By Susan Brinkmann, OCDS
Tucked inside the President’s $825 billion stimulus package is a plan to create a new government agency that will evaluate new medical drugs and products for their “cost effectiveness” before citizens can get access to them. The job of the new agency will be to determine the best way to “save money and lives” when it comes to costly health care problems such as cancer.
According to an article appearing in the Wall Street Journal, President Obama, House Democrats and incoming Health and Human Services Secretary Tom Daschle have included $1.1 billion in the stimulus package to create a new agency similar to Britain’s much criticized National Institute for Health and Clinical Excellence (NICE) agency. Referred to as a “comparative effectiveness” entity, this agency’s research would be used to create “guidelines” to direct doctor’s treatment of difficult, high-cost medical problems.
For instance, in England, NICE has deterrmined that $45,000 is the most that should be invested in a product that extends a person’s life by one “quality-adjusted” year. “By their calculus, a year combating cancer is worth less than a year in perfect health,” writes the Journal’s Scott Gottlieb.
The proposed bill also gives wide discretion to set priorities to incoming Health Secretary Daschle, a man who has long advocated a U.S. approach modeled on England’s national health care system.
“Mr. Daschle argues that the only way to reduce spending is by allocating medical products based on ‘cost effectiveness,’” Gottlieb writes. “He’s also called for a ‘federal health board’ modeled on the Federal Reserve to rate medical products and create central controls on access.”
According to bioethics watchdogs such as attorney Wesley J. Smith, “This sounds like even if we maintain a technically private health care system, it will have to operate under federal care rules.”
Smith had personal experience with how an agency such as the one proposed operates in a real life situation. A few years ago, he was in England advocating for the rights of Leslie Burke, a man with a progressive degenerative neurological disease, to receive food and water through a feeding tube because he could no longer swallow.
“I saw the legal briefs NICE filed against Burke’s position,” Smith writes. “It wanted total control by the doctors over whether he lived or died when he became totally disabled based on quality of life/resource standards. Horrible, just horrible.”
Under NICE standards, an assessment is made of the cost of treatment per additional year of life which it might bring, and on the “quality adjusted life year” or QALY, which takes into consideration the quality of life of the patient during the additional time for which their life will be prolonged.
“In other words, medical care is effectively rationed by the National Health Service under guidelines set by bioethicists based on their beliefs about the low quality of life of patients whom they have never met,” Smith writes. “While the views of patients and families are to be taken into account when deciding whether to provide treatment, they are not determinative.”
Smith believes that the American people will not accept a similar program in this country – If they know about.
“But it seems that this financial fiasco through which we are careening is being used as a pretext to carve out obscure legal nooks and crannies with the potential to hide much perfidy.”
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