NCPA - National Center for Policy Analysis


May 28, 2010

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, says Michael Tanner, a senior fellow with the Cato Institute. 

President Obama's nominee for director of the Centers for Medicare and Medicaid Services, the office that oversees government health care programs, is Dr. Donald Berwick, 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 (NHS).  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." 

  • 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 percent 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, says Tanner. 

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. 

Dr. Berwick wants to bring NICE-style rationing to this country.  "It's not a question of whether we will ration care," he said in a magazine interview for Biotechnology Healthcare, "It is whether we will ration with our eyes open." 

Maybe those worries about death panels weren't so crazy after all, says Tanner.  

Source: Michael Tanner, "'Death panels' were an overblown claim -- until now," Daily Caller, May 27, 2010. 

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