The New Health Care Law and Concerns About Rationing

Q. Does the health care reform law limit what medical treatment my doctor can give me? Will some faceless bureaucrat decide I’m "too old" for surgery?

A. If the law told doctors what they can and cannot do, you could bet that the largest physician organization in the would protest loudly. But when we put this question to James Rohack, M.D., a Texas cardiologist and president of the American Medical Association, he said the group was concerned early on that a provision in the bill could be interpreted the wrong way—and made a recommendation, which was included in the law to preserve the doctor’s independence. The AMA was among many health care provider groups that supported the health care reform law.

The AMA’s concerns were over a provision that created the Patient-Centered Outcomes Research Institute, which conducts research examining what medical treatments are most effective. The institute will get assistance from expert advisory panels. Congress gave the institute more than $1.3 billion through 2019, starting with $10 million this year.

Rohack says the AMA made sure that doctors are not required to follow specific procedures based on the institute’s research, and that the study results cannot be used by insurers—including Medicare—to determine what care to cover.

Still, the research fills an information gap that will help doctors and patients make better decisions about their care, Rohack says. For instance, when a drug is approved by the U.S. Food and Drug Administration, that means the medicine will work the way its manufacturer promises. FDA approval doesn’t mean this drug works better than an alternative, like surgery to implant a coronary stent. Government funding for this kind of research is essential since “private manufacturers are reluctant to fund research that may show their product is less effective,” he says.

Studying which treatments—from drugs to medical devices and procedures—work best benefits patients, says Stuart Guterman, a health economist and assistant vice president for payment system reform at the Commonwealth Fund, an independent research firm based in New York. “That’s not denying care—it’s improving care,” he says.

At the same time, doctors and patients must be free to reject research findings, says Rohack. “We recognize that every patient is unique,” he adds. “The AMA was very firm that we don’t want someone making decisions who is not at the bedside and does not know the patient.”

Susan Jaffe of Washington, D.C., covers health and aging issues and writes the Bulletin’s weekly column, Health Care Reform Explained: Your Questions Answered.