A Failing System Called NICE
In the U.K., medical decisions are made by a government rationing board known as the National Institute for Clinical Excellence. “NICE” was set up to monitor the “effectiveness” of medical treatments and preventative measures, but its main purpose has become to contain costs by rationing patient care.
Early explanations of the need for and goals of NICE were laced with feel-good phraseology and indeed its acronym — certainly intentional — has a positive connotation. These descriptions are not dissimilar from what the U.S. government has now tasked its new health care board with while deleting any direct references to “cost effectiveness research” — NICE’s fundamental underpinning and tool for cost/benefit analysis of patient care. As London’s The Guardian newspaper reported in March 1998: “Health ministers are setting up a National Institute of Clinical Effectiveness (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 practice everywhere. Its watchword is evidencebased medicine.”
The ostensible reason for the establishment of NICE — to make recommendations based on “evidence-based medicine” and to “improve quality and access to services,” are the same issues facing the Obama Administration and Congress in 2009 as they look to solutions from a similar government board and comparative effectiveness research.
QALY: Calculating the Life Value of a Patient NICE’s role may have started out as limited to appraising health care outcomes, but in practice, NICE recommendations and guidelines are used to deny coverage to British citizens on a daily basis. NICE relies on the evaluation from the Orwellian-sounding “quality-adjusted life year” (QALY) to determine if a medical intervention is a “reasonable value for money.”
In effect, QALYs are used to mathematically calculate the value of a patient’s life. The NICE guidelines for 2009 explain the process: The cost per QALY gained is calculated as the difference in mean cost divided by the difference in mean QALYs for one (treatment) strategy compared with the next most effective alternative strategy.
If one intervention appears to be more effective than another, the (Guideline Development Group) will have to decide whether the increase in cost associated with the increase in effectiveness represents reasonable ‘value for money.’” 1
“[I]n general, interventions with an Institute of Clinical and Economic Review (ICER) of less than £20,000 ($29,000) per QALY gained are considered to be cost effective. … Above a most plausible ICER of £30,000 ($44,000) per QALY gained, advisory bodies will need to make an increasingly stronger case for supporting the intervention as an effective use of NHS resources.” 2

http://www.takebackmedicine.com/storage/factsheets/rationing.pdf

My wife is a yellow dog Democrat, so I rarely start political discussions with her.

However, she has a rare genetic disease that causes bone deterioration (she’s had 3 operations to install artificial hips). Fortunately, there is a drug that can stave off the deterioration, and she has been taking it twice monthly for 18 years. But the drug is hideously expensive—it costs $10,000 per dose; $260,000 per year.

(I’ve placed an X in places where I don’t want to give out certain information.)

…………………………………………….

I try to avoid politics in our discussions because I know we are at polar opposites over most issues.

Still, I think you may want to watch this video. It’s narrated by a guy who decided to go to Canada and see for himself the kind of health system that Congress is getting ready to impose on us.

I know you don’t believe me when I say that this kind of healthcare system—which killed Tom Green in 2003 [one of my best friends from high school who had a severe heart condition and died from rationed care in New Zealand]—will begin rationing expensive drugs used to treat older people. But what other way than rationing is there to provide “universal” healthcare?

In every socialized system, the managers have to spread a finite amount of money over a large population. That means cost-cutting, which usually begins with very advanced, or exotic, or expensive medicines and treatments. “Let’s see—for the $20,000 we spend each month on a 64-year-old lady, we can give 10,000 flu shots to kindergarteners. Hmmm, what to decide?” A few thousand X patients don’t have the votes of several million diabetics, so I wouldn’t expect any special consideration.

If you believe that the so-called “public option” means socialized healthcare will be voluntary, think again. Given the option of dumping you into the public option, a private insurer like X is not going to be content continuing to pay $260,000 per year for your medicine. X will drop you as quickly as it can and you will have to depend on the Feds for your treatment.

I’m bringing this up because you can have a much greater effect than I if you drop a line to Boxer and Feinstein opposing this. I’m a Republican, so in their minds I’m of no importance. But you are a loyal Democrat and if they hear from enough people like you, they can scuttle this looming (and for you, personal) disaster.

You cannot ensure or insure human perfection. All you can do is to provide the opportunity for people to make the right decisions.

Obama’s care does the exact opposite and so the same is true of Canada and Britain as well.

Health Minister Michael Murphy said this week that the wage freeze would be similar to the policy being instituted on other public servants as a result of the province’s $740-million deficit.

