A Wall Street Journal editorial shows how England's NICE bureaucrats will ration care not so nicely. WSJ editors write:
The British officials who established NICE in the late 1990s pitched it as a body that would ensure that the government-run National Health System used "best practices" in medicine. As the Guardian reported in 1998: "Health ministers are setting up [NICE], designed to ensure that every treatment, operation, or medicine used is the proven best. It will root out under-performing doctors and useless treatments, spreading best practices everywhere."
What NICE has become in practice is a rationing board. As health costs have exploded in Britain as in most developed countries, NICE has become the heavy that reduces spending by limiting the treatments that 61 million citizens are allowed to receive through the NHS.
WSJ editors add detail on how decisions are made:
We could go on. NICE is the target of frequent protests and lawsuits, and at times under political pressure has reversed or watered-down its rulings. But it has by now established the principle that the only way to control health-care costs is for this panel of medical high priests to dictate limits on certain kinds of care to certain classes of patients.
The NICE board even has a mathematical formula for doing so, based on a "quality adjusted life year." While the guidelines are complex, NICE currently holds that, except in unusual cases, Britain cannot afford to spend more than about $22,000 to extend a life by six months. Why $22,000? It seems to be arbitrary, calculated mainly based on how much the government wants to spend on health care. That figure has remained fairly constant since NICE was established and doesn't adjust for either overall or medical inflation.
Proponents argue that such cost-benefit analysis has to figure into health-care decisions, and that any medical system rations care in some way. And it is true that U.S. private insurers also deny reimbursement for some kinds of care. The core issue is whether those decisions are going to be dictated by the brute force of politics (NICE) or by prices (a private insurance system).
The last six months of life are a particularly difficult moral issue because that is when most health-care spending occurs. But who would you rather have making decisions about whether a treatment is worth the price -- the combination of you, your doctor and a private insurer, or a government board that cuts everyone off at $22,000?
Read the entire editorial for more grim detail.
Then read this New York Times front-pager recounting to-and-fro between interest groups, the White House and 44's HC allies in Congress. Here is one nugget:
Over the past year, Mr. Baucus, Democrat of Montana, has strong-armed industry groups, warning them not to publicly criticize the process if they want to stay in negotiations.
Mr. Baucus, in turn, has said little about his talks with industry players. On Tuesday, he said only that he was “heartened” by how many groups were supporting the health care overhaul.
Question of the Day: If this is how your friendly federal government conducts negotiations with constituent groups, how much sympathy will you get from HC bureaucrats when seeking coverage?
Bottom Line. All HC systems ration care, as resources are never infinite and demand is nearly so. Political rationing will favor constituent groups and those with great political power. Economic rationing will, if unleavened by remedial assistance to those of limited economic means, allocate care to those with purchasing power.
The difference, though, is that by providing people with subsidies in one form or another, we can augment purchasing power to narrow gaps. Full economic equality is not affordable anywhere on the planet. The risk is that Team Obama successfully sells a public system, based upon a leveling down of economic differences. For levelers, it is better that all be equally poor than that all are more prosperous, with some more prosperous than others.
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