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"It is time for US healthcare to be rationed" says President Obama. What he doesn't say is how to do the rationing?
Britain has often praised for spending very little on health care. This cost containment in Britain is due to : the National Institute for health and Clinical Excellence, or (NiCE).
Obama has embraced the NICE basic principles for his new Obama care medical plan. NICE was set up in 1998 with the British health minister acting as caregiver, to ensure that every treatment, operation, or medicine use, is the proven best. It attempts to root out underperforming doctors and useless treatments, spreading best practices everywhere.
In reality, NICE, has become a rationing board. It has reduced spending by limiting the treatments that 61 million British are allowed to receive through their national health service.
NICE ruled against two drugs that prolong the life of breast and stomach cancer patients. It ruled against drugs that would cost about $50,000 that would help terminally ill cancer patients. The director of NICE said, “there is a limited pot of money, and drugs are of marginal benefit at quite often extreme costs”. He stated: “the money might be better spent elsewhere.”
Two years ago, the NICE board restricted access to drugs for macular degeneration, a cause of blindness. One of the drugs was allowed to only one out of five sufferers. The drug was only approved for use in one eye. The hidden meaning is: “if you were lucky enough to get it, you would still go blind in the other eye”. Dillon, CEO of NICE, explained at the time: “treatments are very expensive, and we must use them where they get the most benefit to patients”.
In early stages of Alzheimer's disease, drugs are very restricted in Britain. They ruled that drugs are not cost-effective in early stages, despite doctors from the UK saying it is the most effective way to slow the progress of dementia.
Other NICE rulings include: rejection of drugs for rheumatoid arthritis, multiple sclerosis, and multiple myeloma. American insurers approve all these drugs.
Surgical procedures also have new guidelines in Britain. There is a restriction on fertility treatment, procedures for back pain, surgeries, and steroid injections. In order to reduce government health spending, screening of women under age 25 with Pap smears is not allowed.
All of the above notes that, the only way to control healthcare costs is for the panel at NICE to dictate limits on certain kinds of care to select classes of patients.
There is even a mathematical formula, based on quality adjusted life years. It holds that, Britain cannot afford to spend more than $22,000 to extend a person's life by six months. This is an arbitrary figure, calculated on how much the government WANTS to spend on healthcare. It does not adjust for overall inflation.
These cost-benefit analyses have to figure into health care decisions that we must make in our medical system. US private insurers provide reimbursements for most medical care. The bottom line is: Are decisions going to be dictated by politics, or by prices in a private insurance system?
A moral issue arises, since the last six months of life are particularly difficult. Most health-care spending occurs during that time. Who would you rather have make decisions, about whether a treatment is worth the price-- you with your doctor and insurer, or a government board that cuts everyone’ medical care off at $22,000?
COMMENTARY
The benefits of a private system are that competition allows choice and experimentation. Today. Medicare refuses to reimburse for new less invasive preventive treatments as virtual colonoscopy, despite the procedure being paid by private insurers.
There are some medical consequences to this regulation. Cancer survival rates in Britain are among the worst in Europe. Cancer survival rates in the United States is significantly higher than in Europe (84% versus 73% for breast cancer) and (92% versus 57% for prostate cancer).
Medical innovation and US willingness to reimburse for care are significant factors in improved medical care in the U.S. President Obama argues that, simply automating healthcare records, and squeezing out waste can make huge savings. Britain has done all this, and found it can only rein in medical costs by limiting medical care.
A healthcare system, dominated by the government, always ends up with some version of a board that makes life or death treatment decisions. If the Obama plan passes, taxpayer costs will unbearably soar.
The claim is that, tens of millions of Americans can be subsidized while saving money and improving the quality of care. It is very difficult for this to be done. The plan will result in some version of a NICE board that will tell millions of you that you are too young, or too old, or too sick to be worth paying for your medical care.
You will note that recently, many medical articles are appearing, telling you, the public that many of today’s medical procedures are of no PROVEN value. This is the prelude to limiting your health care options.
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Source: Wall Street Journal July 7, 2009
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