• Where’s all the outrage about rationing in private insurance?

    There was a rather typical story in the NYT about how trying to reduce benefits in Medicare Part D plans would save money. Why?

    In its proposal, the Obama administration cited a 2008 study by the actuarial and consulting firm Milliman that showed that the six protected classes accounted for anywhere from 17 to 33 percent of total outpatient drug spending under Part D of Medicare. In addition, it said that the costs of those drugs were on average 10 percent higher than they would be without the requirement to cover substantially all drugs in these classes.

    The administration predicted savings for both beneficiaries and the Medicare program if prescription drug plans could remove some currently covered drugs from their formularies. It could also give insurers additional tools to limit overuse of certain drugs, such as the prescribing of antipsychotic drugs to nursing-home patients with dementia, a common practice that is widely viewed as inappropriate.

    Of course, lots of people think this is terrible:

    Leaders of numerous patient advocacy groups, many of whom met last week with White House officials to express concern about the proposed rule, said they were worried that patients could be harmed if the policy changed.

    “The proposal undermines a key protection for some of the sickest, most vulnerable Medicare beneficiaries,” said Andrew Sperling, a lobbyist at the National Alliance on Mental Illness.

    Under the proposal, Mr. Sperling said, a Medicare drug plan could have a list of preferred drugs with just two medications to treat schizophrenia. That is inadequate, he said, because antipsychotic drugs work in different ways in the body, and have different side effects. “You get much better outcomes when a doctor can work with patients to figure out which medications will work best for them,” he said.

    Normally, this is where I’d declare that this is why we can’t have nice things, and why real cost control is hard. One man’s waste is another man’s quality or life. Someone is always going to be there to fight the cut. But I was somewhat caught off guard by the honesty here:

    The Medicare Part D program is unusual in that it requires broad coverage of drugs in these categories. Commercial insurance plans, including those in the new marketplaces operating under the federal health care law, have more flexibility. Some drugs are simply not covered, and some plans require that patients and doctors go through additional steps — such as trying other drugs first, or getting approval from the insurer — before a drug will be paid for.

    So basically, what we have here is “rationing” by the private sector. The government, on the other hand, is offering the most comprehensive benefits. So where’s the outrage towards private insurance? Where are the protests about how private insurance is denying people life saving medications? Where are the stories of people who were so grateful to get away from evil commercial insurance to wonderful public insurance so they could finally get the care they were being denied by the private sector? Where are all the “rationing” haters who should be defending our single-payer system for keeping access and availability at a maximum?

    I’m just saying…

    @aaronecarroll

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