November 28, 2009
American medicine is the benchmark for the world. Our physicians and hospitals are the elite in the war against death and suffering, and they have been winning. Ever-lengthening life spans show that the enemy is in retreat, while sickness and disability are routed daily with innovative procedures, drug therapies, and marvelous new medical equipment. Just as our military strength led nations to seek our protection, our medical prowess draws the hopeless to us when the healers of their countries have nothing more to offer them, save comfort and an apology. Remember your last trip to the doctor or hospital, so you will be able to tell your grandchildren that you saw American Medicine at its pinnacle, before the decline that began with the passage of "health care reform."
Our ally Britain has traveled much farther down the socialist road than we have, and they have a great deal to teach us. They have a fully socialized health care system called the National Health Service (NHS), which provides care for all comers regardless of ability to pay or insurance coverage. There is one game in town, and it is a wholly owned subsidiary of the British government.
Britain has sought efficiencies utilizing methods developed by their National Institute of Health and Clinical Excellence, the self-described "health cost watchdog" of the NHS. Known by the Orwellian acronym of NICE, this group assesses everything medical, from new technologies to drugs and clinical procedures, and issues guidelines for their use by the NHS. These guidelines include criteria by which certain patients will be made ineligible for both routine and life-saving procedures. The method is known as Comparative Effectiveness Research and Evidence-Based Decision Making.
Our insurance companies weigh costs as well, but there is a difference. If your insurance company denies access to a procedure you feel you need, you have recourse through the company's own appeals process and, if need be, the judicial system. Both parties to the dispute have incentive to reach an accord: the patient wants to get well, and the insurance company's wants to avoid subverting its profit motive through legal action, which says nothing of the bruising a lawsuit lays upon its commercial image. When you are denied a test or procedure in the British system, you get to ask them to reconsider...and then you are invited to go pound sand.
In an October 9th, 2009 Reuters article by Kate Kelland, Kalipso Chalkidou, the director of the international division of NICE, characterizes our talk of death panels as "childish." She informs us that one of NICE's many achievements in Britain has been to bring a maturity and openness to the conversation regarding the rationing of health care.
NICE has improved the quality of the discussion. Amongst policymakers now we can have a much more mature conversation. They openly state the need to prioritize.
Under the NICE model, everything is subject to a strict cost-benefit rationale, including personal behavior. It establishes a scorecard of life value, quantifying our lives into units known as QALYs. (Quality Adjusted Life Years). It factors intangibles such as "social usefulness" and "reciprocity," which reward patients for past exhibition of approved values -- for example, by bumping them higher on a transplant list over their plumper fellow citizens because they maintain a more moderate weight or belong to a favored group. It is the "death panel" on steroids in that it holds sway over access to all medical care, not just expensive life-saving procedures.
NICE assesses the applicability of tests ordered by NHS physicians, the amount of time that should be spent in consultation with patients, and even the brand of pain reliever your doctor can prescribe for a given injury. There was a recent news item in the British press regarding a young man in his twenties who was denied a life-saving liver transplant because the NHS concluded that he hadn't quit drinking for a long enough period. Never mind that he would have been dead for months before satisfying this requirement. NICE is a faceless bureaucracy of bean-counters, people empowered to tip the scales of suffering and death based on a set of arcane formulas and value-judgments to which the public has neither access nor any meaningful input. And our Congress is preparing to midwife such a leviathan right here, on our own soil.
Ridiculously, the Obama administration denies any intention to ration health care, going so far as to assure no possibility of it happening under this legislation. However, in a paper issued by the National Institutes of Health, Department of Bioethics in Bethesda, Maryland titled "Principals for Allocation of Scarce Medical Interventions," we see citations of NICE and its proprietary methodology touted as a model for our own system. It is interesting to note that the paper is co-authored by Ezekiel Emmanuel -- brother of President Obama's "consigliore," Rahm Emmanuel -- which belies the administration's bogus denials. Under this legislation, rationing is not merely a possibility -- it is a foregone conclusion. Rationing is the bedrock of the entire scheme.
Remember, Chalkidou heads the international division of NICE. The NHS is exporting their system to more than sixty countries with whom they have paid working relationships, the U.S. included. Chalkidou is a former Harkness Fellow with The Commonwealth Fund, a private foundation that concerns itself with health policy. She spent a year here in the U.S. writing and lecturing extensively on the merits and application of Comparative Effectiveness Research and Evidence-Based Decision-Making in formulating health policy. These are the animating principles behind everything NICE, and they will become the cornerstone of our new, redistributionist medical system.
Bottom line: This legislation will not only step between a doctor and his patient when determining course of treatment, but it will step ahead of the doctor and decide what tools the physician is allowed to use, not to mention when he may use the tools he already has. The high likelihood of corruption and political cronyism inherent in making decisions using criteria as amorphous as "social usefulness" and "reciprocity" is reason alone to demand the immediate defeat of these bills.
What we are talking about is rationing. We are talking about a system where not everybody can get everything that may help them all of the time, irrespective of cost.
Simple economics inform the decision-making of both the rationer and the innovator. The innovator creates, and the rationer withholds. The current health care legislation offers no solutions to the real problem of securing greater coverage or lower premiums for underserved populations, nor does it address insurance reforms that would allow competitive market principles to incite downward pressure on costs. How many ACORN-like groups will be spawned from such corruption-prone legislation? Is there any doubt that politicians, unions, and government employees will find themselves among the "socially useful"? With the lives of our families literally on the line, do we really trust this Congress and this administration with a responsibility so grave as this?
Liberty is to the collective body, what health is to every individual body. Without health no pleasure can be tasted by man; without liberty, no happiness can be enjoyed by society.
The author may be contacted at firstname.lastname@example.org.