Health-care rationing vs. abundance
The truth shall set us free
by the Rev. Jackson Day
A couple of years ago a doctor was treating me for a health condition. I began to worry about the results, so I went to a different doctor. The new doctor told me, “Those treatments aren’t evidence-based.”
Medical knowledge can be frustratingly uncertain. I asked myself, has this actually been tested?
Being concerned with evidence isn’t new. I sometimes call the biblical Daniel the first scientist. Why? Because in Babylon, Daniel told the palace guard, in effect, “try giving us vegetables and water for two weeks, and then base your decision on the evidence of your eyes” (Daniel 1:12-13). Daniel was calling for evidence-based decision making on a matter of nutrition and health.
Health-care quality matters to United Methodists.
Health-care quality matters to United Methodists. Our Resolution #3207 “calls upon … health-care providers and government agencies to … devote needed resources to the promotion of quality health care [and] engage in programs of continuous quality improvement.”
“Effectiveness research” to establish evidence-based findings on what medicines and medical procedures work, and what don’t, is a feature of the health-care reform being discussed in the U.S. Congress.
Comparative Effectiveness Research
Comparative Effectiveness Research (CER) has been under consideration for a while. A year ago, CER legislation was introduced by Senate Finance Committee Chair Max Baucus, D-Mont., and Senate Budget Committee Chair Kent Conrad, D-N.D. They wanted to create a health-care CER Institute that would be "responsible for setting national priorities" and "answer the most pressing questions about what works in health care."
By ‘promoting comparative effectiveness research … we can improve quality, value and expand coverage for all.’
Karen Ignagni, president of America’s Health Insurance Plans, voiced her support, as did President Scott Serota of the Blue Cross & Blue Shield Assn. (BCBS). He was quoted in Medical News Today as saying the BCBS has "long advocated for such an entity," and that by "promoting comparative effectiveness research … we can improve quality, value and expand coverage for all."
CER has already been legislated into this spring’s stimulus bill, the American Recovery & Reinvestment Act. In March, the U.S. Dept. of Health & Human Services (DHHS) announced the members of the new Federal Coordinating Council for Comparative Effectiveness Research, which provides information on the relative strengths and weakness of various medical interventions. “Such research will give clinicians and patients valid information to make decisions that will improve the performance of the U.S. health-care system,” according to DHHS.
The brouhaha
You may wonder if CER already exists, what’s the brouhaha about? Succinctly, those opposed to reform are interpreting CER as code for government rationing of health care.
Those opposed to reform are interpreting CER as code for government rationing of health care.
Referring to CER in the Stimulus Plan this February before it was enacted, Betsy McCaughey of the Hudson Institute explained how she connected CER and rationing:
The Federal Council is modeled after a [United Kingdom] board discussed in [former Senator Tom] Daschle’s book. This board approves or rejects treatments using a formula that divides the cost of the treatment by the number of years the patient is likely to benefit. Treatments for younger patients are more often approved than treatments for diseases that affect the elderly, such as osteoporosis.
The fewer years of life you have left, the less health care you get, McCaughey seems to reason. While the U.S. proposals do not reference either Daschle’s book or the laws of the United Kingdom, McCaughey assumes these are the hidden agendas in the legislation.
Others like Peter Ferrara of the Institute for Policy Innovation develop the rationing theme thus:
You may want health care that your doctor has prescribed for you. But the rationing bureaucracy in Washington that doesn’t even know you, or your doctor, may decide that your doctor doesn’t know what he’s talking about, or that you are too old for the government to pay for your hip replacement to stop the pain, or to get an expensive triple bypass or a pacemaker operation to save your life.
Taking the rhetoric to a new level, on Aug. 8, former Alaska governor Sarah Palin wrote on her Facebook page:
And who will suffer the most when they ration care? The sick, the elderly, and the disabled, of course. The America I know and love is not one in which my parents or my baby with Down syndrome will have to stand in front of Obama’s “death panel” so his bureaucrats can decide, based on a subjective judgment of their “level of productivity in society,” whether they are worthy of health care. Such a system is downright evil.
Countless Internet blogs repeat the same false assertions.
Assurances make no difference
Specific assurances to the contrary that are built into the legislation seem to make no difference.
Referring to the CER in the stimulus bill, the DHHS emphasized, “The council will not recommend clinical guidelines for payment, coverage or treatment.”
