This week Secretary Lanier Cansler of NC’s Department of Health and Human Services laid out the sobering facts on health costs in NC’s Medicaid health coverage program to a legislative committee. NC is $250 million over budget in Medicaid and those numbers are rising. Rumors are flying that to make up this difference NC might simply turn over its Medicaid program to NC Blue Cross or another private insurer. This is no doubt because private health insurers are doing such a good job controlling health costs. Cansler also said Medicaid might have to eliminate “optional” services like transplants, hospice or respiratory therapy for children.
Luckily, there are alternatives. Instead of enriching Blue Cross further or stopping heart transplants, we could save lots of money by stopping to pay for care we know is ineffective. Here are just three examples:
1. Stop paying for surgery to attempt to correct general lower back pain. Evidence that surgery is at all effective is extremely limited. UNC’s Dr. Nortin Hadler has just devoted an entire book to this subject.
2. Join the other 44 states in the union in implementing a mandatory preferred drug list to save $40 million in Medicaid spending instead of “voluntary” and quickly-changing drug industry-inspired alternatives. This option was unfortunately rejected by the NC General Assembly last year. Save even more money by adopting the same list for NC’s State Health Plan, Workers Comp, and any other program where the state purchases drugs. Follow the lead of states like Washington where a respected committee of physicians and other professionals works with regional academic centers and others (like Consumer Reports magazine at www.crbestbuydrugs.org) to create a list of the most effective drugs.
3. Don’t pay for Tamiflu, the expensive new drug that is supposed to help with the flu. There is simply no evidence that it reduces complications from flu in high-risk groups. The only benefit seems to be it may reduce the time healthy people have flu symptoms by about a day or so. This isn’t enough benefit to justify the expense or the widespread use of an expensive new drug that can cost $43 to $130 a dose.