I worked in Washington, D. C. with Congress every day for 10 years. Not once was I ever remotely fearful of any government proposal or legislation.
But for the first time in my long life, I am genuinely afraid. Current proposals for health care reform are frightening-not so much because of stratospheric costs but because of the reduction of the quality of health care that these proposals will mandate.
The effort to gain public support is phrased in euphemisms: “comparative effectiveness,” “best practices,” “Health Choices czar,” “Federal Coordinating Council for Comparative Effectiveness Research,” or “Federal Health Board.”
These euphemisms have one thing in common: they will, by definition, place distant third parties in Washington between you and your doctor. And they will diminish the quality of health care and create unavoidable rationing.
Medical treatments, as in England or Canada, will be denied or limited because countless numbers of us are too young, too old, too sick, or not careful enough about lifestyle choices-that is, we’re too thin, too heavy, too sedentary, eat too many Big Mac’s or imbibe too many Bud Lites.
The portentous signs are already present:
The Congressional Budget Office urges reduction of Medicare reimbursement rates for “over valued physician services” – such as diagnostic imaging – while requiring doctors to get prior clearance. How long will such paper exchanges take, with a distant third party driving a wedge between patient and doctor?
White House budget director Peter Orszag urges that hospitals treat patients less expensively “through health information technology” – that is, by a technocrat rather than a doctor.
“Off-label” drugs, prescribed by physician for uses other than those for which they have been specifically approved, will likely be curtailed because they are officially “unapproved.” Oncologists working in the trenches frequently prescribe off-label drugs because, well, they work. Nature reports that between 50 and 70 percent of the drugs used to treat cancer are off-label medications.
With this narrowing of drug availability comes the restriction of a one-size-fits-all treatment. But as Drs. Jerome Groopman and Pamela Hartzband of the Harvard Medical School report, “… rigid and punitive rules to broadly standardize care for all patients often break down. Human beings are not uniform in their biology.” So-called “best practices may not fit you; in fact, they might harm you.
Arthur Garson, M. D., at the University of Texas School of Public Health, wrote recently: “There are currently 800,000 physicians in America. . . . This is a drop in the bucket in providing access to care.” There are also critical shortages of nurses and skilled lab technicians. How would we deal with the addition of 46 million patients who would exacerbate these shortages? By rationing, that’s how; and by denying or limiting treatment to patients too old, too sick, too heavy, or too careless in lifestyle choices.
If 46 million Americans without health insurance are suddenly provided national health care, rationing must inevitably follow. If doctors are limited by national health care to Medicare reimbursement rates, they will make up for lost private-sector revenue by increasing patient volume, which means that patients will have to wait longer for shorter appointments. The medical field is not ready for this influx.
A final harbinger: On April 28, 2009, I received from Medicare a letter canceling my wife’s Medicare insurance because of her death. She died on March 7, 2006. Do you want these bureaucrats managing your health care?
I am afraid because I fear for my health care. You should, too.
Ronald L. Trowbridge, Ph. D. is a resident of The Woodlands and a Visiting Research Fellow at the Texas Public Policy Foundation, a non-profit, free-market research institute based in Austin. Dr. Trowbridge formerly served as vice president of Hillsdale College in Michigan.