Comparative Effectiveness Research Wants To Pull The Plug On Grandma

14 Sep

This, from a letter submitted by Lynn Lowry of Raleigh appeared recently in the News & Observer :

In a Sept. 1 letter, a Chapel Hill writer wrote that the aggressive treatment received by Sen. Ted Kennedy would have been covered by government-run VA hospitals and the government’s Medicare program. He didn’t know why it was suggested that these services would not be provided by the “Public Option.”

Perhaps he does not realize that slipped into the stimulus bill was substantial funding for comparative effectiveness research, which is generally code for limiting care based on a patient’s age. A formula is used, where the cost of treatment is divided by the number of years (called QUALYs, or quality-adjusted life years) that the patient is likely to benefit.
Cuts to Medicare will provide a major source of funds for the Public Option. Those cuts, along with comparative effectiveness research, will result in rationing and cuts in care for the elderly.

Okay, let’s discuss. First, Lynn considers comparative effectiveness research to be code for limiting care based on a patient’s age. Second, Lynn suggests that cuts to Medicare will fund the public option resulting in rationing of care for the elderly. Clearly, Lynn is fighting for seniors here, and thinks they stand to be significantly harmed by health reform.

Pardon my French, but here’s why that’s completely stupid. First, it misses the point on QALYs, which I described in detail a while back. If we are going to be looking at global budgets and making decisions about whether to spend $1,000 on treatment that would enable a toddler to go on to live a healthy productive life or to spend that $1,000 on treatment that would enable an elderly person to live for 1 more year, then Lynn might–and I stress might–have a point. But that’s not what we’re talking about. Rather, if there are two treatment options available for that elderly person, and both extend their life by 1 additional year, we should be paying for the less expensive one. If the person can afford the more expensive option and chooses to do so, no one is stopping them. Comparative effectiveness research helps the medical community by making all of this information available to facilitate decision-making.

Imagine you are going to buy a car. You have a set of criteria you are using to shop, and narrow it down to two models: a black sports car and a red sports car. The black car gets you to your destination at 120 mph and costs $50,000. The red car gets you to your destination at 140 mph and costs $120,000. They are identical in every other respect. Which would you buy? It depends on how much you value the extra speed, right? Still, wouldn’t you think the cheaper car is a great deal? Now, imagine that the cars were identical and one simply cost half the price of the other. Would you have any interest in buying the more expensive model? I certainly hope not. If you do, you may have some self-esteem issues to work out.

It’s funny, really. People clamor for health care to be treated like any other good or service, but as soon as people start talking about how much bang you’re getting for your buck–a well-established purchasing principle for most people–the clamor morphs into a cacophony of outrage over rationing, which brings me to my second point.

As Ezra Klein wrote recently: We ration. We ration. We ration. We ration. Plain and simple, this fear of rationing should already be well full-blown rather than suspenseful and anticipatory. Here’s the difference between now and then: Now, we ration solely on the basis of ability to pay. That means some get care and some don’t. Then, we ration on the basis of need, money well spent, and return on investment. Absolute rationing, where some people are completely denied care, would no longer exist. People really need to stop using this word, or at least stop being frightened by it. It’s been sleeping in the bed with you for the past 50 years, now’s not the time to wake up, chew your arm off, and slink out the door on the walk of shame.

One final point: Democrats gave the country Medicare. Seniors are a highly active voting block. Why in the world would Democrats a) seek to undo one of their biggest political victories, and b) alienate those whose votes they most depend upon? The answer is simple: They would never do that. So all of these claims are beyond ridiculous. Of course, these days, chair of the RNC Michael Steele wants you to believe that the GOP is the champion and defender of Medicare. As Charlie Brown would say, “Good Grief!”

1 Comment

Posted by on September 14, 2009 in Uncategorized


One response to “Comparative Effectiveness Research Wants To Pull The Plug On Grandma

  1. Anonymous

    September 15, 2009 at 3:20 pm

    CER, the way it is structured in the US, does not use cost considerations. CER compares one treatment or therapy to another to determine which has the better clinical outcome.


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