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Don’t Think About Rationing

The Democrats are plainly nervous about the “R” word. As they have shown more of their health-care plan, it has become increasingly obvious that the only way to make ObamaCare fly is to squeeze costs — and that means regulating and limiting care. Yes, that is rationing.

The Democrats go to great lengths to deny this. Sen. Herb Kohl assures us that all this talk about rationing is a myth:

I want to be clear that lowering costs has nothing to do with limiting access to care, though opponents of health care reform will try to convince America otherwise. The idea of “rationing” is a myth, and anything resembling it will not be a part of health care reform. No American should ever be kept from a treatment they need. But if we can cut back on unnecessary testing and over-treatment, then our health care system — and America’s patients — will be in better shape.

Got that? It is just whatever is deemed “unnecessary” that will be eliminated. And who will decide? Why, the government. Just as they do in Canada and the U.K., where health care is, well, rationed. In their less guarded moments, supporters of government-run medicine concede that in fact care will be limited. That is what all the “comparative effectiveness” research is about.

The reason Obama’s red-pill/blue-pill spiel was ridiculed was because the choice the president posed was silly. Of course if two pills are equally effective, you choose the cheaper one. But pills aren’t all alike. And patients aren’t cogs (at least not yet) to be medicated, tested, and treated identically pursuant to some cookie-cutter protocol set by a board of bureaucrats in Washington D.C. Rep. Paul Ryan spots the handwriting on the wall:

The first step was taken back in February when the Economic Stimulus package’s fine print set up a new agency (the Council for Comparative Effectiveness Research, or CCER) patterned on Britain’s National Institute for Health and Clinical Excellence (NICE). This agency’s stated purpose is to identify medical practices that produce outcomes that work as opposed to those that don’t work. As long as there is a competitive private health care market, CCER’s impact will be limited. But under a national health care insurance plan, providers will not be paid out of the plan for health care which CCER disapproves of. Once competing plans have been driven out, the government’s approval or disapproval will dictate the care providers may offer to beneficiaries, automatically denying treatments for certain categories of patients.

England’s NICE operates as a rationing bureaucracy. NICE decisions for or against new medicines, surgeries, and other treatments are life-and-death matters. They determine whether patients under Britain’s government health program will be allowed or denied access to preferred forms of care. NICE’s determinations are pushed and pulled by two forces: national budgeting calculations and factional political pressures. Under NICE rationing, the government has capped the amount that may be spent on treatments to extend someone’s life by six months. The amount is $22,000, an arbitrary number chosen by government accountants, not medical professionals.

So when Democrats tell us not to think about rationing, it’s time to think about rationing. The cost “savings” they are going to obtain will come from limiting payments to doctors and hospitals (which in turn will restrict care to patients) and by denying tests and treatment that under normal circumstances the patient’s doctor would hardly consider “unnecessary.” Call it whatever you want, but that’s what rationing is.



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