The Right Prescription

Obama’s Medical Mystery Shoppers

Big Brother Obama and Big Sis Sebelius tighten the noose on America's doctors.

By 6.30.11

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On Tuesday evening, after being outed by the New York Times, the Obama Administration abandoned plans to have "mystery shoppers" call primary care physicians to determine how easy or difficult it is to get a doctor's appointment and whether being part of a government health insurance program impacted that ease or difficulty.

The original proposal from the Department of Health and Human Services, dated April 28, 2011, specified that a division of HHS would contact 465 Primary Care Physicians (PCPs) in each of nine states: "Each PCP's office will be contacted twice; once using a privately insured patient scenario, and once using a publicly insured patient scenario. The scenarios will simulate requests for an appointment with the sampled PCP from a new patient with both public or private insurance and either an urgent medical concern or routine exam appointment."

HHS also planned to call 465 more PCPs (in total, not per state) who would "be informed about the study and asked directly if they are accepting new patients and how long it would take to obtain an appointment. The purpose of this additional data collection component is to evaluate the validity of the mystery shopper approach in generating accurate estimates of physician availability and timeliness of services." Does anyone believe that a doctor really wants to tell a government questioner that he's avoiding taking new government-funded patients?

As the Times noted, "the decision [to abandon the "mystery shopper" plan], after criticism from doctors and politicians, represents an abrupt turnabout. On Sunday night, officials at the health department and the White House staunchly defended the survey as a way to measure access to primary care, and insisted that it posed no threat to privacy."

It's a remarkable scoop for a newspaper which has operated as an arm of the Obama Administration's press office (and recently has only seemed interested in breaking big stories when they can damage national security or the election chances of Republicans). Nevertheless, the Times' article quotes four doctors opposed to the scheme and no doctors in favor of it. For example: "'I don't like the idea of the government snooping,' said Dr. Raymond Scalettar, an internist in Washington. 'It's a pernicious practice -- Big Brother tactics, which should be opposed.'"

One defense of the plan that has been made by liberal talking heads is that the use of "mystery shoppers" is a common practice by private businesses who want to make sure their products are being sold as much and as well as possible. But of course, government is not a business; government is power. A business is trying to maximize the chances that a consumer makes a decision to buy that business's product rather than someone else's. The government, especially this Administration, has the opposite aim: to take as much decision-making ability as possible away from both consumers and providers of health care. The voluntary aspects of consumer choice and doctors' rights to run their own businesses versus the compulsion of government power makes the comparison ridiculous, though maybe not in the minds of liberals who believe that most people are too stupid to make their own decisions.

The most likely outcome of the "mystery shopper" program would have been heavy-handed federal regulations on how doctors must behave, such as how many patients of what type they must see. Furthermore, given this administration's reputation for attacking anyone who gets in the way of its statist plans, one can only imagine the anti-doctor propaganda that would be used or at least threatened once HHS had data to prove what we already know: low reimbursement rates by government are causing more and more doctors to avoid taking Medicare and Medicaid patients. 

The American Association of Medical Colleges estimates that "the United States will face a shortage of 124,000-159,000 physicians by 2025." But despite the creation of four new medical schools in 2009, there has over the last few years been essentially no growth in the number of people applying to medical school. Let me put on my big surprise face. Would you want to spend the better part of a decade and take on $160,000 in debt (the 2010 median for new medical school graduates)  just to be told by Kathleen Sebelius what to do, which patients to see, and how much you can charge?

To be sure, the sort of information the Administration is seeking to gather would be useful for informing public policy. But it should not be gathered by Big Brother operating undercover. Instead, a private organization or think tank, perhaps working with several physicians associations, should survey doctors in a way that guarantees respondents' anonymity and that no individual data will get into the hands of government. (They'd have to be careful with the AMA since that group has already sold its soul, supporting Obamacare in return for keeping an arcane publishing monopoly and receiving sure-to-be-broken promises about Medicare reimbursement rates.)

The Obama Administration is all about blaming anyone but itself: blame the victim, blame an observer, blame anyone but The One!

• The top 1% of earners who pay nearly 40% of all federal income taxes (more than the bottom 90% of taxpayers combined, and despite earning only about 20% of total national income), nevertheless are the targets of Obama's class warfare rhetoric and policy.

• Obama blamed "the 24-hour news cycle and cable television and blogs" for citizens' anger against Obamacare as displayed at town hall meetings in 2009 when Americans suspected -- as they now know -- that we are victims of the most damaging piece of legislation in modern American history.

• Obama blamed ATMs for unemployment (shorthand for blaming technological progress generally) when the unemployed are victims of this government's failed economic plans. (To be sure, the Bush Administration has plenty to answer for as well. But Obama's economic team -- what's left of it anyway -- is incapable of realizing that they're in a deep hole and it's time to stop digging.)

The doctors are the next victims to be blamed, and they know it. The Obama Administration now says, though it was not in what it submitted to the Federal Register, that data about the doctors' responses would have been kept anonymous and aggregated, and that it would not have been used against any individual or group of doctors. If you believe that, I have a bridge to sell you.

When has this administration ever been able to keep a secret? Well, if it has then we wouldn't know, by definition, but there are plenty of things we do know about which we shouldn't:

• Administration officials agreed, as they should, not to speak about operational details of the mission in which Osama bin Laden was killed. But within 48 hours, details were all over the news, not least from the mouth of Vice President Joe Biden, who told the world that it was a Navy SEAL team which carried out the operation. When asked about the leaks of mission particulars, a clearly frustrated Secretary of Defense Robert Gates said "We had reached agreement that we would not talk about the operational details, and as I said at Camp Lejeune, that lasted about 15 hours." 

• Documents released in the Wikileaks data dump suggest that the Obama Administration agreed to give Russia secret information about the British Trident nuclear missile in return for getting Russia's agreement on a new START Treaty.

• How about this March 30, 2011 doozy of a headline? "President Barack Obama has signed a secret order authorizing covert U.S. government support for rebel forces seeking to oust Libyan leader Muammar Gaddafi, government officials told Reuters on Wednesday."  Secret, eh?

• As reported by Robert Stacy McCain, a top campaign adviser for Barack Obama appears likely to have been the source of a leak to the Washington Post about a military study on the likely impact of repeal of "Don't Ask, Don't Tell." The Post's story then misled readers about the results of the study and may have impacted the outcome of Congress's vote on the controversial legislation.

There is nothing this administration won't do, no "friend" it won't sacrifice, no trust it won't break to get what it wants. And we're supposed to believe that HHS wouldn't misuse the survey data if it thought it would help boost their poll numbers or manipulate Congress and the public?

Even the New York Times can smell a rat as big as the "mystery shopper" idea. And when the Paper of Pinch opposes an Obama Administration policy as too heavy-handed, well that's really saying something.

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About the Author
Ross Kaminsky is a self-employed trader and investor and is a senior fellow of the Heartland Institute. He is the host of The Ross Kaminsky Show on Denver's NewsRadio 850 KOA on Saturday mornings from 6 AM to 9 AM. You can reach Ross by e-mail at rossputin(at)rossputin(dot)com.