January 27, 2013
Malpractice by DecreeBy Deane Waldman
Recently, Huffington Post published a serial panegyric in praise of ObamaCare by Drew Altman, Jeff Young, and Jeffrey Levi. As is often the case with Huffpo, fact and opinion can't be said to diverge as much as they never occupy that same space at any given moment.
Kaiser Family Foundation CEO, Drew Altman Ph.D, completely missed the boat when he wrote, "the health care reform debate has not been about facts but about ideology and partisanship." That is not true, certainly not for MD-doctors.
Medical doctors do not care about political labels, position vis-à-vis the aisle (right or left), ideology, or party affiliation. Good doctors care only about what works and what doesn't. The sicker the patient, the more we care.
For decades, a critically ill patient named Healthcare has been treated by Congressional doctors-without-licenses. Now they are injecting We The Patients from a bottle of snake oil labeled ObamaCare.
Healthcare is a critically ill patient, and sickness is a medical problem. ObamaCare is malpractice. It abrogates the four principles of accepted medical practice: (1) It is not evidence-based. (2) ACA treats symptoms and ignores causes. (3) There is no long-term (cost+risk)/benefit analysis. Most important, (4) the good doctor is in partnership with the patient, but the patient is the final authority. The good doctor never, ever, ever imposes his/her will on an uninformed, non-consenting patient. Technically, ObamaCare is assault and battery.
(1) Evidence of systemic failures elsewhere did not stop Congress and Obama from modeling their ACA on Canada and Great Britain. Wherever the government in charge, welfare of the budget supersedes welfare of the patient. Proper medical practice means the patient always comes first.
(2) ACA does not distinguish symptoms of Healthcare's sickness from its causes. Lack of insurance coverage is a symptom. You don't treat that. The patient's major complaint is lack of care. WHY do patients lack care? What does ACA do?
ACA takes money from health care providers to pay bureaucrats. How does hiring more regulators get people what they want and need -- care? Obviously, it does not. ObamaCare does not even treat symptoms (3).
Altman writes that conservatives "don't like... the increase in the government's role in health care or the federal spending it brings with it, even if those things result in coverage for more than 30 million uninsured Americans." Try substituting the word "doctors" for conservatives.
Doctors do not like expansion of "government's role in health care" because federal bureaucrats will be practicing medicine without licenses. ObamaCare's IPAB (Independent Payment Advisory Board) will determine what is approved and what is not, which means which treatments are available for patient care and which are not. That is practicing medicine.
Doctors do not like an increase in federal spending. We remember the ostensible reason the president started the whole healthcare discussion: overspending on healthcare. How does spending more cure overspending?
The government constantly tells We The Patients that healthcare needs more regulation, more oversight, greater information security, and that it will protect We The Patients from those greedy insurance companies as well as from error-prone providers, (and a chicken in every pot.) This is the executioner telling the prisoner that a sharper guillotine is better for him.
Let me say this clearly, with no qualifiers and no weasel words. U.S. healthcare system failure is due to an ever-expanding governmental bureaucracy, and its attendant complexity. To paraphrase the 40th U.S. President, (governmental) complexity is the problem, not the solution. You cannot cure overregulation and complexity by adding more regulations and greater complexity.
Yet HuffPo staffer Jeff Young seems to think you can! He wrote, "But none of those triumphs will mean a thing to the American people... if Obama can't meet the complex administrative and technical challenges involved in implementing the law." Using more than 500,000 words, ObamaCare is the most complex law ever written, filled with ambiguity, contradictions, magical thinking, and... well, imaginative financial planning.
The complexity and inherent contradictions of ACA can be seen in its health exchanges, recently rebranded as "marketplaces" by Washington. The president assured us that his exchanges harness the power of the free market to get us the most (care) for the least (dollars). Obama's insurance "marketplaces" are, in fact, not free markets at all.
When government controls both supply and demand, the market is centrally controlled, not free. It will have none of the efficiencies of a free market, defining "efficiency" as getting the most care for patients using the least dollars. ObamaCare spends more, not less, while we get less care, not more.
Mr. Young went on: "The massive health care overhaul stands as a test of one of the central premises of his [Obama's] political philosophy: that government, carefully and judiciously applied, can be a positive force in the lives of the citizens it serves."
Now that Obama has won re-election, he and ACA supporters have stopped pretending that ACA is anything less than takeover of US healthcare by the Washington bureaucracy. There is no partnership -- recall principle #4 -- with the patient. "Doctor" Obama is imposing his will on the We The Patients.
As they say on TV, "But wait! There's more!!"
All that shiny new ObamaCare bureaucracy will cost lots of money, your money. Those dollars will come from two places.
ObamaCare takes money from paying care providers to pay bureaucrats. As Robert Moffitt (Heritage Foundation) testified, "You cannot get more of something [care for patients] by paying less for it."
Second, to pay the authorization agents, regulation writers, overseers, compliance officers, and administrators, Washington will have to print trillions, with a "t"! Thus, ObamacCare exacerbates instead of reforming another cause of American illness: the national deficit. The evidence for malpractice keeps piling up.
Those who praise ACA have drunk the Kool-aid. They espouse the chimera of an American right to health care.
Also in HuffPo, Professor of Health Policy Jeffrey Levi wrote, "By birth, every American should have the opportunity to be as healthy as he or she can or wants to be." This is true, the key word being opportunity, as in ability to choose. We have the right to be as healthy or as unhealthy as we choose. With that right, with that freedom, comes the responsibility to accept the consequences of our choice.
Levi continued, "A government that is truly for the people provides everyone with world-class services that protect and support their health." This is categorically wrong. First, government does not provide. Nurses, doctors, and trained therapists do.
By the U.S. Constitution and particularly our Bill of Rights, the government serves the people, who are free and responsible. If the government is responsible, then the individual is not. If the government is in control, the individual is not free. That is not just un-American. That is anti-American.
In Great Britain, and soon here, the government will decide who gets care and who does not. In the NHS, NICE (National Institute for Clinical Excellence) has control, while here it will be IPAB. These government agencies choose both for doctors and for patients. By denying certain treatments, NICE and IPAB choose for us. Their choice is often death: over 65, no heart surgery; over 55, no kidney dialysis. Sometimes, naturally, this will cause death.
Check out the Liverpool Care Pathway on the Internet. NHS hospitals are given financial bonuses for declaring someone terminal and then hastening their demise. I had trouble believing this, but it is true. As a physician, I find this obscene and immoral.
"The success of the Affordable Care Act now hinges on implementation." Wrong. ACA cannot succeed, not if success is measured in terms of healthy Americans. An improperly designed building or bridge cannot stand (succeed). You cannot "implement" a submarine to fly. It was never designed to do so.
ObamaCare cannot cure the sick US healthcare system. It cannot because it never was designed for the health and welfare of the American public.
Deane Waldman MD MBA is a physician who gave up clinical practice after the 2012 election saying, "I cannot practice good, ethical medicine under ObamaCare." He remains Adjunct Scholar for the Rio Grande Foundation in New Mexico, and author of Uproot US Healthcare as well as Not Right! -- Conversations with We The Patients (May 2013).
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