Trust the Government

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. 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,

♦Of course, just because the big government health bill in Congress should be defeated doesn’t mean that America’s health system isn’t in urgent need of reform. For more information about the work we’re doing in health and healthcare, please visit the Center for Health Transformation.

♦The Newt.org Store is running specials on autographed books. Click here.

♦ And don’t forget Ronald Reagan: Rendezvous with Destiny and other DVDs hosted by Callista and me, also available.

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Comments

By janiep @ Monday, August 17, 2009 10:20 AM

mrrivard, thanks for your reply.

As I said, I am a UK citizen and can speak firsthand that our National Health Service is one of the best-loved things about Britain to those of us who live here. It saw me into the world, it treated my father for Motor Neurone Disease and my mother for breast cancer. It has treated me for a myriad routine minor ailments, most recently an eye infection which saw me treated by a consultant at a specialist eye hospital same day, no wait.

You can either choose to believe me or not when I say that I and my fellow UK citizens whole-heartedly support the NHS. The UK is a democracy: do you think that if the NHS wasn't working, we wouldnt' vote to change it? But we haven't: in the 60 years of its existence not one government, not one, has dared to tamper with it, because they know that it enjoys huge public support.

I hope that this first hand evidence from a user (and, as a tax-payer, a funder) of the NHS will count for something in your eyes.

As I said, I am not trying to interfere in the debate which Americans are now engaged in: that is a matter for you. What I am trying to do however is correct blatant and cynical misrepresentations of the NHS, such as Mr Gingrich's assertion above that British bureaucrats "LITERALLY decide if your life is worth living". This is a lie. You are Americans, living in the land of the free: don't let your politicians lie to you, you deserve so, so much better than that.

By mrrivard @ Monday, August 17, 2009 8:47 AM

janiep ... I like a good blog as well as the next person . I am referencing friends, people I know personally. I can Google anything and get all types of positive and negative information and opinions. What I wrote of is a fact to me because I know these people. I know how high their taxes are in the UK and Canada. I know how their illnesses and allergies are treated in these countries versus their experiences in the US. I am not a sheep who will believe everything I read... I either research facts or find someone I know personally that is reiable. Any intelligent person would do the same. Dig for facts, not opinions. Based on what I have found. I still believe we in the US should "fix the wheel" not re-invent it.

By bettyboop4234 @ Sunday, August 16, 2009 2:51 PM

Excerpt from the conclusion of Ron Emanuel's article: Accepting the complete lives system for health care as a whole would be premature. We must first reduce waste and increase spending ………. Sound familiar? Increase spending and reduce waste? Obamanomics in a nutshell. So far we’ve only seen the increase spending part. Reducing waste may be even harder to swallow, depending on what “waste” they want to reduce. The article written by Obama’s health care advisor, Ezekiel Emanuel, et al, gives us an example of one way they may “reduce waste” in the health care system. (Obama says he won’t “pull the plug on grandma.” Actually, he just won’t plug her in to begin with.)Even though the principles of the “Complete lives system” proposed in this article are not spelled out in the health care bills, the bills are just a step in that direction. HR3200 sets up a bureaucracy that will establish the rules of the government controlled system and you can bet they will incorporate this proposal in it. And if you think they aren’t working toward a government controlled system, think again. I have read most of the extremely long, boring very hard to understand bill. By 1/1/2013, all health insurance companies must either join the government’s “Health Insurance Exchange,” which will be controlled and regulated by the bureaucracy the bill establishes, or they will not be able after that date to change any of their policies, premiums, or coverage, or enroll any new customers, thereby preventing them from being competitive with the Health Insurance Exchange and driving them to bankruptcy. Within the Exchange, there will be a “Public Option,” which will compete with the various insurance companies who join the Exchange. Hmmmm…..I wonder how long the other companies will be able to compete with the non-profit public option without going bankrupt.) Obama also gave the example of UPS and FEDEX doing great, “it’s the Post Office that’s struggling. “ UPS and FEDEX are not regulated and controlled by a bureaucracy in the federal government, are they, but the Post Office is. Why should that make us feel any better about government run health care?

By janiep @ Sunday, August 16, 2009 2:04 PM

Mrrivard, take a look at what this American who lived in the UK thought of the NHS:

http://potentialandexpectations.wordpress.com/2009/08/13/this-americans-experience-of-britains-healthcare-system/

The citizens of the USA should make their own choice about their nation's healthcare and I hope you have a good and open debate about your options, but as part of that debate STOP MISREPRESENTING THE UNITED KINGDOM'S NATIONAL HEALTH SERVICE.

It does no-one any good to misrepresent facts as part of the debate.

By mrrivard @ Sunday, August 16, 2009 8:52 AM

You are exactly right. Why re-invent the wheel...fix the healthcare/insurance problems, do not worsen them. Too many people don't realize that a large portion of the USA un-insured citizens choose that. There is affordable healthcare but some make a choice not to purchase. That is their choice, Obama shouldn't punish the nation as a whole because of it.

In reference to health care in the UK and Canada. I have friends from the US who have had to work in both places and utilize their "healthcare". Long waits, lack of medicines, overcrowded ERs (hey it's free so many who only need a meal or bed will show up)...these things both countries seemed to have in common. At one point my friend had kidney stones, painful but simple enough -in the US. She was told she had gas twice and after 3 trips and intervention from her previous doctor in the US it was found that she not only had stones, but also had a severe kidney infection. After a week she did get IV antibiotics... What a joke! I for one do not want socialized healthscare. Fix the wheel.

By janiep @ Friday, August 14, 2009 6:52 PM

Me again.

We Brits are so good at health care we're actually bringing it to the USA where it appears you can't look after your own: http://m.telegraph.co.uk/;s=jO1pK226fMSTCIGUAMDNCw01/article/6030211/

Call yourselves Christians? You ought to hang your heads in shame.

Yours,
A very proud Brit, who LOVES the wonderful NHS.

By janiep @ Friday, August 14, 2009 6:48 PM

This is a terrible slander on my country and on one of our most beloved institutions which has stood the test of over 60 years. We love the NHS. The government doesn't put a price on each year of your life; instead all political parties are committed to the wonderful NHS and the provision of the best possible medical care to ALL citizens, free at the point of delivery. I've followed Newt's tweets with interest; although I don't share his political views he has until now come across as hard-working and intelligent. But this blog on the wonderful NHS is a farrago of lies. His reputation lies in tatters.

As the poster above said, ask Dr Stephen Hawking, world-renowned scientist and satisifed customer of the wonderful NHS.

We love the NHS!

By jbkernan @ Friday, August 14, 2009 3:41 AM

I feel for Mr. Gingrich. He must be doing everything he can to keep his job, but get out of the terrible government run health program Congress provides him.

By jbkernan @ Friday, August 14, 2009 3:33 AM

One wonders why automobiles have better insurance coverage than most people in the USA.

All automobiles have insurance. According to the U.S. Census Bureau, nearly 46 million Americans, or 18 percent of the population under the age of 65, were without health insurance in 2007. It can't be better in this recession.

So as a society, damage to an automobile is more important to us than damage to a human being. That is why car insurance is mandated and human health insurance is not. Where does that fit in our judeo-christian values?

By notageorgiapeach @ Thursday, August 13, 2009 1:44 AM

Please ask a British citizen - Steven Hawking comes to mind. He seems pretty satisfied with the treatment he's received.
This issue is too important to be hidden behind lies and misinformation. I know it may be difficult but please return to an honest, aboveboard and unemotional discussion of health care issues for the benefit of the citizens of the US of A. Or do you care about them at all?

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