Apocalyptic Now

  • by: |
  • 03/26/2012
On Sunday, the New York Times ran a Sunday Dialogue called, “Equitable Health Care.”

(The complete discussion can be found here.)

The lead commentary was written by Alan B. Cohen, professor of health policy and management at Boston University School of Management and executive director of its Health Policy Institute.

Cohen writes, “The specter of rationing has also been invoked by those seeking to repeal the Independent Payment Advisory Board — a panel that would recommend ways to lower Medicare costs — so that Congress and special interests may retain firm control over Medicare spending cuts. By delegating responsibility to independent experts, such a board would help depoliticize the existing process.”

My response?

“Professor Cohen criticizes those who want to repeal the Independent Payment Advisory Board for invoking “the specter of rationing.” That ignores an immediate and crucial concern.

The board will be composed of 15 presidential appointees, unaccountable to the public. It will be given the task of cutting billions in Medicare expenditures — largely by denying government reimbursement for new and innovative medicines.

In other words, its only viable option will be to further ratchet down reimbursement rates for providers, especially doctors, who are already losing money on Medicare patients. Indeed, according to the American Medical Association, the financial burden of too-low payments under Medicare has driven 17 percent of doctors and 31 percent of primary care doctors out of the Medicare program altogether.

If rates fall any lower, seniors will have an increasingly difficult time securing doctor appointments. Visits will be cut short to squeeze in patients and care compromised. The board is even more insidious because it deflects policy makers’ attention from innovative reform efforts with real cost-saving potential.”

To which Cohen retorts:

“Mr. Pitts’s attack on the Independent Payment Advisory Board, on the other hand, contains an apocalyptic vision of stifled innovation and compromised patient care wrought by “insidious” board decisions. This is what reform opponents and industry groups want the public to believe.”

Apocalyptic?  Just what does that mean?

Here are some synonyms for “apocalyptic” from www.thesaurus.com:

- Important
- Prophetic

If my comments are apocalyptic, what are the antonyms that might represent those of Dr. Cohen?

- Insignificant
- Unimportant

Perhaps a more straightforward way to say it (IMHO) is that I’m right and he’s mistaken.

And a big “thank you” to the Gray Lady for providing the forum.


Center for Medicine in the Public Interest is a nonprofit, non-partisan organization promoting innovative solutions that advance medical progress, reduce health disparities, extend life and make health care more affordable, preventive and patient-centered. CMPI also provides the public, policymakers and the media a reliable source of independent scientific analysis on issues ranging from personalized medicine, food and drug safety, health care reform and comparative effectiveness.

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