The council will not recommend clinical guidelines for payment, coverage or treatment.
The current HR 3200 legislation before the House, on line 14, page 524, unambiguously states, “Nothing in this section shall be construed to permit the Commission or the Center to mandate coverage, reimbursement, or other policies for any public or private payer.’’
The scare tactics about how CER will lead to government rationing mask the actual rationing going on right now, rationing that health-care reform is intended to help:
Care, except emergency care, is rationed to those uninsured or unable to pay. David Leonhardt in the New York Times reminds us:
The uninsured still receive some health care, obviously. But they get less care, and worse care, than they need. The Institute of Medicine has estimated that 18,000 people died in 2000 because they lacked insurance.
Coverage for pre-existing conditions is rationed.
Care is rationed when your insurance company says it’s not medically necessary and will not pre-authorize it, regardless of your doctor’s assessment.
Care is rationed when it has become too expensive according to your insurance company, which cancels your policy just when you need it most. “At a recent House hearing, three insurance companies testified that they had ‘rescinded’ or dropped coverage for nearly 20,000 patients between 2003 and 2007,” Leonhardt reported, “often after patients had submitted claims they thought would be covered.”
Quality is rationed, according to Leonhardt, when “billions of dollars [are spent] on operations, tests and drugs that haven’t been proved to make people healthier. Yet we have not spent the money to install computerized medical records — and we suffer more medical errors than many other countries.”
Money is rationed, underpaying primary-care doctors, relative to specialists. Leonhardt writes:
They keep us stewing in waiting rooms while they try to see as many patients as possible. We don’t reimburse different specialists for time spent collaborating with one another, and many hard-to-diagnose conditions go untreated. We don’t pay nurses to counsel people on how to improve their diets or remember to take their pills, and manageable cases of diabetes and heart disease become fatal. We don’t pay for doctors to talk to each other about our care. Doctors are generally not paid to do the blocking and tackling of medicine: collaboration, probing conversations with patients, small steps that avoid medical errors. Many doctors still do such things, out of professional pride. But the full medical system doesn’t do nearly enough. That’s rationing — and it has real consequences. … Over all, the survival rates for many diseases in this country are no better than they are in countries that spend far less on health care.
Keeping vision intact
Your vision and voice are needed to help keep the conversation for health-care reform on track. Keeping vision foremost is hard, it’s similar to trying to remember that you came to drain the swamp while you are surrounded by alligators.
Our vision is a vision of God’s abundance made tangible in health care for all.
That’s why the United Methodist General Board of Church & Society selected the “John 10:10 Challenge” for the name of our campaign to support health-care reform: “I came that they may have life, and have it abundantly.”
Our vision is a vision of God’s abundance made tangible in health care for all. Some may disagree. One writer told us, “John 10:10 has nothing to do with government-sponsored health care, but rather deals with the spiritual life which only comes through faith in Christ.”
I challenge those who have this view to show us where Jesus divided life into spiritual, emotional and material components, and restricted the gift of salvation to only one part of our life, or where Jesus said that God can’t work through government. John Wesley looked at those who would try to keep religion separate from the rest of life and said:
In the same manner have the end and the means of religion been set at variance with each other. Some well-meaning men have seemed to place all religion in attending the prayers of the church, in receiving the Lord's Supper, in hearing sermons, and reading books of piety; neglecting meantime the end of all these, the love of God and their neighbor.
Abundance is an amazing biblical word. It means “more than enough.” It’s what the Psalmist meant when he wrote, “my cup runneth over.” If we lose the vision of abundance, we lose the ability to discern how much scarcity in our world is contrived.
Christ taught us that abundance comes from sharing, which is ultimately the basis for health-care reform. Isn’t that one of the messages of the story of the feeding of the 5,000? And we are taught in 1 John 4:18 that the answer to fear isn’t to clutch tightly to what we have, but to look on others with love, for “perfect love casts out fear.”
In these days of debate, the effort to dig out the truth is so important, to keep us from being swayed by rumors. Whether it is the truth of the Gospel, the truth about Comparative Effectiveness Research, or the truth about where rationing is already leading to sickness and death, each in its own way we need the truth to set us free.
Editor’s note: The Rev. Jackson Day is a consultant with the United Methodist General Board of Church & Society’s addictions and health-care program area. He is a member of the Baltimore-Washington Conference of The United Methodist Church. Date: 8/10/2009
©2005-2009
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