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Can You Say ‘Death Panel’?

November 16, 2009

The bright and happy future that ObamaCare has to offer:

In other words, the Medicare commission would come to function much like the National Institute for Health and Clinical Excellence, which rations care in England. Or a similar Washington state board created in 2003 to control costs. Its handiwork isn’t pretty.

The Washington commission, called the Health Technology Assessment, is manned by 11 bureaucrats, including a chiropractor and a “naturopath” who focuses on alternative, er, remedies like herbs and massage therapy. They consider the clinical effectiveness but above all the cost of medical procedures and technologies. If they decide something isn’t worth the money, then Olympia won’t cover it for some 750,000 Medicaid patients, public employees and prisoners.

So far, the commission has banned knee arthroscopy for osteoarthritis, discography for chronic back pain, and implantable infusion pumps for pain not related to cancer. This year, it is targeting such frivolous luxuries as knee replacements, spinal cord stimulation, a specialized autism therapy and MRIs of the abdomen, pelvis or breasts for cancer. It will also rule on routine ultrasounds for pregnancy, which have a “high” efficacy but also a “high” cost.

Currently, the commission is pushing through the most restrictive payment policy in the nation for drug-eluting cardiac stents—simply because bare metal stents are cheaper, even as they result in worse outcomes. If a patient is wheeled into the operating room with chest pains in an emergency, doctors will first have to determine if he’s covered by a state plan, then the diameter of his blood vessels and his diabetic condition to decide on the appropriate stent. If they don’t, Washington will not reimburse them for “inappropriate care.”

If Democrats impose such a commission nationwide, it would constitute a radical change in U.S. health care. The reason that physician discretion—not Washington’s cost-minded judgments—is at the core of medicine is that usually there are no “right” answers. The data from large clinical trials produce generic conclusions that rarely apply to individual patients, who have vastly different biologies, response rates to treatments, and often multiple conditions. A breakthrough drug like Herceptin, which is designed for a certain genetic subset of breast-cancer patients, might well be ruled out under such a standardized approach.

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