Wednesday, December 15, 2010

Pelosi Advisor Admits: Comparative Effectiveness Research a “Cost Control Method”

Earlier today, Wendell Primus – a “liberal lion,” and Speaker Pelosi’s chief health care advisor – spoke on a panel about the health care outlook for the 112th Congress.  At the bottom of one page of his Powerpoint slideshow is a list of “Cost Control Mechanisms” in the health care bill, the first of which is “comparative effectiveness research.”

It is perhaps unsurprising that one of Speaker Pelosi’s closest policy advisors would make such a statement, as Democrats have a long history of making statements in support of cost-based rationing of health care resources:

A draft House Appropriations Committee report on last year’s “stimulus,” discussing the impact of comparative effectiveness research:  “Those items, procedures, and interventions that are most effective to prevent, control, and treat health conditions will be utilized, while those that are found to be less effective and in some cases, more expensive, will no longer be prescribed.”

Former Senate Majority Leader Tom Daschle, writing in his book Critical:  “We won’t be able to make a significant dent in health-care spending without getting into the nitty-gritty of which treatments are the most clinically valuable and cost-effective….The federal government could exert tremendous leverage with its decisions.”

President Obama, in a New York Times interview last year:   “The chronically ill and those toward the end of their lives are accounting for potentially 80 percent of the total health care bill out here….There is going to have to be a conversation that is guided by doctors, scientists, ethicists.  And then there is going to have to be a very difficult democratic conversation that takes place.”

Medicare Administrator Donald Berwick, in a 2009 magazine piece:  “The decision is not whether or not we will ration care—the decision is whether we will ration with our eyes open.”

The first page of slides includes the following so-called “Republican provisions” in Obamacare, the fifth of which is that it “Must reduce [the] deficit.” (Emphasis mine.)  If Speaker Pelosi’s office believes the bill “MUST” reduce the deficit, does that mean that she will support repealing the legislation if it does not accomplish that objective?  The non-partisan Congressional Budget Office categorized most of the major savings provisions in the health care law as “widely expected” to change, or “difficult to sustain for a long period” – meaning that under a more realistic scenario (as opposed to the rosy scenarios painted by Democrats), the law will likely increase, rather than decrease, federal budget deficits.

It may be difficult to reconcile the statement that the health care law “must” reduce the deficit with non-partisan opinions raising significant questions about the accuracy of that assertion.  Then again, if Speaker Pelosi and Democrats plan to use comparative effectiveness research as a “cost control mechanism” by denying patients access to expensive treatments, the law may in fact reduce the deficit – at an extraordinarily high price to American patients.