The Public Policy

Repeal Health Care Fascism

Obama rule will reform health care by allowing you less of it.

By 2.25.09

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Buried in Barack Obama's so-called stimulus bill is funding for a bureaucratic structure for the government to begin rationing the health care of the American people. A centralized government bureaucracy would be established that would ultimately have the power to decide what health care you can have, and when, especially when it involves highly expensive, advanced medical care for the seriously ill. Unless this is stopped, many of you reading this article right now will one day suffer death-by-liberalism, when the government bureaucracy decides that the health care you need is not worth the cost, or puts you in a waiting line where death will arrive before treatment.

But Republicans and conservatives are not helpless in the face of this fascist power grab. They can sponsor a new bill of their own proposing to repeal the health care rationing provisions of the supposed stimulus bill. They can then lead a national, populist, grassroots movement to force Congress to pass the bill, and President Obama to sign it, educating the public along way about the intractable problems of socialized medicine.

Health Care Rationing: Law and Policy

The supposed stimulus bill includes $1.1 billion in funding for a Federal Coordinating Council for Comparative Effectiveness Research (CER). The Council is to conduct so-called federal comparative effectiveness research in regard to different health care services to determine which is the most "cost-effective". The sponsors of that provision explained,

By knowing what works best and presenting this information more broadly to patients and healthcare professionals, those items, procedures, and interventions that are most effective to prevent, control, and treat health conditions will be utilized, while those that are found to be less effective and in some cases, more expensive, will no longer be prescribed." (Emphasis added.)

President Obama's ill-fated first choice for Secretary of Health and Human Services was former Senate Majority Leader Tom Daschle (forced to withdraw when it was revealed that he had failed to pay all of his federal income taxes). Obama picked him for that post because Obama liked the health care reform plan Daschle proposed in his new book, Critical: What We Can Do About the Health Care Crisis.

In that book Daschle, as we know, proposes a "Federal Health Board" similar to the new CER bureaucracy in the stimulus bill, which helps us to understand what the CER is all about. Daschle explains:

Today most health research focuses on whether a particular medicine or treatment is safe and works. We should go further by promoting research that compares drugs and treatments to determine which ones deliver the best bang for the buck. Does an over the counter drug work as well as a brand name prescription drug? What are the relative merits of heart disease treatment options?...We also should sponsor more research on how new technologies -- the main driver of rising health care costs -- should be deployed….But if we want to get health-care costs under control, we're going to have to pay more attention to whether we are getting our money's worth.

The key question this statement raises is who is the "we," Kemosabe? Is it the private medical community, medical institutes, medical schools, Professors of Medicine, private researchers, etc., informing doctors and their patients, where the ultimate decisions are made? Or is it the government, informing Big Government bureaucracies, who will then impose their decisions on these matters on doctors and patients?

Daschle continues in his book providing more illumination as to what is going on here, saying,

To make more significant progress, however, we have to concentrate more on the value of the care we are getting. We can and should strive to get more for our health care money by steering providers towards drugs, treatments, and procedures that yield the best results at the lowest cost. We should spend money on expensive new technologies that benefit patients, but we shouldn't waste it on ineffective, poor quality care." (emphasis added).

But who decides what "drugs, treatments, and procedures…yield the best results at the lowest cost?" Doctors and their patients, or the government? Who decides which new technologies "benefit patients" and which provide "ineffective, poor quality care?" Is that the patients, on the advice of their doctors, or a wise, highly centralized, far away government bureaucracy? Ultimately, who does the "steering" of doctors and other health providers in this brave, new world, the patients, or the government again?

Daschle further explains:

The federal government could exert tremendous leverage with its decisions on covered benefits and payment incentives. In choosing what it will cover and how much it will pay, it could steer providers to the services that are the most clinically valuable and cost-effective, and dissuade them from wasting time and money on those that are neither. (Emphasis added.)

Daschle continues:

In our fragmented health-care system, only the federal government is in a position to develop national quality standards that everyone would follow -- and it would cost relatively little for it to do so. In Great Britain, the National Institute on Clinical Excellence (NICE), which develops guidelines for the National Health Service (NHS), spends less than 1% a year of its total national health spending.

Indeed, NICE is so nice that in 2006, as Betsy McCaughey reports at Bloomberg.com, it "decreed that elderly patients with macular degeneration had to wait until they went blind in one eye before they could get a costly new drug to save the other eye." This was not an isolated policy decision. As McCaughey further reports, NICE "approves or rejects treatments using a formula that divides the cost of the treatment by the number of years the patient is likely to benefit." This leaves senior citizens at a great disadvantage, because they have fewer years left to enjoy the benefits of any medical treatment. As a result, McCaughey continues, "Treatments for younger patients are more often approved than treatments for diseases that affect the elderly, such as osteoporosis." Do you see the fascism yet?

Yet, Daschle holds up this bureaucratic nightmare as a model for the U.S. Indeed, Daschle proposes the creation of a Federal Health Board to run the U.S. health care system explicitly modeled after this U.K. bureaucracy that mercilessly rations health care for the British people. Daschle writes:

In other countries, national health boards have helped ensure quality and rein in costs in the face of these challenges. In Great Britain,…NICE…is the single entity responsible for providing guidance on the use of new and existing drugs, treatments, and procedures….NICE also weighs what it calls 'economic evidence,' or how well the medicine or treatment works in relation to how much it costs.

