10.31.2009 0

How Comparative Effectiveness Can Cost You Your Life

  • On: 11/13/2009 09:16:05
  • In: Health Care
  • by Victor Morawski

    The phrase “Comparative Effectiveness” is becoming increasingly in vogue among Obama health care advocates. So, it’s important to note that it actually amounts to little more than a euphemism for health care rationing.

    Based on comparative effectiveness research, patients will inevitably be denied life-saving medicines, services or procedures because they are not deemed to produce substantial enough benefits to justify their costs. In short, the government will decide whether your life is worth saving depending upon whether its bureaucrats deem you a productive member of society.

    And how will the bureaucrats make such life and death determinations? Probably the same way they decide whether they should take your property under eminent domain: it’s all a matter of tax revenues. Under eminent domain, the more you pay in taxes, the better the chances you have of keeping your property. Under comparative effectiveness, the more you pay, the longer you’ll be allowed to live.

    There is simply no other way to look at it. And, of course, there can be no question that it will stack the cards against the elderly as a group that consumes the largest quantity of health services and pays the lowest taxes.

    Effectiveness is all too often gauged using a standard like QALY [Quality Adjusted Life Years], which in the British NIH measures it in terms of the length and quality of life a patient can normally be expected to have following some specific medical intervention. Procedures or medicines that do not, for an elderly patient, prolong life enough or enhance its quality enough to justify their cost are thus judged to have insufficient effectiveness and may be denied.

    It is common opinion that the most prominent example of an agency that conducts comparative effectiveness research and then uses it as the basis for decisions regarding the approval or disapproval of health services is Great Britain’s National Institute for Health and Clinical Excellence (NICE). The Senate Baucus Health Care Reform Bill has within it provision for just such an organization, which it calls the “Health Care Comparative Effectiveness Research Institute.”

    The Senate expressed belief that, “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) Thus, they would pressure doctors financially to adjust their care decisions to bring them in line with the Institute’s findings and recommendations in ways that would ultimately lead to rationed care.

    And what are we then to make of the fact that the latest version of the House Health Care Reform Bill, H.R. 3962, has within it a provision for setting up and funding a “Center for Comparative Effectiveness Research” — and yet also contains a clause which seems to render this government agency all but ineffective? For we are told in the bill that the Center’s “Research May Not Be Used to Deny or Ration Care.” And that kind of obvious duplicity only adds insult to injury.

    After all, why have such a research body at all if its findings are not going to be used for the one purpose that justifies its creation: supplying the information on the basis of which prospective medical interventions are either approved or disapproved? Isn’t it, in fact, more reasonable to think that this clause will be dropped when it is reconciled with the Senate version? Or, that the bureaucrats who administer it will simply be told to ignore the clause altogether, as is so often the case when such legislative sleight of hand?

    While the ‘Center’ in H.R. 3962 is now a toothless tiger, it is not hard to imagine its equivalent eventually becoming the full-fledged, powerful health care rationing body that Great Britain’s NICE now is. Eventually – inevitably – the healthcare monstrosity that Nancy Pelosi has just released on an unwitting American public will grow to full maturity. And it will then gobble up not only a vast chunk of the US economy, but an untold number of victims whose lives, based on the results of comparative effectiveness research, will simply be deemed not worth the cost of saving.

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

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