You can count on the Wall Street Journal for pretty good reporting and for extremist right-wing wackaloonery on the OpEd page. Today, they deliver the latter, with bonus fear-mongering at no extra charge.
The piece is entitled, “GovermentCare’s Assault on Seniors” and that pretty much sums up the content of the article. Unfortunately (at least, for the moral health of the author), there is little below the headline to justify the inflammatory headline.
Setting aside the oxymoronic tone that simultaneously lauds Medicare and condemns government involvement, the piece is one big mendacious piece of crap. The meat (or “gristle” if you will) of her argument is this:
The assault against seniors began with the stimulus package in February. Slipped into the bill was substantial funding for comparative effectiveness research, which is generally code for limiting care based on the patient’s age.
How does she justify this unjustifiable conclusion? She doesn’t. She simply asserts it. “Comparative effectiveness” is an au courant term used to describe research that looks at medical practices and tried to assess its effects. For example, there are two surgical ways to fix blood flow to the heart muscle: percutaneous coronary interventions (PCIs) such as angioplasty and stenting, and coronary artery bypass grafting (CABG or “heart bypass”). I’m not going to tell you which one is better, because the answer is complicated and still being investigated, but to choose the correct therapy for a patient we must answer a number of questions: which works best in which kind of patient; how long does each last; which has lower complication rates; which leads to longer survival; which leads to longer survival without additional need for a second intervention; which costs more, and over what time period; which makes people feel and function better. These questions and others need to be asked about many of the things we do, and comparative effectiveness research is a reasonable way to approach this.
To ignore these questions because we don’t like the answers is so frighteningly ignorant that it’s hard to believe an intelligent person could suggest it. Knowing these answers doesn’t mean it’s time to start making Soylent Green. What we do with the information is where our ethics as individual and as a society are tested. If we find that kidney dialysis in eighty year olds on average does not provide much quality or quantity of life, do we decide to stop covering it? Do we create algorithms for deciding what do offer an individual? Do we make a subjective choice in each case?
Anyone who has ever worked in an ICU knows how much futile care we provide in the U.S., but futile and improper care exists at all stages of life. Knowing what our care does and does not do is a good thing. We will be judged by what we do with this knowledge, not whether or not we collect it.
The current wording of HR 3200 regarding comparative effectiveness can be found here. Here is a sample:
(4) TAKING INTO ACCOUNT POTENTIAL DIFFERENCES- Research shall–
`(A) be designed, as appropriate, to take into account the potential for differences in the effectiveness of health care items and services used with various subpopulations such as racial and ethnic minorities, women, different age groups (including children, adolescents, adults, and seniors), and individuals with different comorbidities; and
`(B) seek, as feasible and appropriate, to include members of such subpopulations as subjects in the research.