Dick Morris claimed that one of the ways President Obama can pay for health care reform is to "do what he's increasingly doing, which is to crack down on health care spending and have severe rationing." In fact, the Obama administration has not advocated "rationing" or eliminating any of the medical procedures Morris identified.
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On the June 15 edition of Fox News' Hannity, Fox News contributor Dick Morris claimed that one of the ways President Obama can pay for health care reform is to "do what he's increasingly doing, which is to crack down on health care spending and have severe rationing." Morris added: "Already, he's identified four key areas: MRIs and CAT scans. You won't get it for your knee or your shoulder. You may not get it for your colon if you have cancer. No Caesarians, limited antibiotics, and back surgery cutback." In fact, the Obama administration has not advocated "rationing" or eliminating any of the medical procedures Morris identified.
Rather, in response to the administration's stated goal of reducing the growth in health care spending, the American Medical Association (AMA) proposed addressing "the overuse of certain services or procedures" [emphasis added]. The procedures identified by the AMA included the following ones mentioned by Morris: "MRI of the knee," "MRI of the shoulder," "Caesarean sections," "[a]ntibiotic prescriptions" for "[s]inusitus," and "[s]urgical and non-surgical management of back pain." Moreover, the AMA did not propose eliminating altogether the use of Caesarean sections or MRIs for knees and shoulders, as Morris alleged.
The AMA issued the proposals to address the overuse of certain procedures in a June 1 letter to Obama, which the group submitted jointly with five other health care organizations. From a portion of the letter submitted by the AMA's Physician Consortium for Performance Improvement (PCPI):
The PCPI selected the following topics for development of overuse measures this year:
- Surgical and non-surgical management of back pain
Significance: A major health plan reported that nearly 20% of plan members' spine surgery occurred within the first 6 weeks of symptoms, which is not consistent with guidelines. The volume of spinal fusion surgery has increased significantly. Eliminating unwarranted variations in treatment will produce substantial savings.
- Percutaneous Coronary Intervention (PCI) (encompasses a variety of procedures) for Chronic Stable Coronary Artery Disease
Significance: Studies project large potential savings from adhering to evidence based guidelines for coronary artery disease.
- Maternity Care: Induction of labor/Caesarean Sections
Significance: There has been a substantial increase in the rate of elective induction of labor. Practice patterns are not always consistent with ACOG guidelines. Expenses related to csection births account for 45% of the more than $79 billion in annual hospital charges attributed [sic] to childbirth in the U.S. annually.
- Sinusitis: Antibiotic prescriptions and sinus radiography
Significance: Antibiotics for sinusitis account for 21 percent of all antibiotic prescriptions for adults and 9 percent for children. More than 1 in 5 antibiotic courses for adults are for sinusitis. Sinusitis is the fifth most common diagnosis for which an antibiotic is prescribed. Overuse of antibiotics for respiratory and sinus infections is an increasing problem, with potential savings of $525 million to $1.1 billion (New England Healthcare Institute).
PCPI will develop measures for diagnostic imaging, examples include:
- CT angiography for pulmonary embolism
- MRI of the knee
- MRI of the shoulder
- CT or MRI of the head
- Stress Echocardiography
- SPECT MPI
Significance: Although their growth has moderated significantly since implementation of the Deficit Reduction Act of 2005, Medicare payments for physician imaging services increased from $7 billion to $14 billion between 2000 and 2006. This represented a 13 percent annual increase in spending for these services, versus an 8 percent increase in all Medicare physician-billed services over the 2000 to 2006 time period. For a 10 year period from 1997 to 2006, a large private insurer saw CT utilization per enrollee increase 14 percent per year, and MRI increase 26 percent per year. Specialty societies, PCPI members, health plans and government agencies have identified diagnostic imaging as an important area for developing measures of overuse given the rising costs, increased volume and numerous published articles on the topic.
From the June 15 edition of Fox News' Hannity:
SEAN HANNITY (host): Dick, the CBO estimate -- I think this really gets to the heart of this. But, folks, you're not going to hear this in the mainstream media. They're just going to sell the Obama plan, the Obama numbers. But here's what it said.
It literally said that the Democratic proposal, it will decrease the number of uninsured, they say, by 16 million. OK, it seems like a noble goal. It's going to cost a trillion dollars or $62,500 per uninsured person.
MORRIS: Exactly. And this -- and this is really the interesting political dilemma Obama's in. This could be his Waterloo. You've got to plan two or three moves ahead, and this is what's coming down to. He's got this trillion-dollar cost for health care reform. Now, he's got to do it because he promised to do it. He could raise taxes on the middle class by taxing health insurance premiums that people now get from their employer that they now have to pay taxes on --
HANNITY: Or a VAT [value-added] tax.
MORRIS: -- or he could borrow the money, in which case the deficit's going to skyrocket, interest rates will go up, and he'll be savaged for it. Or he can do what he's increasingly doing, which is to crack down on health care spending and have severe rationing. But none of those choices are good. All of those choices are very politically dangerous.
Already, he's identified four key areas: MRIs and CAT scans. You won't get it for your knee or your shoulder. You may not get it for your colon if you have cancer. No Caesarians, limited antibiotics, and back surgery cutback.