On the Road to Rationing

In the summer of 2009, town hall meetings erupted as people voiced fears about greater government control over health care decisions. The fears were sparked by a small provision in an early version of the health bill involving end-of-life care.

People sensed a potential conflict of interest if the federal government was paying doctors for end-of-life counseling and also paying for end-of-life care. Many Americans worry that, as government tries to control health spending, unelected officials could decide not to pay for treatments seen as too expensive.

These fears are not fanciful. A pattern is emerging that at least gives the appearance that payment can be denied if therapies are seen as too costly. For example:

• The FDA in December withdrew its approval for Avastin for late-stage breast cancer.

• A Medicare advisory panel met in November to review findings from an investigation into Provenge, a pioneering but costly vaccine approved to treat prostate cancer.

• Medicare is picking winners and losers in its competitive bidding program for medical equipment, drying up competition and driving out suppliers whose products save lives but might cost more.

• The new Independent Payment Advisory Board and the Patient-Centered Outcomes Research Institute will have sweeping authority over payments and access. In other countries with government-run heath systems, bodies like these lead to explicit rationing.

When government controls so much of health spending, it can quash investments in innovation and interfere with the natural processes of scientific investigation by denying payment and therefore blocking access to its huge markets.

Many investigations are better than one centralized government body in determining whether a product is efficacious. Governments too often make decisions in silos. Integrated private plans are more likely to see the overall benefit of paying for a costly drug to avert an even more expensive hospitalization.

We need a more diverse, dynamic, information-based approval system to pave the way for personalized medicine. Some patients’ lives could be extended for years because they respond particularly well to a drug. Others don’t. The challenge of 21st century medicine is to find out why.

Published in USA Today, January 7, 2011.

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