Medical Necessity: A Moving Target
Abstract
Humans act for complex practical reasons but create rationales for their actions. However, when careful intellectual scrutiny is applied to a rationalization, it often crumbles and slips from one's grasp. So it is with "medical necessity," which Dr. Paul Chodoff discusses from a different angle beginning on page 1481. We return to the practicalities to make sense of things. When President Clinton's health plan was being decimated, few people understood that the question was not whether health care reform would occur, but under whose control: government bureaucrats or insurance bureaucrats. Given adequate resources, this country would gladly support a universal right to optimal health care. But it can't, and neither can Canada, Germany, nor Sweden, which have been considered to have rational and economical universal health care systems. Inflation has entered their systems, though less dramatically than here, and they are developing their own modes of rationing, using their own versions of medical necessity. What have our insurance companies contracted to pay for? Cynics might say "as little as possible"; that is true of some companies, but not of all. I do reviews for some managed care companies; our monthly teleconference of physician advisers is a serious, professional