December 10 2012
U.S. News & World Report
Carrie L. Lukas
Especially in a campaign year like this one, Americans are used to rolling their eyes about politicians' overwrought rhetoric. The term "death panels," which was used to describe how the new healthcare law known as Obamacare will lead to rationing of medical care, turned off many who dismiss the idea that our government would ever let bureaucrats control the availability of treatments for American citizens.
While the term "death panels" certainly takes it to an extreme, Americans should be aware of how government's increased involvement in the provision of health treatments—and their understandable desire to control rising healthcare costs—will impact the availability of some medical care, and is already doing so. Moreover, experience suggests that Americans can expect decisions about best practices will be made not only with an eye toward keeping down costs, but also toward politics.
For example, in 2009, the U.S. Preventive Services Task Force (that's a panel charged with reviewing evidence and making recommendations for preventive services) changed their guidance on best practices for screening women for breast cancer, suggesting that women in their 40s should not have annual mammograms and older women should reduce the use of this screening device.
The change was justified based on the high number of false positives in the prevailing testing regime, which led to lots of unnecessary stress and procedures for relatively few lives saved. Americans recoiled from the math behind the recommendations: Is it really government's place to declare that it's better to have one woman die from breast cancer than to have 500 unnecessary medical procedures? Such logic may work from a green-eye-shades government bureaucratic perspective, but not through the eyes of someone worried that their sister, mother, wife, or daughter might have an undiagnosed cancer. The panel claimed not to have taken cost into account, but certainly in an era of trillion-dollar deficits and with the government set to subsidize the insurance of millions more Americans, costs will have to be a consideration, if they really aren't already.
Breast cancer groups—known for their omnipresent pink-ribbon marketing campaigns—pushed back forcefully against the recommendations, and they were joined by countless politicians, none of whom want to cross the politically-powerful breast cancer lobby. The guidance was pulled and mammogram screenings beginning at age 40 remain the norm.
Yet how will this process work for other, less politically-powerful constituencies? Not surprisingly, experience suggests the result will be quite different. For example, respiratory syncytial virus is a common infection endured by a majority of babies during their young lives, and is the leading cause of infant hospitalization. While most babies can recover from the virus, it creates a deadly risk to some—particularly those born prematurely and with other ailments. The good news is that while there is no vaccine to protect from respiratory syncytial virus, there is a treatment that can help prevent its contraction and limit its impact.
The American Association of Pediatrics has for years issued guidelines based on efficacy and safety, which then become standard procedure for what medical treatment is made available. However, the association has increasingly incorporated cost considerations into their judgments, and respiratory syncytial virus treatment protocols were among those recommendations changed as a result.
As a result of these new recommendations, today fewer preemies and infants are getting preventative treatment for the virus. Unfortunately, this means hospitalization rates are increasing among untreated children, which actually drives up the cost of care in the long run. Some medical associations and concerned parents have protested the new protocols, but they have nothing like the clout of the breast cancer lobby.
Americans should ask themselves: Is this really how medical decisions should be made?
Of course, cost has to be a consideration when it comes to healthcare, as it is with every decision made in life. Everyday Americans weigh costs against the benefit of additional safety, when we buy cars, new appliances, or decide what path to take home. Yet such cost-benefit considerations should be made, whenever possible, at the individual level. Americans should be concerned when it is the government, or in the case of Obamacare, a small cadre of politically-influenced bureaucrats that comprise the Independent Payment Advisory Board, who are tasked with making a cost-benefit analysis for all Americans.
Call it a death panel, call it rationing, but you cannot call it a system that comports with the American principles of a limited government and free, independent citizens.
Carrie Lukas is the managing director of the Independent Women's Forum.