Murphy said if the doctors agree to a two-year pay freeze, the province would save about $36 million, including $25 million from the fee-for-service doctors, who bill the province by procedure or patient, and $9-million from the salaried physicians.

If the doctors don’t agree, Murphy said he’ll have to make cuts somewhere else

“If we were to turn the tentative agreement into a full agreement, it’s undoubtable that we’d have to close down hospitals and shut down programs. And then the question is, where are we going to do that?” Murphy said.
[snip]
If the freeze goes ahead, it will be even harder to recruit new doctors and retain existing ones, said Dr. Don Craig, president of the medical staff organization in southwestern New Brunswick, which represents about 400 doctors.

[snip]

This wouldn’t be the first fight between the provincial government and the medical society. Doctors went on strike for three days in 2001 after contract talks with the Conservative government fell apart.

http://www.cbc.ca/canada/new-brunswick/story/2009/05/29/nb-doctors-pay-freeze-545.html?ref=rss

At least when the doctors go on strike, you KNOW you won’t see a doctor that day.

In terms of quality, the quality of care, IMHO, is dependent on the quality of the doctor caring for you. I could cite several examples in my own family where mis-diagnosis by a doctor resulted in catastrophe.

I will cite one.
In early 1996, my mother, age 83, didn’t feel good. She hurt, felt lousy and went to her doctor. His diagnosis– she was old, old people hurt. This went on for several months until she finally went for a second opinion to a Canadian doctor who had immigrated to the US to escape the Canadian system (the Canadian part is incidental to his diagnosis).
He conducted a series of tests and discovered she had pancreatic cancer, but it was April before the correct diagnosis was made. She died December 3rd. Those that know about this particular cancer know that is advances quickly and is rarely successfully treated (especially in 1996). Had the first doctor done a better job (been more intuitive or experienced or whatever) my mother might have been successfully treated. We’ll never know.

The point I’m making is that some doctor’s are better at what they do than others, and it doesn’t seem to be dependent on the system of service or even the medical shool they attended. In my mother’s case, the system was ready to work for her, did everything possible to save her, except for an early diagnosis by a doctor that didn’t take her complaints seriously enough. But on to my point.
The Canadian doctor, was working here on a green card, and hoped to get permanent status. Due to a mistake by his lawyer, he not only was denied permanent status, but had to leave the country. I believe he went back to Canada in 1999 or so.
He was not a fan of the Canadian system, and I suspect that many doctors in Canada share his view.
Including this Canadian who describes himself as a “former believer”:

…Health care is expensive. And, with all expensive services, there are hard decisions to make. In the United States, the rise of managed care was an attempt by insurance companies to contain rising expenses. Single-payer proponents suggest that public system can avoid such harsh decision-making. In truth, Canadian bureaucrats don’t — they just find other ways to limit expenditures.

Therein lies the dirty truth of Canadian health care. It is just like the old Soviet system: everything is free, nothing is readily available. Of course, it’s entertaining to talk about people queuing for toilet paper in Moscow in 1976. It’s far less funny to think about Canadian breast cancer patients waiting months for radiation therapy in 2006.

Nowhere is this clearer than in the technology gap. Canada lags badly behind the United States in terms of basic diagnostic machinery. Indeed, Canada lags behind most Western countries. The OECD analyses the availability of such machinery and ranks the various countries. Canada’s results are striking: it ranks 21st of 28 OECD nations for CAT scanners, 19th of 22 in availability of lithotriptors (used to treat kidney stones and gallstones), and 19th of 27 in availability of MRIs. Canada ranks 6th of 17 in availability of radiation equipment.

http://www.freemarketcure.com/whynotgovhc.php

We are a unique country, with a population and needs different than Canada. It is simplistic and dangerous to assume we can import Canadian health care like we import Canadian oil without disasterous results.

Everyone, including those honest on the other side of the debate, recognize that the system proposed by the administration will lead to limitations in procedures. Our current system did everything possible to save my mother, once a diagnosis was made.
In this brave new world, will a government mandated system offer that same chance for the elderly who face a similar crisis?

What is absolutely unbelievable is everything that comes after the ER part. Americans will go NUTS if that happens here.

I have people who scream at us in the hospital when they have to wait an extra couple of hours before the doctor comes up to the floor to see them. I can scarcely imagine what would happen if we told them it would take months . . .

Deana

And they wonder why I hate them, why I seek their total and utter obliteration.