MENEFEE: 'Stimulus' bill may change health care forever

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By Amy Menefee

OP-ED:

The "stimulus" bill in Congress would fundamentally change the way health care is delivered to all Americans. It would hand over decisions about your care to a group of bureaucrats you won't have the chance to elect.

The "stimulus" establishes a new government body to assess Americans' health care and to make sure drugs and treatments "that are found to be less effective and in some cases, more expensive, will no longer be prescribed." That's how House Appropriations Chairman David Obey (D-Wis.) described it. The words have changed, but the effect stays the same. Where is the outrage?

The predecessor of this new bureaucracy operates in the United Kingdom. The British National Health Service (NHS), revered by fans of government health care, has a body that compares and assesses drugs and treatments. It's called the National Institute for Health and Clinical Effectiveness (not-too-aptly nicknamed NICE). It became infamous for denying cancer patients new drugs that had proven to be effective. They were deemed medically effective - but not cost-effective.

Patients can opt to buy these drugs out of their own pockets, while still paying the taxes that fund the NHS, of course. One man has wanted a similar board to govern the treatment of U.S. patients: Tom Daschle, who just ended his quest to be the new Secretary of Health and Human Services after being investigated for tax evasion. He laid out his entire vision in a book, "Critical: What We Can Do about the Health Care Crisis."

The focus is a federal health board modeled on the Federal Reserve. This board would oversee the entire health sector, including research on drugs and treatments known as comparative effectiveness research. And, like the British version, it would concern itself not only with helping patients, but with the costs of treatment.

"We won't be able to make a significant dent in health-care spending without getting into the nitty-gritty of which treatments are the most clinically valuable and cost effective," Daschle wrote.

Health care spending is indeed a problem. But having the government decide which treatments are acceptable is beyond frightening - and it doesn't make sense.

The House bill calls for this appointed board, dubbed the Federal Coordinating Council for Comparative Effectiveness Research, to be at least 50 percent "physicians or other experts with clinical expertise." However, there is no way the Council's 15 members - all of whom also must be employed in federal government agencies - can determine which drug or treatment is going to work .

You are a unique human being, with genetic and environmental factors influencing your health. Perhaps Benadryl has the predictable effect of making you drowsy; or, perhaps it does the opposite and keeps you awake. Take that a step further to prescription medicines for serious illnesses. Your sister has severe depression, and she responds only to one antidepressant. What if it isn't the one that works for most people? Or it's the most expensive one?

Peter Pitts, head of the Center for Medicine in the Public Interest and a former FDA associate commissioner, explained why "one-size-fits-all" medicine doesn't work: Most comparative effectiveness studies "don't capture the genetic variations that explain differences in response to medicines by different patients."

Having a board that excludes any treatment on the basis of comparative effectiveness is a danger to the health of those who fall outside the norms - and with the government setting those norms, any of us could end up as outliers.

The "stimulus" bill passed by the House creates this board. It allocates more than $1 billion for comparative effectiveness research. And it gives the new health and human services secretary (whoever that turns out to be) an additional $400 million at his or her discretion.

The supposed purpose of the bill - to "stimulate" the U.S. economy - is long gone.

As The New York Times's Robert Pear so eloquently put it: "For Democrats, it is also a tool for rewriting the social contract with the poor, the uninsured and the unemployed, in ways they have long yearned to do." He noted this was taking place "with little notice and no public hearings."

That fits perfectly with the plan Daschle laid out - he never intended for Americans to know what was happening to their health-care structure. "I do not believe we should draft a bill laying out this vision in excruciating detail," he wrote in "Critical." "I believe a Federal Health Board should be charged with establishing the system's framework and filling in most of the details."

If his plan continues in his absence, this board will "fill in the details" of a completely government-driven health care overhaul.

Amy Menefee is director of communications for the Galen Institute, a nonprofit research organization that focuses on health policy.