Patient Power

Model Federal Health Board on UK’s “NICE”?

Who decides? …

In health care, the question is whether you, together with your doctor, will make your most personal and important health care decisions, or whether the government will make them for you. Government-run national health care systems are all about limiting choices. For example, nearly all national health care system impose global budgets, strictly limiting how much can be spent on health care. — Michael Tanner

Keep this in mind when considering the wisdom of a “Federal Health Board.”  Health Czar Tom Dascle says his proposed Federal Health Board would “it would work much like the Federal Reserve Board does today. … What it is— is the executor, the decision maker, the policy setting framework within which most of the managerial decisions are ultimately made.”

In his book Daschle writes:

In Great Britain, NICE … uses cost-effectiveness information in deciding whether to cover a new drug or procedure.  I’m not suggesting that we should adopt a hard-and-fast rule on cost-effectiveness in public policy.  … The challenge … is creating an entity with the credibility and the clout to make those tough decisions.

Sounds to me that Daschle is suggesting that the Federal Health Board’s “clout” would make rules on cost-effectiveness.  As Jeet Guram and Robert E. Moffit point out:

NICE sets a threshold for cost-effectiveness that it applies uniformly: … If a treatment is found to cost more than about $30,000-$45,000 per “quality-adjusted life-year,” it is rarely covered. This approach has led to the denial of valuable care:

• NICE restricted access to two drugs for Age-Related Macular Degeneration, Britain’s leading cause of blindness. … Winfried Amoaku of the Royal College of Ophthalmologists explained, “There are differences in action between these two drugs, which may be important in individual cases, and so we do not wish to be limited in our treatment options in this way.”
• NICE limited several Alzheimer’s drugs to use in patients whose disease had advanced from early to middle-stage. Even though doctors argued that starting treatment at the onset of dementia would be most effective in slowing the progression of the disease,[8] NICE decided that patients would have to wait until they became sick enough for the treatments to meet the cost-effectiveness threshold. …
• NICE blocked access to Glivec, a leukemia treatment. Ann Tittley, a 55-year-old patient, was being treated for breast cancer when she was diagnosed with leukemia. After realizing she would be denied access to Glivec even though her physician had recommended she start it immediately, Ms. Tittley wrote a letter to then-Prime Minister Tony Blair …

• Tom Daschle’s High Court of Health
• Tom Daschle wants a “Federal Reserve for Health Care”
• Federal Health Board could extend government-controlled insurance
• Instead of government comparative-effectiveness research
• Sign the Do No Harm petition on health care policy