08.31.2009 0

BaucusCare: A NICE Alternative to ObamaCare

  • On: 09/25/2009 09:17:58
  • In: Health Care
  • by Victor Morawski

    Viewed by some as a better alternative to ObamaCare because of its much-touted lack of the controversial Public Option, the Baucus plan may seem, with a little tweaking and fine-tuning, to be a promising route to a possible be-partisan compromise on Health Care Reform.

    The Public Option in ObamaCare has given rise to fears of government rationing of Health Services. Could the Baucus Plan now lay them to rest? Clearly not everyone thinks so. One mainstream news commentator has remarked that Republicans in particular were staying away from it, in part because it would make significant cuts to Medicare, hurting Seniors.

    Those fears are justified and wildly understated. BaucusCare launches an all-out frontal assault on Medicare and legally sanctions exactly the sort of rationing of health services most feared by those leery of the public option in ObamaCare.

    Last week we observed that Comparative Effectiveness Research, which would recommend the provision of health services based on the results of a cost-benefit analysis, inevitably leads to rationing and denial of services. These and similar phrases thus become mere euphemisms for rationing.

    Senator Baucus showed awareness of this on June 9th when he quipped before a Brookings Institution-sponsored conference that the phrase “Comparative Effective Research” may just sound a little too ‘ominous’ and suggested substituting a softer expression like “patient-centered outcomes research” in its stead. Or, he jokingly claimed, just call it “Fred.”

    According to a December 2007 CBO Paper Entitled “Research on the Comparative Effectiveness of Medical Treatments,” now “under current policy and law, Medicare generally covers any treatment or procedure that has net medical benefits—that is benefits that outweigh the risks of the procedure—regardless of its costs….”(32).

    Additionally “Medicare is effectively precluded from taking costs into account when making decisions about coverage” and would need “new legal authority”(29) to do so. The Baucus Plan would give Medicare exactly this authority.

    And what it now gives to Medicare it would like to see extended throughout the whole health system. As pointed out in a White Paper outlining the essentials of BaucusCare entitled “Call to Action: Health Reform 2009,” “Many of the proposals in the plan are based in the Medicare program because of its unique ability to lead the way for system-wide changes.”(36)

    To carry out the comparative effectiveness research, the Baucus Plan would set up the “Health Care Comparative Effectiveness Research Institute” as an independent entity shielded from Congressional or other government oversight.(56) It would perform functions similar to those of the British National Health Services’s “National Institute for Health and Clinical Excellence (NICE), namely assessing “the full spectrum of clinical interventions, including pharmaceuticals, medical devices, procedures, services and other therapies”(56) and making binding recommendations on its findings intended to guide clinical decisions by specifying a range of approved drugs and procedures. But, the CBO paper observed, “to reduce health care spending, the results of comparative effectiveness analysis would ultimately have to change the behavior of doctors and patients—that is, to get them to use fewer…or less expensive services.”(30)

    To force doctors to fall in line behind the Institute’s recommendations, the Baucus Plan would change Medicare’s payment structure from the current fee-for-service [pay-for-reporting] reimbursement system to what it calls a “pay for quality” model(42) because it says the former offers doctors little incentive to work toward quality and efficiency improvements(49). The change would reward physicians for following the Institute’s recommendations and penalize them for not doing so, giving them a significant financial incentive for essentially rationing care.

    Now, NICE is mentioned in the CBO paper as, “Perhaps the best known example of an agency that assesses comparative effectiveness….” (6) Yet, it is for others also the best known example of a rationing board, because of its practice of screening drugs and procedures for approval via quality-adjusted life years (QALYs), a decision procedure which decidedly favors the interests of the young over the old. It is for Sarah Palin the very paradigm of a “Death Panel.”

    Thus, if you would like to see health care decisions in the US governed by a rationing board similar to that which governs them in the British National Health Service then, for you, BaucusCare is a NICE alternative to ObamaCare!

    Victor Morawski, a professor at Coppin State University, is a Liberty Features Syndicated writer.

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