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Not NICE

Obama’s pick to head Medicare and Medicaid highlights the choice we face regarding health care: repeal or rationed care.

1:34 PM, Apr 29, 2010 • By JEFFREY H. ANDERSON
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NICE certainly rations with its eyes open.  On its website, it explains that “choices have to be made.”  Thus, “It makes sense to focus on treatments that improve the quality and/or length of someone’s life and, at the same time, are an effective use of NHS resources.” NICE elaborates: 

To ensure our judgements are fair, we use a standard and internationally recognised method to compare different drugs and measure their clinical effectiveness: the quality-adjusted life years measurement (the ‘QALY’)….

A QALY gives an idea of how many extra months or years of life of a reasonable quality a person might gain as a result of treatment (particularly important when considering treatments for chronic conditions).

A number of factors are considered when measuring someone’s quality of life, in terms of their health.  They include, for example, the level of pain the person is in, their mobility and their general mood.

In other words, if you want treatment, don’t show signs of pain, immobility, or moodiness.  The description proceeds thus:

Having used the QALY measurement to compare how much someone’s life can be extended and improved, we then consider cost effectiveness — that is, how much the drug or treatment costs per QALY….

Cost effectiveness is expressed as ‘£ per QALY.'

Am I the only one who feels a chill? 

The Wall Street Journal aptly summarizes the problem: “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.”  The Journal adds, “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?”

Berwick favors the government board.  In a piece published in 2004, he writes, “Both the UK and the US are struggling to improve their troubled healthcare systems. Which is more likely to succeed?  The two countries are strikingly similar in the problems they face, and equally dissimilar in their plans of action.  I am a fan of both but, when bets are placed, my money will be on the UK.”

In a publication from 2000, he and his co-author write that “we share an optimism about the NHS that is hard to find in the UK nowadays.”  In a plainspoken passage, they add, “We think nationalized health care was a wise choice in 1948 and that it remains so now.”

Thus, President Obama has nominated a man to run Medicare who’s an outspoken advocate of nationalized health care, of NICE, and of U.K.-style cost cutting.  This likely won’t provide much comfort to seniors, who are already alarmed that nearly half of Obamacare would be paid for through cuts to Medicare.  No wonder seniors favor repeal of Obamacare by an even greater tally than the 56-to-40 margin among Americans as a whole (the average across a month’s worth of Rasmussen polls).

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