post by Bill Gardner
Paul Kelleher and Aaron Carroll are writing about the new American College of Physicians Ethics Manual, and in particular a passage from the summary in the Annals of Internal Medicine:
Physicians have a responsibility to practice effective and efficient health care and to use health care resources responsibly. Parsimonious care that utilizes the most efficient means to effectively diagnose a condition and treat a patient respects the need to use resources wisely and to help ensure that resources are equitably available.
I applaud the candor of this statement. Parsimony is an unhappy word, but this is an unhappy topic. At considerable risk of putting words in their eminent mouths, I read the the ACP statement as recognizing, first, that there should be a limit on what the US spends on publicly subsidized health care. Second, given such a limit, I read "equitably available" as saying that we should not limit the growth of health care spending by shrinking the portion of the population that has insurance coverage.
But if you want limits on spending, and you want at least an approximation of universal coverage, then you need a technological and organizational revolution in health care that will increase the productivity of the medical workforce and reduce the price of good care. And I have a kind of blind faith that this will happen. But until that year of jubilee, we have to accept that insurance cannot cover everything.
Apparently, not everyone accepts this. Scott Gottlieb said that "Saying that the use of resources should be parsimonious - that... really implies that care should be withheld." I agree. What is the alternative? Does Gottlieb think that there should be no limits on what, say, Medicare will pay for, or does he think that we should shrink the population of covered individuals? What is needed is a frank debate on the principles that should be used to determine what Medicare and Medicaid cover, and the procedures through which such decisions are made. The ACP's candor about this is welcome.
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