Hidden Healthcare: The Financial Mess and it's Furtive Features

{ Posted by Pauline Linck on August 18, 2017 }

For some time now, Democrats have been hyperventilating over the "crisis" in American healthcare, and not without just cause. They have laboriously insisted that they have the right ideas to mend the tragedy. Interesting, then, that they would go to such great lengths to ensure that their first efforts at reform be as clandestine as possible. Using the financial mess as cover, Democrats have managed to sneak some major health policy initiatives into the much discussed yet barely scrutinized "stimulus" package. With the bill's passage, these backdoor measures have the force of law, and vault us (further) down the road to centralized, government-run healthcare.

The secrecy, in and of itself, is not altogether unexpected. If the Democrats learned anything from the 1994 HillaryCare boondoggle, it was the mistake of advertising their ultimate intention of federalizing the healthcare sector and going for it full throttle. Former Senator Tom Daschle, President Obama's initial pick for HHS Secretary and an ardent support of the Clinton effort, attributed its failure to the debate and delay of the legislative (read: democratic) process. As recently as last year, Daschle wrote that the next president, should he be a Democrat, must act on the issue quickly, before critics have time to draw attention to it and mount an opposition. "If that means attaching a healthcare plan to the federal budget," he said, "so be it. The issue is too important to be stalled by Senate protocol." In other words, the issue is such that it cannot abide open discussion and debate, let alone consideration of alternatives to nationalization. It must rather be imposed on the people from above, for their own good.

With Obama's signature, the medical treatments you receive will now be electronically tracked by the federal government. The new bureaucracy charged with this task, the National Coordinator of Health Information Technology, is ostensibly intended to "guide" your doctor's decisions, ensuring that she adheres to practices the government deems appropriate. While the literature on the subject makes it quite clear that the cost-saving possibilities of health IT are minimal, it is less clear as to whether such an approach is even clinically beneficial. Uniformity of care, irrespective of the hype, is not necessarily a good thing. In fact, it can be quite detrimental to patient welfare.

Every patient is physiologically unique, and as such can require unique and differing treatment regimes. Limiting your doctor to so-called "best practices" effectively prohibits the individual treatment of patients, as well as places constraints on the availability of experimental options that may prove fruitful. Proponents see no problem with this, with Sen. Daschle arguing that physicians have to give up autonomy and "learn to operate less like solo practitioners." They must rather subvert their professional opinions to those pre-determined in Washington.

I pause for a moment as, for some reason, the words "Oh, brave new world," creep into my mind.

Determining which treatments will be deemed "appropriate" and thus approved as part of a doctor's repertoire, is of course a delicate matter. Congress, being a political body, quite naturally would like to avoid making such tough, and potentially unpopular, decisions. To solve this dilemma, the "stimulus" delegates this task to a kind of healthcare Fed, to be known as the Federal Coordinating Council for Comparative Effectiveness Research.

The stated goal of this body, as outlined in Sen. Daschle's book, is to slow the development and utilization of new medications and technologies as a method of controlling rising costs. While some may see this as an affront to patient choice, proponents praise Europeans for their willingness to accept "hopeless diagnoses" and foregoing experimental treatments, in effect chastising Americans for expecting too much from the healthcare system. Seniors in particular, Sen. Daschle argues, should be more accommodating of the conditions that come with age, rather than seek treatment.

One can't help but be think of stories of Eskimo seniors being cast adrift on icebergs once they are no longer of use to society.

Oh, brave new world.

Of course, cost-effectiveness language is conspicuously absent from the final version of the bill, which refers instead to "clinical appropriateness." The experience of other countries with similar bodies however, as well as common sense, tells us that as budget constraints become increasingly pressing, these groups devolve into unaccountable and undemocratic cost control bodies, inevitably resorting to the rationing of care.

The decision to approve or reject particular services and treatments will be reached using a formula that divides the cost of a treatment by the number of years a patient is expected to benefit. This implies that services for senior citizens, who are the primary utilizers of medical care, will be much less likely to be granted approval than services for younger patients. One anecdote among many for how such a policy can play out was recently revealed in a story from Bloomberg news:

In 2006, the U.K. health board NICE, upon which the American council is to be modeled, decreed that elderly patients with macular degeneration had to wait until they went blind in one eye before they would be granted access to a costly new drug to save the other eye. Being politically unaccountable, it took more than three years of protests before the board reversed it's decision.

When one considers the budget problems looming over the Medicare program, measured in tens of trillions of dollars, it is not difficult to imagine such draconian cost-saving measures being introduced in the United States. The implications of this are compounded when one considers that seniors are already finding it more and more difficult to find a new physician as Medicare reimbursement levels continue to to fall in a futile attempt to stem rising costs. As Democratic ambitions to expand government-run healthcare to more and more Americans come to fruition, we can expect the constrains on care for seniors to befall the rest of us.

It's a brave new world out there. Let's hope we can all be accomodating of it, even without the benefit of heaping doses of soma.