significant polyps. However, the fact remains that if people are not getting screened (by any method) then no one will find and remove the polyps that could prevent colon cancer to begin with.

    On the topic of polyp removal, only 10%-20% of the general screening age population need polyps removed. However, without effective screening no one will know who falls into that 10%- 20% group.

    CT Colonoscopy offers a proven, economical, and viable option for colon cancer screening. There is plenty of evidence in published clinical trials over the past 10 years to show that CTC is as good as OC for detecting clinically significant polyps. The commercial health insurance carriers see the light and are beginning to reimburse for CTC screening.

    The problem is that CMS cites that all this supporting data is on patients with an average age of 58, not 65 (Medicare age). If 10-20% of those being screened (at 58) have polyps that can turn into cancer, imagine how many 65 and over will have polyps that turn into cancer because they are NOT screened! Did CMS make a truly medical decision or a financial one by taking the easy way? Reimbursement for CT Colonoscopy now may increase some Medicare costs in the short-term, but would save enormous amounts later by significantly reducing the cost of treating colon cancer. Is CMS “passing the buck” to control their spending now vs. investing in the future?

    On one hand, our government talks about preventative health care, on the other, we are paying billions of dollars for treating colon cancer now but do nothing to improve prevention of the disease even when it is available. The reality is that optical colonoscopy is not working as it should for colon cancer prevention. Should we ignore this problem by choosing to accept it, or do something about it in a proactive manner? Maintaining status quo, as CMS has done, is really not the option to choose.

  3. AdamL

    May 21, 2009 at 11:08 am

    IBXer, as usual you’re a bit to literal my friend. We all know what utilitarianism means, although I don’t mind you using our comment section to explain what you learned yesterday in your philosophy class.

    Emily5131, I know that people have problems with various decisions by CMS but the larger point is that Medicare and private insurers have never paid for every procedure. We all disagree with some of the methods Medicare AND private insurers use to decide what to cover — however, the WSJ makes it sound as if this is something new. Also, while you might contend that Medicare should cover this one procedure, I don’t think anyone, except the WSJ, would suggest that CMS should approve payments for everything regardless of cost or effectiveness.

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