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Health Reform's Dirty Little Secrets: Rationing and Arbitrary Medical Decisions

Posted by: Peter Roff on Monday, December 21, 2009 at 8:53:36 am

One of the few practicing physicians in the United States Senate, Dr. Tom Coburn should be considered something of an authority on the state of healthcare in America. In Thursday's Wall Street Journal, the Oklahoma Republican makes a persuasive case as to why the Obama-Reid-Pelosi approach to reform, so-called, deserves the fisheye. The dirty little secret of healthcare reform is that it is not at all about improving the quality of healthcare, as Coburn hints in his op-ed and as President Obama explained more directly to ABC's Charlie Gibson. The real objective of healthcare reform, the dirty little secret if you will, is to bring the cost of healthcare under control.

Now by the cost of healthcare that doesn't mean how much you and I pay for medical care or even insurance (and most people will see their premiums go up under the Obama-Reid-Pelosi-backed proposal) but the costs the U.S. government incurs, now and in the future if the if the grand plan redesigning the U.S. healthcare system becomes law.

The Reid bill—as initially offered—includes a section responsible for creating new comparative effectiveness research programs which, as Coburn writes, have been used by other countries as de facto rationing commissions. "CER panels here could effectively dictate coverage options and ration care for plans that participate in the state insurance exchanges created by the bill," he says. These are not "death panels," per se. But relying reliance on them to determine who gets what care, or at least the care that the public system or the publicly approved plans will pay for, amounts to nearly the same thing.

Likewise a cause for concern—Coburn points out—is the dependence of the Reid approach on the U.S. Preventive Services Task Force, which is identified in more than 10 places in the bill. These are the folks, lest we forget, who said women under the age of 50 did not need annual mammograms and who discouraged self-exams because of the false positives they produce. As the Reid bill allows for coverage for services approved by the task force then, by implication, coverage for those services they did not specify were necessary might be denied. "This chilling provision represents the government stepping between doctors and patients," he says. "When the government asserts the power to provide care, it also asserts the power to deny care."

Coburn is right, but he doesn't go far enough. It is not simply that the government is asserting the power to provide care; it is that the government is assuming the responsibility for controlling costs, and not in a market-based way. The Obama-Reid-Pelosi vision of cost control is one in which decisions are made in a seemingly-arbitrary manner, with the quickest pathway out of the red and into the black to deny people the opportunity to receive the care and drugs they need and, of equal importance, that their physicians recommend.


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