More fun for medical practitioners buried in the stimulus?

[Manedwolf]

If this is true, the "Atlas Shrugged" moment for doctors is going to come even sooner. Yay.

One new bureaucracy, the National Coordinator of Health Information Technology, will monitor treatments to make sure your doctor is doing what the federal government deems appropriate and cost effective. The goal is to reduce costs and “guide” your doctor’s decisions

I just can't believe this is happening. This is going to affect the business I work for, too. What if that mess determines that our products aren't as cost-effective as some inferior ones made in Mexico?

Ruin Your Health With the Obama Stimulus Plan: Betsy McCaughey

Commentary by Betsy McCaughey

Feb. 9 (Bloomberg) -- Republican Senators are questioning whether President Barack Obama’s stimulus bill contains the right mix of tax breaks and cash infusions to jump-start the economy.

Tragically, no one from either party is objecting to the health provisions slipped in without discussion. These provisions reflect the handiwork of Tom Daschle, until recently the nominee to head the Health and Human Services Department.

Senators should read these provisions and vote against them because they are dangerous to your health. (Page numbers refer to H.R. 1 EH, pdf version).

The bill’s health rules will affect “every individual in the United States” (445, 454, 479). Your medical treatments will be tracked electronically by a federal system. Having electronic medical records at your fingertips, easily transferred to a hospital, is beneficial. It will help avoid duplicate tests and errors.

But the bill goes further. One new bureaucracy, the National Coordinator of Health Information Technology, will monitor treatments to make sure your doctor is doing what the federal government deems appropriate and cost effective. The goal is to reduce costs and “guide” your doctor’s decisions (442, 446). These provisions in the stimulus bill are virtually identical to what Daschle prescribed in his 2008 book, “Critical: What We Can Do About the Health-Care Crisis.” According to Daschle, doctors have to give up autonomy and “learn to operate less like solo practitioners.”

Keeping doctors informed of the newest medical findings is important, but enforcing uniformity goes too far.

New Penalties

Hospitals and doctors that are not “meaningful users” of the new system will face penalties.  “Meaningful user” isn’t defined in the bill. That will be left to the HHS secretary, who will be empowered to impose “more stringent measures of meaningful use over time” (511, 518, 540-541)

What penalties will deter your doctor from going beyond the electronically delivered protocols when your condition is atypical or you need an experimental treatment? The vagueness is intentional. In his book, Daschle proposed an appointed body with vast powers to make the “tough” decisions elected politicians won’t make.

The stimulus bill does that, and calls it the Federal Coordinating Council for Comparative Effectiveness Research (190-192). The goal, Daschle’s book explained, is to slow the development and use of new medications and technologies because they are driving up costs. He praises Europeans for being more willing to accept “hopeless diagnoses” and “forgo experimental treatments,” and he chastises Americans for expecting too much from the health-care system.

Elderly Hardest Hit

Daschle says health-care reform “will not be pain free.” Seniors should be more accepting of the conditions that come with age instead of treating them. That means the elderly will bear the brunt.

Medicare now pays for treatments deemed safe and effective. The stimulus bill would change that and apply a cost- effectiveness standard set by the Federal Council (464).

The Federal Council is modeled after a U.K. board discussed in Daschle’s book. This board approves or rejects treatments using a formula that divides the cost of the treatment by the number of years the patient is likely to benefit. Treatments for younger patients are more often approved than treatments for diseases that affect the elderly, such as osteoporosis.

In 2006, a U.K. health board decreed that elderly patients with macular degeneration had to wait until they went blind in one eye before they could get a costly new drug to save the other eye. It took almost three years of public protests before the board reversed its decision.

Hidden Provisions

If the Obama administration’s economic stimulus bill passes the Senate in its current form, seniors in the U.S. will face similar rationing. Defenders of the system say that individuals benefit in younger years and sacrifice later.

The stimulus bill will affect every part of health care, from medical and nursing education, to how patients are treated and how much hospitals get paid. The bill allocates more funding for this bureaucracy than for the Army, Navy, Marines, and Air Force combined (90-92, 174-177, 181).

Hiding health legislation in a stimulus bill is intentional. Daschle supported the Clinton administration’s health-care overhaul in 1994, and attributed its failure to debate and delay. A year ago, Daschle wrote that the next president should act quickly before critics mount an opposition. “If that means attaching a health-care plan to the federal budget, so be it,” he said. “The issue is too important to be stalled by Senate protocol.”

More Scrutiny Needed

On Friday, President Obama called it “inexcusable and irresponsible” for senators to delay passing the stimulus bill. In truth, this bill needs more scrutiny.

