Observation Deck – The Toughest Question of All

The photo of Adolf Hitler pretty much said it all. There it was, accompanying an editorial in the Washington Times whose title was “Health ‘efficiency’ can be deadly.” Granted, the Washington Times isn’t known for subtlety. Even so, this was a definite tip-off that the fight over healthcare reform won’t be easy or even civilized.

The furor that led to the Fuhrer’s photo appearing in a U.S. newspaper has to do with something called “comparative effectiveness.” The recently enacted stimulus package included $1.1 billion for the creation of a so-called Federal Coordinating Council for Comparative Effectiveness Research, which has been charged with “accelerat[ing] the development and dissemination of research assessing the comparative effectiveness of health care treatments and strategies.” The council is also charged with “encouraging the development and use of clinical registries, clinical data networks, and other forms of electronic health data that can be used to generate or obtain outcomes data.”

The Washington Times compared it to a program in Hitler’s Germany called Aktion T-4. “Under this program,” wrote the paper, “elderly people with incurable diseases, young children who were critically disabled, and others who were deemed non-productive, were euthanized. This was the Nazi version of efficiency, a pitiless expulsion of the ‘unproductive’ members of society in the most expeditious way possible.”

Pretty strong language. But not isolated. Rush Limbaugh said in his radio program that the comparative-effectiveness provision was the government’s way of telling seniors to “get out of the way and die.” (His words.) (AARP disagreed, by the way. In a letter to the Washington Times, Bill Novelli, CEO of the AARP, and John Tooker, M.D., executive vice president and CEO of the American College of Physicians, wrote, “We are confident that the American people will see through this fear-mongering propaganda….Comparative effectiveness … has existed for decades and has widespread support from doctors and consumers.”)

Papers such as the Washington Times and commentators such as Limbaugh fear that comparative effectiveness will ultimately lead to some governmental authority dictating how doctors should deliver care. They also fear that that same governmental authority will find itself making treatment decisions based not just on the effectiveness of care, but on its cost-effectiveness as well. Some countries are already doing this.

Well, we’re in for a lot of vitriol in the months ahead, as President Obama tackles healthcare reform, a sick economy, the uninsured, etc. And JHC readers will find themselves in the thick of it. Before you or your clinical staff bring in any new technology, many questions will be asked, but the most important ones may be: “Does it work?” “Does it work better than what we’re already using?” “What are the long-term costs or cost-savings associated with it?” But the trickiest question of all, the one that the Washington Times warned against, is this one: “Is it worth the cost in terms of saved lives or improved quality of life?” That one won’t be easy to answer at all.

Mark Thill About Mark Thill

Mark Thill is the Editor of The Journal of Healthcare Contracting and has been reporting on healthcare supply chain issues since 1985. He is a graduate of Dominican University in River Forest, Ill., and he received a master's degree in journalism from Northwestern University in Evanston, Ill.

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