Peter Orszag on Access to Treatments and Malpractice Reform
On a New York Times blog yesterday, former OMB head Peter Orszag writes in support of a David Leonhardt column about ways to reduce Medicare spending, specifically by limiting access to new, costly treatments. Both Orszag and Leonhardt discuss an article (subscription required) in this month’s issue of Health Affairs, which proposes a reimbursement regime whereby Medicare would pay for new treatments for three years, at which point a given drug or therapy would have to prove its worth relative to other, cheaper alternatives in order to justify higher payments from Medicare. Orszag approvingly notes that “the newly created Independent Payment Advisory Board could propose this type of payment change in order to help reduce costs and improve quality in Medicare. The change would then take effect by default – if Congress ignored the board’s proposals, if one house voted them down, or even if both houses voted them down and then the President vetoed that legislation.”
Given the approval of Dr. Orszag – who was intimately involved in health care reform from the first days he joined the Administration – to this approach restricting access to treatments, and Medicare Administrator Donald Berwick’s prior support for “rationing with our eyes open,” it’s worth asking: Does the Obama Administration support these types of proposals to have unelected bureaucrats on a federal board withholding access to important but costly treatments – and are these types of access-limiting initiatives the kind we can expect from the Independent Payment Advisory Board created by the law?
Separately, Dr. Orszag used his regular column in the Times yesterday to point out what Republicans have long known: namely, that the health care law “does almost nothing to reform medical malpractice laws.” Orszag dismisses the idea of caps on non-economic damages – which many Republicans advocate – but he does support “provid[ing] safe harbor to doctors who follow evidence-based guidelines.” This is a curious statement, as Republicans offered multiple amendments to enact exactly the types of liability reforms that Dr. Orszag – at the time one of the most influential experts on health care within the Administration – supports, yet none of them made it into the legislation. Former Vermont Governor Howard Dean previously provided one possible explanation as to the omission: “The reason that tort reform [was] not in the bill is because the people who wrote it did not want to take on the trial lawyers in addition to everyone else they were taking on. And that is the plain and simple truth.”