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We should be discussing Comparative Effectiveness

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Posted: Saturday, July 7, 2012 12:00 am | Updated: 6:40 am, Sat Jul 7, 2012.

I think the Lodi News-Sentinel should do an article on what I call phase 2 of health care reform — Comparative Effectiveness Research. This is where true cost-cutting and rationing measures will take place, and no one is talking about it.

In this initial phase of Obamacare, the government gains control. In the second phase, they dictate what care we will receive. Just to show how important this is to the Obama administration, there are two panels set up to start this process, one under PPACA the other under the ARRA Act of 2009.

People might be upset with Obamacare now, but the real threat is down the road. Comparative Effectiveness Research is going to result in protocols that will dictate who gets what medical treatment based on cost versus outcome. The government is going to replace your doctor when deciding on appropriateness of care. Don't believe me? Go to www.irs.gov/pub/irs-drop/n-11-35.pdf and www.hhs.gov/recovery/programs/cer/index.html.

Wake up, America. The rationing of socialized medicine will soon be upon us.

Ron Werner

Lodi

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Welcome to the discussion.

8 comments:

  • Darrell Baumbach posted at 4:28 pm on Mon, Jul 9, 2012.

    Darrell Baumbach Posts: 9405

    Ron, I appreciate your objective perspective and would encourage you to write more letters to LNS articulating more specifics. Accurate education for the public would be refreshing.

    As far as insurance companies rationing care by denying claims, I have not seen it.
    In performing health care claim's adjudication for many years, I have not seen one claim out of thousands denied that was showed covered in contract provisions.

     
  • Ron Werner posted at 2:22 pm on Mon, Jul 9, 2012.

    Ron Werner Posts: 87

    Joanne: Lets assume what you say is true and insurance companies have been rationing care by denying claims. Obviously the reason is to save money. The purpose of these comparative effectiveness panels is also to save money. Do you think rationing care to save money is ok when the govenment does it but wrong when insurance companies do it?
    One could say that once we have such government protocols, those on MediCal and MediCare will now be able to have their healthcare rationed like those with private insurance.

     
  • Darrell Baumbach posted at 12:17 pm on Mon, Jul 9, 2012.

    Darrell Baumbach Posts: 9405

    What Mr. Werner has pointed out exists today and has existed for many, many years in every health plan, especially HMO's.

    Really Ms Bobin. Please educate us. Please post the name of the federal department that has the same power as the Obamacare panel that controls health care now. Who heads this department?

    Please explain how all health insurance companies who have at least 30 different health plans with different policy provisions, exclusions and coverages,is the same thing as the Federal government controlling “all” provisions from “all” contracts with “all” insurance companies.

    So you are with a straight face stating there is no difference between a federal centralized unelected independent committee that can control all healthcare in America as to what is covered without oversight from elected officials... to private sector health plans that have complete accountability to elected officials.

    No one can be that ignorant, so why did you say it?

     
  • Joanne Bobin posted at 8:59 am on Mon, Jul 9, 2012.

    Joanne Bobin Posts: 4488

    Once again, Mr. Baumbach, your fantasy love affair with Sarah Palin has blinded you to the facts. What Mr. Werner has pointed out exists today and has existed for many, many years in every health plan, especially HMO's.

    Why do you think that there have been multiple horror stories over the years about insurance companies who have denied coverage to people for all kinds of illnesses. To continue to claim that "death panels" are newly created by the government is an insult to everyone.

    Since you claim to be an expert in the insurance industry, i.e., one who adjudicates (read "processes") claims for payment in accordance with a plans guidelines, you should know this.

     
  • Darrell Baumbach posted at 7:51 am on Mon, Jul 9, 2012.

    Darrell Baumbach Posts: 9405

    This is an example of rationing in England which will soon be in United States...

    http://rationinghealth.org/united-kingdom-rationing-by-cost/uprint

    A Cancer Patient Fights Back
    “Imagine how I feel when I hear people saying that if they give me the drugs I need to stay alive, babies are dying,” said David Cook, one of a growing number of British cancer patients speaking out against NICE and its rationing formula.
    While sipping strong English tea in his village farmhouse kitchen, Cook argued that NICE’s logic breaks down when you go from the abstract formula to specific patients—like him.
    A senior government manager in his fifties, Cook was diagnosed with kidney cancer in 2004. Two years later his prognosis was bad.
    Cook’s doctor said he would die within months unless he got a drug to slow the growth of his tumors. But the cost of the drug was high—too high for NICE in light of the advanced stage of Cook’s cancer—and the NHS refused to pay for it.
    Cook fought back. He contended that NICE’s rationing formula calculates cost-effectiveness based on the average patient, but individual patients might do better on a given treatment, which would make the drug more cost effective than NICE suggests. Cook’s doctor believed that was true for him, so Cook pleaded his case before a panel of experts.
    “I had to persuade a total of six people that were in the room” he said. “I had to talk for my life.” Cook won his appeal—he got the drug—but he resented that he had to fight for it, that he was treated as an exception.

     
  • Darrell Baumbach posted at 6:03 am on Mon, Jul 9, 2012.

    Darrell Baumbach Posts: 9405

    If I am not mistaken, their are millions in our country who made fun of the phrase
    "death panels" when referring to Obamacare. Many will continue to stick their head in the sand, but thankfully their are some like Mr Werner who has taken the time to understand what was in the bill that democrats and Pelosi said we would have to pass to see what is in it. Rationing of health care has hit countries that have government contrlol like in England. Now it's our turn thanks to Obama.

    If you are over 65 and have medical conditions, I would be very worried about your future.

     
  • wendy coe posted at 7:10 am on Sun, Jul 8, 2012.

    wendy coe Posts: 39

    I think that is a great idea. It would be nice to know the truth. So many rumors vs. facts that have been swirling. It would nice to know what the tax is going to cost. It is going to be a deductable or like a 125 plan?, or will it still be only allowed if it over 7.5% of your income?

     
  • Andrew Liebich posted at 8:29 am on Sat, Jul 7, 2012.

    Andrew Liebich Posts: 2999

    One mind awakened is worth a dozen sleepers.

    Thank-you Mr. Werner for pointing out what many choose to ignore.

     

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