Cutting Costs, Risking Lives
Obamacare promised access to health care to millions of Americans who lacked it, with the president personally promising those who had health care that they liked that they wouldn’t be forced to change. Magically, all of this was supposed to be accompanied by lower premiums for those already insured and overall savings in the health care system to slow. But as the program swings into full gear, it is becoming apparent those promises can’t be kept – at least not without major intrusion into health care decisions that affect patients. One of the only ways to save money is to restrict access to more costly treatments, which is exactly what the Patient-Centered Outcomes Research Institute (PCORI), a public-private organization set up by the Affordable Care Act, is meant to do. The PCORI recommends lower reimbursement for drugs and treatments that ostensibly are not research-based.
Obamacare promised access to health care to millions of Americans who lacked it, with the president personally promising those who had health care that they liked that they wouldn’t be forced to change. Magically, all of this was supposed to be accompanied by lower premiums for those already insured and overall savings in the health care system to slow.
But as the program swings into full gear, it is becoming apparent those promises can’t be kept – at least not without major intrusion into health care decisions that affect patients. One of the only ways to save money is to restrict access to more costly treatments, which is exactly what the Patient-Centered Outcomes Research Institute (PCORI), a public-private organization set up by the Affordable Care Act, is meant to do. The PCORI recommends lower reimbursement for drugs and treatments that ostensibly are not research-based.
Unfortunately, even the new rules don’t deliver as anticipated. Instead of basing health care decisions on evidence-based research, the government is pushing providers to cut costlier treatments, even if there isn’t a good empirically researched reason for doing so. And the results could end up costing more money as patients denied certain treatments become sicker and harder to serve.
A group of patients whose lives may be endangered by this shift are among the most vulnerable: premature babies. Babies born before 37 weeks of pregnancy are at increased risk for many health complications, and among the most dangerous are respiratory diseases. These tiny babies’ lungs are more susceptible to serious infections from common childhood diseases like RSV (respiratory syncytial virus), and the consequences from infection can be much more dangerous.
RSV is one of the most common infections to afflict young children. In most healthy, full-term babies and toddlers, the infection may create discomfort, mild fever and cough, but the symptoms disappear after a few days. But for babies and young children with impaired immune systems or immature lungs, the virus can lead to pneumonia and bronchiolitis, which cases airwaves to fill with mucus and makes it difficult for the baby to breathe. Each year RSV sends about 400,000 children to emergency rooms, while 125,000 children end up hospitalized and 500 die.
Despite this, the American Academy of Pediatrics has adopted new recommendations on RSV prevention for preemies that seem more focused on cost cutting than good patient care.
There is no vaccine to prevent RSV infections, but there has been one treatment available proven to work well to lessen the chances of infection for premature babies. A drug called Synagis has been shown in studies to reduce the risk of hospitalization from RSV in babies born prematurely, if it is administered prophylactically during the RSV season. But the drug is expensive – according to the Wall Street Journal, about $6000 for five intramuscular inoculations. The AAP has now recommended that the drug be injected less frequently and to a smaller group of premature infants in the interests of cutting health care costs.
As a result many insurance companies won’t pay for prevention beyond the lower recommendations, nor will government-provided health care programs.
Everyone would like to see costs go down in health care. But cutting costs can also mean shortening lives. Even when denial of preventive treatment doesn’t end up with the patient dying, it still may be a failure at cutting costs. According to one study, hospitalizations for RSV were reduced by 50 percent with the administration of Synagis – and one day in the hospital costs considerably more than a full course of preventive treatment.
The AAP recommendations on preventive RSV treatments – which were reissued last year, without any new research to back them up – are a glimpse into the future of health care under the Affordable Care Act. The only way to cut costs is through some system of rationing. This years victims may be premature babies, but eventually all of us will end up with less care than we want – and in many cases need.
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