"Thomas Scully: ‘Medicare Makes Decisions On Coverage All The Time, I Made Decisions On Coverage All The Time’"
Today, the Center for American Progress Action Fund hosted a forum to discuss how the Medicare program can inform this year’s health care reform debate. After the event, ThinkProgress sat down with Thomas Scully, the Administrator of the Centers for Medicare and Medicaid Services (CMS) from 2001-2003, and asked him to respond to conservatives (like Sen. Jon Kyl (R-AZ)) who argue that health information technology and comparative effectiveness research would ration health care:
I had a lot of those fights because the reality is the government should be able to look at what’s the appropriate level for PET scans or MRIs?…You know, Medicare makes decisions on coverage all the time. I made decisions on coverage all the time based on what I thought was not – on comparative effectiveness research. You got to do it the right way. But I think – I’ve always been a big fan of comparative effectiveness research if done correctly.
Scully dismissed the likes of Sally Pipes and Betsy McCaughey as “just noise” and argued that since Republicans are in the minority, “their job is to hurl attacks,” just as some Democrats did during the debate surrounding Medicare Part D.
Asked if the odds of health reform are better this year, Scully predicted that “the odds are lower” of passing health reform now “because the economy is in such bad shape, I think it’s going to be very difficult to finance this thing.” “I don’t think that the core people that are really in the weeds of health care in the Senate is as big as it was…I don’t think there is a group of 20 guys that really are health care wonks like there was 15 years ago,” Scully explained.
During the panel discussion, however, Scully admitted that the world would have been a better place had Congress passed President Clinton’s health reform plan. “They made a lot of strategic errors back then…but the core issue was trying to fix the commercial insurance option…which is the right thing to do, they probably went too far… but had the plan passed back then, the fundamental concept behind it was regional purchasing cooperatives with a better structured insurance market, which is exactly what we’re talking about right now.”
SCULLY: The government does it anyway. I think there’s got to be limitations, but I think the reality is — look, I had a lot of fights – I’ve had giant fights. I declared the two biggest drugs in Medicare, (inaudible), to be functionally equivalent because they were. I got attacked by the drug companies. I had a lot of those fights because the reality is the government should be able to look at what’s the appropriate level for PET scans or MRIs? I never gave a speech – in four years I haven’t given a speech yet without beating up Nexium. Nexium’s the most bogus drug ever made. Nobody should ever take Nexium. Prilosec’s the same thing. So the government should be out there saying, ‘we’re not paying for Nexium, we’re paying for Prilosec.
THINK PROGRESS: So you, because there’s the controversy over CR obviously is cost and can you use CR research to deny coverage?
THINK PROGRESS: So you would approve –?
SCULLY: I did it at CMS all the time. People talk about it and say it’s the right thing to do. There’s no question, in my opinion it’s absolutely the right thing to do. There’s a lot of fear from some people that it’s going to stifle innovation of drugs and devices and other things and I just don’t that’s correct. I think the political system is – patients want good drugs, they want good devices, they want good anti-cancer radiation and Medicare denies service every day. I like Senator Kyl, he’s a very big free market guy, he’s got a lot of doctors in Arizona that are very worried about this. And so, like any member of congress he tries to please constituents. He’s one of the nicest people to ever meet. One this one I obviously don’t agree with him. You know, Medicare makes decisions on coverage all the time. I made decisions on coverage all the time based on what I thought was not – (inaudible) research. You got to do it the right way. But I think – I’ve always been a big fan of (inaudible) research if done correctly.
I’m a big fan of Health IT and I wish I would have done more. My problem with Health IT and I don’t blame republicans for this but I spent a lot of time on Medicare forms and trying to fix CMS. I’m a huge fan of Health IT and it can save a lot of money, but you’ve got to have mandates for one platform. I think its crazy for us to spend 25-30 million dollars on Health IT when every hospital and every doctor’s office has something different. We should say look, if you want Health care IT from the federal government, if you want to get paid by Medicare and Medicaid, great – you can use any one of sixty vendors but just like ATMs at banks…