What’s your comparative effectiveness?

Sam Smith – I’ve told my doctor that if I get to the point where I can’t argue with him anymore, he can pull the plug. I told one of my sons about this and he promptly responded, “What do you mean, Dad? Don’t you want me and my brother arguing about you on national TV?”

(In fact, it’s not totally a joke. During the one serious operation I’ve ever had, the doctors gave me extra anesthesia, explaining later that I was talking so much politics that it was distracting them.)

So I come to the end of life issue from the pragmatic side, but I also respect that fact that many wouldn’t agree with me. Further, you’ll note that it was – at least in my imagination – my choice and not that of the doctors, insurance companies or the government.

And so, unlike many in the Democratic Party and the media, I don’t think the issue is some rightwing plot designed to sabotage the healthcare bills.

But how to discuss it rationally? Well, here’s a starting point. The Christian Science Monitor notes that in the “British national health service, a government board approves only expensive treatments that add at least the equivalent of one year of quality life for every $50,000 in spending.”

In a time when doctors are being told how many minutes they may spend with a patient, it doesn’t help to avoid the issue of healthcare rationing.

Although the Democrats deny they are planning “death panels,” they are pushing for studies of the “comparative effectiveness” of treatment plans, a perfectly sensible inquiry, but also one that is just a step or two away from the British system. For example, without any direct government intervention at all, a hospital might refuse a treatment based on a recent government comparative effectiveness study.

How one feels about all this is a much better guide to the issue than most of what you will read or hear these days. What is the comparative effectiveness of another year of your life? And who gets to decide?

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