"Comparative effectiveness research"

They say, "No one wants to live to be 100 except the guy who's 99." Michael DeBakey, the world-renowned cardiovascular surgeon who invented the roller pump that made open-heart surgery possible, was a mere 97 when he said "no" to a heart operation to fix a main artery. But his family said "yes," and the procedure bought him two extra years of productive life.

DeBakey is the kind of example that drives me nuts. I personally don't think I would feel good about consuming medical resources that could go to someone half my age (assuming this was a zero-sum game)---or about being ahead of a 20-year-old on a list of organ donor hopefuls.

On the other hand, I don't think I would feel good about living in a country that bumps me off a list because of some arbitrary, government-mandated age requirement ("Too old for health care"), or that doesn't consider a procedure "cost effective" for me because the actuarial tables say my life's not worth living anymore. I'd like to make that decision myself. It reminds me too much of the SS "selections" at Auschwitz, where new arrivals were directed either into the work force or the gas chambers depending on their perceived fitness.

Charles Krauthammer is as baffled as anyone about how President Obama is going to pay for his "vastly expanded welfare state." Assuming that Obama is not totally off his rocker, the conservative commentator has come to the conclusion, by picking up on the president's hints about "additional adjustments" in the health care system, that the money to pay for his ambitious plans will come from rationing. This, surmises Krauthammer, is the real aim of Obama's "comparative effectiveness research," to be carried on by a new government agency that will assess the relative effectiveness of treatments.

I like the idea of CER if it means an end to unnecessary procedures, and to cover-your-behind redundancy of testing. (I'm wondering if my upcoming MRI is really necessary, or just a hyper-conservative measure done more for my radiologist than for me.) Is there a wise man in the house?

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