Road to Rationing

In the past few months, much has been said about the President’s healthcare plan.  From debates about cost to the likelihood of rationing care, there is almost too much to consider.  It is easy to become lost in the rhetoric and lose sight of the real issues at stake.  This is why I am actually thankful that Barack Obama gave a presentation to the AARP last week.   During his talk, he (unintentionally I’m sure) showed his hand by saying this, “We also want to start rewarding doctors for quality, not just the quantity of care that they provide.  Instead of rewarding them for how many procedures they perform or how many tests they order, we’ll bundle payments so providers aren’t paid for every treatment they offer… to a patient with a chronic condition like diabetes, but instead are paid for how they are managing that disease overall.”  After all of the many talks the President has given on healthcare, I find this one statement to be the most revealing.  In two sentences, Barack Obama managed to confirm the fears of conservatives and contradict every assurance he has given us.

My first thought, after hearing the President’s comment was, “Since when is it any of your business, Mr. President, how a doctor (or mechanic, waitress, zookeeper,etc) is ‘rewarded?’”  More to the point, “Since when do you have the authority to monitor such a thing?” Now before anyone says, “That’s not what he meant,” or “It was a poor choice of words,” he made the same remarks in a June presentation before the AMA.  In fact, in the earlier speech Barack Obama expounded on this idea saying, “You did not enter this profession to be bean-counters and paper-pushers. You entered this profession to be healers.”  I must say, for a man so concerned about the job-description of others, it seems he could use a refresher course on the job of President of the United States.    I assure you, Article II of the Constitution does not grant the President the power to financially reward or punish anybody. And while I find this concept outrageous, it doesn’t really surprise me.  If President Obama has made one thing abundantly clear during his presidency thus far, it is that he will not be constrained by silly matters such as the Constitutional role of President.  No, this is not the least bit shocking, but something else was.  This administration has, from the beginning, carefully orchestrated every move and statement.  The speech to the AARP was a major misstep because the President let something crucial slip, the true nature of government-run healthcare.

The President has promised us all along that Obamacare does not equal rationed medical care.  In fact, his team would have us believe that we would not only have “free” care under his plan, but that care would be far superior to anything we are currently receiving.  Many on the left claim that notions of the government restricting the availability of care are absurd, and in the very short-term, they are probably right.  President Obama is not going to release a list of which people get which treatments.  He will not openly declare life-saving procedures “unnecessary.”  The move to rationed care will be subtle, and this new “reward” system is a step in that direction.  While it sounds like a way to increase the quality of care, if implemented, more Americans would have to rely on the care of state-run clinics and fewer would have access to specialists.  Think I’m paranoid? Let’s follow this to its logical conclusion.

Imagine you are a doctor.  You are the world’s best oncologist.  You spent years honing your skills.  You keep up on the latest technologies.  You are the doctor people seek, when others have failed them.  You take on as many cases as you can, even elderly patients and those deemed hopeless by other doctors.  You believe in trying every possible technique to save a person.  You know you can’t save them all, but you give it your best shot. Due to the fact that you take on many high-risk patients (as most specialists do), you are already open to a higher rate of malpractice lawsuits, but you do it anyways.  Now, there is a new system of “rewarding” doctors.  You will no longer receive payment based purely on the amount of time and effort you put into treating patients.  Now, compensation will be based on the degree to which you have “managed” your patients illnesses. You know that despite every effort, some of your patients will not survive or even show improvement. So you are left with some important questions.  Do you continue to treat anyone who walks through the door and lose money? Or do you only accept patients with a better chance of survival?  Do you spend time running every imaginable test in the hopes of a better diagnosis, even if you will not be paid for that time?  Or will you spend a minimal amount of time with the tough cases, so that you can take on more “rewarding” patients?  You may even frame your dilemma this way; If you continue to treat everyone with every available option, you practice will be far less profitable.  You may no longer be able to afford the best equipment, a qualified support staff, or even to remain a privately owned ( and let’s face it, you wouldn’t be much of a “specialist” at that point either ).  However, if you turn away some of the tough cases, you may be able to continue to operate in the manner which you have grown accustomed to.  You may not be able to help as many people, but you will still provide quality care for some.

We may like to believe that physicians would still be willing to treat any and all, but let’s be realistic.  There are already a great number of doctors who won’t take on elderly or high-risk patients.  They don’t want to risk having a record of patients dying under their care, and they don’t want to be sued if they can’t save someone.  Why give them another reason to turn down patients?  If they are not going to be compensated for every test they run, why would they bother to run every test? Yes, physicians take an oath.  Yes, most of them truly care for their patients.  But, bottom line, it is a job.  Like any professional, they expect to be compensated for their work.  They have families to feed, mortgages to pay, and malpractice insurance to buy.  When we stop paying, they stop working.  Would you do that much work for free?

Government run programs all seem to have one thing in common. …They inadvertently create mediocrity.  Phrases like “quality, not just the quantity” sound great until you look at what that little motto means for the long-run.  It is the responsibility of doctors to inform patients of every available option. If a doctor suggests a treatment the patient doesn’t want , the patient says, “No thanks, I can live with it the way it is.”  What good is a healthcare system that rewards physicians for doing anything less?  We all know someone who had an illness that was difficult to diagnose.  Someone who went to several doctors and came away with no answers.  Someone who finally found a physician who ran every imaginable test and came up with a diagnosis no one else thought of.  Or we know a person who tried treatment after treatment, and got nowhere.  Then one day a doctor says, “It’s a long-shot, but let’s try this.”  These are not uncommon stories.  How many faces of friends and relatives came to mind when you read those scenarios?  Now, imagine if the doctors were told they would only be paid for their time if there were tangible results.  Would the physicians have given up sooner?  More importantly, would those loved ones still be here?