The American Spectator

The Practice of Medicine

The so-called stimulus bill that just passed the House of Representatives included $1.1 billion in funding for a Federal Coordinating Council for Comparative Effectiveness Research (CER). The Council is to conduct so-called federal comparative effectiveness research in regard to health care services. The sponsors of that provision explained:

How is it that the studies of this federal bureaucracy could lead to some medical items, procedures, interventions and treatments no longer being prescribed? When the Council issues a finding prohibiting a medical item, practice, procedure or treatment, the HAAs across the country would then be expected to force their insurers to follow it, by refusing reimbursement for any such item, procedure, intervention or treatment. Ultimately, the HAA could throw out any recalcitrant insurers. But insurers generally do not need too much encouragement to deny reimbursement.

What if your doctor disagrees with the Washington bureaucracy about whether an item, procedure, intervention or treatment is effective, or worth the cost, in your case? That doesn’t matter, because he is no longer in control of your care or his practice. The federal bureaucracy is. In fact, he had better keep his mouth shut, or he could be banned from the insurer’s preferred provider network altogether, or even have his license yanked, for not maintaining quality standards of care, or following best practices, or upholding cost effective medicine.

The New Health Bureaucrats

Under these proposed health care reforms, the government will dictate to insurance companies what they must cover, what they can charge, who they can accept as customers, and every other aspect of their “business.” They are forced to accept whoever shows up and asks for their coverage, no matter how sick or costly they may be, for the same premiums as young, healthy, virtually cost free patients. These insurers will be allowed just enough compensation to keep them from quitting, but these regulatory features will still make their insurance quite costly. These insurers are reduced to mere bureaucrats doing clerical work for the government.

Virtually the same is true for doctors and hospitals. Under this legislation, they will be working for the government, not for the patients, because it is the government that is paying them, not the patients. They will consequently follow the directives that come down from the federal bureaucracy as to how to treat their patients and “practice” medicine, regardless of whether they think the directives make sense in the case of any particular patient. In fact, these doctors and hospitals would no longer be medical professionals, but manual laborers, following the instructions of the federal bureaucracy.

And they will be compensated as such. Every year, their reimbursements will be squeezed a little more, until they are making barely enough to keep them from quitting. Indeed, if the government can offer young graduates from foreign medical schools admission to the U.S. if they will work for less, the government would be glad to replace current doctors, surgeons and practitioners with these newcomers. That would be so “cost effective,” of course. If patients feel these foreign trained, inexperienced newcomers do not provide the same quality of care as traditional, experienced American doctors, they can file a complaint with the Federal Coordinating Council in Washington.

The fundamental problem is that these health care reforms turn control of health care completely over to the government. Every aspect of the system is effectively run by government: insurers, doctors, hospitals, and everything else. The patient is left with no real power, especially those who are sick and really need health care. If they don’t like the way they are treated, they can leave and take their costs with them. The threat to leave would only be effective for young, healthy, cost-free patients, who the insurers and their preferred provider networks would attend to most assiduously.

Health Care Rationing and Collapsing Quality of Care

Under these health care reforms, patients have no incentive to keep their demands for health care services down. They will instead seek to utilize the coverage they are paying hefty taxes for, driving up health costs. Voters will then start to scream as the income taxes they are forced to pay for health care premiums increase with these rapidly rising costs. Politicians will consequently pressure the Federal Coordinating Council, the HAAs, and the insurers to do more to keep costs down. More top quality practices and treatments will consequently be dropped, and approval for new innovations as cost effective will be slowed sharply. These bureaucracies will put more pressure on doctors, hospitals and other practitioners to keep costs down, and that will be further enforced by lagging reimbursements not keeping up with costs. So the practitioners will reduce the quality of care, and access to care to reduce costs. That is where the waiting lists come in. And if patients complain, the politicians can hide behind the Federal Coordinating Council, the HAAs, the insurers, and those dastardly doctors and hospitals.

In this environment, who will invest in new state of the art, modern, top of the line facilities? That is why facilities always seem to deteriorate in countries that follow these socialized medicine policies. And who will invest in the research, development and production of new, innovative breakthroughs, medical technologies, pharmaceuticals, etc.? Will new innovations be approved? After how long? Will they then be adequately reimbursed in this hostile environment? That is why new advances always lag badly wherever these socialized medicine practices prevail, further reducing quality.

Advocates of these reforms argue that competition among insurers will keep costs down. But insurers have no power to keep costs down unless they have the power to deny care. Which they will demand from the politicians more and more to stay in business and remain profitable. And the politicians will be glad to give them those powers in the name of cost effectiveness. Do you see the fascism yet?

All So Unnecessary

This health care nightmare, which is another assault on the standard of living of the American middle class, is all completely unnecessary to deal with the problem of the uninsured 8 million (less than 3% of the U.S. population) who are not illegal immigrants, already eligible for government health programs, or in families earning over twice the poverty line. I don’t believe in anyone suffering or losing their long-term health because they can’t afford medical care. But it is not necessary for the government to take over all health care to deal with this problem.