A Wall Street Journal article explains that — contrary to the promises of President Barack Obama and supporters of his health care plan — rationing of health care is happening and will become more pervasive.
Citing the story of Avastin (see below), the authors write “The Avastin story is emblematic of the government’s broader agenda to ration care based on cost and politics. Once ObamaCare comes into full force, such rationing will be pervasive. When the government sees insufficient benefit, all but the wealthiest and most politically connected will have to go without.”
The article explains the doctrine of “comparative effectiveness,” used in England to ration health care, and how the 2009 stimulus bill allocated $1.1 billion to study this.
Additionally, end-of-life counseling has been revived through regulation, not legislation. This, the authors write, “might coax the elderly away from life-sustaining but expensive treatments.”
Where I might disagree with the authors is in this passage:
There’s an enormous difference between government-imposed rationing and treatment decisions in the private sector. When insurance companies deny coverage — for example, on grounds that treatment is “experimental” or not “medically necessary” — they do so based on contract language agreed to in advance by subscribers. If you don’t like what a particular insurer offers, you’re free to shop around.
The idea that people can shop around for health insurance is not a reality for most people. For those who receive insurance from their employers, they get what the boss offers, maybe with a few choices. Contrast this with the lightly-regulated automobile insurance market, where policies are available with many options, and insurance companies actively compete for customers. Those on Medicare get what the government provides, although many seniors shop around for a supplemental policy that meets their needs.
If the health insurance market were less regulated, particularly eliminating the perverse practice of insurance being tied to employment, a market would likely develop where customers would be able to shop for or specify policies that meet their needs. If someone wanted a policy that would pay for experimental, cutting-edge treatments, they could pay an additional amount for such a policy. I have no idea how much extra this option would cost, but I imagine we would be surprised at how little it would be.
Or, if someone has signed an advance directive indicating that they do not want extraordinary and expensive care at the end of their life, shouldn’t they be allowed to buy policies that specify this as part of the contract between the insurance company and the insured? That could save a lot of money.
The rationing of health care has implications for economic development in Wichita. The State of Kansas and Wichita are making a large investment in Center of Innovation for Biomaterials in Orthopaedic Research. This center seeks to make advancements in medical devices, including artificial hips and knees. These types of operations, however, are the type of medical care that we can easily foresee will be restricted as the federal government seeks to control spending on health care.
‘Death Panels’ Come Back to Life
The FDA’s restrictions on the drug Avastin are the beginning of a long slide toward health-care rationing.
Earlier this month, the Food and Drug Administration banned doctors from prescribing Avastin, a potent but costly drug, to patients with advanced-stage breast cancer. According to the FDA, the drug doesn’t offer “a sufficient benefit in slowing disease progression to outweigh the significant risk to patients.” Yet in some clinical trials Avastin has halted the spread of patients’ cancer for months, providing respite to women and their families wracked by physical and psychological pain.
Ponder the FDA’s justification—there wasn’t “sufficient” benefit in relation to Avastin’s risks. Sufficient according to whom? For your wife, mother or daughter with terminal breast cancer, how much is an additional month of good-quality life worth? And what costs should be weighed? Like all drugs, Avastin has side effects including bleeding and high blood pressure. But isn’t the real cost to these women a swifter, less dignified death? The FDA made a crude cost calculation; as everyone in Washington knows, it wouldn’t have banned Avastin if the drug cost only $1,000 a year, instead of $90,000.