The Raleigh News &
board thinks, "Ultimately the alternative to having companies decide
key health policy issues is to give greater power to public boards and
commissions, which should include ample physician participation. The democratic
process can be messy and uneven, but it’s still the fairest decision-making
tool we have."
In reaching that conclusion, the state’s paper of record first acknowledges
that Blue Cross Blue Shield of North Carolina is justified in its decision to
question when spinal fusion surgery is necessary. BCBSNC was mentioned briefly
in a Wall
Street Journal story last month detailing how a
few doctors who received large royalty payments from Medtronic were all at a
single hospital in Kentucky that "performed the third-most spinal fusions
on Medicare patients in the country."
Blue Cross spokesman Lew Borman explained to me that the insurer would still
pay for necessary spinal fusions, but that its medical board made a decision
based on numerous research studies and reviewed the decision with spinal surgeons. Device makers and some
medical groups have challenged the
new policy and will discuss their concerns with the state’s largest insurer.
None of this would be an issue if governments and insurers did not make the
final call on what treatment is available. Informed patients who bear the cost
of their own care are much better arbiters of what is appropriate than public
boards or insurance companies. Too bad the health care law goes the other