Opening the Door to Health Care Rationing Under Obamacare

Alyene Senger /

One of the biggest fears Americans have about Obamacare is who will ultimately control health care decisions: the government or patients and their doctors. New research by Heritage health policy analyst Kathryn Nix explains that while the law does not explicitly put those decisions in the hands of the government, it does allow government bureaucrats to unduly influence medical care. Enter comparative effectiveness research (CER), which compares different methods for preventing, diagnosing, or treating a specific disease or condition. In her paper, Nix explores the many ways CER might be used under Obamacare in ways that harm patients more than help them.

Obamacare creates the Patient-Centered Outcomes Research Institute (PCORI), which as Nix explains in previous research, is responsible for “comparing options for prevention, diagnosis, and treatment for specific health problems; improving health care systems; informing patients and other stakeholders; addressing disparities among patient populations and health outcomes; and designing research to be patient-centered.”

PCORI cannot use CER to issue coverage recommendations or make payment decisions. However, changes made by Obamacare to the Medicare bureaucracy will impact patients’ ability to make decisions. Obamacare also creates a value-based purchasing program for certain Medicare providers, which will financially reward some and punish others based on federal quality measures. These could eventually be influenced by CER produced by PCORI.

This new program, Nix writes, “could encourage physician behavior that does not put the patient first, meanwhile treating providers in ways that are unfair, inequitable, and unlikely to truly reflect better-value, high-quality care.” She describes some of the consequences:

Obamacare fails to take the health care system in a direction that would limit CER use to an informational tool, creating the potential for it to reduce patient choice and physician autonomy. To read the full report, click here.