[Anecdotes] Practicality, not idealism, should drive essential benefits

The Physicians for a National Health Program (PNHP) recently sent a to the Obama administration protesting the “grossly inadequate, skimpy, spartan standard” benefits made by the Institute of Medicine (IOM) on the definition of essential health benefits. The – mistakingly deemed “damaging” by PNHP – indeed offer a realistic, yet NOT ideal, set of directions for the government to follow in deciding the essential benefits package.

As, there are limitations that need to be placed on any essential benefits package in order to appropriately offer the widest set of coverage.   The “skimpy” standards of small businesses are typically developed with this in mind.  The essential benefits package, in and of itself, was not intended to carry the weight of solving all of our health and economic woes. Yes, some may still go without lifesaving medications with this single change.  But the bigger picture is key.

What may be deemed “essential” will unequivocally be argued and changed at the rate that scientific data and literature are produced. However, monetary funding is calculable and finite.  The question that must be asked is one of valuation: Do we offer some for all, or a lot for some?  Would we rather cover everything – including the most expensive medications or procedures that benefit an extremely limited number of patients or instead be able to provide a set of preventative services and catastrophic coverage that will protect nearly our entire population?

I offer a terminology shift – from essential to shared.  As a community, we will decide through a deliberative and evidence-based process what standard benefits we elect to share.  This concept may change from time to time, but it is only through the acknowledgement that we cannot, through government’s shared resources, offer every solution to our nation’s healthcare problems.