Is This What You Want?

Excerpts from the “Life Insurance selling Magazine” article, “To your good health: Of TV shows and children’s games”, by

• David A. Saltzman

Published 7/1/2009

Included in the “American Recovery and Reinvestment Act of 2009” (aka “The Stimulus Bill”) was $1.1 billion to fund The Federal Coordinating Council for Comparative Effectiveness Research. When he was at The Brookings Institute, Obama budget director Peter Orszag became interested in a Dartmouth study indicating that despite wide regional disparities in payments for similar conditions, there was no corresponding improvement in outcomes. Additional fuel for the Council came from Senator Tom Daschle’s book, Critical: What We Can Do About The Health-Care Crisis, where he argues for a council similar to the British National Institute for Health and Clinical Excellence, which goes by the acronym “NICE.”

If the Federal Council in the stimulus bill is the beginning of this idea, NICE is the realization of what it could — and most likely will — become. A group of presidential appointees will begin reviewing treatments to decide which are more — or less — effective. This sounds innocuous and like the biggest no-brainer in the history of the universe, doesn’t it? A frequently-cited example of the type of review that the Council might undertake would be to determine whether drugs and “watchful waiting” are a better treatment than surgery for back-related issues. Who could argue that expensive and risk-laden surgeries should only be done if they can be proven to be more effective than non-invasive treatments?

A discussion of how the Council’s work might be brought into practice quickly leads to concern. For the moment, ignore those who, rightly in my view, believe that giving government access to our electronic personal health records in tandem with this Council’s guidelines will ultimately create the medical equivalent of Big Brother. We need only look at NICE to see the likely outcome.

NICE guidelines center on cost effectiveness, not around quality of care. How long will it take for Americans to realize that our version of NICE will likely mirror our cousins across the pond? To help everyone along, I suggest that you invest eight minutes of your time to watch a video clip about my friend Beth Ashmore. Some of you know Beth as a former president of the National Association of Health Underwriters, though you may not know her mother’s story. It is a shocking, firsthand account of what could be in store for us if we project the path of our current initiatives.   Watch the video here:

Critics in the medical community are becoming concerned about the Council’s effect on their ability to practice medicine and the potential effect on their physician-patient relationships. Their concern centers on the research from the Council leading to a “one-treatment-fits-all” set of rules and that the government would become the third party in the exam room, so to speak.

Many of us recall the admonitions made nearly two decades ago about “accountants at HMOs making medical decisions.” Absent a discussion of “medical necessity,” the HMOs were excoriated for enforcing the terms of a voluntary contract between employers and the HMO — terms which were known in advance. We’ve all heard the arguments about employees being the ones in that particular crossfire, and to a great extent that is true.

This is not the whole article. You can read the entire article here, at the Life Insurance Selling magazine.