Public Wary Of Government Deciding Medical Care
A chart of whom people trust to decide which medical treatments they should have.
Deciding which medical treatments work better than others is a tough job, but health policy experts say it could help hold down health care costs. Still, Americans aren't too sure they want the government deciding which treatments their insurance should pay for, according to a new poll conducted by NPR, the Kaiser Family Foundation and the Harvard School of Public Health.
More than half of Americans polled said they would trust an independent scientific panel to make decisions about which medical treatments insurers could cover. Yet only 42 percent said they would trust a government health agency to do the same job.
The government stimulus package includes $1 billion to conduct comparative effectiveness research, which would carefully study the different types of medical treatment to determine what works best. The Obama administration has been soliciting the advice of health experts and the public on how it should be done, and who should have the final word.
Right now, there are no national standards for what health insurance contracts are required to cover.
Some say decisions about comparative effectiveness can be left to the marketplace. Insurance companies could make it clear what they would and would not pay for, and people could decide between policies.
Some of that is already going on, says Grace-Marie Turner, president of the Galen Institute, a nonprofit institute that promotes free-market solutions. "We have lots of companies now that are doing a lot of work to decide what treatments have value, and what don't."
(Lindsay Powell/NPR)
But other health policy experts say it will take a government body or an independent board to really determine what works and what doesn't. A government board could handle it, says health economist Uwe Reinhardt of Princeton University, but an independent board might be more acceptable to the public.
What's important, Reinhardt says, is that something gets done soon.
"The idea that every American has the right to everything imaginable — whether it's been shown to work or not — is just tragic," he says. "Ultimately that leads to what we've had, where health spending grows 2.5 percentage points faster than the rest of the GDP. For the last 40 years we've had this."
He says if we continue on this path, in 2050 we'll be spending 40 percent of the GDP on health care.
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LYNN NEARY, host:
Many economists say one of the best ways to bring down health care costs in the U.S. is to stop paying for diagnostics and treatments that aren't necessary. But how do you determine what's not needed? According to a new poll conducted by NPR, the Kaiser Family Foundation and the Harvard School of Public Health, a slim majority of Americans don't want health insurers to limit care. And overall, Americans are hesitant about the government getting involved in treatment recommendations. NPR's Joanne Silberner reports.
JOANNE SILBERNER: Kerry Sailors(ph) of La Vista, Nebraska represents 55 percent of those polled. He does not want his insurance company or anyone else second guessing doctors. He's retired military and in the VA system. And his doctor had to fill out all sorts of forms to get him on a second cholesterol drug when the first one didn't work.
Mr. KERRY SAILORS: I think the doctor knows more about you, seen you, knows what's going on and is trying to make decisions to better your health.
SILBERNER: Ann Madson(ph) of Kalamazoo, Michigan represents the minority of those polled, who said insurance companies should not have to pay for an extensive treatment ordered by a doctor that hasn't proven to be more effective than other treatments.
Ms. ANN MADSON: Your primary doctor is only as good as the information he gets and the information that he studies and checks into. They're not infallible, they're people. They're humans.
SILBERNER: Madson's view that standards for doctors and hospitals could help make medical care most cost efficient, are shared by many experts who have been studying this issue for years. Economist Uwe Reinhardt with Princeton University says something has to be done.
Professor UWE REINHARDT (Economist, Princeton University): The idea that every American has the right to everything imaginable, whether it's shown to work or not and have someone else pay for that, I think it's just tragic, almost.
SILBERNER: If insurers pay for every little thing Reinhardt says…
Prof. REINHARDT: We'll have a lot of robust and healthy neurotic people 'cause we can't afford education.
SILBERNER: To avoid this scenario, the Obama administration got $1 billion set aside in the stimulus package for what's called comparative effectiveness research. It determines the value of different types of medical treatments. So given that a majority of Americans do not want insurance companies to be able to overrule their doctors, who should determine what's worthwhile? Kerry Sailors really doesn't want it to be in the government.
Mr. SAILORS: Why do I want some person sitting behind some desk that I'm paying $100,000 on my taxes for, to sit there and say Mr. Sailors doesn't need this. We don't care what the doctor says, he doesn't need it?
SILBERNER: Forty-two percent of Americans would trust a government organization to define appropriate treatment, compared to 55 percent who would trust a panel of experts from an independent scientific organization. Ten years ago, Great Britain came up with one way to do it. It created an organization called NICE, the National Institute of Health and Clinical Excellence. NICE gets a 70 percent approval rating. NICE chairman Sir Michael Rawlins says that's because committee members are academic and clinical doctors, nurses and pharmacists, not government employees.
Sir MICHAEL RAWLINS (Chairman, National Institute of Health & Clinical Excellence, Great Britain): Although NICE is, you know, heavily paid for by the government, it is independent. And that is actually valued by the government, too.
SILBERNER: Rawlins says government officials like it because they don't get blamed for controversial decisions. Meanwhile, the Obama administration is in the process of figuring out how decisions will be made and who will make them.
Joanne Silberner, NPR News. Transcript provided by NPR, Copyright National Public Radio.
