The title of the blog entry was "Comparative Effectiveness: Is Obama Really Calling for Rationing?" "Rationing"? That alone would grab your attention.

But then there's  the woman who wrote the entry at the U.S. News & World Report web page. Bernadine Healy, MD,  is  author of U.S. News & World Report's "On Health column," the "former head of the National Institutes of Health, the American Red Cross, and the College of Medicine and Public Health at Ohio State University," according to her mini-bio. This made even me read the 1,000+ word blog a couple of  times through.

According to Healy, when you think of your and my medical records whirling through cyberspace, think of "a giant research laboratory. You name it: Prevention strategies, diagnostic approaches, treatments, outcomes, and costs will be analyzed to reach a better understanding of practice patterns and find those that seem to work the best. Resulting insights, integrated with evidence from clinical research, will be distilled into clinical decision-making tools for doctors--such as those user-friendly pop-ups."

"Pop-ups" were a completely new notion to me, and perhaps to you. We need to understand what they are because Healy tells us they are part and parcel of how Obama promises to supposedly cut costs and standardize the quality of care. (Hint from Healy: care could be standardized downward!)

The idea is that when the doctor types in your medical condition, he or she will receive a real-time assessment (the aforementioned "pop up") of "what is deemed to be the best option for care" And truly the devil (in this case rationing)  is in the details-- the guidelines within which that assessment is made and how those guidelines are arrived at.

Enter "comparative effectiveness." Along with the standardization of care, it is (in Healy's words) the "other pillar of reform." Indeed, it's allegedly so effective that (quoting Healy) "A little over a year ago, the Congressional Budget Office, under Peter Orszag (now the head of Obama's Office of Management and Budget), issued a paper noting the opportunity for 'an expanded federal role' in constraining costs without adverse health consequences by more aggressively investing in comparative-effectiveness research."

So for those of us worried about rationing, are there dangers lurking in "comparative effectiveness"? Well, first (as Healy does) it's important to acknowledge that sometimes tried and true (and much cheaper) technologies and treatment are available. So just adapting something pricier doesn't necessarily mean you are getting better care.

But sometimes it does mean that. What to do then? Healy notes there is "an obvious approach." By this she means, for example, "tough and open negotiations on price--between the government and drug companies."

Let's see what's going on in Great Britain. Something called the "National Institute for Clinical Excellence" (NICE!) makes pronouncements that assess "a therapy's value and setting standards of care." The National Health Service uses this to guide what it offers patients.  If the cost of your treatment isn't "justified," you're out of luck.

Whether something is "justified" is where the diagnostic rubber hits the rationing road.

According to Dr. Healy, Britain uses "the quality-adjusted life year" (QALY), a measuring tool to decide if your treatment is "worthwhile." It's too complex to explain at length but the gist is ominous.

Healthwise, say you are the lower end of the QALY  scale. An expensive treatment would bring you the same one-year extension of life that someone whose overall health is twice as good as yours would receive. However, under the QALY formula (since you are only half as "healthy"), it would be counting as providing only six months more for you to live and thus (under the formula) twice as expensive. Consequently, the treatment "may be deemed too costly."

There are no two ways about it: QALY makes clear quality-of-life judgments--judgments about "the worth of a less-than-'perfect' life," as Healy writes. "The Germans, for example, have categorically rejected QALYs, and many believe fervently that they have no place in healthcare decisions."

Does Obama's plan specifically reference the British model? No, but "Tom Daschle, his first choice to lead healthcare reform, is a fan of creating a NICE equivalent," Healy explains. "I doubt it would be so welcomed here."

Healy's penultimate paragraph brilliantly weaves these threads together.