July 27, 2012
Meet Your New M.D.By Deane Waldman
In response to a 2008 article titled "WHO is practicing medicine," "John" posted the following. His remarks demand a public response.
WHO isn't my care provider?
The shortage of doctors and nurses in the U.S. is reaching a critical level. Applications to U.S. medical schools fell almost 20% between 1995 and 2010. There are over 500,000 unfilled nursing positions in the U.S. In 2010, there were 120 available positions for training in heart surgery -- sixty people applied.
Doctors caring for Medicare or Medicaid patients are now paid at levels below their cost of doing business. They will either have to close their practices or see only privately insured patients -- that is, those not covered by the ACA or Medicare.
With ACA cutting provider reimbursements even further (to pay for more bureaucrats), doctors have become an endangered species. The conversion of 30 million uninsured Americans to the lists of the insured, with fewer and fewer doctors, takes a critical personnel shortage approach and makes it terminal. As Robert Moffit of Heritage Foundation succinctly testified before Congress, "[y]ou cannot get more of something by paying less for it."
Most doctors must refuse to see ACA-covered patients because they cannot afford to. Those who agree to see these patients will soon be financially forced out of practice. Either way, the ACA may provide insurance coverage, but it won't provide care.
President Obama's promise, "If you like your doctor, you can keep your doctor," was a cruel play on words. You may keep your doctor, but your doctor can't keep you.
And it gets worse.
You (rightly) expect that you, in consultation with your doctor, make your own medical decisions. Wrong! Before the ACA, it was the insurance company that decided. After the ACA, a government agency called IPAB (Independent Payment Advisory Board) will decide.
Behind closed doors, IPAB (Independent Payment Advisory Board) will determine what it believes are nationally cost-effective medical treatments. What they deem "not cost-effective" will become unavailable.
In England, the IPAB is called NICE (National Institute for Clinical Excellence) -- possibly a new standard for disingenuous labeling. NICE has declared that kidney dialysis after age 55 and heart surgery after 65 are nationally "not cost-effective." So, if my 69-year-old British brother Stewart develops renal or heart failure, he just...dies?! Even though effective treatments are readily possible?!
IPAB decides your health care plan without regard to your health. The doctor can study all the hard evidence she wants and carefully recommend what is scientifically best for you. The health care you actually get is what IPAB decides is best for the federal budget.
John stimulated this article by asking, "Is there case law allowing insurance companies to make these [medical] decisions without actually seeing the patient?" The answer is an emphatic no. Case law strongly opposes anyone except your personal doctor from practicing medicine on you.
In an Arizona case, Murphy v. the Board of Medical Examiners, the Court ruled that a medical doctor working for an insurance company could not overrule a patient's personal physician. The insurance doctor cannot substitute his or her judgment for that of the patient's chosen physician.
In Tallahassee Memorial v. Cook, the U.S. District Court held that a medical organization such as an MCO (Medical Care Organization), or presumably now an ACO (Accountable Care Organization), could not overrule the patient's personal physician as to "appropriate medical care."
Thus, case law holds that only you and your doctor decide -- not the insurance doctor, and not a medical organization. Apparently, a political organization called the federal government can be and will become your care decider.
John's second and third questions were similar. "Why haven't state licensing boards taken this on?" and "Where is the smart attorney or politician with big enough balls (either male or female) to take this on?" To rephrase, why doesn't someone with power (that obviously excludes doctors) fight for the patients? Why doesn't a State Medical Board, the AMA, or your hospital fight to assure that you get the care you need?
Quality Assurance Departments do not assure quality for patients. They function solely to assure hospital compliance with federal rules and regulations. Risk Management Departments do not manage medical risks for patients. They manage institutional, not personal legal and financial risks, in the best interests of the hospital.
The larger bureaucracies -- Medical Boards, Professional Associations, AMA, AARP -- treat federal agencies the same way that sharks treat lawyers: with professional courtesy due "their own." They never bite the hand that feeds them.
In 2009, Daniel Putkowski published a novel titled Universal Coverage. This was a fictional account of U.S. health care under a government-run "universal" system. His cautionary tale is quickly becoming our frightening reality.
What about my health care?
Let's return to my two questions.
(1) Who will provide my health care? Not your doctor or nurse. Not your hospital or the AMA. Your health care provider is a faceless, nameless bureaucrat in Washington who never heard of you and doesn't care about you. That is your new "doctor."
(2) Will the health care I get be the health care I need? Certainly not if rationed by the government, where cutting costs, not optimizing your health, is all that matters.
President Obama assured us that under the ACA, all American citizens could get health insurance. What good is having health insurance if you cannot get the health care you need, when you need it? Welcome to Obama's world of smoke, mirrors, and politically motivated empty promises.
John's final question was, "Why am I the only person to comment on this in four years?" I have answers for John, but none that I like.
Healthcare is sick. The ACA is making it sicker. Only We The Patients can and must cure healthcare.
Deane Waldman, M.D., MBA is tenured professor of pediatrics, pathology, and decision science; adjunct scholar for Rio Grande Foundation; and the author of over 300 articles, as well as the books Uproot US Healthcare and Not Right! (December 2012).
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