Republican Congressman Hits "Dangerous" Orzag Plan

May 26, 2009 (LPAC)—Rep. Charles Bouskany (R., Louisiana) wrote the column excerpted here two months ago. Boustany was a heart surgeon before being elected to Congress. He is on the House Ways and Means Committee and is the ranking member on the Subcommittee on Oversight.

Boustany: "Controlling Costs Is Top Priority." March 23, 2009

Special to Roll Call [Capitol Hill newspaper]

Americans want Congress to pass meaningful legislation to reduce health costs, improve access to needed care, expand coverage and shore up the unstable Medicare program....

One central health reform fight will be focused on Medicare coverage decisions. Private insurers tend to follow Medicare decisions to deny coverage for new treatments. More than 44 million Americans currently receive health coverage under the program, whose costs are skyrocketing. One dangerous cost-saving proposal, cost-effectiveness analysis, could prevent millions of patients from receiving medically necessary care when the government deems it too costly.

Office of Management and Budget Director Peter Orszag previously urged Congress to consider denying coverage for more effective but more expensive services in Medicare. He said determining which treatment was most cost effective for a given population would involve placing a dollar value on an additional year of life. Daniel Callahan of the Hastings Center, a health care foundation, correctly points out, Effective control [by government] will force patients to give up treatments they may need.

....A growing number of organizations, including AARP, the Congressional Black Caucus and the New Democrats, oppose Medicare depriving patients of needed care solely because of costs.

However, the economic stimulus package and omnibus bill provided a combined total of $1.15 billion for cost-effectiveness analysis. Before Washington sets research priorities for this funding, surely medical societies should be allowed to survey their physician members? Ranking the most frequent challenges encountered by doctors for comparing treatments provides practical benefits for patients.

The conference agreement on the stimulus excluded language from the Senate bill preventing Medicare from using this data to withhold coverage. As a result, nothing in the new law prevents Medicare from using cost alone to deny coverage for medically necessary care.

I recently wrote a bipartisan letter, signed by 45 of my colleagues, asking the president to establish reasonable patient protections. The letter calls for more transparency and reliance on clinical expertise during Medicare coverage decisions to ensure the availability of medically necessary treatment options....