The health-care industry is the largest employer in the U.S. It produces almost 17 percent of the nation’s gross domestic product. Yet the bill treats health care the way European governments do: as a cost problem instead of a growth industry. Imagine limiting growth and innovation in the electronics or auto industry during this downturn. This stimulus is dangerous to your health and the economy.

(Betsy McCaughey is former lieutenant governor of New York and is an adjunct senior fellow at the Hudson Institute. The opinions expressed are her own.)

To contact the writer of this column: Betsy McCaughey at Betsymross@aol.com
Last Updated: February 9, 2009 00:01 EST

http://www.bloomberg.com/apps/news?pid=20601039&refer=columnist_mccaughey&sid=aLzfDxfbwhzs#

[Nick1911]

Hmm... this could seriously affect me.

[AZRedhawk44]

If this is true, the "Atlas Shrugged" moment for doctors is going to come even sooner. Yay.

I already know doctors from my previous job that refuse to accept Medicare/Medicaid as a source of payment.  I expect that number to steadily increase as time goes by.

I even know one doctor that refuses to take any insurance and only deals in cash (and checks and credit cards...).

This may adversely affect my previous employer, a medical records hosting provider.  I dunno.  Treating records costs as a liability will shutter the door on growth in that industry.

I know that they have no interest in giving a SSH-based HL7 (or any other style) interface into the datacenter over to Uncle Sam. 

[longeyes]

The Machine must be served.  And it is best served by young families, preferably young families that don't ask too many questions. The old "legacy Americans," the ones that might still remember something about the Constitution and the Founding Fathers and all that, have really become rather tedious, annoying, and, well, extraneous; the sooner they pass on the better.

I'm affected by this.  One more reason to do everything you can to stay in good shape.  Think of yourself as a resistance fighter who must keep his edge.  That's a metaphor that is not far from the coming reality.

[Waitone]

"Legacy Americans"-- I like it!

[RocketMan]

"It is no longer cost effective to keep you alive.  We can realize more revenue if you terminate and another patient is serviced."

[Firethorn]

I even know one doctor that refuses to take any insurance and only deals in cash (and checks and credit cards...).

What's he charge compared to docs that DO take insurance?

Years ago I read about a female doctor that ended up saying 'screw it', opened a clinic out of her house with a part time nurse - netted 70-80% of what she did at the clinic for half the hours and a quarter of the stress.

She also charged less than most copays.

Makes me wonder how this stuff would work with a HSP/HDIP.  Don't most of them issue a debit card?

[Monkeyleg]

So, the plan is to pull the plug on seniors, eh? How old is Daschle? Kennedy is ripe about now. Ruth Bader Ginsberg? A waste of taxpayer health care dollars right there in that woman.

Let's use our elected officials as the guinea pigs in this experiment.

[MicroBalrog]

He praises Europeans for being more willing to accept “hopeless diagnoses” and “forgo experimental treatments,” and he chastises Americans for expecting too much from the health-care system.

...we're supposed to forgo scientific medical advances?

[AZRedhawk44]

What's he charge compared to docs that DO take insurance?

He charges the same as the Medicare physician's fee schedule for procedures (which is lower than just about every other contract out there), but he actually gets paid at time of service.  No legions of billing staff filling a 1000+ square foot room with half a dozen computers, printers, file cabinets, electricity, bandwidth or salaries.  No complicated billing software to train his staff on (my software suite handled the complicated multipayor situations, but could also handle cash just fine too).

You pay, the receptionist takes the money.  You see the doc.  No claims, no submissions, no rejections, no haggling, no hassles.  That stuff takes up as much time and labor as the doctor visit itself.  The amount of labor involved in producing nothing in the form of insurance is staggering... from the folks at Humana/Blue Cross/Cigna to the HR lady at work that gets you the insurance to the billing weasel at the doctor's office that processes the paperwork to the clerk at Humana that rejects the claim to the mailman that delivers notice of your rejection and so on.

I've seen the back-end of his books since I hosted his database and came up with some reports for him from time to time... he'd selectively lower his rates as he felt he wanted to for particular patients.

But he never took Medicare or any other health insurance.

[Headless Thompson Gunner]

Lovely.

[El Tejon]

Think of yourself as a resistance fighter who must keep his edge.

Outstanding.  I always need motivation to go to yoga and martial arts practice.

[lone_gunman]

He praises Europeans for being more willing to accept “hopeless diagnoses” and “forgo experimental treatments,” and he chastises Americans for expecting too much from the health-care system.

I am no fan of Daschle, but this statement is generally true.  Americans do expect too much from health care, nearly up to an expectation of immortality.  A tremendous amount of money is spent on medical care in hopeless situations that does nothing but prolong the inevitable, and in many cases, makes the quality of life worse.

