“HHS Prohibited Panel Developing Contraception Mandate from Considering ‘Cost Effectiveness’”
Money is no object! Particularly when it isn’t yours!
And yet those with the Utopian impulse still seem mystified when their grand schemes crumble under the weight of both math and the individual’s refusal to be enslaved by the State.
There would be no consideration of cost effectiveness.
That was the explicit condition that the Department of Health and Human Services imposed on the panel of scientists it commissioned to develop the “preventive services” mandate that will require virtually all health-insurance plans in the United States to cover sterilizations and contraceptives—including those that cause abortions.
The fact that HHS prohibited the panel from considering the cost effectiveness of the mandate it developed sharply contrasts with President Obama’s declaration at the White House last Friday that his administration had adopted the panel’s recommendations precisely because they will “make the overall cost of health care lower”
Or, more simply put, the President lied.
One scientist who served on the panel, meanwhile, suggested in a dissenting opinion that the panel’s recommendations in fact might not be cost effective and that the panel’s process for arriving at its recommendations “tended to result in a mix of objective and subjective determinations filtered through a lens of advocacy.”
The panel—The Committee on Preventive Services for Women–had only 6 months to do its work and met only 5 times. On July 19, 2011, it issued a report with its recommendations. These included the following: “The committee recommends for consideration as a preventive service for women: the full range of Food and Drug Administration-approved contraceptive methods, sterilization procedures, and patient education and counseling for women with reproductive capacity.”
Less than two weeks later, on Aug. 1 of last year, HHS Secretary Kathleen Sebelius issued the panel’s contraception-sterilization recommendation as a new federal regulation—set to take effect on Aug. 1 of this year.
In its report, the committee had noted the short time in which it had to work and repeatedly reiterated HHS’s order that it could not consider cost effectiveness in determining its recommendations.
“The committee met five times within six months,” the report said.
“The cost-effectiveness of screening or services could not be a factor for the committee to consider in its analysis leading to its recommendations,” the report said.
“However, it should be noted that the committee did not have adequate time or resources to conduct its own meta-analyses or comprehensive systematic review of each preventive service,” the committee warned.
“Finally,” the committee said, “cost-effectiveness was explicitly excluded as a factor that the committee could use in developing recommendations, and so the committee process could not evaluate preventive services on that basis.”
“Furthermore,” the committee said, “for consistency in approach with the other three guidelines used by the ACA and given the time limitations for this study, the committee was restricted from considering cost-effectiveness in its process for identifying gaps in current recommendations.”
One of the 16 scientists on the panel—Prof. Anthony Lo Sasso a senior research scientist at the University of Illinois at Chicago’s School of Public Health–issued a dissenting report. He criticized the panel’s process for lack a rigorous analytical method and for filtering things “through a lens of advocacy.” He also suggested there was good reason to believe the panel’s recommendations might not be cost effective.
“Readers of the Report should be clear on the facts that the recommendations were made without high quality, systematic evidence of the preventive nature of the services considered,” Lo Sasso wrote. “Put differently, evidence that use of the services in question leads to lower rates of disability or disease and increased rates of well-being is generally absent.
“The view of this dissent,” wrote Lo Sasso, “is that the committee process for evaluation of the evidence lacked transparency and was largely subject to the preferences of the committee’s composition. Troublingly, the process tended to result in a mix of objective and subjective determinations filtered through the lends of advocacy. An abiding principle in the evaluation of the evidence and the recommendations put forth as a consequence should be transparency and strict objectivity, but the committee failed to demonstrate these principles in the Report.”
Lo Sasso also raised a question about the potential cost effectiveness of offering some preventive services for free because it would create a “benign moral hazard”—leading more people to utilize the free service.
“Whether coverage of preventive service leads to a reduction in healthcare expenditure depends on the fraction of enrollees using the service before the service becomes covered and the magnitude of the response among enrollees who experience the reduction in out-of-pocket price,” wrote Lo Sasso. “Knowing how elastic patient demand is to preventive services is a critical element to a coverage decision even if one already has good estimates of the effectiveness and cost-effectiveness. This is self-evidently a useful parameter to know for any preventive service because it highlights the impact that first-dollar coverage of the service will have, perhaps in relation to other forms of outreach.”
Because the committee was not given the time to do a serious analysis of the real impact of the recommended “preventive services,” Lo Sasso recommended that Secretary Sebelius not mandate the services “until such time as the evidence can be objectively and systematically evaluated.”
Despite the fact that this scientifically panel charged with coming up with the recommended preventive services had been expressly forbidden from looking at their cost effectiveness, President Obama declared that his administration had moved forward with the recommendations precisely because of their cost effectiveness.
Or, more simply put, the President lied.
The “science” marshaled here is no more than another postmodern effort to manufacture consent by providing a veneer of logic and study — all of which is intended to create an overall perception of rigor and considered analysis where none in fact took place.
Scientists, as envisioned by this Administration — and by the left more generally — are either willing advocates or useful idiots. Much like the Blue Dog Democrats the DNC uses to present moderation in order to win the majorities needed to ram through its progressive agenda.
So how ’bout it? Can we just say it, dodge the lightning strikes, and keep going? That the President lied? Or do we need to just keep pretending poor ol’ Barack is simply in over his head — a Good Man with good intentions, albeit with bad plans to bring those good intentions to fruition.
And yes, that was a rhetorical question.