Lane 3

“Death Panels” in Private / Public Plans?

A friend recently tweeted: “Death panels? Cigna has one “If the appeal involves..experimental treatment, a committee will conduct this appeal review” http://is.gd/2mSYI”

In an interview with David Lionhardt of the New York Times, President Obama said the following with regard to end-of-life care:

“So that’s where I think you just get into some very difficult moral issues. But that’s also a huge driver of cost, right? I mean, the chronically ill and those toward the end of their lives are accounting for potentially 80 percent of the total health care bill out here. Well, I think that there is going to have to be a conversation that is guided by doctors, scientists, ethicists. And then there is going to have to be a very difficult democratic conversation that takes place.”

So, when President Obama says these words one could reasonably conclude that he is speaking of a new system of limiting care because Medicare and Medicaid already have an exclusion for “experimental and investigational” services (Section 411.15(o)).

What might such a system look like? We only have to look as far as the UK for the answer. Compare President Obama’s comments to the words found on the web page of National Institute of Health and Clinical Excellence (NICE), the rationing board for the NHS:

With the rapid advances in modern medicine, most people accept that no publicly funded healthcare system, including the NHS, can possibly pay for every new medical treatment which becomes available. The enormous costs involved mean that choices have to be made.

The NHS employ a tool called a QALY (quality-adjusted life years measurement) to help decide whether a person is deserving of a particular medical treatment. So, what we really are discussing is whether or not, as a society, we want ObamaCare to include a QALY-type system of limiting treatment and services to our citizens.

A person may look at a committee at a private insurer deciding on experimental or investigational medical treatments and equate that to a QALY system under ObamaCare but there are differences.

• Under a QALY system we are talking about denying to people proven treatments (read not experimental or investigational). Contrast that to a denial of payment for an experimental or investigational treatment. These would include procedures that have not been approved by the Food and Drug Administration or treatments that have not been proved effective in clinical studies.




• Frequency. The vast majority of people covered by private insurance are under age 65 (read much younger than today’s life expectancy of 77.9 years). Whereas, people on Medicare are quickly approaching or even exceeding 77.9. The introduction of a QALY-type system will, by its very nature, impact more senior citizens than the under age 65 crowd currently covered by private insurance.




• You can sue a private insurance company! When is the last time you heard of a successful suit against the Federal government? Private insurers have an incentive to make their product attractive to the buying public. A government-run, single-payer plan has no such worries.




• Look at what has happened in the UK. Britons were promised a plan of benefits. That became expensive and rationing ensued. People demanded that they have access to these denied treatments. So, now in the UK you get to pay the taxes for your “free” government insurance – and, if you want it (and can afford it) you can “top-up” and the government will allow you to pay for that life saving drug out of your own pocket!

Conclusion

A friend wrote, “…being skeptical of a public plan is not the same as being against health-care reform.” There are a number of things that can be done to make coverage more affordable and accessible. A QALY-type system of rationing care would come as a rude shock to Americans. We are a society of achievers who possess a “can-do” attitude. To throw up our hands and take an easy approach of just letting the government handle things is a mistake.

So, now that you understand the difference between “experimental and investigational” exclusions and a QALY system, when politicians speak of “cutting wasteful spending” be careful. They may be speaking of me-ma, you, your spouse or your child.