Deadly Health Care Rationale

September 13, 2010 09:00 AM

Sometimes the strangest things pop up in the news and one is left wondering why they weren’t front page material from one end of this nation to the other. Such was the case when the “comparative effectiveness research” (CER) phrase was recently converted to “patient-centered outcomes research” (PCOR).

Background information might shed some light on why the first phrase became subject to a reinvention by the Secretary of Health and Human Services, pro-abortion Catholic Kathleen Sebelius. In 2007, the Congressional Budget Office (CBO) examined the comparative effectiveness of various types of medical treatments. The purpose of this analysis, which by the way predated both Obama and Sebelius, was to analyze federal spending on Medicare and Medicaid, with an eye toward determining what sort of commissions or government entities could be created to effectively monitor the cost of health care services in comparison to the actual effectiveness of various types of treatment. The report did not suggest that this analysis would result in some patients being denied treatments while others were able to receive the treatment, but it did recognize that the fiscal burden of Medicare and Medicaid services was growing. In that regard, the report recommended studying treatment options of every type.

This sounds harmless and could be viewed as a project designed to save the taxpayers’ money. But then the election occurred and health care took on an entirely new type of challenge for not only the bureaucrats, but for Americans of all ages.

In June of this year, published a discussion of CER which quoted Donald Berwick, now administrator for the Centers for Medicare and Medicaid, from a 2009 interview. At that time he said, “The decision is not whether or not we will ration care—the decision is whether we will ration with our eyes open.” Others, however, also quoted by, adamantly argued that this was not the case. So, could one presume that the question of health care rationing was actually moot?

Not so fast.

The newly announced PCOR has just been awarded $17 million. According to the report, Kathleen Sebelius has said, “Patient-centered outcomes research can improve health outcomes by developing and disseminating evidence-based information to patients, providers, and decision-makers about the effectiveness of different treatments.”

The goal is for these funds to help formulate strategies that will boost health information technology and make various treatment outcomes, and the information behind those outcomes, available to physicians and others who could use the information when advising patients about possible treatment options. But could that same information be used to ration treatment based on age, condition and so forth?

When President Obama was discussing his grandmother’s hip replacement surgery during an April 2009 interview, he opined, “I don’t know how much that hip replacement cost. … I would have paid out of pocket for that hip replacement just because she’s my grandmother.” Later in the interview, “Obama said, ‘you just get into some very difficult moral issues’ when considering whether ‘to give my grandmother, or everybody else’s aging grandparents or parents, a hip replacement when they’re terminally ill.’” Obama went on to say, “The chronically ill and those toward the end of their lives are accounting for potentially 80 percent of the total health-care bill out here.”

While some would suggest that we need not refer back to the historical record for comments that might give us a clue as to what could be a particular outcome of the new PCOR, I would beg to differ. Health care rationing may have disappeared from the public dialogue now that the health care reform measure is firmly in place, but that does not mean the idea is dead, especially when our president makes such comments as above.

When columnist Ken Blackwell took a look at this subject recently in the context of political races involving incumbents who are in trouble because of their vote on health care reform and other unpopular questions, he wrote,

Political rationing only mimics health care rationing. The members whose campaigns are flat lining will not suffer anything more than the loss of political office. As one who has held public office and who has suffered political defeat, I can assure the worried incumbents there are great days ahead of them. It is better for them to lose office than to continue pushing America toward real health care rationing. The losers in that game are not just “left for dead” politically. I personally would rather be voted out than participate in such a public disservice.


We need to watch out for, and take care of, the elderly in our society. They are valued members of our families and of our communities and we must show them that we value their lives at all stages.

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