Here's an older article about Tom Daschele's plan (which Obama is using)
I'll post the entire link but just throw in some more salient points for discussion. . . .
now the relavent passages. . .
"We won't be able to make a significant dent in health-care spending without getting into the nitty-gritty of which treatments are the most
clinically valuable and cost effective. That means taking a harder look at the real costs and benefits of new drugs and procedures."
Notice that Daschle is conflating two kinds of comparisons—clinical effectiveness and cost effectiveness. Determining clinical effectiveness—that
is, comparing different treatments to find out which ones work better—is certainly an appealing idea. After all, no patient would want an inferior
treatment when a better one is available. However, determining cost-effectiveness is a much more fraught activity. How much is an extra few months of
life worth? How much more should be spent on treatments that have fewer nasty side effects?
Daschle explicitly models his Fed Health on Britain's National Institute for Health and Clinical Excellence (NICE). NICE evaluates treatments for
both clinical and cost effectiveness. A treatment may be clinically beneficial, but patients may not get access to it through Britain's National
Health Service (NHS) if NICE determines that it's too expensive.
But will comparative effectiveness research really reduce health care spending, as Daschle claims? Not by much and not soon, according to a 2007
report by the Congressional Budget Office (CBO), if the research is limited to comparative clinical effectiveness.
and. . .
But what about cost-effectiveness comparisons? That could indeed save the feds some money, but only at the price of limiting patients' access to
medical treatments. Let's look again at how Britain's NICE operates. According an article in the November 6 issue of the New England Journal of
Medicine, "NICE considers treatments cost-effective if their cost-effectiveness ratio is £20,000 ($34,000) per QALY (quality adjusted life year)."
If an action gives a person an extra year of healthy life expectancy, that counts as one QALY.
How does this work out in practice? Currently, NICE appears ready to rule out four new effective treatments for kidney cancer because they merely
double patients' life expectancies from six months to a year. As Cambridge University oncologist Tim Eisen explained, "If an intervention which
doubles progression-free and overall survival in a disease where nothing else works is deemed to be cost-ineffective, the chances of introducing any
new cancer medication must be deemed remote."
If NICE rules against the new anti-cancer drugs, British kidney cancer patients will have access only to a treatment that is 20 years old and which
works in 10 percent of patients. On the other hand, by paying only for the older treatment, the National Health Service will save British taxpayers
some money. Basically, NICE determines when the good of society outweighs the benefits to individuals. The result is that British NHS patients don't
have access to many treatments available in the U.S., including clinically effective drugs for Alzheimer's, colon cancer, and rheumatoid arthritis.
NICE is a way to administer centralized bureaucratic rationing.
and. . .
Daschle avoids using the "R-word" in his book, and he expresses irritation when asked about it. According to the Black Hills Pioneer, Daschle
recently said, "A myth is that we don't ration. We ration in the worst possible way, on the inability to pay." Of course, the converse formulation
is that we "ration" based on the ability to pay. Most people don't think it's "rationing" when someone pays more for a bigger house, a faster
car, or a fancy restaurant meal. In the health care context, it means that some fortunate people are still free to choose to pay for treatments they
and their physicians think may benefit them.
The CBO report makes it clear that comparative clinical research won't significantly cut health care costs. The upshot is that Daschle's Fed Health
would be able to cut costs only by limiting access to care. Daschle wants to apply Fed Health's cost-effectiveness recommendations to all federal
health care programs (about 45 percent of all U.S. care expenditures). In addition, he suggests that the federal tax exclusion for health insurance
would be retained only for insurance that complies with Fed Health's recommendations. Ultimately, Daschle's talk of comparative effectiveness
research is just a smokescreen for a plan to establish bureaucratic centralized health care rationing.