The Stimulus Package and Health Care Reform: Change We Fear
On February 17, President Obama signed the American Recovery and Reinvestment Act of 2009. Many are asking whether this is a down payment on universal healthcare. If so, what is the future of healthcare in America, including that of natural and alternative medicine?
Buried in this legislative monstrosity are two provisions that could have far-reaching consequences on access and availability to natural medicine and other alternative therapies specifically, and on freedom of choice in healthcare generally.
In this blog entry, we will address freedom of choice in healthcare. In the next entry, we will address the future of alternative medicine.
Comparative Effectiveness Research and Electronic Health Records
Under the Act, the Federal Coordinating Council for Comparative Effectiveness Research has now been created. The Council’s purpose has yet to be meaningfully explained. The description in the Act only states that the Council shall “foster optimum coordination of comparative effectiveness and related health services research” “with the goal of reducing duplicative efforts and encouraging coordinated and complementary use of resources.” (1)
In a separate portion of the Act, it specifies that $700 million has been allocated for this “comparative effectiveness research” with an additional $400 million made available for such research at the discretion of the Secretary of Health and Human Services. What is this research for?
According to the Act, such research will be conducted by the government to assess and compare “the clinical outcomes, effectiveness, and appropriateness of items, services, and procedures that are used to prevent, diagnose, or treat disease, disorders, and other health conditions…” In other words, the government now has the authority to make official determinations as to the effectiveness of medical treatments and devices. This research will also be used to develop “clinical registries” and “clinical data networks.” It is unclear what these registries and networks will be used for other than housing “outcomes data.”
Also in the Act is a section dealing with the promotion of health information technology. Under the Act, the National Coordinator of the Office of Health Information and Technology is charged with seeing to it that every person in the United States has an electronic health record by 2014. These electronic health records would be used for many purposes, including data collection, “biosurveillance,” and to facilitate the “continuity of care.”
Combining comparative effectiveness research with electronic health records can open up the door to government interference in the doctor-patient relationship, the ability of the government to overrule the clinical decisions of private physicians, and less freedom of choice in healthcare decisions for patients.
It is no secret that the Obama administration is pro- centralized healthcare decision-making, and President Obama himself supports a single-payer system. We only have to look to Tom Daschle, President Obama’s original pick for Secretary of Health and Human Services to see the direction in which we may be headed. While Daschle withdrew his name from consideration, his concepts echo in the current administration’s moves toward government-controlled healthcare. In Daschle’s book Critical: What we can do about the health-care crisis, he promotes the formation of a Federal Health Board, which would carryout cost-effectiveness research. Its recommendations would be mandatory for federal health programs. While that would initially affect only enrollees in government health programs, Daschle proposes that Congress could link the tax exclusion for health insurance that complies with its recommendations. In other words, in the private sector, not complying with the Board’s recommendations could lead to severe tax penalties. In practice, as Peter Barry Chowka, an investigative journalist and former advisor to the National Institute of Health, points out, this would probably be the end of the independent private-sector healthcare in America, as no health insurance would be sold if it was denied the tax deduction. (2) As a result, “every policy, every standard decided by this board would be the law of the land for every drug company, every hospital, every doctor, every health insurance company.” (2)
In Daschle’s scenario, the Federal Health Board would be akin to the National Health Service (NHS) in England, a group which Daschle applauds. (3) As is necessary when dealing with nationalized, single payer healthcare systems (which President Obama favors), healthcare must be rationed to citizens based on the budget. In England, this means that the NHS rations through long waiting lists and omission of treatment. (3) First, take it from someone who’s lived there: When it comes to waiting lists, by the time you’re able to see a doctor and receive treatment, in most cases, the illness has either healed on its own, or you’re already dead. Omission of treatment is another problem. The NHS is funded by the Department of Health and researches the cost, effectiveness, and impact of health technologies. The British government has also now set up the National Institute of Health and Clinical Excellence (NICE), which issues formal guidance on the use of new and existing medicines based on rigid economic and clinical formulas that determine the cost-effectiveness of treatments. The NHS is bound by the NICE’s pronouncements. The criteria used by the NICE to make its economic decisions is a secret to the public. In 2001, the NICE stopped patients suffering from multiple sclerosis from receiving certain treatment that was helping them. (3) NICE told those suffering that the cost of the medicine was too high, and it was jeopardizing the efficacy of the system. (3) In 2006, elderly patients with macular degeneration were told they had to wait until they went blind in one eye before they could get a costly drug to save the other eye. (4) In August of 2008, kidney cancer patients were denied access to treatments that could have prolonged their lives significantly, and patients with rheumatoid arthritis were told they will not have access to a sequential range of medicines if the first one doesn’t work. (3) Similar devastating proclamations were made for patients with breast cancer, osteoporosis, and Alzheimer’s. (3) Their medications were just too expensive, and according to the criteria used by the NICE, those medications did not deliver enough bang for the buck.
