The foundations for health-care rationing and even so-called death panels may have already been quietly laid in largely unreported sections of President Obama’s health-care legislation.
There is also concern for preferential treatment based on race, ethnicity and so-called life preferences.
The Patient Protection and Affordable Care Act, commonly called Obamacare, called for the establishment of a Patient-Centered Outcomes Research Institute.
The new institute’s purpose is to carry out “comparative clinical effectiveness research,” which is defined in the law as evaluating and comparing “health outcomes” and “clinical effectiveness, risks and benefits” of two or more medical treatments or services.
The purpose of the research is purportedly for the government to determine which treatments work best so that money is not spent on less effective treatments.
Such research was already previously alloted $1.1 billion in Obama’s 2009 “stimulus” package. That legislation first created a Federal Coordinating Council for Comparative Effectiveness Research.
Obamacare now allows for about $3.8 billion in additional funding for effectiveness research, with the establishment of the new Patient-Centered Outcomes Research Institute.
The institute is to be governed by a “board” to assist in identifying research priorities and establishing the research project agenda.
Also weighing in will be an “expert advisory panel” of practicing and research clinicians, patients and experts in scientific and health services research and health services delivery.
A section of Obamacare makes clear the secretary of health and human services may not use research data from the new institute in a manner that treats the life of an elderly, disabled or terminally ill individual as lower in value than that of an individual who is younger, non-disabled or not terminally ill.
However, the dictate comes with a qualifier some many find concerning.
Obamacare contains largely unreported text that allows the health secretary to limit any “alternative treatments” of the elderly, disabled or terminally ill if such treatments are not recommended by the new research institute.
Reads that qualifier:
Paragraph (1) shall not be construed as preventing the Secretary from using evidence or findings from such comparative clinical effectiveness research in determining coverage, reimbursement, or incentive programs under title XVIII based upon a comparison of the difference in the effectiveness of alternative treatments in extending an individual’s life due to the individual’s age, disability, or terminal illness.
Paragraph (1) refers to the section that bars the health secretary from valuing the life of an elderly, disabled or terminally ill patient as lower than that of the younger or nondisabled patient.
The qualifier leaves the health secretary with the power to use government-provided research data to determine whether “alternative treatments” are effective in extending the life of the elderly, disables, or terminally ill.
Health-care rationing based on ethnicity?
Another section of Obamacare calls for the new institute to study the effectiveness of treatment in “subpopulations,” including “racial and ethnic minorities, women, age and groups of individuals with different comorbidities, genetic and molecular sub-types, or quality of life preferences.”
The effectiveness of such research has been widely called into question.
In a 2009 study, the CATO Institute raised concern about such government-funded research being politicized or influenced by lobbying.
“Unlike market-generated research, a federal comparative-effectiveness agency would be subject to political manipulation, which could block the generation of any useful research,” wrote CATO.
Continued CATO: “Such research necessarily poses a direct threat to the incomes of pharmaceutical manufacturers, medical device manufacturers and millions of providers. If a government agency produces unwelcome research, those groups will spend vast sums on lobbying campaigns and political contributions to discredit or defund the agency.”
During the “stimulus” debate, Sen. Jon Kyl, R-Ariz., fought the $1.1 billion spending on effectiveness research, spotlighting countries like Britain as cautionary tales.
“Think about this a moment,” Kyl said on the Senate floor. “Do you want Washington bureaucrats, such as those who brought you the AIG mess, making your health care decisions for you and your family?”
Currently, in the U.K., the equivalent to Obamacare’s institute is the National Institute for Health and Clinical Excellence, or NICE.
The New England Journal of Medicine related that “NICE considers treatments cost-effective if their cost-effectiveness ratio is £20,000 ($34,000) per QALY (quality adjusted life year).”
A QALY is an extra year of “quality” life expectancy added based on the treatment.
There were recent reports that NICE was refusing to fund four new treatments for kidney cancer because they only change a patient’s life expectancy from six months to a year.
Andrew Dillon, NICE Chief Executive, commented on the denial of one drug for kidney cancer: “Before we recommend any new treatment we have to be sure the evidence on how well it works is robust and that it is cost effective. We do not want to divert NHS funds to a treatment that costs more but doesn’t help people live longer.”
Writing in Forbes last month, Sally Pipes, president of the Pacific Research Institute, slammed effectiveness research under Obamacare as a “recipe for cook-book medicine, where the government can pressure doctors into prescribing treatments according to average results rather than an individual patient’s needs and preferences.”
With additional research by Brenda J. Elliott
by Aaron Klein