If we are going to have some type of government sponsored health care such as Medicare and Medicaid, then it is not unreasonable to limit what it will and will not cover.  This does not mean that care would be denied to patients; it simply would not be covered by Medicare, much like cosmetic surgery is not generally covered.  Tax payer money should not be wasted on medical procedures that accomplish nothing, do not prolong life, adn do not improve quality of life.  If you are in a hopeless situation, and you want to try something experimental or without proven benefit, then that should be paid out of your pocket, not mine.

[john828]

...we're supposed to forgo scientific medical advances?

According to lone_gunman, yes.  That will never fly.  The R&D doctors will receive money from NIH, FDA, other gubmint entities, and in the end whether or not it is covered by medicare/medicaid/whatever, lone_gunman will still be paying for it.

lone_gunman:  you want to try something experimental or without proven benefit, then that should be paid out of your pocket, not mine.

[buzz_knox]

All medical advances were experimental at one time or another.  Making them the exclusive province of those who can afford them will guarantee that the procedures never hit the mainstream or simply never get tried.

But hey, if you are suicidial or nihilistic or believe yourself immortal, that's a great plan.

[De Selby]

So the government is reviewing your doctor's orders and deciding what you need and don't need...

I hope anyone who is scared of this doesn't have medical insurance.  Because guess what the insurers do...

[john828]

Yeah, Obama is right.  Think about it.  Say you have a limb severed in such a way that reattachment is feasible and probably guaranteed.  DON'T DO IT!  A prosthetic is way cheaper and people do fine with them. 

[lone_gunman]

Making them the exclusive province of those who can afford them will guarantee that the procedures never hit the mainstream or simply never get tried.

Insurance companies generally do not allow payment for experimental treatments as it is.

Yeah, Obama is right.  Think about it.  Say you have a limb severed in such a way that reattachment is feasible and probably guaranteed.  DON'T DO IT!  A prosthetic is way cheaper and people do fine with them. 

I don't think it is as simple as that.  If you are young, healthy, and productive you would get your limb reattached. If you are old or nonproductive, then you would get a prosthetic.  They are looking at this from a cost effectiveness standpoint.

And there is a way around all this, even if you are old and non-productive you can get your limb reattached, just not at government expense.

[De Selby]

Yeah, Obama is right.  Think about it.  Say you have a limb severed in such a way that reattachment is feasible and probably guaranteed.  DON'T DO IT!  A prosthetic is way cheaper and people do fine with them. 

And the alternative of an insurance company making this decision is more likely to be useful to you why?

[john828]

In that example, it would be a decision made before any insurance personnel had any say whatsoever.  And, yes, a decent insurance plan covers reattachment. 

[makattak]

So the government is reviewing your doctor's orders and deciding what you need and don't need...

I hope anyone who is scared of this doesn't have medical insurance.  Because guess what the insurers do...

I can choose different insurers. I can't choose a different government program.

Was that simple enough for you?

Also, I'll look to Canada. How well do they do with buying medical services not provided by the governments plan?... Oh right, they come here for that.

[buzz_knox]

Insurance companies generally do not allow payment for experimental treatments as it is.

Some do.  You can negotiate with companies that don't and bring public pressure to bear.  You can't do that with a gov't committee with the full power of the feds behind it.

[lone_gunman]

I can choose different insurers. I can't choose a different government program.

The average person has little choice in what insurance company they use.  Most are going to have to use whatever insurance company their employer contracts with.  This decision is made by the employers, not the employee, and is usually decided based on cost of the insurance, not the benefits.

[makattak]

The average person has little choice in what insurance company they use.  Most are going to have to use whatever insurance company their employer contracts with.  This decision is made by the employers, not the employee, and is usually decided based on cost of the insurance, not the benefits.

Simply because it's EASIER and CHEAPER to take your employers plan does not mean they have no choice.

The government taking everything over DOES MEAN you have no choice.

Is it truly impossible for the people on your side of the issue to see that? Difficulties do not equal impossibilities.

Edit: Also, you seem to have avoided the whole, "You can't buy services not provided by the government in Canada."

[lone_gunman]

Simply because it's EASIER and CHEAPER to take your employers plan does not mean they have no choice.

OK I see what you are saying.  I guess you also think that if I have $20,000 and want to buy a new car, I have a choice whether I want to by a Hyundai or a Bentley? 

Edit: Also, you seem to have avoided the whole, "You can't buy services not provided by the government in Canada."

I have seen nothing to suggest that anyone has plans to make the government the only provider of health care in the US.  Insurance companies will still be there, and private pay is also an option.  The plan is to simply limit what services are provided at government expense.  The government has been cutting benefits for years, and this is just an extension of that.