Thursday, August 13, 2009

You Call This a Health Care Debate?

Any of us who do health care policy full time might as well take the rest of the month off and let the demagogues bent on scarring the American people just get it all out. I swear it is getting worse by the hour. Then maybe we can get back to a rational debate.

The British Health System's National Institute for Health and Clinical Excellence (NICE) and Dr. Ezekiel Emanuel have been particularly taking it on the chin lately. They are what we are all supposed to be afraid of.

NICE is run by a guy named Andrew Dillon. Dr. Emanuel is advising the Obama administration on health care and is one of the most respected health care ethicists in the country (but is handicapped by what his brother does for a living).

Sarah Palin want-to-be Betsy McCaughey, who had her last 15 minutes of fame during the Clinton health care debate, claims Dr. Emanuel endorses age discrimination for health care services--basically saying he wants to pull grandma's plug.

NICE actually makes the British system's tough decisions so many worry might have to be made here. For example, last year NICE issued guidance rejecting kidney cancer drugs Sutent (sunitinib), Avastin (bevacizumab), Nexavar (sorafenib) and Torisel (temsirolimus). This leaves patients with only one treatment option – interferon. The reason is these drugs only extended the life of the patient a very few months but they cost about $200,000 to keep a patient alive that long.

Dr. Emanuel is one of the most widely respected health care ethicists in the country. The issues McCaughey is using were quoted out of context and had to do with one of the things Dr. Emanuel gets to think about at the National Institutes of Health--what to do when you don't have enough organ donors for those who want organs.

A few years ago Andrew spoke at an international conference I chaired in DC having to do with how different industrialized nations manage their use of medical technology. It was clear to me that NICE was making some very difficult but unavoidable decisions about when to use expensive technology and when it just did not make sense to--all following the science. Whatever, he was doing what a consensus in his country had decided he should be doing.

Would you expect your group insurance plan to spend hundreds of thousands of dollars on a drug that extended your life for a very few months? Or your individual health plan? Or Medicare? Lots of gray areas? How would you propose settling them?

Unless of course you are one of these people out there these days telling the American people there is nothing wrong with a health care system that we can't afford (and is on its way to doubling in cost in the next ten years) and there is no reason why we can't just pretend that we can continue to have it all.

Would you want careful and deliberate thought given to just how we manage organs whose supply falls short of demand? Would you want someone to stand up and say $200,000 coming out of an insurance pool--public or private--for two more months with your body racked with cancer is nuts?

Well I would.

Tell you what, I will stand with Zeke Emanuel and Andrew Dillon any day of the week rather than these fear mongers that know better than to say the things they are saying and have no conscience for what they are doing.

I don't like the Democratic health care plans nor am I a single payer advocate. But just when did we get to the point that smearing some really fine people and getting 15 minutes of fame was worth scoring some cheap political points?

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Related article in the London Telegraph rebutting criticisms of UK system.
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