As Daschle says in his book, if this model is adopted in the United States, “Doctors and patients might resent any encroachment on their ability to choose certain treatments, even if they are expensive or ineffectual compared to the alternatives.” (2) But too bad for them.
So where do the health reform provisions buried in this stimulus package fall on the spectrum of the government-controlled healthcare scenario? Are we headed toward Daschle’s vision and the NHS/NICE?
In the Discussion Draft of the Act, the House of Representatives said that the comparative effectiveness research would be used to eliminate certain procedures and treatments. In the words of the House report, “those items, procedures, and interventions that are most effective to prevent, control, and treat health conditions will be utilized, while those that are found to be less effective and in some cases, more expensive, will no longer be prescribed.” (emphasis added) (5) Such language seems to lay the ground work for a cost-effectiveness system of healthcare rationing. In the Senate version of the bill, however, mention of cost was removed. But in the final version that President Obama signed, a different word was added: “appropriateness.” The Council will be examining the “clinical outcomes, effectiveness, and appropriateness” of treatments, devices, and procedures that are used to treat various health conditions. If you ask me, the word “appropriate” is even more dangerous than an analysis of cost. “Appropriateness” is vague indeed, and it’s the sort of word that provides a blank check for the government, handing it unbridled discretion and the ability to make decisions that are not based on clear, open, or well-delineated guidelines or precepts. “Appropriate” can mean a whole host of different things, cost-effectiveness being only one of them. What is appropriate when it comes to healthcare? And who’s deciding- the 15-member panel made up of senior officers and employees from various branches of government, as the Act specifies? Shouldn’t the “appropriateness” of any treatment be left up to the individual treating doctor and the patient?
As it turns out, the final version of the Act contains a provision that says the Council’s reports and recommendations “shall not be construed as mandates or clinical guidelines for payment, coverage, or treatment.” But then what will the billion dollars worth of research be used for? What does “reducing duplicative efforts” and “encouraging coordinated and complementary use of resources” mean in practice? At some point, even those euphemistically-described purposes have to result in some sort of decision-making about the type and availability of care that is offered.
One has to ask whether this is the Obama administration’s down payment on universal healthcare. These could be the first steps towards such as system. It is not clear what the role of the Council will be in the end. If we are headed towards Daschle’s vision, there is reason to be worried. What we will end up with is “committee medicine.” Healthcare will be rationed based on cost-effectiveness (or “appropriateness”) and patients will be told what kind of care they can receive. Thanks to the electronic health system, the computer will tell the doctors what treatments to prescribe (i.e. those that passed the comparative effectiveness test), and compliance will be tracked through the electronic health records. It is likely that your doctor could face penalties for going outside of the electronically delivered protocols to use experimental treatments or address an atypical condition. Personalized medicine will be a thing of the past. It will be one-size-fits all approach to healthcare with little freedom of choice for doctors and patients alike. Even such things as immunizations could be monitored and easily enforced.
In our next blog entry, we will be discussing the specific impact that these changes could have on alternative medicine.
References:
(1) American Recovery and Reinvestment Act 2009
(2) Chowka, Peter Barry. “Out of the Fog: Health Care ‘Reform’ 2009 Becoming Clearer.” December 1, 2008. Available through naturalhealthline.com.
(3) Evans, Helen. Comparative Effectiveness in Health Care Reform: Lessons from Abroad. Backgrounder. No. 2239. February 4, 2009.
(4) McCaughey, Betsy. “Ruin Your Health with the Obama Stimulus Plan.” February 9, 2009. Available through Bloomberg.com.
March 2nd, 2009 at 3:50 pm
It is scary to think of the ideas that can blossom!! Can it possibly all work out ok, or will it be bad no matter what it ends up being??
As far as alternative care, I don`t get why it would fail because, the system would not have to pay for it, we as individuals would, as it always has been!! CASH PAID SERVICES ON ANY ALT> HEALTH CARE!!!!!
Or what?? thanks……
March 2nd, 2009 at 4:38 pm
Hi Laura-
As of yet, we are not sure what the eventual role of the Council will be. But you are right- the possibilities are scary. For the “or what” you mention, and how the reform could potentially affect alternative medicine- see our blog entry posted today:
http://www.naturalissues.com/?p=32
In future entries, we will explore how to protect your healthcare choices and freedoms.