Death Panels -- Alive and Well

Both here and across the pond in the UK, government agencies ration healthcare. In the UK, the rationing board is ironically called NICE, or National Institute for Health and Care Excellence. Under ObamaCare, the comparable agency is IPAB, the Independent Payment Advisory Board. Rationing boards evaluate “cost effectiveness” of treatments and medications, deciding which ones to pay for, or not.

If the rationing board decides to not pay for a particular treatment or drug, patients are out of luck. If the denied treatment is lifesaving, guess what follows? Hence the characterization of these rationing boards as “death panels.” Sarah Palin warned of “death panels” within ObamaCare but as usual was ridiculed by the media. Yet in the UK, their National Health Service (NHS), the model for ObamaCare, just demonstrated another example of their death panels. “Six breast cancer drugs are to be banned from use by NHS patients,” according to the Daily Mail. How’s that for “war on women”?

One of these drugs is Eribulin, which according to the National Cancer Institute, “Demonstrated a statistically significant improvement in overall survival in patients receiving Eribulin compared with those receiving a single-agent therapy.” The problem is the cost, at $6000 per chemotherapy cycle and only “a 12% response rate and a 2.5-month gain in survival.”

These numbers represent averages, however. And averages are not individual patients. The Daily Mail reported one such non-average patient; “I saw a woman in my clinic this morning who has been taking it successfully for six months after other drugs failed and she said there was ‘nothing to compare’.”

Based on language in the Affordable Care Act, the IPAB is, “Charged with enforcing a limit on Medicare spending growth.” A laudable goal, but the only way to limit spending on a service is to provide less of it, or make the recipient pay a larger portion of the cost. Narrow provider networks are one way to provide less service, with fewer available hospitals or physicians to care for patients. Higher copays and deductibles are another method of reducing healthcare expenditures.

The IPAB has many options at its disposal, including limiting access to expensive drugs and technology as well as reducing physician fees. The net result is rationed healthcare. And for some, the lack of care will lead to death, hence the characterization as “death panels.”

Medicaid provides a clear example of what happens when physician fees are cut to an extreme degree. Fewer than half of physicians are willing to accept new Medicaid patients according to a recent physician survey. The result is long waits for appointments and procedures. The VA system illustrated the consequences of delayed medical care with 20 patients dying while waiting for treatment at the Phoenix VA hospital.

There is nothing wrong with using a cost-benefit analysis before spending money. We do that all the time when choosing where to sit on an airplane, what kind of car to purchase, or what to order in a restaurant. But we are making these decisions individually and none of them involve life or death. When it comes to healthcare rationing, the IPAB or NICE are making those decisions for us, and the decisions do involve life or death.

Some may say you should pay for it yourself if the government won’t pay for it. This option is available in the UK, but with a significant catch. Go outside the NHS system and the door closes and locks behind you. “NHS has invoked a policy of refusing care altogether to patients who, often upon physician recommendation, choose to pay out-of-pocket for best-available drug treatments”, according to the Sunday Times.

A breast cancer patient in the UK “Found that out the hard way when she tried to buy Avastin out of her own pocket, only to have her doctor inform her that if she did so, she would have to pay for all her treatment.” Yet she has been paying income taxes of 20 to 45 percent for her “government provided free healthcare”.

For Medicare recipients here in America, it’s no better. Make a private contract with a physician and you are totally on your own. “Medicare won't pay any amount for the services you get from this doctor or provider, even if it's a Medicare-covered service,” according to the web site.

“My way or the highway” is the message from the rationing boards. Accept their denial of care, or have at it, totally on your own, paying for your entire healthcare out of your own pocket.

Suppose you paid for home insurance for twenty years and when your house burns down, the insurance company decides that it’s not “cost effective” to replace your home. Or if you choose to upgrade the replacement they recommend, they refuse to pay anything. American workers have been paying taxes into the Medicare system for their entire working lives and understandably expect to have healthcare insurance in retirement.

So what happens when an unelected and unaccountable rationing board decides you can’t receive the lifesaving or extending treatment you need? Instead of the patient and their physician making these decisions, as it should be, the government is doing all of the deciding. Cancer patients in the UK are learning this lesson the hard way.

President Obama nominated Donald Berwick to run Medicare and Medicaid. Dr. Berwick is a big fan of the NHS; “I am a romantic about the NHS; I love it.” Expect to see ObamaCare morph into a version of the NHS as it continues to unfold. Including rationing. Death panels are indeed alive and well.

Brian C Joondeph, MD, MPS, a Denver based physician, is an advocate of smaller, more efficient government. Twitter @retinaldoctor.

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