Will We Ration Health Care? The Coming Public Policy Debate

The passage of the Affordable Care Act has generated concerns that the government will ration valuable health care services. But what exactly is rationing, and how does the U.S. health care system allocate scarce resources today? In this podcast, University of Virginia Professor Eric Patashnik discusses his research on the politics of evidence-based medicine and why rationing has emerged as a major public policy issue. He covers the role of doctors, political leaders, and public opinion in shaping the context in which the debate over rationing is playing out.

Standard Podcast [1:25m]

patashnik_110209Eric Patashnik is Associate Dean and Professor of Politics and Public Policy at the Frank Batten School of Leadership and Public Policy. He is also Nonresident Senior Fellow at the Brookings Institution and Fellow of the National Academy of Public Administration. Patashnik received both his MPP and PhD (political science) from the University of California, Berkeley. He previously held faculty positions at Yale University and UCLA. Patashnik’s latest book is Reforms at Risk: What Happens After Major Policy Changes Are Enacted (Princeton University Press, 2008), which received the 2009 Louis Brownlow Book Award given by the National Academy of Public Administration. His two other books are Promoting the General Welfare: New Perspectives on Government Performance (co-editor with Alan S. Gerber, Brookings Institution Press, 2006), and Putting Trust in the U.S. Budget: Federal Trust Funds and the Politics of Commitment (Cambridge University Press, 2000). His essays have appeared in Political Science Quarterly, Governance, Journal of Health Politics, Policy & Law, Social Service Review, and in many edited volumes. His current major research project, with Alan Gerber of Yale University, explores the politics of evidence-based medicine in the United States and is supported by grants from the Smith Richardson and the Robert Wood Johnson Foundations.

Mr. Patashnik spoke at the February 9, 2011 meeting of the Senior Statesmen of Virginia. The meeting was held at The Charlottesville Senior Center. Following the presentation, questions were taken from the audience. The program was moderated by SSV board member Bob McGrath.

Program Summary

At the February 9 SSV meeting, Eric Patashnik, Associate Dean and Professor of Politics and Public Policy at the Frank Batten School of Leadership and Public Policy, addressed the issue of, “Will We Ration Health Care? The Coming Public Policy Debate.” Rationing is simply the process of allocating scarce resources, anything from 50 yard line tickets at Redskin games to health care. We ration medical care implicitly and obliquely, and in contrast to other wealthy countries we mainly ration on the ability to pay rather than on the basis of need or anticipated benefit.

“The decision is not whether or not we will ration care; the decision is whether we will ration with our eyes open.” But explicit rationing is upsetting to many: Oregon’s attempt in the 1990s to ration Medicaid services unraveled under constituent pressure and provider gaming; explicit rationing might mean that some people who are accustomed to getting pretty much whatever care they want would be denied care or would have to pay more to get certain services; explicit rationing could increase the role of government, and most Americans don’t trust government to make good decisions

The US spends almost twice as much per capita ($7,290) as the next country (Canada $3,895), and yet in 10 out of 12 measures such as quality, access, efficiency, long health productive lives, the US is in the bottom tier. Within the US, there are huge variations in medical spending, and the areas that spend more on health care per capita do not necessarily get better results. Medicare spent more than $71,000 per end-stage patient in Miami, and only $33,000 in Green Bay. Hospital stays in Green Bay were 25 percent shorter than national average yet had no worse outcomes.

Popular treatments may not work as advertised. A common surgical procedure, arthroscopy for osteoarthritis of the knee, was found to be no more effective than a fake operation in which the surgeon merely pretended to operate.

Comparative effectiveness research (CER): recent legislation (health reform law, stimulus bill) have established funding and infrastructure for research on what works best: use research to establish practice guidelines that doctors should follow. Although the public grasps there is a problem, it is very skeptical of anything they believe will reduce choice or interfere with patient doctor relationship.

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