March 28, 2009

The pain in Bill Murray's arthritic hip throbbed for more than a year while he waited to see a specialist.

When he finally got an appointment, the specialist said Murray needed a cutting edge hip-resurfacing treatment. Murray, a 57-year-old living in Alberta, Canada, tried to schedule the procedure, but was flatly rejected.

It wasn't an insurance company that turned him down or even a hospital worried about his ability to pay. In fact, Murray tried to pay for the procedure out of his own pocket.

Instead, Murray was denied by the Canadian government's health care bureaucracy, which declared that he was just too old to appreciate the benefits of the procedure. Simply put, his pain wasn't worth the cost.

Anyone who thinks a health care horror story like this couldn't happen in the United States needs to think again.

Thanks to recent efforts to build a national health information technology system while beefing up spending on comparative effectiveness research, the infrastructure for health care rationing in America is being created even now.

To start with, the recently passed economic stimulus bill designates roughly $20 billion for the creation of health information technology architecture. The aim would be to create a centralized electronic database of health records for every American.

Doctors might resist, but any such effort would likely deal out financial penalties to any health care provider who refused to take part.

Murray was denied his request because Canada's health care bureaucrats decided that his procedure wasn't worth the cost. How did they decide? Government-funded cost-effectiveness research, an idea that's gaining traction - and considerable funding - here in the U.S.

The same bill that provides funding for health information technology also allocates $1.1 billion toward comparative-effectiveness research. And it creates a Federal Coordinating Council for Comparative Effectiveness Research - an advisory group intended to coordinate the research and advise the president and Congress on its future needs.

Centralized health information technology is intended to make the management of U.S. medical records more efficient, and comparative-effectiveness research is designed to save money by determining which treatments create the most patient value.

In theory, these would allow health agencies to better coordinate and more effectively prioritize treatments by focusing on those who would benefit from it most.

But in combination, these programs put in place all the necessary infrastructure for health care rationing in the U.S.: A council with a broad mandate armed with cost-effectiveness data could easily use a centralized health information technology system to push doctors away from treatments they deemed ineffective.

Bureaucrats already are under instructions to "guide" treatments. How long before that guidance becomes a push - or a mandate?

Overseas, this already has happened. In the U.K., a similar formula for determining cost-effectiveness resulted in elderly patients suffering from retinal decay being forced to wait until they are blind in one eye before seeking treatment.

It's a formula that affects older individuals in particular, because part of the formula calculates how long any given treatment will provide value. In other words, as Bill Murray found out, anyone deemed "too old" is liable to be left without treatment.

Murray, of course, tried to pay for the treatment himself. But even then he was denied. Why? Because government bureaucracies survive by barring competing services - and health care is no exception.

A 2005 Canadian Supreme Court ruling, for example, ostensibly gave the country's patients the right to purchase health insurance on the private market. But Quebec's government responded with a set of rules designed to protect its monopoly on health care that essentially made the ruling moot.

The U.S. already has taken steps down this path. Medicare effectively prohibits those it covers from going outside the system for many common services: 97 percent of U.S. doctors accept Medicare funding, and they're all restricted from taking Medicare patients for any services covered by the program.

No government should leave its citizens helpless to provide medical care for themselves, but with the provisions for cost-effectiveness and health information technology, that's just what Washington has decided to do.

We ought to seek out ways to promote efficiency and cost-savings in health care, but too often, when the government is involved, the tough truth is that all those words are just Beltway code for bureaucratic rationing and control.

We believe that the Constitution of the United States speaks for itself. There is no need to rewrite, change or reinterpret it to suit the fancies of special interest groups or protected classes.