Mental health and proposed new mandates

Like other mental health advocates here in Southeast Missouri, I know from long experience that medical care works best when patients and their doctors get to make decisions without outside interference. And that's why I'm worried -- deeply worried -- about some proposed new mandates emanating from Washington, D.C. that would interfere with the ways that some of the most vulnerable patients get needed medical care.

The proposed rules, known by the harmless-sounding title "Medicare Part B Drug Payment Model," amount to little more than drug rationing in-all-but-name for some of the most important treatments to emerge from research labs over the past decade. These medications, administered in doctors' offices and outpatient clinics, help with a wide range of difficult-to-treat conditions ranging from arthritis to cancer. They're typically injections or infusions that require special equipment to store and real expertise to administer. Some are customized to the individual patient. Usually, they're prescribed as last-resort measures for patients who have already tried and failed to treat their conditions with drugs from local pharmacies.

Access to such treatments are particularly important locally because of the on-going mental health crisis in Missouri and around the country. We know that access to treatment is vital to patients managing their disease and any disruption -- requiring the patient to travel further or changing medication -- places an additional burden on the patient. Those who are unable to access treatment often suffer from dangerous addictions and risk ending up incarcerated, where their mental health remains untreated and the cost to society skyrockets.

Under the new rules being pushed by the Administration, doctors would see their reimbursements for administering these miracle drugs cut to the bone. Given that many medical practices treating chronic conditions operate on thin margins, some would likely have to close under this regime while many more would find it difficult to retain staff necessary to provide the drugs.

The results from similar schemes implemented in much of western Europe are well known: waiting lists to get drugs and government officials rather than doctors making decisions about who "really" needs them. And things could get worse. In fact, because Medicare uses broadly determined "average" prices to set rates, some smaller practices without much purchasing power might not even be able to recover their own out-of-pocket costs. And, even though they're called a "demonstration," the rules will apply to a majority of Medicare beneficiaries almost immediately. They're unacceptable in the United States as a whole and downright dangerous here in Missouri.

Meanwhile, there's no evidence that the proposals will do anything to contain medical costs. The payments made to doctors for administering drugs in their offices currently comprise only about one tenth of one percent of all federal health care spending while the drugs themselves represent less than 2 percent. Indeed, because almost all of them treat chronic conditions, which comprise the lion's share of Medicare costs themselves, drugs administered in doctors' offices may well save money in the long run by keeping elderly and disabled citizens out of hospitals and emergency rooms.

Luckily, there's plenty of opposition in Congress to the new rules -- which overturn decades of carefully negotiated procedures -- and I'm proud that Rep. Jason Smith (R-Mo.) has been a leader in opposing the unwise proposal. He joins a bipartisan group of more than 200 members of Congress that has called for overturning them. Groups representing everyone from asthma doctors to mental health advocates have also lined up in opposition.

Letting such bureaucratic overreach move forward would be a tragic mistake for the country and disrupt the relationship between doctors and their patients. Rep. Smith and his colleagues in Congress are doing the right thing by standing up for Missourians at a time when they need it most.

Linda Sanders is a resident of Cape Girardeau and an active advocate for the National Alliance on Mental Illness (NAMI).