Bad side effects

Healthcare | The signs of a system for rationing healthcare began with stimulus package provisions

WASHINGTON-largely lost in the current healthcare debate is that the Obama administration did not wait until the president's televised speech in September to step prominently into the fray but used February's stimulus package to push its healthcare agenda. By allocating $1.1 billion for "comparative effectiveness research"-a phrase often heard in the British healthcare system-the stimulus provided what some fearfully call the first down payment on healthcare that could lead to rationing.

This stimulus expenditure pours $300 million into the Agency for Healthcare Research and Quality, $400 million for the National Institutes of Health, and $400 million for the Secretary of Health and Human Services (HHS). The law also created a 15-member panel dubbed the Federal Coordinating Council for Comparative Effectiveness Research. Tasked with corralling the federal government's health research, the council is to work closely with HHS as well as the departments of Veterans Affairs and Defense to determine "the relative strengths and weakness of various medical interventions."

Its members were named in March and held their first public session in April. They come from more than a dozen federal agencies, including the FDA and Centers for Disease Control and Prevention and other health-related offices. Included on the panel: Ezekiel Emanuel.

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Emanuel is an oncologist who has taught at Harvard Medical School and is the brother of White House Chief of Staff Rham Emanuel. He has written that the prevailing interpretation of the Hippocratic Oath leads to the overuse of medical care and fosters a culture where "reasoning based on cost has been strenuously resisted."

Critics of Democratic healthcare proposals say that you only have to look at the writings of Ezekiel Emanuel to see that rationing-while not discussed publicly-is an ingrained philosophy of some within the administration. And as one of President Obama's top healthcare advisors, his presence on the council is likely pivotal.

"Government-run healthcare has led to rationing everywhere it has been put into place," said Richard Land, president of the Southern Baptist Convention's Ethics & Religious Liberty Commis­sion. "Obamacare is the first bite of that apple."

Andrea Lafferty, executive director of the Traditional Values Coalition, says Democratic proposals to have the government pay for end-of-life counseling also raise concerns. She argues that laws to include government in a private process are dangerous because when the government pays for something it eventually tries to regulate it: "Government bureaucracy is getting invited into our doctor's office."

Despite the proposal's $500 billion in cuts to Medicare, President Obama discounted those fears as byproducts of "scare tactics" in his Sept. 9 speech to Congress.

"Too many have used this as an opportunity to score short-term political points," he told lawmakers. "And out of this blizzard of charges and counter-charges, confusion has reigned."

But Mathew Staver, chairman of Liberty Counsel, predicts that allowing the government to set minimum and maximum coverage standards combined with an expanded pool of insured can only lead to rationing as costs spiral.

While staying miles away from the word rationing, overhaul proponents have criticized the rationale behind certain treatments given to the sick and dying. "I mean, the chronically ill and those toward the end of their lives are accounting for potentially 80 percent of the total healthcare bill out here," Obama has told the media.

Such statements especially raise concerns in light of rationing in other government-run systems. The U.K.'s National Health Service has resulted in longer wait times to see physicians, get diagnosed, and receive treatment. The medical bureaucracy there has nearly doubled in the last four years, with nearly twice as much money funneled to administration and clerical staff as to anti-cancer drugs.

Overtaxed and undertrained nurses and doctors have led to 45 percent higher than expected mortality rates in emergency rooms and a 28 percent increase over the last five years in major surgical errors. That country's medical ruling board, the National Institute for Health and Clinical Excellence, finds itself in regular controversy for such rulings as:

• Denying a drug to almost 100,000 Alzheimer's patients because it is not "cost effective."

• Cutting treatment of 57,000 patients suffering from back pain to save money.

• Delaying macular degeneration medication until a patient goes blind in one eye.

• Warning medical professionals that talking about religion with patients could be considered harassment and lead to dismissal.

Supporters of current healthcare legislation say the establishment of a government-run option to compete with private insurers is a long way from the British single-payer system. Opponents counter that the only distance separating the two is a slippery slope.

Questions and answers

How does the healthcare bill treat illegal immigrants? The House bill states that illegal immigrants are not eligible for the affordable premiums credits given by the federal government to individuals who can't afford insurance. However, there is nothing in the bill to enforce this. In fact, an amendment to make this exclusion subject to the nation's computer database system for background checks (Systematic Alien Verification for Entitlements program, or SAVE) failed in a House committee by one vote. "It's like having a speed limit sign at a place where police have stated they will never patrol," says Steven Camarota with the Center for Immigration Studies. The Congressional Budget Office predicts that covering illegals through the government's proposed healthcare subsidies would cost taxpayers $30 billion annually.

Will there be mandates requiring me to buy insurance? Right now it appears clear that if a bill passes it will include some sort of individual mandate to buy insurance with "acceptable coverage" or face paying an additional 2.5 percent tax to the government. What is not as clear is whether employers also will be mandated to provide insurance or face penalties of up to 8 percent of payroll. Republicans fear that this could lead to job losses in an already bad economy as employers opt to reduce staff instead of paying for coverage. An employer mandate is in the House bill but not in the current draft of a key Senate bill.

I know most Republicans oppose the current healthcare proposal, but what are they for? Conservative lawmakers say they agree that the system is too costly and needs fixing. Among the reforms they favor: allowing small businesses to pool their resources to form groups that could buy health insurance at a cheaper rate; allowing individuals to purchase insurance plans from other states to increase competition among insurers and drive down costs; limiting lawsuits for medical malpractice; making it possible for people with preexisting conditions to buy insurance and not lose coverage when they switch jobs.

Where will the epicenter of the healthcare debate be during September? Pay particular attention to the Senate Finance Committee, which has set a September deadline for legislation that will pay for the proposed changes. Many moderate Democrats in the House, worried about how a vote for healthcare legislation will impact their reelection efforts next fall, will wait and see how the Senate progresses before attaching themselves to a bill that may be DOA in the Senate. The Finance Committee is the last place where even a semblance of bipartisanship is taking place. Three Republicans are in the "Gang of Six" tasked with hammering out a proposal. Expect this group-with Republican Sens. Charles Grassley of Iowa, Mike Enzi of Wyoming, and Olympia Snowe of Maine-to have a pressure-filled month.

Edward Lee Pitts
Edward Lee Pitts

Lee teaches journalism at Dordt College in Sioux Center, Iowa, and is the associate dean of the World Journalism Institute.


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