Lehe: GOP wrong to reject ‘rationing’

‘ ‘ ‘ Lately, Republican pundits have vilified the most well-spent billion dollars in the whole… ‘ ‘ ‘ Lately, Republican pundits have vilified the most well-spent billion dollars in the whole $800 billion stimulus: $1.1 billion for ‘comparative effectiveness research.’ Conservative commentator Betsy McCaughey even wrote an article called, ‘Ruin Your Health With the Obama Stimulus Plan.’ ‘ ‘ ‘ Comparative effectiveness research is a type of medical research. Like current medical research, it uses statistics and trials to compare several treatments to see which treatment usually works best against a given ailment. But comparative effectiveness research goes further because it also factors the costs of treatments into comparisons. ‘ ‘ ‘ For example, let’s say that there are two medicines that cure the common cold. MedA cures 50 percent of cases and MedB cures 51 percent. But MedB is 20 times as expensive as MedA. ‘ ‘ ‘ Comparative effectiveness research would not tell a doctor to prescribe MedA or MedB. But it lets us ask, ‘Is curing an extra 1′ percent of patients worth spending an extra 1,900 percent on all patients?’ Maybe, maybe not. ‘ ‘ ‘ This type of questioning has two uses: First, it informs patients about how an extra dollar will likely affect their situation. You might find yourself choosing between spinal surgery and muscle therapy. But without these statistics, you or your doctor will have to act on a gut instinct that’s statistically no better than a coin toss. It’s like gambling, but with much more money at stake than most people will toss around during a whole week in Vegas. ‘ ‘ ‘ Additionally, the system rations government health spending. ‘Rationing’ means that the government would only pay for treatments deemed cost-effective. Your doctor might prescribe a treatment, like MedB, but the government program that provides your health insurance will refuse to pay for the treatment. For the record, Medicare, Medicaid, Veterans Affairs and SCHIP are sources of government health insurance. ‘ ‘ ‘ It’s this rationing that has Republicans frothing: ‘ ‘ ‘ ‘If the federal government spends, as this does, $1.1 billion to begin to figure out what treatments or drugs are more expensive, it’s going to use that information to deny you and your doctor the right to get those treatments,’ said Rep. John Shadegg, R-Ariz. ‘ ‘ ‘ ‘Federal bureaucrats will misuse this research to ration care, to deny life-saving treatments to seniors and disabled people,’ said Rep. Charles Boustany Jr., R-La. ‘ ‘ ‘ I sympathize with Republican concerns about big government. I do not want the United States to be like France or Britain, where government intervenes to make sure everyone has equal access to health care. These governments will sometimes prevent or delay one person’s treatment so that another person can get treatment. ‘ ‘ ‘ However, the claim, ‘It’s going to use that information to deny you and your doctor the right to get those treatments’ is fundamentally a lie. There is nothing tyrannical about government rationing government health care. ‘ ‘ ‘ If you’re on Medicare and the government refuses to pay for a knee surgery, your right to health care is intact. You can still go get 10 knee surgeries if you want to, it’s just that taxes will not pay for them. ‘ ‘ ‘ Taxes will also not buy you a car, even if your doctor is sure it will cure cancer. This example sounds ridiculous, but cancer doctors recently lobbied successfully for Medicare to start covering ‘off-label’ cancer drugs ‘mdash; meaning drugs that are prescribed for conditions they are not approved to treat, and for which there is no clinical evidence that the drugs will work. Some off-label drugs cost $10,000 per month, so in a sense it would be better for taxpayers and patients alike if Medicare really did buy cars for cancer patients. ‘ ‘ ‘ Plus, we already have rationing. Medicare will not pay for your treatment if you are not elderly. And Medicaid won’t pay if you are not impoverished. ‘ ‘ ‘ Yet Republicans don’t advocate extending Medicare or Medicaid to more Americans. Their position seems to be this: Few people should have government insurance because it’s socialist for the government to buy health care. However, should someone have government health insurance, it’s socialist for the government to not buy them health care indiscriminately. ‘ ‘ ‘ Republicans should be smarter than to fret over the ‘R-word.’ Comparative effectiveness is something sober conservatives embrace: It cuts useless spending. Plus, conservatives have always advocated using stats to fire lazy teachers, slash regulations and restructure welfare. ‘ ‘ ‘ If Republicans resist rationing for government health care, will they also start fighting studies that learn how much traffic on a highway will be eased by a new bridge? I guess Republicans are set on applying their ‘Bridge to Nowhere’ ethos to health care. E-mail Lewis at lewis500@gmail.com.