Opinion

‘Death panels’ were an overblown claim – until now

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Michael Tanner
Senior Fellow, Cato Institute
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      Michael Tanner

      Michael Tanner heads research into a variety of domestic policies with a particular emphasis on health care reform, social welfare policy, and Social Security. His most recent book, Leviathan on the Right: How Big-Government Conservatism Brought Down the Republican Revolution (2007), chronicles the demise of the Republican party as it has shifted away from its limited government roots and warns that reform is necessary to avoid continual electoral defeat.

      Under Tanner's direction, Cato launched the Project on Social Security Choice, which is widely considered the leading impetus for transforming the soon-to-be-bankrupt system into a private savings program. Time Magazine calls Tanner, "one of the architects of the private accounts movement," and Congressional Quarterly named him one of the nation's five most influential experts on Social Security.

      His other books include, Healthy Competition: What's Holding Back Health Care and How to Free It (Second Edition, 2007), The Poverty of Welfare: Helping Others in Civil Society (2003), and A New Deal for Social Security (1998). Tanner's writings have appeared in nearly every major American newspaper, including the New York Times, Washington Post, Los Angeles Times, Wall Street Journal, and USA Today. A prolific writer and frequent guest lecturer, Tanner appears regularly on network and cable news programs. Before joining Cato in 1993, Tanner served as director of research of the Georgia Public Policy Foundation and as legislative director for the American Legislative Exchange Council.

During the debate over ObamaCare, the bill’s opponents were excoriated for talk of rationing and “death panels.” And in fairness, with a few minor exceptions governing Medicare reimbursements, the law does not directly ration care or allow the government to dictate how doctors practice medicine.

But if President Obama wanted to keep a lid on that particular controversy, he just selected about the worst possible nominee for director of the Center for Medicare and Medicaid Services, the office that oversees government health care programs. Obama’s pick, Dr. Donald Berwick, is an outspoken admirer of the British National Health Service and its rationing arm, the National Institute for Clinical Effectiveness (NICE).

“I am romantic about the National Health Service. I love it,” Berwick said during a 2008 speech to British physicians, going on to call it “generous, hopeful, confident, joyous, and just.” He compared the wonders of British health care to a U.S. system that he described as trapped in “the darkness of private enterprise.”

Berwick was referring to a British health care system where 750,000 patients are awaiting admission to NHS hospitals. The government’s official target for diagnostic testing was a wait of no more than 18 weeks by 2008. The reality doesn’t come close. The latest estimates suggest that for most specialties, only 30 to 50 percent of patients are treated within 18 weeks. For trauma and orthopedics patients, the figure is only 20 percent.

Overall, more than half of British patients wait more than 18 weeks for care. Every year, 50,000 surgeries are canceled because patients become too sick on the waiting list to proceed.

The one thing the NHS is good at is saving money. After all, it is far cheaper to let the sick die than to provide care.

At the forefront of this cost-based rationing is NICE. It acts as a comparative-effectiveness tool for NHS, comparing various treatments and determining whether the benefits the patient receives, such as prolonged life, are cost-efficient for the government.

NICE, however, is not simply a government agency that helps bureaucrats decide if one treatment is better than another. With the creation of NICE, the U.K. government has effectively put a dollar amount to how much a citizen’s life is worth. To be exact, each year of added life is worth approximately $44,305 (£30,000). Of course, this is a general rule and, as NICE chairman Michael Rawlins points out, the agency has sometimes approved treatments costing as much as $70,887 (£48,000) per year of extended life.

To Dr. Berwick , this is exactly how it should be. “NICE is not just a national treasure,” he says, “it is a global treasure.”

And, Dr. Berwick wants to bring NICE-style rationing to this country. “It’s not a question of whether we will ration care,” he said in a magazine interview for Biotechnology Healthcare, “It is whether we will ration with our eyes open.”

Dr. Berwick, a professor of health policy at Harvard, actually favors a single-payer system for the U.S. But what he considers absolutely essential to health care reform is government control over health care spending, not just for government programs but by patients themselves. “The hallmarks of proper financial management in a system,” he wrote, “are government policies, purchasing contracts, or market mechanisms that lead to a cap on total spending, with strictly limited year-on-year growth targets.” That way “rational collective action overrid[es] individual self-interest.”

Recent reports suggest that the recently passed health care bill will be far more expensive than originally projected. As it becomes apparent that that ObamaCare is unsustainable, the calls for controlling its costs through rationing will grow louder. With Donald Berwick running the government’s health care efforts, those voices will have a ready ear.

Maybe those worries about death panels weren’t so crazy after all.

Michael Tanner is a senior fellow at the Cato Institute.

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  • mcgtrinsofla

    most of the “conservitive” teapublicans can’t or won’t let a few facts cloud the issues. nor will theyy put a fact up to supprt thier claims. just to be fair, mmost libs don’t either. it’s easier to sell sound bites and opinions to the uneducated, than to put up something rational to back a claim. as for the line
    The one thing the NHS is good at is saving money. After all, it is far cheaper to let the sick die than to provide care.” Could the same thing be said about U.S. insurance companies? remember the HMO mantra “deny, deny, deny, untill dead”? oh yeah, big insurance, like big phama, and big oil, have YOUR best intrest at heart. one more FACT obama won! the health care reform he promised was compromised to bring the teapublicans into a bi-partisan agreement, after which not ONE teapublican voted for it.
    the GOP has your best intrest at heart, like NOT letting the fed bargain for the best prices for meds.

  • philipjames

    So, a woman in Alaska correctly analyses the Obamacare situation and uses the words death panels to get everyones attention to what is coming. Now, a year later, the geniuses are figuring it out and can see the “death panels” coming into reality.
    So, which would you like more…. common sense intelligence that can see the problem immediately or the fossilized genius that takes a year to see the same thing?
    As usual, the woman in Alaska points out how “stupid” the geniuses are.

  • complacencykills

    excellent points. but wouldnt it b great to establish a workable system where we wouldnt have to worry about this stuff?
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    thezeigeistmovement.com
    zeitgeistmovie.com

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  • http://www.facebook.com/people/Douglas-Field/1128326474 Douglas Field

    The article was great at providing limited information and leaping to conclusions that support the author’s pre-existing view. It was not good at actual logic and evidence. I’m not saying the author is wrong, but there is no way to tell from what was posted.

    “Overall, more than half of British patients wait more than 18 weeks for care.”
    Care for what? Breast implants? Liver transplants? Having a broken bone put into a cast? Having a wart removed? And what are they waiting for? Are they waiting for a bed to become available? For a liver to be available for transplant? Lumping all possible care together and all possible reasons for delay together makes the number meaningless.

    Then it does not even compare that number to the U.S. How long do people in the U.S. wait for care? You cannot tell if the UK system is better or worse than the U.S. system without actually comparing them.

    Likewise “Every year, 50,000 surgeries are canceled because patients become too sick on the waiting list to proceed.” provides no comparison to the U.S. What is the rate of surgery cancellations in both countries (and what is the rate of people in the U.S. who are not scheduled for surgeries because they cannot afford them).

    And finally “The one thing the NHS is good at is saving money. After all, it is far cheaper to let the sick die than to provide care.” Could the same thing be said about U.S. insurance companies?

    I am forced to conclude that the author’s real problem with Berwick is not that he “is an outspoken admirer of the British National Health Service and its rationing arm” but that “He compared the wonders of British health care to a U.S. system” because the author seems determined to avoid an actual comparison.

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