Rationing health care

When engaged in a health care debate with someone who opposes universal health care I am always prepared to hear the opponent make an argument about the evils of rationing. That is with universal care health care will have to be rationed in order to keep costs down and we as a society should not be encouraging such rationing by "bureaucrats." "Let the doctors and patients have the choice of procedure," they say.

My simple retort to this scare tactic is simply to ask if the person is at all familiar with the concept of "Managed Care." "Of course," they respond. Well what do you think that that means exactly? It's the insurance companies nice way of saying that they are going to ration your care. It's not up to you and your doctor, it's the decision of a low-level or mid-level insurance company bean counter will make for you.

In today's Denver Post business columnist Al Lewis uses the untimely death of Tim Russert to illustrate exactly how this works,

Tim Russert was a heart - attack candidate as far back as 1998, according to Dr. James Ehrlich, medical director at Heart Check Washington, which imaged Russert 10 years ago.

Technicians stuffed Russert inside an electron beam computed tomography machine. The machine, which measures arterial calcium buildup, gave Russert a score of 210. A good score is under 10.

"When he came into our center in 1998, he was at a similar risk as a person who had already had a heart attack," Ehrlich told me...

Imagine this. General Electric, which owns NBC, where Russert worked, makes $1.6 million EBCT machines to painlessly check people for plaque. But when employees of GE companies go to get one of these tests, their GE-sponsored health insurance doesn't cover it.

Insurers have long classified the test as experimental. This not only serves as an economic barrier but discredits the technology to the point where many physicians won't recommend it.

"The scientific research is unproven," said Cheryl Randolph, spokeswoman for UnitedHealthcare, one of the nation's largest managed-care payers.

Medicare will pay for this test in some cases but has expressed concern that the tests sometimes are done on people with no signs of heart disease, unnecessarily exposing them to radiation risk.

Dr. Matthew Budoff of the Harbor-UCLA Medical Center wrote the expert-consensus article on heart scans in 2006. His words represented the American Heart Association and the American College of Cardiology.

He concluded the technology will save lives and money.

"The simple economics of coronary calcium scanning will save significant costs to health care," Budoff e-mailed me Monday.

New and expensive tests and imaging machines are not always the answer. It's important though that people understand how managed care operates. Many of the traits they are concerned with in regards to universal health care are actually the traits of the managed care insurance programs they are currently enrolled in. It's amazing how few people truly understand how their current insurance operates but are convinced that universal coverage is somehow deficient and will lead to rationing.