Use a Scalpel, Not a Club

In June, doctors at George Washington University Medical Center implanted a sophisticated pacemaker in Vice President Dick Cheney’s chest. The $25,000 device, which can also act as a defibrillator to stabilize an irregular heartbeat, is now covered by Medicare.

The pacemaker is one of about 1,100 high-tech treatments threatened by proposed Medicare rules requiring hospitals to slash spending on outpatient medical procedures including some types of chemotherapy. Hospital officials and medical device makers correctly observe that the rules could encourage hospitals to evade the outpatient limit by lengthening inpatient stays. Curbing costs is good, but doing it with a bludgeon is not.

Medicare costs, say a recent Congressional Budget Office report, are the one burden most likely to throw the entire government back into deficit spending. Some limits on high-tech procedures are proper. But decisions should be based on better information than Medicare administrators are using.

True, lobbyists representing manufacturers of high-tech medical devices may be crying wolf. It is their job to protect the $68 billion that Americans spend each year on diagnostic kits, heart valves and other devices facing cuts. But the escalating debate has also drawn attention to a long-ignored flaw in the nation’s public health system: the lack of any coherent system for assessing what works, what gives the biggest medical benefit for the buck. In recent years, several federal studies have shown that the United States’ $1.5-trillion-plus health care industry lags in implementing simple monitoring to ensure efficiency--and in releasing the data it has.

Making quality information public pushes hospitals and doctors to focus on effective treatments and reduce medical errors. Cardiac surgery in New York, for example, improved after surgeons and hospitals were publicly rated on their performances.

Medicare officials, after suggesting earlier this year that they would cut inpatient payments, backed down under opposition from hospitals. The new plan for outpatient cuts is also in political trouble. If the government had better-quality information, it would be able to fend off critics and defend its cuts.