Sunday, May 30, 2010

Things to look forward to: hearings on confirmation, or rejection, of Dr. Death as director of Medicare-Medicaid

During the debate over ObamaCare, the bill's opponents were excoriated for talk of rationing and "death panels." And in fairness, with a few minor exceptions governing Medicare reimbursements, the law does not directly ration care or allow the government to dictate how doctors practice medicine.

But if President Obama wanted to keep a lid on that particular controversy, he just selected about the worst possible nominee for director of the Center for Medicare and Medicaid Services, the office that oversees government health care programs. Obama's pick, Dr. Donald Berwick, is an outspoken admirer of the British National Health Service and its rationing arm, the National Institute for Clinical Effectiveness (NICE).

"I am romantic about the National Health Service. I love it," Berwick said during a 2008 speech to British physicians, going on to call it "generous, hopeful, confident, joyous, and just." He compared the wonders of British health care to a U.S. system that he described as trapped in "the darkness of private enterprise."

As it becomes apparent that that ObamaCare is unsustainable, the calls for controlling its costs through rationing will grow louder.

Berwick was referring to a British health care system where 750,000 patients are awaiting admission to NHS hospitals. The government's official target for diagnostic testing was a wait of no more than 18 weeks by 2008. The reality doesn't come close. The latest estimates suggest that for most specialties, only 30 to 50 percent of patients are treated within 18 weeks. For trauma and orthopedics patients, the figure is only 20 percent.

Overall, more than half of British patients wait more than 18 weeks for care. Every year, 50,000 surgeries are canceled because patients become too sick on the waiting list to proceed.

The one thing the NHS is good at is saving money. After all, it is far cheaper to let the sick die than to provide care.

At the forefront of this cost-based rationing is NICE. It acts as a comparative-effectiveness tool for NHS, comparing various treatments and determining whether the benefits the patient receives, such as prolonged life, are cost-efficient for the government.

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