Fascinating, DoctorJ, thanks. Who is the *existing *“death panel” who performs the $/QALY calculation, btw? The hospital administration? And is the existence of insurance a consideration?
The political problem, of course, is that we already have rationing of health care under the current system, so decrying it in ACA is ignorant/hypocritical/all that.
Except for abortion policy, you mean.
Seriously, though, this is a discussion worth having. However your VP candidate 4 years ago pretty much shut it down with her “death panel” smear, which of course was just about paying for end of life counseling from doctors, and not about end of life decisions. We ration health care now, of course, but in an irrational way.
Part of ACA, I believe, is an attempt to start on evidence based medicine, that is paying for treatments that have been demonstrated to be effective. That should save money, while reducing waste.
The Medicare cuts that Ryan goes on about are not to patients, but for rates. Unless you micromanage healthcare, something that I don’t want to see, this is a good way of reducing costs. After all, it is exactly what WalMart does using its market power with its suppliers. Anyone who has been to a range of doctors can see that some are far more efficient than others. Why not drive efficiency?
The free market has failed miserably in driving efficiency, which is not surprising since there is a good excuse for inefficiency and because there was incentive for inefficiency.
We’ve seen some consolidation as larger companies buy up capacity to prepare for a flood of new patients. They seem to be thinking they will profit under the new system. I’d be very happy if there is a reduction of healthcare costs and an increase in profits through the benefits of scale. Win-win.
It depends on who and what you’re talking about. When it comes to screening tests this all gets taken into account by the boards who make screening recommendations, like the US Preventive Services Task Force or the various medical specialty groups, and payers base what they’ll pay for on those recommendations.
As to particular treatments, insurance companies definitely make calculations like this every day, as do Medicare/Medicaid regulators.