NRL News


by | May 8, 2012

Jennifer Popik, J.D. Robert Powell Center for Medical Ethics


By Jennifer Popik, JD,

Robert Powell Center for Medical Ethics

Overall health care spending in 2009 and 2010 grew less than 4 percent per year, the slowest annual pace in more than fifty years, according to a report by the federal government’s Centers for Medicaid and Medicare Services (CMS).

While much of this slowing is a result of the recession, experts concluded that a significant part could not be attributed to the poor economy. While reluctant to make definitive predictions, economists think that the lower rates of growth might persist even as the economy picks up.

“The tectonic plates might be beginning to shift,”  Karen Davis, president of the Commonwealth Fund, told the New York Times. “It’s hard to believe everything that’s been tried over the last decade to slow spending wouldn’t be making a difference.”

What goes unsaid, however, is that limiting what we can spend to save lives results in preventable loss of life.

A recent article in Health Affairs, titled “Higher Spending in the US Versus Europe: Is It Worth It?,” compared spending and cancer survival rates between the U.S. and Europe. It found that higher U.S. spending on treating most major cancers leads to U.S. patients gaining significantly more years of life than Europeans with the same cancers who receive cheaper treatment.


Perhaps predictably, the New York Times  article on the CMS report was titled, “In Hopeful Sign, Health Spending Is Flattening Out” [].  It notedthat as the “most important”  among the possible reasons for the slowing in health care spending growth, “health economists point to a shift toward accountable care, in which providers are paid for the quality of care, not the quantity.”

Under the Obama Health Care Law (ObamaCare), the federal government is empowered to impose so-called “quality” standards on all health care providers, standards based on recommendations on how to prevent Americans’ private health care spending from being allowed to keep up with the rate of medical inflation.  Those recommendations are to be  issued in 2015 and every two years thereafter by the 18-member “Independent Payment Advisory Board.” [See]

What happens to doctors who violate a “quality” standard by prescribing more lifesaving medical treatment than the IPAB permits? They will be disqualified from contracting with any of the health insurance plans that individual Americans, under the Obama Health Care Law, will be mandated to purchase. Few doctors would be able to remain in practice if subjected to that penalty.

This means that treatment a doctor and patient deem advisable to save that patient’s life or preserve or improve the patient’s health–-but which exceeds the standard imposed by the IPAB –-will be denied even if the patient is willing and able to pay for it out of their own resources.

Is it wise to prevent those who would want to buy better health care from doing so? When Americans are allowed to spend money to save their own lives without arbitrary government-imposed limits, they enable health care to improve. Over the 15 years between 1990 and 2005, because of medical progress the cancer death rate fell 19.2% for men and 11.4% for women, according to the American Cancer Society. Consequently, 650,000 more lives have been saved than would have been possible under 1990-era medicine.

Although not the conventional  wisdom, as a society, America CAN afford more and better health care. For a webinar on why, see:

A decline in the resources Americans are being allowed to devote to preserving the lives and improving the health of their families should be lamented, not celebrated.

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