ARMSTRONG: Obamacare grants doctors liberty to withhold care – Washington Times

ARMSTRONG: Obamacare grants doctors liberty to withhold care – Washington Times.

Plan rewards physicians for scrimping on treatment

If you haven’t noticed it yet, you soon will. The Obama administration has launch-ed a full-court press to sell the president’s “signature” achievement, Obamacare, or the Affordable Care Act, to the American public as well as to the 800,000 American physicians it directly impacts.

As one of those doctors, it was no surprise when an article in the Journal of the American Medical Association by lead author Dr. Ezekiel Emanuel attempted to convince American physicians that they will enjoy expanded autonomy and greater liberty under the new act.

Dr. Emanuel helped create the 2,700-page law and has now been enlisted to sell it. As a bioethicist of considerable acclaim, Dr. Emanuel goes to great lengths to establish his case, maintaining that with new payment models promoted by the law, doctors will be in a position to free themselves from the fee-for-service system that he and others have worked to vilify in the physician-patient relationship. What he misses entirely is that it’s the opaque economic arrangement caused by our third-party payment systems, not the honest exchange of payment for a service that is the root cause of the soaring costs in American health care today.

The law promotes a “new” model, the Accountable Care Organization (ACO), in which an entity that covers a specified number of Medicare patients is given a fixed pot of money. This is quite similar to the HMO capitation systems that caused tremendous backlash in the early 1990s. In both, if the doctors can provide care for less than what is in the pot over a defined period, they get to share the leftovers. If, however, the doctors overspend the pot, they are financially liable for the consequences. With sleight of hand and fanciful re-packaging, Dr. Emanuel attempts to convince physicians that this gallows for private practice somehow improves and enhances autonomy. Nice try, but doctors have been fooled once, which is quite enough.

Do you see the problem? It should be obvious to all physicians and the public. When you see your doctor, what do you want the caregiver to have foremost in mind: your medical needs or the doctor’s income? Is this ethical? Hardly. But this is the reality of any payment model that ties physician income directly to the unstated decision to withhold expensive services. Either consciously or subliminally, the message is the same: The less you spend on patient care, the more you gain financially. This is the reality of the ACO model and the “new ethics” of government cost control in medicine, courtesy of the Affordable Care Act. Shouldn’t economic and professional decisions be transparent in medicine, where doctors and patients make joint decisions based upon available resources, not some underlying, unspoken financial advantage for the physician to offer the patient less.

This administration held up the Mayo Clinic, the Cleveland Clinic and others as shining examples of the best medical systems in the country. They didn’t tell you that when Dr. Charlie and Dr. Will Mayo opened the Mayo Clinic in 1889 and when Dr. George Crile and colleagues opened the Cleveland Clinic in 1921, they were not coerced by any government entity or law to provide honest medical care under the most ethical economic model that exists – fee-for-service – in which the doctors care for the patient and the patient pays the doctor.

Using the terms “autonomy” and “liberty” in the same paragraphs as descriptions of Affordable Care Act and the ACO is disingenuous at a minimum and laughable when you know even a portion of what this law contains. Obamacare endows the office of the secretary of Health and Human Services with more power than any Cabinet officer in history and to virtually control the American health care economy by 2014. Any argument asserting that autonomy and liberty are enshrined in the thousands of pages of regulations emanating from the Cabinet secretary is risible.

What occurred with the Catholic Church and its associated organizations over contraception services last week is only a small preview of what is in store for the remainder of the United States. Attempts to frame this law as promoting enhanced physician autonomy and liberty is akin to rearranging the furniture in a prison; you can seat yourself on the loveseat or a chair, but you can’t leave the premises.

The Mayos and Crile would not be amused. My sense is that the founders of our nation would spit on Dr. Emanuel’s shoes – or worse.

Dr. Richard A. Armstrong is the chief operating officer of Docs4PatientCare (

The FDA Kills – John Stossel – Townhall Conservative

Photograph of the Taxus drug-eluting stent, fr...

Image via Wikipedia

The FDA Kills – John Stossel – Townhall Conservative.

It would be nice if politicians and regulators left us alone. But they don’t. They always want to do more. Recently, there have been shortages of some medicines. Cancer patients can’t get drugs they need. Why not?

One reason is that a big drugmaker shut down for a year in part to meet Food and Drug Administration rules. The FDA makes it so expensive and difficult to sell drugs that there isn’t an eager pack of companies rushing to the fill the gap. The free market would provide that, but government intervention, such as low Medicare reimbursement, strangles it. So people suffer.

Does the FDA say it’s sorry for its part and back off? Of course not. Regulators almost never do that. In fact, the FDA wants more power.

It wants to regulate how your doctor uses his smartphone. I’m not kidding! The FDA wants the power to approve mobile medical apps that let doctors monitor patients’ vital signs over their phones. As one doctor put it, “Even though I’m away from the hospital, I can still look at … real-time wave form data just as if I were at the patient’s bedside.”

Sounds great. It makes doctors more efficient. But the FDA basically says, “No, you just can’t put something on your phone if it’s a medical device. What if it doesn’t work right? We have to approve it first.”

That caution makes sense to people. Our first instinct is to say, “I don’t want someone getting rich off a device that might not work right. It might kill me. I want the FDA to make sure everything is safe and effective.”

But lawyer Jonathan Emord says our instinct is wrong.

“It is wrong because these regulations are costly, burdensome, and they prevent essential medical apps from getting into the marketplace,” Emord said.

But an app might kill me.

Emord said that although many medical apps are available, there is “not a single complaint that someone has died or been seriously injured by a single one.”

But what’s the harm in running apps past the regulators?

“There is so much corruption at the Food and Drug Administration … so much anticompetitive bias.”

The FDA takes bribes?

“Almost,” Emord explained. “If you feather the right nest, you will do well for yourself after you leave. This is well known.”

This is known as “regulatory capture.” A regulator makes it tough for some company’s competitor and then gets a job with the first company when he leaves his government job.

There’s a big cost to the public when companies submit applications and then wait years for FDA approval.

“We’re losing time, precious time that lives are dependent upon,” Emord said. “MIM Software developed a simple mobile device that would combine MRI images, PET scans, CAT scans all together and produce a super image that was better for diagnosis … right on your phone. To get that through the agency, it took two and a half years and cost some hundreds of thousands of dollars. All the while it could have been in use, and ultimately it was approved.”

Lawyers and reporters encourage bureaucrats to move slowly. If something goes wrong, the media make a huge fuss about it, and the class-action parasites pounce. But when the FDA delays a device for years and people die, we don’t report that. We don’t even know who the victims are.

Useful HIV drugs were available in Europe for years before the FDA approved them for use here.

A doctor at the Cleveland Clinic invented a medical app that helped physicians calibrate the amount of radiation to give to women with breast cancer. The FDA demanded so much extra and expensive proof of its safety that he abandoned it.

The FDA’s caution leads many companies to just give up on potentially lifesaving ideas.

Yet I don’t hear companies complaining.

“If you raise your head above the parapet and you become vocal in your criticism, the FDA remembers like an elephant and will stamp you out of existence. They’ll punish you. It’s so much discretion in their hands. They sit like emperors reigning over this stuff.”