A provision in the stimulus package that would authorize $1.1 billion in spending on “comparative effectiveness” medical research has some Republicans worried that it could be aimed at rationing care ahead of President Obama’s push for universal health care.
Before going into the specifics of the provision, it’s important to keep in mind that, philosophically, liberals believe that one of the reasons why health-care costs are so high in America is that doctors authorize expensive medical procedures and write prescriptions for high-priced drugs just to be on the safe side, leading to waste. Liberals argue that government-run health care is more efficient because such systems save money by doing a cost/benefit analysis of medicines and medical procedures and denying some types of treatment if it isn’t deemed to be a good value. The flip side, of course, is that you end up with a system in which health care is rationed, and government bureaucrats are making decisions about what type of care is best, rather than doctors and their patients. An extreme example of this is Britain’s National Institute for Health and Clinical Excellence (NICE), which, as the NY Times reported in December, has effectively determined that it’s worth $22,750 to extend somebody’s life by six months. In his book Critical: What We Can Do About the Health-Care Crisis, Obama’s former nominee for health-care czar, Tom Daschle called for the creation of a Federal Health Board, comprised of “independent experts” that would perform much the same function.
Now, as part of the stimulus bill, Rep. David Obey, the House appropriations chairman, added a provision, to create a “Federal Coordinating Council for Comparative Effectiveness Research.” The new entity, which sounds similar to Daschle’s idea of a Federal Health Board, would be tasked with, “assist[ing] the offices and agencies of the Federal Government, including the Departments of Health and Human Services, Veterans Affairs, and Defense, and other Federal departments or agencies, to coordinate the conduct or support of comparative effectiveness and related health services research;” and to “advise the President and Congress” on such matters.
It sounds benign, but as Shadegg notes:
Just read the words from the House Appropriations Committee’s own report on the stimulus regarding this provision: “Those items, procedures, and interventions… that are found to be less effective and in some cases, more expensive, will no longer be prescribed.” In reaction, 63 patient advocacy groups including the AIDS Institute, the Alzheimer’s Foundation of America, and the American Association for Cancer Research, have written a letter to Congress, expressing their concerns. They explained that this provision could lead to “restrictions on patients’ access to treatments and physicians’ and other providers’ ability to deliver care that best meets the needs of the individual patient.”
It could also pave the way for further health-care rationing if President Obama gets his way in terms of overhauling the entire health-care system. For instance, President Obama’s campaign health-care plan calls for subsidies to be given to Americans to purchase health-care from a government run exchange, choosing between a Medicare-like government plan and among private options. The government could mandate that any insurer participating in the government-run exchange must adopt the effectiveness recommendations of the Federal Coordinating Council, and the government could use its increased leverage in the health insurance market to pressure other insurers to go along. Congress could even go further, and pass a law saying that in order for an insurance policy to be eligible for the employer tax deduction, it must follow the same set of recommendations. All of this is spelled out in detail in Daschle’s book, which was widely praised by Obama. But more relevant to the current debate, it’s another example of how the stimulus package has been used by Democrats as a ruse to achieve some long-standing policy goals that aren’t relevant to stimulating the economy.
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