Human Exceptionalism

Obamacare: Would Rationing Boards Insist on Providing More Expensive Care?

For the last few days we have been discussing cost cutting and the threat of rationing in the context of Obamacare, focusing on proposals that the govt. and private insurance not cover some efficacious treatments based on cost/benefit analyses, sometimes called evidence based medicine.

This morning I saw a story that raised a question in my mind.  The study concludes that a more expensive treatment–bypass surgery– should be performed for heart disease more often than is currently the case . From the story:

Tens or even hundreds of thousands of Americans are having coronary artery angioplasty and stenting every year when they should be having bypass grafts, and the result is an extra 5,000 or more deaths annually, researchers said Sunday.

Patients and cardiologists frequently prefer angioplasty and the insertion of a stent to keep arteries open because it is quicker and easier, and patients go home sooner and return to work more quickly.

But new data from a major European-American study on more than 1,800 patients show that three years after the procedure, those who got stents were 28 percent more likely to suffer a major event, such as a heart attack or stroke, and 46 percent more likely to require a repeat procedure to reopen arteries. They were 22 percent more likely to die.

This raises an interesting question.  Bypass surgery is much more expensive than putting in stents.  Would the Obamacare cost/benefit panels strongly recommend to cardiologists that they perform more bypass surgeries based on the evidence that it saves more lives, even though the cost is exponentially higher? To be consistent, they should.  But I doubt they would.