Brian Gratzer's article on Tom Daschle says some very smart things, and some very misleading ones. In particular, he's part of the emergent effort to distort the role and vision of Daschle's Federal Health Board:
How to get better value? Daschle et al. look across the Atlantic: They like, for example, the United Kingdom's National Institute for Health and Clinical Evaluation, or NICE, which is "the single entity responsible for providing guidance on the use of new and existing drugs, treatments, and procedures."They note that NICE doesn't simply tap the expertise of professional bodies but also weighs "economic evidence — how well the medicine or treatment works in relation to how much it costs."Daschle et al. push the idea further, envisioning a superboard — he likens it to the Federal Reserve — that would compare drugs and treatments, then use the federal government's enormous buying power (Medicare, Medicaid, VA) and influence (published reports and public statements) to push the rest of us along.
The problem comes in four little words: "Push the idea further." Actually, Daschle takes the idea half as far as the UK does. In Britain, everyone is covered under the National Health Service. NICE makes empirically-informed judgments on the cost-effectiveness of treatments to decide what the National Health Service will and will not cover, which is to say, what treatments the British people can and cannot access. For a longer discussion of NICE, see this article, or this post. In America, about 26 percent of the population is on public insurance. Most of those individuals can also buy private insurance (the exception is most folks on Medicaid can't afford private insurance, and if they could, they wouldn't be on Medicaid). Many of them do. In other words, Daschle's Federal Health Board, even if it passed in its maximal form, would make decisions covering 26 percent of Americans, most of whom could, if they disagreed with those decisions, purchase supplementary coverage that had different rules. It is very hard to understand how that "takes it further" than an agency that makes basically binding decisions on something approaching 100 percent of the population.
