Wednesday, August 12, 2009

Trust the Government

The Newt Gingrich Letter
Newt Gingrich
August 12, 2009  |  Vol. 4, No. 32

Trust the Government
by Newt Gingrich

How much is one additional year of your life worth?

Or one more year of life for your father or your wife? For your child?

In Great Britain, the government has settled on a number: $45,000.

That's how much a government commission with the Orwellian acronym NICE has decided British government-run health care will pay for one additional year of life for a British subject.
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British Government Bureaucrats Literally Decide if Your Life is Worth Living

The British single-payer bureaucrats arrived at the price of an additional year of life in the same way they decide how much health care all British people will get, through a formula called "quality-adjusted life years."

That means that if you're sick in Great Britain, government bureaucrats literally decide if your life is worth living and, if so, how much longer and at what cost.

If it's more than $45,000, you're out of luck.

A Well-Connected White House Advocate for Allocating Health Care
Based on Perceived Societal Worth

In the highest levels of the Obama Administration there is a theory of how to ration health care that is troublingly reminiscent of the British system of "quality-adjusted life years."

Dr. Ezekial Emanuel is a key health care advisor to President Obama and the brother of White House Chief of Staff Rahm Emanuel. Earlier this year, Dr. Emanuel wrote an article that advocated what he called "the complete lives system" as a method for rationing health care. You can read it here.

The system advocated by Dr. Emanuel would allocate health care based on the government's perception of the societal worth of the patients. Accordingly, the very young and the very old would receive less care since the former have received less societal investment and the latter have less left to contribute.

"Forstall[ing] the Concern that Disproportionate Amounts of Resources
Will be Directed to Young People with Poor Prognosis"

"The Complete Lives System" would also consider the prognosis of the individual.

Quoting Dr. Emanuel: "A young person with a poor prognosis has had few life-years but lacks the potential to live a complete life. Considering prognosis forestalls the concern that disproportionately large amounts of resources will be directed to young people with poor prognosis."

When fully implemented, Dr. Emanuel's system, in his words, "produces a priority curve on which individuals aged between roughly 15 and 40 years get the most substantial chance, whereas the youngest and oldest people get chances that are attenuated."

"Chances that are attenuated" is a nice way of saying the young and the old are considered less worthy of health care and, under this system, will get less.

Once Government Becomes the Provider of Health Care,
Personal Decisions Become Public Decisions

The point is not that a health care rationing system like the one favored by Dr. Emmanuel will be implemented in the United States tomorrow.

The point is that, as in the British system, once government becomes the single payer or even the main payer of health care, what were once intensely personal decisions become public decisions. And as costs rise, government will look for ways to contain them.

The inevitable result of this pressure to control costs will be rationing, whether it occurs during this administration or the next. At some point, the government will be forced to deny care to those who don't meet the latest "quality-adjusted life years" cost-benefit analysis.

So the decision on what treatment to pursue that once would have been made by you and your doctor is now made for you by a bureaucrat using a formula - a formula to literally determine if your life is worth saving.

The Camel's Nose Under the Tent of Health Care Rationing

Societies don't arrive at this point overnight.

British health care was nationalized soon after World War II, but NICE, the health care rationing agency, wasn't created until the late 1990s as a way to control costs.

Today NICE routinely denies Britons life-prolonging drugs that are deemed not "cost effective" - drugs that are widely prescribed in America to treat cancer, Alzheimer's disease and other serious conditions.

The result, studies show, is that Great Britain's cancer survival rates are among the worst in Europe and lag behind the United States.

In America, Rationing Begins with Comparative Effectiveness Research (CER)

In our country, the road to dehumanizing, bureaucratic health care rationing begins with something called comparative effectiveness research (CER). It sounds completely innocent. In practice, CER means comparing different treatments for diseases to see which works best. And what doctor or patient would object to that, right?

The problem is that, in the context of a government-run health care system, comparative effectiveness research becomes a way to find a cheaper, one-size-fits-all approach to medicine that will limit health care choices for patients.

But don't just take my word for it. Congressional Democrats included $1.1 billion in the Stimulus Bill for CER. Report language explaining the bill noted that the treatments found to be "more expensive" as result of the research "will no longer be prescribed" and that "guidelines" should be developed to manage doctors.

Congressional Democrats also killed several amendments to the current health care bill that would have prevented CER from being used to ration care. (To learn more about the common-sense amendments to the bill that have been blocked, click here).

The Government Has Determined You Must Take the Blue Pill

President Obama innocuously described the intended result of comparative effectiveness research like this: "If there's a blue pill and a red pill, and the blue pill is half the price of the red pill and works just as well, why not pay half price for the thing that's going to make you well?"

Listen to what the President is saying here. He's saying that the government is capable of determining which pill works best for you and should therefore only pay for that pill.

But this one-size-fits-all approach goes against everything modern medicine is learning about the genetics of the human body. Different individuals and members of different ethnic and age groups respond differently to treatments. More and more, treatment of diseases like cancer is highly individualized and based on a genetic analysis of both the patient and her disease. Science is leading us in one direction and the administration and the Congress are taking us in the other.

What if you get sick and your doctor says you need the red pill, but the government has determined that the blue pill is what works best for its budget? In a single payer health world, what do you do then?

Creating a Commission to do the Dirty Work

Government bureaucrats limiting health care choices is terribly unpopular of course, which is why politicians use terms like "comparative effectiveness research" instead of "rationing."
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Another method Washington uses to avoid complicity in health care rationing is the creation of government boards or commissions - like Britain's NICE - to do the job for them.

President Obama has expressed his support for using the Medicare Payment Advisory Commission (MedPAC), a commission created to advise Congress on Medicare, to achieve cost savings under health care reform.

Because the commission's decisions could only be over-ridden by a joint resolution of Congress, it would be virtually unaccountable to the people - and nervous members of Congress could blame the commission for unpopular decisions.

Combine this kind of a commission with the "complete lives system" advocated by White House health care advisor Dr. Ezekial Emanuel and you end up with a government rationing board literally determining which Americans should live and which should die.

Just Trust the Government

Supporters of government-run health care dismiss these worries as alarmist. They argue that because their big government health care bill doesn't overtly call for rationing, it is somehow illegitimate to talk about this danger.

But it is always legitimate to consider the long-term consequences of a government program. By refusing to have an honest debate of this issue - to explore honestly the consequences of the "painful choices" that all supporters of government health care say must be made - their argument boils down to nothing more than this:

Trust the government.

Trust the politicians who are passing 1000-page bills they haven't read.

Trust the leaders who are demonizing the citizens seeking to express their disagreement by calling them "un-American."

Trust the advisors who advocate sacrificing the weak and the old and then hide in the shadows.

Trust the government to know what's best for the most intimate, most personal part of you and your family's life: your health.

Go ask a British citizen if it's worth it.

To just shut up and trust the government.


  Your friend,
Newt Gingrich
   Newt Gingrich

Newt's Quick Links:

  • Of course, just because the big government health bill in Congress should be defeated doesn't mean that America's health system isn't in urgent need of reform. For more information about the work we're doing in health and healthcare, please visit the Center for Health Transformation.

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