Trust our government—WHY?


“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.

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. Ezekiel 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.

‘Forestall[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.’ (I plan to post the curve with my next post—my addition.)

‘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?

[From H. R. 3200 page 501 and beyond:

“TITLE IV—QUALITY

Subtitle A—Comparative Effectiveness Research

SEC. 1401. COMPARATIVE EFFECTIVENESS RESEARCH.

(a) IN GENERAL.—title XI of the Social Security Act is amended (NOTICE: This is an amendment to the Social Security Act—my addition.) by adding at the end the following new part:

“PART D—COMPARATIVE EFFECTIVENESS RESEARCH

“COMPARATIVE EFFECTIVENESS RESEARCH

“SEC. 1181. (a) CENTER FOR COMPARATIVE EFFECTIVENESS RESEARCH ESTABLISHED.—

“(1) IN GENERAL.—The Secretary shall establish within the Agency for Healthcare Research and Quality a Center for Comparative Effectiveness Research (in this section referred to as the ‘Center’) to conduct, support, and synthesize research (including research conducted or supported under section 1013 of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003) with respect to the outcomes, effectiveness, and appropriateness of health care services and procedures in order to identify the manner in which diseases, disorders, and other health conditions can most effectively and appropriately be prevented, diagnosed, treated, and managed clinically. (AND managed is a key concept here—my addition.)

“(2) DUTIES.—The Center shall—

“(A) conduct, support, and synthesize research relevant to the comparative effectiveness of the full spectrum of health care items, services and systems, including pharmaceuticals, medical devices, medical and surgical procedures, and other medical interventions;

“(B) conduct and support systematic reviews of clinical research, including original research conducted subsequent to the date of the enactment of this section;

“(C) continuously develop rigorous scientific methodologies for conducting comparative effectiveness studies, and use such methodologies appropriately;

“(D) submit to the Comparative Effectiveness Research Commission, the Secretary, and
Congress appropriate relevant reports described in subsection (d)(2); and

“(E) encourage, as appropriate, the development and use of clinical registries and the development of clinical effectiveness research data networks from electronic health records, post marketing drug and medical device surveillance efforts, and other forms of electronic health data.

“(3) POWERS.—

“(A) OBTAINING OFFICIAL DATA.—The Center may secure directly from any department or agency of the United States information necessary to enable it to carry out this section. Upon request of the Center, the head of that department or agency shall furnish that information to the Center on an agreed upon schedule. (How many new bureaucrats will be necessary to obtain this data?—my addition)

“(B) DATA COLLECTION.—In order to carry out its functions, the Center shall—

“(i) utilize existing information, both published and unpublished, where possible, collected and assessed either by its own staff or under other arrangements made in accordance with this section,

“(ii) carry out, or award grants or contracts for, original research and experimentation, where existing information is inadequate, and

“(iii) adopt procedures allowing any interested party to submit information for the use by the Center and Commission under subsection (b) in making reports and recommendations.

“(C) ACCESS OF GAO TO INFORMATION.—The Comptroller General shall have unrestricted access to all deliberations, records, and nonproprietary data of the Center and Commission under subsection (b), immediately upon request.

“(D) PERIODIC AUDIT.—The Center and Commission under subsection (b) shall be subject to periodic audit by the Comptroller General.

“(b) OVERSIGHT BY COMPARATIVE EFFECTIVENESS RESEARCH COMMISSION.—

“(1) IN GENERAL.—The Secretary shall establish an independent Comparative Effectiveness Research Commission (in this section referred to as the ‘Commission’) to oversee and evaluate the activities carried out by the Center under subsection (a), subject to the authority of the Secretary, to ensure such activities result in highly credible research and information resulting from such research.

“(2) DUTIES.—The Commission shall—

“(A) determine national priorities (Too bad the government doesn’t establish priorities in their yearly budget!—my addition) for research described in subsection (a) and in making such determinations consult with a broad array of public and private stakeholders, including patients and health care providers and payers;

“(B) monitor the appropriateness of use of the CERTF described in subsection (g) with respect to the timely production of comparative effectiveness research determined to be a national priority under subparagraph (A);

“(C) identify highly credible research methods and standards of evidence for such research to be considered by the Center;

“(D) review the methodologies developed by the center under subsection (a)(2)(C);

“(E) not later than one year after the date of the enactment of this section, enter into an arrangement under which the Institute of Medicine of the National Academy of Sciences shall conduct an evaluation and report on standards of evidence for such research;

“(F) support forums to increase stakeholder awareness and permit stakeholder feedback on the efforts of the Center to advance methods and standards that promote highly credible research;

“(G) make recommendations for policies that would allow for public access of data produced under this section, in accordance with appropriate privacy and proprietary practices, while ensuring that the information produced through such data is timely and credible;

“(H) appoint a clinical perspective advisory panel for each research priority determined under subparagraph (A), which shall consult with patients and advise the Center on research questions, methods, and evidence gaps in terms of clinical outcomes for the specific research inquiry to be examined with respect to such priority to ensure that the information produced from such research is clinically relevant to decisions made by clinicians and patients at the point of care;

“(I) make recommendations for the priority for periodic reviews of previous comparative effectiveness research and studies conducted by the Center under subsection (a);

“(J) routinely review processes of the Center with respect to such research to confirm that the information produced by such research is objective, credible, consistent with standards of evidence established under this section, and developed through a transparent process that includes consultations with appropriate stakeholders; and

“(K) make recommendations to the center for the broad dissemination of the findings of research conducted and supported under this section that enables clinicians, patients, consumers, and payers to make more informed health care decisions that improve quality and value.

“(3) COMPOSITION OF COMMISSION.—

(A) IN GENERAL.—The members of the ….”

The real question on this “Comparative Effectiveness Research” section is this: Do you TRUST the government? I do NOT. I will never trust a government which condones MURDERING unborn babies as a right, which believes that homosexual behavior should receive special protections, and which tries to remove GOD from the public arena. I also don’t TRUST a President who, within one month of office, issues an executive order allowing the MURDER of unborn babies around the world and calls protests against those MURDERS “stale and tired arguments.” Unless, of course, GOD is “stale and tired.” HE IS NOT!—my addition]

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 (And there are gender differences too—my addition.) 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. Ezekiel 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:

(As I’ve said before, economically it is impossible to add millions of new members to the system, increasingly add more benefits, and make the whole system affordable without increasing taxes, creating greater deficits, and/or rationing healthcare. Just look at Social Security, Medicare, and Medicaid! All three—increased taxes, deficits, and rationing—have happened to all three programs and the government is still talking about “fixing” these three programs. Now they want to ad a fourth system to cover everyone else in the United States! It’s economic insanity! Barack Hussein Obama DOES NOT HAVE enough magic wands. Wait! He does NOT have any magic wands!

Trust him? During the campaign didn’t he declare that like everyone he wanted to see less MURDER of unborn babies although he supported these same MURDERS? Then, in less than one month after taking office, he signed an executive order to pay for the MURDER of unborn babies in other countries while declaring he was not going to listen to the same “tired and stale arguments” against such MURDERS. Trust Barack Hussein Obama? Trust a person who supports and promotes the MURDER of unborn babies? NEVER!!!—my addition)

Trust the government.

Trust the politicians who are passing 1000-page bills they haven’t read. (And don’t understand!—my addition)

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. (Actually, it is your spiritual life!—my addition)

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

To just shut up and trust the government. (Trust us! We are MURDERERS of unborn babies, but TRUST US!—my addition)

Your friend,
Newt Gingrich”