This is what is meant by "government run health care." You don't want a remote, far away, centralized, national health bureaucracy making decisions about what health care is right for you, what medical services and treatments will be right for you, what latest, most advanced, medical technologies and treatments will be available for you. You want doctors and patients making those decisions. Big government bureaucracies can never have all the information about you and your health that you and your doctor have, and they don't have the same interest in you and your family that you have. You don't want such government bureaucracies in control of your health care. You want to be in control of your own health care.

Nevertheless, such government run health care is exactly what Daschle proposes, as favored by Obama:

The Federal Health Board would promote "high value" medical care by recommending coverage of those drugs and procedures backed by solid evidence. It would exert influence by ranking services and therapies by their health cost impacts….We won't be able to make a significant dent in health care spending without getting into the nitty-gritty of which treatments are the most clinically valuable and cost effective. That means taking a harder look at the real costs and benefits of new drugs and procedures. In Great Britain, NICE…uses cost effectiveness information in deciding whether to cover a new drug or procedure….The challenge…is creating an entity with the credibility and the clout to make those tough decisions. (Emphasis added.)

A centralized, Big Government bureaucracy doesn't know "which treatments are the most clinically valuable and cost effective," and doesn't even have the right incentives to find out in a timely manner. In country after country where such systems have been established, the interests of truly sick patients have been routinely sacrificed on the alter of the government's short term political interests in serving the far more numerous and politically active healthy patients, and keeping their costs down. Yet Daschle touts the health rationing bureaucracies of these countries as well as models for the U.S.

McCaughey explains what is really going on here:

In his book, Daschle proposed an appointed body with vast powers to make the "tough" decisions elected politicians won't make. The stimulus bill does that, and calls it the Federal Coordinating Council for Comparative Effectiveness Research….The goal, Daschle's book explained, is to slow the development and use of new medications and technologies because they are driving up costs. He praises Europeans for being more willing to accept "hopeless diagnoses" and "forego experimental treatments," and he chastises Americans for expecting too much from the health care system. Daschle says health care reform "will not be pain free." Seniors should be more accepting of the conditions that come with age instead of treating them. That means the elderly will bear the brunt.

Indeed, Daschle confesses in his book that "Medicare could pay more for operations that are recommended, and less for procedures and drugs that seem discretionary," according to the Federal Health Board. That Board could also "link the tax exclusion for health insurance to insurance that complies with the Board's recommendations." Daschle concludes, "If the Federal Health Board fulfills its mission, it will have to reduce or deny payment for new drugs and procedures that aren't as effective as current ones."

Canada is another country with a national health care rationing system similar to Great Britain's. In a recent article in the Wall Street Journal, Nadeem Esmail, Director of Health System Performance Studies at the Fraser Institute in Canada, provides some examples of experience under that system:

In Ontario, Lindsay McCreith was suffering from headaches and seizures yet faced a four and a half month wait for an MRI scan….He went south, and paid for an MRI scan across the border in Buffalo. The MRI revealed a malignant brain tumor. Ontario's government system still refused to provide timely treatment, offering instead a months long wait for surgery. In the end, McCreith returned to Buffalo and paid for surgery that may have saved his life.

Esmail offers another example:

In March of 2005, [Ontario resident Shona] Holmes began losing her vision and experienced headaches, anxiety attacks, extreme fatigue, and weight gain. Despite an MRI scan showing a brain tumor, Ms. Holmes was told she would have to wait months to see a specialist. In June, her vision deteriorating rapidly, Ms. Holmes went to the Mayo Clinic in Arizona, where she found that immediate surgery was required to prevent permanent vision loss and potentially death. Again, the government system in Ontario required more appointments and more tests, along with more wait times. Ms. Holmes returned to the Mayo clinic and paid for her surgery.

In another example:

[Alberta resident] Bill Murray waited in pain for more than a year to see a specialist for his arthritic hip. The specialist recommended a "Birmingham" hip resurfacing surgery (a state of the art procedure that gives better results than basic hip replacement)….But government bureaucrats determined that Mr. Murray, who was 57, was "too old" to enjoy the benefits of this procedure and said no.

Murray is now suing the government to get his "free" health care.

If you read between the lines of Obama's speech last night, you realized that this is how he plans to slash the deficit, by denying you promised health care. Let's nip that in the bud now with a national crusade to repeal the foundation for health rationing that was just adopted in the fraudulent stimulus bill. Let's repeal the Federal Coordinating Council for Comparative Effectiveness Research, and establish firmly in law that the federal government may take no steps that would deny patients any treatments, procedures, drugs, or practices that satisfy a standard simply of safe and effective.

Not one single American should suffer or die because he or she does not have access to health care, or fall into bankruptcy because of the uncovered costs of such care. Those are my values. Full protection from those results can be achieved by focusing on reforms to establish a complete health care safety net. It is not necessary to steal from the American people freedom and control over their own health care. I agree that they have already lost too much freedom and control in the current system.

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About the Author
Peter Ferrara is Director of Entitlement and Budget Policy at the Heartland Institute, General Counsel of the American Civil Rights Union, Senior Fellow at the National Center for Policy Analysis, and Senior Policy Advisor on Entitlements and Budget Policy at the National Tax Limitation Foundation. He served in the White House Office of Policy Development under President Reagan, and as Associate Deputy Attorney General of the United States under President George H.W. Bush.