And finally, Newt discusses this in Sunday's papers: Trust the government?
By Newt Gingrich
Sunday, August 16, 2009
pittsburghlive.com
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.
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.
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 adviser 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.
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. "The Complete Lives System" would also consider the prognosis of the individual.
Quoting 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 prognoses."
When fully implemented, 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. Emanuel disavowed his position last week.
The point is not that a health care rationing system like the one once favored by Emanuel 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.
The road to dehumanizing, bureaucratic health care rationing begins in the United States 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 a result of the research "will no longer be prescribed" and that "guidelines" should be developed to manage doctors.
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: The government is capable of determining which pill works best for you and should therefore pay only for that pill.
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?
Government bureaucrats limiting health care choices is terribly unpopular, of course, which is why politicians use terms like "comparative effectiveness research" instead of "rationing."
Supporters of government-run health care dismiss these and other 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 1,000-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 advisers 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 your 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.
Newt Gingrich, a Republican, is the former speaker of the U.S. House of Representatives.
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