February 4, 2009
How the Stimulus Bill Could Kill You
When you read through the nearly seven hundred pages of the House stimulus bill it is easy to begin dozing off after a few hundred billion dollars worth of run-of-the-mill wasteful government spending. One has to keep a keen eye out for the components of the bill that don't just steal your money, but that may actually do you great physical harm, if not kill you outright.
On page 151 of this legislative pork-fest is one of the clandestine nuggets of social policy manipulation that are peppered throughout the bill. Section 9201 of the stimulus package establishes the "Federal Coordinating Council for Comparative Effectiveness Research." This body, which would be made up of federal bureaucrats will "coordinate the conduct or support of comparative effectiveness and related health services research."
Sounds benign enough, but the man behind the Coordinating Council, Health and Human Services Secretary-designate (and tax cheat) Tom Daschle, was kind enough to explain the goal of this organization. It is to cut health care costs by preventing Americans from getting treatments that the government decides don't meet their standards for cost effectiveness. In his 2008 book on health care, he explained that such a council would, "lower overall spending by determining which medicines, treatments and procedures are most effective-and identifying those that do not justify their high price tags."
Once a panel of government experts decides what is and what is not cost-effective by their definition, the government will stop paying for treatments, medicines, therapies or devices that fall into the latter category. Initially, this will limit access to very expensive treatments for federal employees, veterans, the elderly, members of the military and their dependents and others who rely on the feds to pay for their health care. But since this would place nearly half of health care dollars off limits for such treatments, the demand for and further development of such treatments would likely dry up. And Daschle wants to expand the Coordinating Council's power even further, allowing the government to deny tax benefits for private insurance that covers treatments deemed too expensive by the Council. Thus, if a handful of government employees deem a therapy not cost effective, no health insurance will cover it and it will become virtually unobtainable to patients at any cost.
Mind you, they are not simply looking to exclude treatments that don't work, but to exclude treatments that are effective, but whose cost, in their opinion, does not justify their use. You, the patient, and your physician don't get a vote. This would make the federal government the single most important decision-maker regarding health care for every patient in America.
This is also another wonderful example within the stimulus bill of infantile economics. When something is new it is usually expensive, (think $3,000 VCR's back in the ‘70s). As supply increases, two important things happen. First, innovations take place that improve the product. Second, the cost comes down. If the feds step in and say, no, that new treatment is too expensive, it will never have the chance to become better, the supply will not increase and it won't become more cost-effective. It will just die on the shelf, and so will the patients who potentially could have benefited.
For example, scientists have found that proton beams can be used to destroy cancerous tumors by pinpointing the beam on a tumor diminishing the collateral damage to surrounding tissue that often accompanies conventional photon radiation treatment. Five facilities in the United States offer proton therapy at places like Massachusetts General Hospital and the University of Texas. The five can treat a total of about 8,000 patients a year. Protons are most beneficial for children who can suffer severe developmental side-effects from radiation treatment. But the therapy is expensive, often running over $100,000 for a six-week course of treatment. But as new proton treatment facilities are built, improving the delivery of the therapy and increasing its supply, prices will decrease and quality will improve. But how will a panel of bureaucrats react to this situation? Will they allow insurance to cover a treatment that can be many times more expensive than conventional care and let it reach its full potential? Or will it be blackballed for future patients in the name of cost-containment?
Imagine the conversation: Parents are told that their daughter has a brain tumor. Doctors will immediately begin radiation treatment to destroy the tumor. But they also tell the parents that bombarding the child's brain with radiation will likely have developmental impacts. The doctors lament that there once was a better way to deal with this situation with a higher success rate and virtually no side effects, but some people in Washington decided it was too expensive and the centers that offered it closed and no one persisted in further developing the therapy.
Repeat this scenario time and time again and you will glimpse health care in the Age of Hope and Change. Emphasis will be shifted to prevention and management of chronic illness-an excellent idea and potentially very economically beneficial. But health care will be frozen in time. New treatments come on the market at very high costs and most often represent incremental improvements over existing care. That is how progress works and that is why we live longer lives than our great-grandparents. But that is exactly the kind of progress that Daschle and his Coordinating Council will be targeting in order to limit health care spending. It is a perfect example of the way socialized medicine rations care in the name of equality of access and proves the old Canadian axiom that, "national health care is wonderful, unless you get really sick."
Now, all this time, we have been told that Republicans were the ones who only saw health care in terms of dollars and sense and that the Democrats were champions of the needs of the ordinary people. The reality is the exact opposite. A market-based system promoted by many Republicans allows patients to control their care rather than bureaucrats and encourages innovations that save and prolong lives. Under this new health care order, it will be the express task of government employees to stand between you and your family and potentially life-saving care, all in the name of dollars and cents.
Douglas O'Brien is a public affairs consultant and served in the Department of Health and Human Services in the Bush Administration.