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Not so NICE
Why a Democratic super-majority would be bad for your health.


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Does Jack Tagg represent the future of American health care? Tagg, a World War II hero, is losing the sight in his right eye from macular degeneration, a progressive disease that ends in blindness. His left eye is okay, though. While a drug is available on the market that would save his remaining eyesight, his health insurance refused to pay for it, since he’s only half-blind. You might guess that Tagg is the victim of a heartless HMO, but actually, he’s covered by Britain’s National Health Service. The NHS relies for its funding decisions on the opinion of the quasi-governmental National Institute for Clinical Evaluation and Excellence (NICE), which ruled that Tagg’s medication was too expensive.

An Englishman with an eye problem may seem unrelated to the U.S. election. But consider: many Democrats hail NICE as a model for America. With the Democratic party threatening to establish a filibuster-proof majority in Congress, a British-style health super-board could well be coming to our shores. In fact, some Democrats see this as just a first step, with Washington eventually reshaping clinical medicine. But NICE is nasty, and John McCain should warn Americans about the perils of unchecked Democratic ambition.

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We can all agree on one thing: U.S. health care is getting more and more expensive. Health insurance premiums have roughly doubled since 2000. While no one doubts the excellence of American health care, costs are all over the map, literally. A Medicare recipient in Minneapolis, for example, uses half the health dollars that his Miami cousin does — without any difference in health outcomes. That’s why Democrats talk about attaining better value for our health-care dollars. But how? Some Democrats suggest that NICE is the answer.

In the late 1990s, Tony Blair’s Labour Government created the Orwellian-named NICE hoping to de-politicize decisions about the funding of new drugs and medical devices. New isn’t necessarily better, the government argued, and such treatments could be extraordinarily expensive. But NICE has been controversial from day one, and its decisions have met with vigorous criticism from patients and physicians. Jack Tagg’s case is just one among many. NICE also ruled that drugs called cognitive enhancers — the first-line agents used in North America to slow the progress of Alzheimer’s Disease — weren’t worth the money. Cancer drugs like Avastin, used to fight advanced colon cancer, didn’t make the NICE cut, either; nor did Temodal, which is used in the treatment of certain brain cancers, such as Senator Edward Kennedy’s.

Such rulings have sparked carnival-like press conferences led by angry patients, inspired blaring newspaper headlines, and prompted lawsuits. Not shy for a fight himself, Tagg showed up at 10 Downing Street with his family doctor — and the national media in tow. Taking a critical beating, NICE is undertaking a full review of its procedures and has quietly overturned many of its restrictions. Tagg now gets his medicine and the head of NICE publicly apologized for the sluggish approval of the drug.

Yet as controversial as NICE is in Britain, the concept is gaining popularity on this side of the Atlantic. Count former South Dakota senator Tom Daschle as a proponent. He speaks fondly of the idea in his book, Critical: What To Do About the Health-Care Crisis. “In other countries,” he writes, “national health boards have helped ensure quality and reign in costs in the face of those challenges.” Doesn’t that sound NICE?

Daschle’s view may carry real weight in 2009, as he is rumored to be under consideration for a serious role in a possible Obama administration (perhaps as chief of staff). And there is support for NICE-like solutions on Capitol Hill, too. In July, Senator Max Baucus, Chairman of the Senate Finance Committee, sponsored legislation to establish a British-style super-board. On the House side, at hearings of the Committee on the Budget, several committee members spoke favorably about the concept. (Disclosure: I was a witness.)

While the British version of NICE focuses on determining approvals for novel treatments, Daschle and others have pushed further, suggesting a super-board that would rule on all clinically effective treatments. With Medicare and Medicaid spending accounting for one-third of our health dollars, Daschle envisions an American NICE with a much broader scope: using public money, the federal government would demand that doctors, clinics, and hospitals comply with the best practices set out by the all-powerful super-board. Proponents of such solutions also speculate that private insurers would eventually follow the super-board’s dictates, as well. In essence, the pro-NICE advocates envision a government takeover of all American health-care decisions in the name of efficiency.



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