12XLR8

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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Think it could never happen here? Then you need to pay closer attention to what Washington is planning for your health care.
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."


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

cutter

What amazes me is that Administration members are on record as recently as today, 08/13/09, as saying that the conservative position that this health care idea in all its forms is bad while every poll on the subject, no matter who took the poll, is saying that a majority of the American people are against it. There are no two ways about it folks, the Administration is lying and they know it. Their hope is that they will lie convincingly enough to make enough of us to give up to change the numbers in their favor.

cutter

Something occurs to me. I remember back in the Roe vs. Wade days, one of the arguments to legalizing abortion was that to do so would bring the procedure out of the shadows of the black market and make it "safer". Now abortion's "safety" is something of a re-defining of the word from the aborted child's point of view, but that is another discussion for another time.

It occurs to me that we are going to have a similar situation in practice if any of these disastrous health care "reform" bills go through. It seems to me that if the Government refuses to cover a given treatment or procedure for whatever reason, the patient will simply seek it on the black market. There is no question that there will be doctors and other medical professionals who will provide these black market treatments. People are people. If someone wants or needs something bad enough, they will obtain it however and wherever they can and pay any price they can afford for it. It is equally true that there are people who can provide whatever that something is, if they smell profits in the deal. No doubt the price will be high and the quality of facilities and even providers will be questionable and vary greatly from one to the next, but they will exist.

If anybody has any doubts, ask yourself this. If it were your spouse, child, parent, or yourself that either needed a given treatment or would most certainly die a lingering, painful and premature death, the Government refused to cover it (essentially forbidding it), you could get it on the black market, and had or could get the money to pay for it on that same black market, would you do it? I don't even have to think on my answer. I would do it in a heartbeat and that with a clear conscience.

I wonder if they have a "medical black market" in Britian.

12XLR8

You're right that's human nature. I don't care what end of the pay scale you're in if it's your family you'll get it one way or another. It's just the rich will have a easier time because they have the money.

cutter

You know, I once knew me a doctor that still made house calls. He carried his "little black bag" and everything. He drove a cargo van 3 days a week to folks' homes and generally had his office in the back. He was an old, wrinkled country doctor with sparkling blue eyes, a ready smile, a kindly manner, a very dry wit, and a superb bedside manner. He was fond of drinking a cup of coffee with is patients when he came to call, was known to talk with them about everything from the patient's doctoring to the weather to crop yields. He was even known to to have a great weakness for cherry pie and peach cobbler. He was reasonable in his fees and accepted cash, check, chickens, cheese, milk, fresh vegetables, and even butchered meat in exchange for his services. You never hear of that anymore. We really lost something in our health care when doctors quit making house calls. Back then, doctors knew better what they were up against because the patients were generally friends of the doctor and the doctor knew how they lived as well as what ailed them. I have a feeling that we will see something like this quietly resurrect itself if this "health care reform" passes in any of its current forms.

BTW, the old doc is dead now. While he lived he was never a truly wealthy man, but he lived comfortably and well. He died beloved and his funeral was standing room only.

12XLR8

Wow that was quite a guy ! the world would be so much better if they're more people like that around. Most of the doctors here drive mercedes, Lexus, land cruisers, land rovers etc. and live in the rich part of the island.
But I do have to say they have a hard job.

cutter

Oh don't fool yourself, Doc owned a vintage Rolls-Royce. The thing always looked like he was driving it home from the showroom floor. It just so happened that that car was his one true passion outside of his God, loved ones, and patients. The man knew where his priorities were. He once said that he saved for over 10 years to buy that car and spent another 5 years restoring it as he had the spare money to do so.

He was a practical man. He knew that if he took food in exchange for minor services, he would not have to buy it at the grocery. Generally, he received more food for his services than his fee would have bought. He was tickled to death to barter for his services. He did some of that to get the Rolls fixed up. He understood that often people judge their time and labor as less valuable than their limited money. I run power to your shed and you service my heating and air conditioning. We each buy the parts at cost. I'm out 20 bucks for freon and a new thingamajig and you are out 30 bucks for wire and a couple of plugs. We both call the actual work we did for each other "trading favors". You don't think about the value of crawling under my house to service my furnace any more than I think about digging the trench to put your electric line in. We both talked and joked and generally enjoyed each other's company while doing both projects. We see it as something of a social event where we just happened to sweat a lot. See what I mean?

And yes, Doc was a great and honorable man. He was also a strong Christian, which was the most common reason he gave for doing what he did, both in medicine and in his life.

12XLR8

But he didn't do it for just the Money he actually cared for the people he treated. I believe that's a big difference. When at the hospital I see the youger generation that's working there ( Intern etc. ) doing it for the money
you can tell by their body language, tone of their voice, and over all attitude.

money30

Think it could never happen here? Then you need to pay closer attention to what Washington is planning for your health care.
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."