Within the “stimulus” package was some language that establishes a health advisory committee similar to the British National Institute of Health and Clinical Excellence (NICE). In November 2008, the New England Journal of Medicine (NEJM) had a long article on NICE. The following is a summary of some of the major points. You can see the whole article here (subscription required).
Michael Rawlins, the physician who has chaired NICE since its inception said in the article that NICE was designed to:
“be fair to all patients in the National Health Service (NHS), not just patients with macular degeneration or breast cancer or renal cancer. If we spend a lot of money on a few patients, we have less money to spend on everyone else. We are not trying to be unkind or cruel. We are trying to look after everybody.”
Established in 1999, NICE offers technology appraisals, public health guidance, clinical guidelines, and guidance about diagnostic and therapeutic procedures on a budget of $55 million and 270 full-time/part-time staff. It can take over a year for NICE to approve a drug/treatment for coverage. Although NICE recently began to open part of their meetings to the public, most of the action is held in secret, allegedly due to considering confidential commercial, patient, and academic data. NICE’s role is not to determine safety or effectiveness of a drug, only to compare clinical effectiveness with relevant alternatives – i.e. is it a better “value-for-the-money”. NICE does not publicize its drug economic models making challenging its assumptions extremely difficult.
The measurement for cost effectiveness is the cost per quality-adjusted life-year (QALY). This admittedly imperfect measurement is a percent (0 being death to 1 being perfect health) for a given time period.
According to the NEJM,
“However… the cost-effectiveness ratio applies to groups of patients, not individuals, and is commonly confused with the cost of the medication, which is only one of many costs that are considered — others include, for example, the cost of medical care related to the treatment. Of course, if pharmaceutical manufacturers charged less for their products, NICE would find more medications cost-effective. The analyses are also susceptible to bias, and the cost-effectiveness ratio can vary widely depending on assumptions made about clinical benefit and harmful effects or other factors. Although resource use is most inefficient when an expensive intervention provides little or no benefit, resources can also be squandered through wide use of less expensive but relatively ineffective medicines…. In general, NICE considers treatments cost-effective if their incremental cost-effectiveness ratio is $34,400 or less.
According to Dr. Rawlins
“The big problem is why we have chosen ~$34,000 per QALY. I have always been very honest about this. There is really no empirical research that tells us where the boundaries ought to be. It is really a judgment of the economic community that has provided that sort of number.”
So, there you have it. NICE is an economic system. Available expenditures are set by the government (which controls 95% of the health market), and NICE was established to set the rules for rationing. Note that Britain represents only a small percentage of the global drug market – and even less of drug development. What will happen to new drug development when the United States begins to ration? Universal health care coverage is everyone’s goal, is rationing the only way?
I forget who wrote England was now in the grip of “soft authoritarianism,” but surely the the euphemistic, Orwellian acronym NICE for a rationed health care system is an indicator he is correct.
When the agency authorizing vehicles transporting the sick to the health clinics is called “Charitable Transport Company for the Sick,” then we’ll know without a doubt the fix England is in.
I was going to write a longish piece about the dangers of an English style health care system, but found this lecture by Mark Steyn. He summarizes where we’re heading under the present administration extremely well.
http://www.hillsdale.edu/news/imprimis.asp
Basically, yes, I agree with you that we’re headed for rationed and inferior health care as well as loss of leadership in medical innovations.
But we’re going to lose much more than our technological edge in medicine.
Steyn is right: We’re going to lose our freedom.
Best,
Fay Voshell
Fay:
That is a great piece by Mr. Steyn. “Live Free or Die!”
I was always struck by left-wing media elites who said “If (fill-in-the-blank) gets elected, I’m going to leave the country.” My position has always been that I’m going to stay and fight for my country. That was part of the reason for the choice of the name for the blog.
See you,
Charlie.
Charlie,
Yes, Steyn is brilliant. I’ve read his America Alone, and he is trenchant, pertinent and on target as well as being hilariously funny.
He has paid a price for his outspokeness, as you probably know. Thought police are after him big time.
And, yes, we need people to stand up and fight for our state and country rather than leave.
But frankly, just where would the disaffected go? For all its problems, this is a country which has not yet passed from greatness into irretrievable decline. America really is a “beacon on a shining hill.” Practically speaking, if the US loses its dominance, just which entity is going to fill the power vacuum? The UN? China? The EU?
BTW, I’m reading Hayek’s The Road to Serfdom. I highly recommend every concerned American read or re-read it. What he warned against in 1944 is incredibly pertinent as we see the socialist/statist trends the current administration is fostering.
Best,
Fay Voshell
u guys are cracking me up, have you studied the French Health care system that has evolved since WWII……..The wasteful AMA and our insurance structure are a joke……..you guys are like blinded fawns in the headlights, the inevitable Socialist future is well nigh here.
Charlie said,
“My position has always been that I’m going to stay and fight for my country”
Hey patriot boy, the likes of you would have been tarred and feathered and put on a ship to Halifax with the rest of the ignorant Torys in 1776. The fight for the country is between you and me pal, metaphorically speaking, and I am on the right side of history. So, chose your weapon!!!!!
