A federal court blocked a recent move of the Bush administration to allow Medicare to only pay for the least expensive treatment available without regard to the medical issues. The administration saw instituting this limitation as a way to cut costs to the financially strapped Medicare Program.
The court decided that congress sets the Medicare payment rates and never intended to give broad discretion to government officials that would allow them to alter the rates.
The case, decided on October 16, 2008, involved a dispute over the choice of drugs to treat chronic obstructive pulmonary disease (CPOD). Judge Henry H. Kennedy ruled that the policy of paying only for “the least costly alternative” was not permitted under the Medicare Law. He wrote that the administration”s position would give the Health and Human Services Secretary enormous discretion to determine the amount paid for all services and treatments covered by Medicare without references to the rates set by congress in the legislation.
Historically, Medicare officials have attempted to structure regulations, which would allow them to consider costs in deciding whether to cover a treatment. Big pharm, health advocates and equipment manufactures have fought them claiming that these decisions should be made on clinical effectiveness, not costs.
This decision has significant and positive impact on prostate cancer survivors. If the administration had been able to prevail, decisions about primary treatment (radiation vs. surgery including the types of radiation and surgical procedures) and drugs vs. orchiectomy would be made solely on the cost, not the individual medical circumstances. Many of us have come to the conclusion that the future of good medical care will become individualized, not like or current “cookie cutter” methods currently used. Additionally, low income and minority patients would lose the opportunity to receive more expensive treatments, which were deemed medically superior.
We hail this decision.
Joel T Nowak MA, MSW