To Ration or Not to Ration? Let’s Hope for the Obvious Answer

Kathleen Sebelius, the Secretary of the Department of Health and Human Services (DHHS), wrote the following to state governors on February 3rd:

“In light of difficult circumstances, we are stepping up our efforts to help you identify cost drivers in the Medicaid program and provide you with new tools and resources to achieve both short-term savings and longer-term sustainability while providing high-quality care to the citizens of your states.”

This statement was made regarding the highly potential need for increased state funding to allow for millions of Americans to be added to Medicaid under President Obama’s health care plan. States are wondering where they are going to scrounge up the finances to cover so many people. Kathleen Sebelius responded with the above statement.

Furthermore, the DHHS feels that “some of these key areas of cost-savings to states include changing optional benefits by limiting their amount, duration or scope.” Let me take you through some medical scenarios of how limiting amount, duration, or scope of treatment would negatively impact the health of our country.

Amount: As a cost-saving measure, a 48 year old diabetic female with cellulitis of her right lower leg requiring an extended course of daily antibiotics for a month is allowed only 7 days worth because the amount needed for a full month is too expensive. A lot of money is saved initially, but the patient develops a worsening infection that ultimately leads to a below-the-knee amputation. The surgery itself results in a more costly expenditure than the missing 21 days of antibiotics.

Duration: In order to save some money, a 53 year old female with breast cancer receives only two rounds of radiation and chemotherapy, without much improvement. She should have had more intense therapy, but this was all the budget allowed for, so she took what the government was willing to give her.

Scope: A 55 year old male was receiving his routine preventative colonoscopy when the gastroenterologist performing the procedure realized he was only partially covered for the patient’s colon. The doctor visualized the sigmoid colon, up the descending colon, but stopped at the flexure, leaving the transverse colon and ascending colon uninspected.

These are some extreme, possibly absurd, examples. The haunting truth is that these are not that far from the truth of what a health care society that relies upon rationing of health care would amount to. We need to be smart as doctors with our use of health care services, but rationing is not the healthy approach.