Greenman:
First, tell us where you get your information on how wonderful the french system is. No one else, including the Obama administration that is in charge, is talking about it.
As for 1776, please check the following site: http://genforum.genealogy.com/lovering/messages/181.html — Joseph Lovering was my 5th great maternal grandfather.
Well Charlie, I think you know how to use Google, do some research on the French system, much better care for all for much less $$$$$…. The french Doctors are happy, the French people are happy and the WHO ranks the French health system far above the US………you really oughta get beyond all the anecdotal crap you read in the Rush Limbaugh GOP press and put out by the American insurance industry…….
As per your ten year old Boston ancestor, who cares…..I am talking about YOU…….you really are NOT too well educated and current on your info……and why don’t you go to Iraq with last refuge of a scoundrel, patriot Beau if you are such a gun ho Patriot…..the conservatives and greedy American business and ignorant American consumers have done more damage to this nation than any foreign foe….
and ……..Obama really ain’t too swift on alot of issues…..he’s basically a city boy and golfer type, he also knows that politics is the art of the possible…..the insurance lobby WILL lose in the long run, it is inevitable, way too economically inefficient to continue much longer in anything other than a single insurer system…….one can always buy supplemntal insurance if they please
Greenman; Greenman. Sigh…
Seriously, if you regard yourself as a perfected specimen resulting from the inevitable evolutionary historical progress of the communist/socialist ideal, then you may want to moderate your Khruschev shoe pounding I’ll-bury-your-grandchildren approach.
Rest assured, I will suggest to my representatives that any bi-partisan effort for a health plan include medical marijuana.
I add that concession because it appears that’s what you’ve been smoking.
All the above in good fun, of course.
Anyway, while Greenman’s diatribes provide an irresistible target for good humored fun, those interested in serious dialogue might want to read Larry Kudlow’s column on the projected costs of the Obama administration’s proposals as well as his suggestions for alternative plans.
http://www.realclearpolitics.com/articles/2009/05/14/we_cant_afford_a_public_health_plan.html
A couple comments about the French health system: 20% of the French people’s wages go to support the system; there is massive waste and it appears it , like SS and Medicare, will soon be unsustainable. So it is in need of drastic reform as well.
Point being, we don’t have to imitate the French system in order to construct a viable health care plan that avoids socialized medicine.
And we don’t want to imitate England or France because the main problem with the marriage of government and the economy as well as healthcare is that it gives the chief levers of control of freedom to impersonal bureaucrats and takes choice out of our hands.
Once the government can say things like, “This bank’s president can’t earn more than (fill in the blank); or “Mrs. Jones, you don’t get dialysis because you’re too old and we need to save our resources for the young,” then individual freedom is lost.
Best,
Fay Voshell
Hey Twisted Sister FAY!!!
Time will tell, and it won’t be a long time. And ofcourse, I am a seer and can divine the future. Fay says “socialized medicine”, , the big negative, naw, just more of the negative GOP canned speech crap . Well, Fay, our medical system is currently about 75% socialized, and it WILL be come moreso, it will become more equitable for all, and will improve our Nations well being. INEVITABLE And yes, Obama IS a SOCIALIST, HA.
More GOP crap, “then individual freedom is lost” Hey babe, I am monarch of all I survey, I am penniless and as free as a bird. Don’t worry about my freedom, worry more about the Homeland Security Industry Police State Charlie is building. Don’t worry about my individual freedom, I am as free as a red tailed hawk, worry more about expanding your vacuous mind, and maybe you will be set free, more likely, just a larger vaccuous space.
Thanks for your health plan and inclusion of ” medical marijuana”. Medical marijuana is already included in FREE INDIVIDUALS “health plans”, INDIVIDUAL FREEDOM for those that are FREE is a state of mind, sweetheart, not something legislated. I am an American, therfore by definition , I am free, ( although Scalia, Roberts and Alito do their best to ABORT freedom) my family has been here since White Europeans first started exterminating Indians. FAY, you are quite the programmed FOOL, eh .
Here’s a suggestion, Fay: the next time you’re on hold waiting to beg an insurance industry bureaucrat to approve an “elective” medical procedure, try meditating on the elusive meaning of words like “freedom” and “liberty”. Under the current post-Reagan laisses-faire capitalist regime middle class family income (read: “liberty”) has declined significantly. Under the onslaught of the Reagan inspired Republican-corporate collaboration (read: “fascism”) union membership (read: “freedom to assemble”) has tumbled from 25% to around 7%. Glenn Beck applauds having the “freedom to fail”, but I suspect he likes it better now that he has a new $50 million contract with Fox safely tucked away in his pocket.
Libertarians and far right conservatives carefully neglect to mention that the baleful “gummint” they warn us against is actually “us”, unless we allow it to become something else. So are police forces, fire departments, and all the other collective mechanisms that societies above the hunter-gatherer stage find essential for their survival and, yes, for their freedom too.
[...] in a purely Orwellian fashion, for the group that rations health care in Britain is known as NICE (I’ve blogged about the creation and purpose of NICE before). Tonight, I suspect that the President will try to downplay the need to create an American NICE [...]