Oct. 20, 2014 SIGN IN | REGISTER

Boustany: Controlling Costs Is Top Priority

Americans want Congress to pass meaningful legislation to reduce health costs, improve access to needed care, expand coverage and shore up the unstable Medicare program.

Controlling rising costs remains the top priority on the health reform agenda. Rising health costs make health insurance coverage unaffordable for millions of Americans. Others face massive increases in co-payments, premiums and deductibles. Nevertheless, solutions to these problems must first allow Americans to maintain their existing private coverage.

Medical decisions should remain in the hands of patients and physicians, not federal bureaucrats. Patients need useful, reliable information about cost and quality to make informed decisions. We can eliminate waste by giving physicians better information

about available resources used by their peers.

As a heart surgeon in Southwest Louisiana, I saw this firsthand when we posted price comparisons for medical stents at the hospital for surgeons to review. Doctors took note, and use of the more expensive and less effective devices decreased. Physicians and patients can be empowered to lower costs without harsh limits from Washington, D.C.

As the national economy struggles, families and employers worry about maintaining current coverage levels while remaining competitive. Employer mandates and penalties merely lead to job cuts and stifle job creation in our economy. We must work toward solutions that provide universal access and make American businesses and entrepreneurs more competitive.

Health costs can be lowered by introducing competition and disease prevention. Under current law, people are restricted from purchasing insurance across state lines, a significant burden to lowering costs and increasing private coverage options for small businesses. In addition, prevention allows patients to stay out of the hospital and increases their quality of life.

One central health reform fight will be focused on Medicare coverage decisions. Private insurers tend to follow Medicare decisions to deny coverage for new treatments. More than 44 million Americans currently receive health coverage under the program, whose costs are skyrocketing. One dangerous cost-saving proposal, cost-effectiveness analysis, could prevent millions of patients from receiving medically necessary care when the government deems it too costly.

Office of Management and Budget Director Peter Orszag previously urged Congress to consider denying coverage for “more effective but more expensive services” in Medicare. He said “determining which treatment was most cost effective for a given population would involve placing a dollar value on an additional year of life.” Daniel Callahan of the Hastings Center, a health care foundation, correctly points out, “Effective control [by government] will force patients to give up treatments they may need.”

Medicare must reduce costs by eliminating waste, fraud and abuse. Republicans believe the program can improve quality while respecting the doctor-patient relationship. A growing number of organizations, including AARP, the Congressional Black Caucus and the New Democrats, oppose Medicare depriving patients of needed care solely because of costs.

However, the economic stimulus package and omnibus bill provided a combined total of $1.15 billion for cost-effectiveness analysis. Before Washington sets research priorities for this funding, surely medical societies should be allowed to survey their physician members? Ranking the most frequent challenges encountered by doctors for comparing treatments provides practical benefits for patients.

The conference agreement on the stimulus excluded language from the Senate bill preventing Medicare from using this data to “withhold coverage.” As a result, nothing in the new law prevents Medicare from using cost alone to deny coverage for medically necessary care.

I recently wrote a bipartisan letter, signed by 45 of my colleagues, asking the president to establish reasonable patient protections. The letter calls for more transparency and reliance on clinical expertise during Medicare coverage decisions to ensure the availability of medically necessary treatment options. Common-sense protections are needed for groups that respond differently to various treatments such as women and minorities.

Orszag and other advocates of cost-effectiveness analysis cannot afford to forget the value of personalized medicine. We can save money by making our health care system more accountable and cost effective, while providing higher quality care. Blanket coverage denials on effective treatments might initially save money but force patients to suffer needlessly and lead to higher costs in the end.

Rather than sweeping coverage denials, lawmakers can lower Medicare costs with risk-adjusted pay-for-performance tools based on medical societies’ clinical guidelines informed by comparative effectiveness research. When I practiced medicine, surgery for severe ulcers was common. The invasive surgery removed portions of the stomach, but today the procedure is rare following the approval of the drug cimetidine. That was three decades ago, and the originally expensive drug now results in significant savings, which might have been lost if cost alone was considered.

For far too long, Republicans failed to talk about our health care ideas. But the American people deserve to hear viable alternatives. Republicans believe providing access to a doctor to every American and lowering costs on patients and taxpayers is achievable. Our health care system needs reform, but along with that reform comes a responsibility for Congress to be open and transparent. Working together, an unprecedented opportunity exists to develop meaningful reform, not simply more government bureaucracy.

Rep. Charles Boustany (R-La.) was a heart surgeon before being elected to Congress. He serves on the House Ways and Means Committee and is the ranking member on the Subcommittee on Oversight.

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