NCPA - National Center for Policy Analysis


July 23, 2009

Obama Administration officials are saying it in every way there is to say it and the mainstream media is not paying attention: The only way to control health care costs is to get doctors to provide less care -- fewer tests, fewer procedures, fewer everything.  Of course, the Administration wants to eliminate only that care that is "unnecessary."  But HMOs say the same thing, says John C. Goodman, President, CEO and the Kellye Wright Fellow with the National Center for Policy Analysis.

Clearly the Administration does not consider doctors the best judge of what people need. The obvious end game, says Goodman, is that Washington will tell doctors how to practice medicine.

One proposal is the creation of a new federal health board to decide whether health care services are "effective" or "appropriate."  When he first advanced this idea in Critical, Obama health care guru Tom Daschle pointed to the British National Institute for Health and Clinical Excellence (NICE) as the model:

  • NICE has adopted a rule of thumb that health expenditures are inappropriate if they involve spending more than $22,000 to save six months of life.
  • As a result, British cancer patients do not have access to drugs that are routinely available in the United States.
  • The World Health Organization (WHO) estimates that 25,000 British cancer patients die prematurely every year because of these restrictions.

If health care is to be rationed, what's the right way to do it?  Zeke Emanuel (who is also the brother of White House Chief of Staff Rahm Emanuel) wrote an entire article on this subject in the Lancet on January 31, 2009.  Emanuel advocated allocating health resources in order to maximize collective life years.  Suppose a 25-year-old and a 65-year-old have a life threatening disease.  Since the 25-year-old has many more potential years of life ahead of him, he should receive preferential treatment, says Emanuel.  He justifies denying care to elderly patients in the following way:

  • The complete lives system discriminates against older people…. Unlike allocation by sex or race, allocation by age is not invidious discrimination; every person lives through different life stages rather than being a single age.
  • Even if 25-year-olds receive priority over 65-year-olds, everyone who is 65 years now was previously 25 years.

There's more, says Goodman.  In a different article written more than 10 years ago for the Hastings Center Report, Emanuel said health services should not be guaranteed to "individuals who are irreversibly prevented from being or becoming participating citizens."  He continues, "An obvious example is not guaranteeing health services to patients with dementia."

Source: John C. Goodman, "Rationing Health Care," National Center for Policy Analysis, July 22, 2009.

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For Lancet text: 

For Hastings text: 


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