Myth 26. Government-directed rationing will be rational.
Saturday, November 28, 2009 at 7:04PM It all sounds very reasonable: to set priorities, to use the most effective therapies, to serve the neediest first. Rationing is a given, say reform advocates. Insurance companies already do it. Let’s just make it rational and fair.
Some say that Comparative Effectiveness Research (CER) isn’t really about rationing. “Nothing in the legislation…provided for payment restriction based on CER findings,” writes Jerry Avorn (N Engl J Med 2009;360:1927-1929). It’s “Orwellian” to suggest such a thing. Anyway, “unaffordability rations care far more than comparative studies ever could.”
The end-stage of rationing actually has little to do with comparative effectiveness. There are more basic questions: “Have you suffered enough yet?” And “Can you get through the clinic door?”
One young Canadian mother suffered from pain and incontinence and required a walker, because of spondylolisthesis. She aggressively presented herself at four surgeons’ offices before or after hours or at lunch, pleading her case. Four surgeons saw her. Three said she was she’d just have to wait, as others were either older than she was and/or had already suffered longer. Finally a surgeon took pity on her and worked her in—only 6 months later—because she was “too young to have to live like that.” Never mind the need for emergent surgery in the event of neurologic compromise, or more than 2 years of total disability.
CER results can’t be applied until a patient can get a diagnosis. A video team documented efforts to get help from Canadian clinics, and then interviewed a number of Canadians.
CER is not needed to determine that it is traumatic and less safe to give birth in corridors or reception areas because labor beds are full—as 4,000 mothers did in the UK in 2008. The government cut maternity beds by 22%, although birth rates were up 20% in some areas, and spending on the National Health Service was tripled (Daily Mail 8/26/09).
A pediatric ophthalmologist, in the only such practice in Georgia still accepting Medicaid, writes that Medicaid will not pay for the antibiotic needed for an infected corneal ulcer. It takes a year to approve a contact lens after surgery for neonatal cataract. Private funding fills the gap. No research is needed to tell the difference between successful treatment and likely blindness (Zane F. Pollard, M.D., American Thinker. August 2008).But how many such treatments would be denied while approval wended its way through a system with 111 bureaucracies?
With or without CER, government plans always ration care. “The idea of an omnipotent board that makes unpopular decisions on access and price isn’t a new construct. It’s a European import. In countries such as France and Germany, layers of bureaucracy like health boards have been specifically engineered to delay the adoption of new medical products and services, thus lowering spending” (Scott Gottlieb, Wall St J 6/25/09).
We have our own examples in the U.S., as in Oregon.
Throwing $1.1 billion into CER is guaranteed to produce no new knowledge—only poorly controlled data about the implementation in different practice settings of methods already tested for safety and efficacy in well-controlled studies (Naik AD, Petersen LA. The neglected purpose of comparative-effectiveness research. N Engl J Med 2009;360:1229-1231). It will provide the rationale for rationing.
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Reader Comments (8)
Our infamous Howard Dean in Vermont is all for CER and has talked it up while doing his book signing tour. He's also quite an advocate for a single payer system. But he doesn't like it much, as I recently found out, if you provide information that is contrary to his opinions, even when they are based on facts.
Lets make this very simple - give all U.S. citizens the same health insurance that Congress has. Plain and simple. Then they may be willing to limit thier terms. Just a passing thought.
congress voted NOT to joing the health plan, they want nothing to do with it for themselves. if it is not good enough for them then why are they trying to push it off on us. no one in their right mind should vote for it. seems like our representives don't care about our well being, they think only of themselves.
congress voted NOT to joing the health plan, they want nothing to do with it for themselves. if it is not good enough for them then why are they trying to push it off on us. no one in their right mind should vote for it. seems like our representives don't care about our well being, they think only of themselves.
There is nothing rational in what government does. Once someone has a rule to follow then the rule will be followed -- no need to think about it or worry about the consequences.
The House and Senate are public servants in name only. They never touch the daily life of the people they represent with so much as the tip of their little finger.
There is nothing rational in what government does. Once someone has a rule to follow then the rule will be followed -- no need to think about it or worry about the consequences.
The House and Senate are public servants in name only. They never touch the daily life of the people they represent with so much as the tip of their little finger.
With the baby boomers soon eligible for medicare, the governments plan to cut cost rather than raise taxes or withholding for this additional burden on medicare is to simply deny coverage to elders by eliminating 400 billion from medicare. Like Obama said " my plan won't add one cent to the deficit." If you believe that I have some swamp land I will sell to you a great price.
Denying good health care to the elderly has already started, I'm ANGRY beyond belief, but also live with terrible hurt, and fear for my Mother. (she's 71 yrs old), She had her anual mammogram done three months ago, was told that they'd seen something, did a second mammogram one week later. They set her up for surgery two weeks after that, for a biopsy, they saw two nodules in her left breast, her family has been living in fear for two weeks, right?, she goes in for the surgery, they prep her for the surgery, leave her waiting for two hours, her Dr. comes in and tells her, "Well, you can go ahead and go home!!!!" I AM NOT kidding!! He then tells her to go in and have a THIRD mammogram done next month ( December), at a different hospital. He says the mamogram machine is a new and improved version? He said he didn't think she needed the surgery, BUT the two nodules are still there and he's the Dr. that scheduled her surgery in the first place. Does anyone understand this, because I don't. So now she lives in fear because she's afraid to go get her flu shot, says they might euthinize her. Our country needs help, and everyone out there needs to get on board. Please, everyone, Pray for my Mother!