The most recent installment of the reality TV series, known as
the Republican Presidential Debates, drew more cable viewers than
The Jersey Shore or any of the cable channels’ tributes to
Whitney Houston. Never before have so many Americans been directly
engaged in political discourse. (There were as many tweets, Google
searches, etc. for the Arizona debate than for any other show on TV
the other night!)
If you are like me, you were channeling the candidates and
thinking of things they should have said but didn’t. Why didn’t
Romney just say that Romneycare’s individual insurance mandate was
a mistake just as was Santorum’s support for No Child Left Behind?
Why not add that much of Romneycare — individual buying at group
rates, reforming Medicaid, and having insurance plans add a health
savings account to their offerings — are things Republicans
support.
I hoping CNN’s John King would have asked Rick Santorum
about his views regarding prenatal testing. Santorum could have
restated, without the left’s media filter, that he doesn’t want to
ban contraception or prenatal screening.
Instead, he is concerned that prenatal screening, to
detect for so-called birth “defects” such as Down’s Syndrome, spina
bifida, cystic fibrosis and Fabry’s Disease, will be used in
combination with abortion to place limits on neonatal care to
control health care costs for high risk infants.
He is right to be concerned and talk about it. The health
systems of Britain, Canada, the Netherlands and Australia
discourage life-sustaining treatment for extremely premature or low
birthweight babies. In 2005, the Royal College of Obstetrics and
Gynaecology (RCOG)
announced that “very premature babies were taking up intensive
care space that could be used for healthier babies” and suggested
that those born at very low gestations should not be intensively
treated but rather allowed to die.
It said such infants were “bed blocking” and that due to
better medicines and devices, “[t]here has been a constant need to
expand numbers of cots to cover the increasing tendency to try and
rescue babies at lower and lower gestations.”
A review of neonatal intensive care units in Canada
found
“the majority of medical staff members do not
recommend NICU care for an infant born at 24 weeks’ gestation…” The
review concludes that in some Canadian NICUs, preterm infants are
not considered to be persons and, thus, are not treated in the same
way as a larger patient. It doesn’t help that Canada has severely
limited growth in the number of NICUs. But that’s by design.
Indeed, to keep their babies alive, Canadian parents go to
U.S. hospitals. In recent
years hundreds have done so. U.S. doctors try to do what their
Canadian colleagues cannot or will not, as in the case of Michelle
James. Her doctors in Canada could not halt her labor when it began
at 24 weeks and were not optimistic about the viability of her
pregnancy. In the U.S., doctors succeeded
in stopping labor for three weeks, improving her daughter’s ability
to survive and avoid a disability.
Could the cold calculus of cost-effectiveness be paired
with prenatal screening under Obamacare? It already is.
The Agency for Healthcare Research and Quality and a
senior advisor to the Patient-Centered Outcomes Research Institute
— the two agencies responsible for producing comparative
effectiveness findings — are already issuing guidance that would
ration care to sick, vulnerable infants based on cost consideration
and one-size fits all research.
Jean Slutsky — who works for both AHRQ and PCORI — heads
up a committee that decides what technologies PCORI will examine.
Here’s what she and two colleagues said
about prenatal screening: “Compelling stories of children who died
from very rare metabolic disorders that might have been detected
with newer, more expensive equipment have created powerful momentum
for expanded screening of newborns. But in an era of constrained
budgets, state policymakers need to weigh the benefits and costs of
new screening programs against those of other equally important
programs. Nonetheless, it remains politically risky to frame a
health policy decision as being based primarily on cost or
cost-effectiveness.” That’s compassion for you.
AHRQ and PCORI were established to obscure the fact that
health policy decisions based on cost are politically cheap. AHRQ
claims that there is no benefit for routine use of inhaled nitrous
oxide to oxidate the lungs of pre-term infants. Yet dozens of
studies demonstrate that newborns with iNO in combination with
continuous airway pressure saves the lives of those with severe
respiratory failure and pulmonary hyperplasia. It has been shown to
save the lives of infants with premature rupture of the membranes
(before 24 weeks of gestation). And it is looking at whether
spending so much money on care for at risk babies is
“cost-effective.”
America spends more on at risk infants than any other
nation. More babies that once died because they were too sick or
small after birth are alive and part of loving families. We lead
the world in life sustaining therapies for newborns. Santorum is
standing up against the monstrous moral certainty of Obamacare.
Amen to that.
