Monday, November 14, 2011

Palmisano on CER and Rationing

In this 11/11/2011 New Orleans Times-Picayune OpEd, Dr. Donald Palmisano explains why we should "Beware use of data to ration health care".

In particular, he describes how federally-funded "comparative effectiveness research" (or CER) will be used as a stepping stone to government medical rationing. One excerpt:
How exactly would this work? Take rheumatoid arthritis, for example. If tests done on rheumatoid arthritis drugs A and B revealed that Drug A was effective for 80 percent of patients, while Drug B was only effective for 20 percent, the government could refuse to cover Drug B for patients, leaving 20 percent of patients no choice but to purchase the drugs themselves or go without treatment.

At the last minute, language was inserted into the legislation to alleviate growing public concern that CER could be used for rationing. However, at a time when lawmakers are desperate to find cost savings in health care, I believe that the law eventually could be manipulated to meet the needs of these lawmakers.

This is not a far-fetched idea. In fact, CER data is already used for just this purpose in England, where the National Health Institute routinely denies patients treatments that CER has determined insufficiently cost effective.
In other words:
Although the authors of the report seemed to understand that CER is not meant to be used for rationing, they nevertheless recommend that services included in the essential health benefits package should be "cost effective, so that the gain for individual and population health is sufficient to justify the additional cost to taxpayers and consumers."

It is only a matter of time before cost-cutting bureaucrats turn to CER results as an excuse to cut health care costs.
(Read the full text of "Beware use of data to ration health care".)

The other half of the rationing piece is the widespread use of government-mandated electronic health records (EHRs). That way, physicians who stray too far from government CER guidelines can be punished for failure to deliver "appropriate" care. Even if few physicians are actually punished, the threat of punishment will be enough to keep most physicians in line with government controls.

Those Americans who still value their medical freedom still have time to act to protect it. But time is running short. Once these programs (CER and EHRs) are fully implemented over the next few years, it will be much harder to undo them.