I think too that in the US there will not be success in any sort of
selectivity in medical treatments unless it is patient-driven.
When HMOs wanted to deny insurance coverage of bone-marrow treatments
for breast cancer patients, patients organized and got Congress to
mandate coverage. When a government-funded group recommended
that 40-to-50-year-old-women
might make their own decisions about whether to have mammograms yearly or
every two years, there was outrage and their funding was threatened till
they changed the recommendation to yearly. A recommendation to do more is
easily accepted whereas a recommendation to do less is greeted with anger,
outrage, and the sense that somebody wants to save money on patients by
not valuing their lives.
This suspicion is not entirely unwarranted. Idealistic ideas/efforts
are frequently coopted as slogans for those who really do want to increase
stockholder profits or inhibit public funding. The other day the Texas
Medical Association (which supports
"Medicaid simplification" to make easier a very convoluted process of
eligibility) reported that: "The Texas Association of Business and
Chambers of Commerce held a press conference Friday to announce its
opposition to plans to simplify the enrollment process for Medicaid. . . .
TABCC President Bill Hammond said the simplification plans would cause the
Medicaid program to balloon . . . Among other recommendations, TABCC
suggests expanding CHIP and Medicaid managed care, as well as reducing the
number of 'medical errors' by physicians and other providers by
establishing an evidence-based (sic) evaluation system." In a state with
one of the highest percentages of uninsured, business people IMO want to
assure continued lack of coverage (many or most providers already won't
accept Medicaid patients because of meager reimbursement) by also
threatening providers with the club of retribution for the care they do
provide, and they are using the slogan "evidence-based" in this way.
Real understanding among the public is as difficult to achieve as
real understanding among physicians, or more so, but I think it is
critical to making progress. When patients themselves grasp that it is
not always in their interest to get more medical care, and decline some of
what is available to them even if it is "free" of out-of-pocket cost,
we can have a different environment.
I would be interested in a discussion as to how to achieve it, the
obstacles to doing so and what can be done about them.
regards,
Anne Peticolas
Austin, Texas
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