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.
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