The Wall Street Journal’s Alicia Mundy has this report pointing out that now that the elections are over, Republicans are clamoring to cut out unnecessary medical spending in Medicare — something they had previously referred to as “rationing” and likened to “death panels.” Darrell Issa (R-CA), the incoming chairman of the House Committee on Oversight and Government Reform, is a big fan:
“If I can help every senior get the same care they’re getting and still save tens of billions of dollars and have no doctors cheated out of what they’re entitled to, what’s not to like?” he said. [...]
Mr. Issa said his own doctor told him that surgeons have an incentive under Medicare to implant many joint and bone screws to support patients’ spines, when fewer implants—or none at all—might be equally effective and safer.
“They have got to come up with a system that doesn’t reward people for putting more metal in somebody’s spine,” Mr. Issa said.
Under current rules, Medicare cannot consider cost-effectiveness in its coverage decisions. But Mr. Issa said it may be time to consider costs as well as efficacy, as long as medical decisions are made by doctors, not by “bureaucrats” in government. “My committee can help by looking at whether the government is answering and informing about the lowest-cost, least-invasive procedures,” he said. [...] “Republicans have to step back from the words ‘death panels,’ ” Mr. Issa said.
The Affordable Care Act puts us on a path to paying providers for quality rather than quantity of services and tries to encourage efficient care. Republicans put on a great stink about the law’s investment in comparative effectiveness research, the results of which, they argued, should not be used to make coverage decisions. In this story, Issa is siding with Don Berwick in saying that we need to consider these kinds of solutions if we ever hope to change the inefficient fee-for-service model.
In fact, for all the brouhaha over Berwick and comparative effectiveness and rationing, Issa’s comments highlight just how uncontroversial all the ideas behind those labels (like payment reform and changing the incentives in the health care system) really are. They faced opposition because they came from a Democrat named Barack Obama and were successfully neutered and watered down into what is now a very very moderate piece of legislation. Too bad Issa didn’t tell us until after the fact that he actually wanted to go even further and is now pushing to defund and repeal the entire operation.