August 6, 2009
ObamaCare's Poison PillBy Linda Halderman, MD
Three House committees just choked down the bitter pill of a compromise version of a healthcare reform bill, HR 3200. But for vulnerable patients -- and taxpayers -- the cure may be worse than the disease.
Problematic policy recommendations by proponents of rationing and socializing costs may be part of why the bill is so unpalatable to opponents of government intervention in healthcare decision making.
President Obama's director of the Office of Management and Budget, Peter Orszag, is himself advised by Ezekiel Emanuel -- brother of White House Chief of Staff Rahm Emanuel.
In addition to serving as a Special Advisor in the Obama Administration, Dr. Ezekiel Emanuel is a fellow at the Hastings Center. The Hastings Center, a bioethics research center, has published articles and books on the patient's right to die, as well as promoted "Assisted Dying" policy as a component of healthcare reform.
Dr. Emanuel's June 2008 article in the Journal of the American Medical Association criticized the Hippocratic Oath as an unwelcome "imperative [for physicians] to do everything for the patient regardless of cost or effect on others."
In the article, titled "The Perfect Storm of Overutilization," he instead encourages a "move toward more socially sustainable, cost-effective care."
This philosophy of "socially sustainable care" for older Americans is reflected in nine pages of the bill devoted to a description of a new Medicare benefit: "Advance Care Planning Consultation."
Concerns with these provisions (quoted below from pages 425-434 of HR 3200) have been dismissed as spin and minimized by the Administration and supporters of the bill.
HR 3200 describes what a private discussion between a patient and doctor should include: "an explanation by the practitioner of the continuum of end-of-life services...and an explanation of orders regarding life sustaining treatment" with "the reasons why such an order should be updated periodically as the health of the individual changes."
The discussion of end of life choices would be further detailed by the federal government to address an individual's desire for "the intensity of medical intervention if the patient is pulseless, apneic, or has serious cardiac or pulmonary problems" and whether or not the individual will allow "the use of antibiotics" or "artificially administered nutrition and hydration."
The President refuses to say if he specifically supports Medicare reimbursement for end of life counseling sessions or the wisdom of allowing the federal government to dictate the content of medical discussions. According to his aides, he is unconcerned that such reimbursement might lead to government interference in life or death decisions about health care.
Also informing healthcare policy is Dr. David Blumenthal, the National Coordinator for the Obama Administration's new Health Information Technology $19 billion bureaucracy. Dr. Blumenthal is the author of "Controlling Health Care Expenditures," published in the New England Journal of Medicine on March 8, 2001 (pages 495-498).
In the same article, Dr. Blumenthal extols the virtues of government cost controls for healthcare, though he concedes the inevitable result of this intrusion into patient-doctor decision making: "Longer waits for elective procedures and reduced availability of new and expensive treatments and devices."
Government cost controls would need to be extreme to prevent HR 3200's assault on taxpayers. How much green can a taxpayer's wallet hemorrhage? The House bill aims to find out. Current estimates for the bloated legislation -- over 1,000 pages and counting --reach nearly $1 trillion.
In a classic example of government mathematics, Legislators involved in negotiations bragged that said the most recent amendments would cut the bill's cost by about $100 billion over 10 years. These same dealmakers carefully omitted reference to additional new amendments that would actually RAISE the fiscal burden-by about $100 billion.
It is possible that the same economic logic was used to draft page 203, lines 14-15 of HR 3200: "The tax imposed under this section shall not be treated as tax."
Complaining about critics, the President scolded, "These folks need to stop scaring everybody, you know?"
He may be right. The President's plan is frightening enough on its own.
Dr. Linda Halderman was a Breast Cancer Surgeon in rural central California until unsustainable Medicaid payment practices contributed to her practice's closure. She now serves as the healthcare policy advisor for California's Senator Sam Aanestad.