Best practices. It sounds so nice and simple. Everyone wants the best medical care possible, right? And we want doctors to use the best practices available to care for us, don't we? Well, "best practices" may not really mean best practices.
Take the United Kingdom, which is often praised for spending as little as half as much per capita on health care as the U.S. Credit for this cost containment goes in large part to the National Institute for Health and Clinical Excellence, or NICE. Americans should understand how NICE works because under ObamaCare it will eventually be coming to a hospital near you.
The British officials who established NICE in the late 1990s pitched it as a body that would ensure that the government-run National Health System used "best practices" in medicine. As the Guardian reported in 1998: "Health ministers are setting up [NICE], designed to ensure that every treatment, operation, or medicine used is the proven best. It will root out under-performing doctors and useless treatments, spreading best practices everywhere."
What NICE has become in practice is a rationing board. As health costs have exploded in Britain as in most developed countries, NICE has become the heavy that reduces spending by limiting the treatments that 61 million citizens are allowed to receive through the NHS.
The list of medications and treatments NICE bans or limits the use of are legion, including cancer treatments, back surgeries, pap smears and Alzheimer's drugs. My personal favorite is the restricted use of the drug Lucentis, which treats macular degeneration.
The other, Lucentis, was limited to a particular category of individuals with the disease, restricting it to about one in five sufferers. Even then, the drug was only approved for use in one eye, meaning those lucky enough to get it would still go blind in the other. As Andrew Dillon, the chief executive of NICE, explained at the time: "When treatments are very expensive, we have to use them where they give the most benefit to patients."
So, if you go blind in one eye, that's ok, since you have one eye. Get it?
This is the way health care rationing works. When the government is the health care provider--and it will happen if a public option is put in place--the government will determine who gets treated and why. And how much.
Lots of folks argue that we already have rationing because insurance companies dictate what procedures and treatments get covered and which do not. But there's a big difference in government bureaucrats making these determinations and market forces. For one thing, it's possible to get better coverage if you are willing to pay for it with private insurance. But a public plan forces everyone to get the same treatment. And then, if you want different treatment, you have to pay for additional insurance. If your government permits it.
And more to the point, socialized medicine requires rationing in a way you don't have to accept in private insurance. You can seek different insurance, or even pay for the treatment yourself. And the profit motive spurs innovation and invention in the medical industry, something that will suffer when a NICE board determines that you only get $22,000 for care in the last year of your life.
Special thanks to Chuck Serio for pointing out the WSJ article.
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