The Hidden Role of Cost: Medicare Decisions, Transparency, and Public Trust
51 Pages Posted: 29 Aug 2010 Last revised: 10 Mar 2011
Date Written: February 11, 2011
Abstract
There is an extraordinary, distorting pressure that cost places on the healthcare system. While the political system dictates the content of laws in this system, it is often the problem of cost that truly shapes how these laws are implemented. This article looks closely at this dynamic in the Medicare system, but also seeks to create a blueprint for further critical study of the broader problem’s effect on the institutions that health law seeks to regulate. In Medicare, CMS is not allowed to consider cost when making potentially expensive national coverage determinations about new medical technologies and procedures. Even with this constraint, it must grapple with both its own budget and the broader political problem of increased funding demands. This dynamic leads to hidden rationing of medical care for cost saving purposes. This article argues that broad scale rationing decisions such as these should be handled in a transparent manner, with ample opportunity for public input, which would be a significant change from the status quo. This process will not always result in better decisions than those currently made, and will certainly impose painful political costs on some participants. However, this article argues that its proposed process is 1) politically legitimate, 2) more likely to lead to a national consensus to guide rationing decisions, and 3) may be successful at reducing costs in the future.
Keywords: Medicare, Health Reform, Rationing
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