Rationing - On Being Nice in Health Care, What Is Is

What is is.

Rush Limbaugh, 1951-

It depends on what is is..

President Bill Clinton, 1946 –

People should be taught what is, not what should be.

Lenny Bruce, 1925-1966

That is, is.

Shakespeare, 1564-1616

Be nice to people on your way up, because you’ll meet them on your way down.

Wilson Mizner, 1876-1933

Saying No Isn’t NICE - The Travails of Britain’s National Institute for Health and Clinical Excellence.”

Robert Steinbrook. MD, title of article in New England Journal of Medicine, November 5, 2008

Sorry about the quotation –littered lead-in, but I wanted to establish beyond doubt the reality that reality that being nice is nice, particularly in the politics of health care.

No politician of modern times has been better at this than President Barack Obama, who is universally seen as a nice guy, with a nice family, and nice intentions.

Obama wants to be nice to most of the people most of the time. This is nice politics, but whether is sound policy is not yet known.

Obama’s policies and politics remind me of Winston Churchill’s famous observation, “The inherent vice of capitalism is is the unequal sharing of blessings; the inherent virtue of socialism is the equal sharing of miseries.”

President Obama might rephrase this to read,” The inherent vice of capitalism is the unequal sharing of nastiness; the inherent virtue of socialism is the equal sharing of niceness.'

But alas, universal niceness has its downside – there isn’t enough money to go around. Here is how Robert Steinbrook, MD, appraised Britain’s NICEness policy, i.e, withholding treatments for certain drugs and procedures to make “universal coverage” work.

“Britain’s National Institute for Health and Clinical Excellence, known as NICE, is an indEpendeNt, government-funded organization that advises the British National Health Service. Since 2002, NHS organizations in England and Wales have been required to pay for medications and treatments recommended in NICE “technology appraisals.” The NHS usually does not provide medicines or treatments that are not recommended by NICE – although exceptions are possible.”

“NICE,however, has been criticized for the slow release of appraisals…Some of tis decisions seem unfair, and the institute has been vilified for recommendations to limit coveragefor some high-profile medicines for cancer and other life-threatening diseases. Its decisions are often appealed, --- and one decision has been challenged in court…saying no takes courage – and inevitably provokes outrage.”

What it comes down to is this. If government is to ration care by setting clinical effectiveness standards, it cannot be nice to all the people all of the time. Being nice to people has its limits, even in a non-litigious society like Britain, You can be nice to most of the people most of the time, but you cannot be nice to all of the people all of the time.