2009-09-04 / Columnists

It's My Turn

Facts Are Not Distortions
By Robert Goldberg Vice President, The Center For Medicine In The Public Interest

When it comes to evaluating the claims of Democrats about rationing and how to deal with grandma, I am guided by that great philosopher, Marx. That's Groucho, not Karl, who famously said, "Who do you believe, me or your eyes?"

The President and Democrats are promising that there will be no "death panels" and that no one will "pull the plug on grandma."

I am not worried about death panels or plugs being pulled. I am worried about expanding government power about what to pay doctors, how to allocate care, and telling me a treatment is ineffective, wasteful, or unnecessary.

That's government rationing. And it will happen.

The House and Senate health bills would require 20 million Americans to use Medicaid for healthcare coverage. That doubles the number of people on Medicaid and reduces Medicaid's already low reimbursement rate. Cutting payments to doctors and hospitals to subsidize the health premiums of Generation X-ers who can afford to pay for insurance but don't leads to rationing.

The White House and Democrats respond that there is rationing by private insurance companies. Yes, companies use "comparative-effectiveness research" (CER) to decide what new technologies to pay for. By ignoring individual differences and information from the real world, CER studies usually show that there is no benefit to new treatments.

There is also rationing by government agencies such as Medicaid, Medicare, and the VA system. All using CER.

Forget about grandma for a second. How about the kids? Edith Andrews of Zanesville, Ohio, faced that problem last year when her twin girls, Sara and Samantha, were born prematurely. Each weighed less than 3 pounds and needed a ventilator to breathe.

According to an article in the Cincinnati Enquirer: "To get care she had to take her infants to a Zanesville clinic or an emergency room, where they saw a different doctor every time, if they saw a doctor at all."

When Sara's lung collapsed, Edith couldn't find a Medicaid pediatrician to care for her. "Sarah's complications got worse and worse, and there was never a doctor around when I needed to talk to somebody." She finally found a doctor to take her daughters on as patients after a year of searching.

No rationing? According to a 2007 Wall Street Journal article, Nicole Garrett's three teen-age children lost their private coverage, so she enrolled them in Michigan's managed-care Medicaid program.

When Nicole's 16-year-old daughter, Jada, needed to see a rheumatologist, the one listed in her managed-care Medicaid plan's network would not see her.

By the time she found a Medicaid-approved rheumatologist in a nearby county, Jada's debilitating pain had caused her to miss several weeks of school.

CER is already being used in Medicare.

Two years ago, Medicare used CER to eliminate differences in the amount of blood-boosting drugs available to elderly cancer patients. The result? More seniors required more transfusions instead of a one-time shot of a drug to maintain healthy red blood-cell levels.

Congress and the President pushed for $1.1 billion of comparative effectiveness studies mostly doled out by the Agency for Healthcare Research and Quality (AHRQ). According to proponents, it's all about "eliminating unnecessary procedures and hospitalizations."

Starting with Medicare.

AHRQ would also examine how to "control" costs where the money is now spent: seniors with chronic illnesses such as cancer and end of life care, special-needs kids like Jada and Sara, and low birth-weight infants fighting to survive.

The Jadas and Saras of America will feel the effect immediately. Those who are sick at the beginning and end of life will wait longer for fewer advances. Death panels and pulling plugs? No. Rationing that limits our freedom to choose and seek out the best care possible? Believe your eyes, not me.

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