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 (docs4patientcare.org).

Is Liberalism a Religion? – John C. Goodman – Townhall Conservative

Is Liberalism a Religion? – John C. Goodman – Townhall Conservative.

When people make statements that are completely at variance with reality and they continue to repeat them and you know they are not crazy, it’s only natural to wonder, what’s going on?

I’ve concluded that for some people on the left, political beliefs are like a false religion in which the parishioners become unable to distinguish myth from reality.

How else can you explain the statements of Donald Berwick, President Obama’s recess appointee to run Medicare and Medicaid, on his way out of office the other day? For starters, he claimed that the Affordable Care Act (what some people call ObamaCare) “is making health care a basic human right.” Then he went on to say that because of the new law, “we are a nation headed for justice, for fairness and justice in access to care.”

Now I can’t claim to have read everything in the 2,700-page law, but I can assure you that “making health care a right” just isn’t in there. Nor is there anything in the new law that makes the role of government more “just” or “fair.”

To the contrary, a lot of knowledgeable people (not just conservative critics) are predicting that access to care is going to be more difficult for our most vulnerable populations. That appears to have been the experience in Massachusetts, which Obama cites as the model for the new federal reforms. It’s not that Massachusetts tried and failed to expand access to care. It didn’t even try.

True enough, Massachusetts cut the number of uninsured in that state in half through Governor Romney’s health reform. But it didn’t create any new doctors. The state expanded the demand for care, but it did nothing to expand supply. More people than ever are trying to get care, but because there was no increase in medical services, it has become more difficult than ever to actually see a doctor.

And far from fair, the new federal health law will give some people health insurance subsidies that are as much as $20,000 more than the subsidies available to other people at the same level of income. In fact, the new system of health insurance subsidies is about as arbitrary as it can be.

Berwick isn’t alone in making bizarre statements about health reform. Right after the passage of the Affordable Care Act, administration health advisors Robert Kocher, Ezekiel Emanuel and Nancy-Ann DeParle announced that the new health reform law “guarantees access to health care for all Americans.”

In fact, nothing in the act guarantees access to care for any America, let alone all Americans. Far from it. Again, take Massachusetts as the precedent. The waiting time to see a new family practice doctor in Boston (63 days) is longer than in any other major U.S. city. In a sense, a new patient seeking care in Boston has less access to care than in just about every other U.S. city!

The disconnect between belief and reality is not unique to our country. With the enactment of the British National Health Service after World War II, the reformers claimed that they too had made health care a “right.” The same claim was made in Canada after that country established its “single-payer” Medicare scheme.

Yet in reality, neither country has made health care a right. They didn’t even come close. Neither British nor Canadian citizens have a right to any particular health care. A patient with a mysterious lump on her breast has no right to an MRI scan in either country. A cancer patient has no right to the latest cancer drug. A cardiac patient has no right to open heart surgery. They may get the care they need. Or they may not. Sadly, all too often they do not.

The British and the Canadians not only have no legally enforceable right to any particular type of care, they don’t even have a right to a place in line. For example, a patient who is 100th on the waiting list for heart surgery is not entitled to the 100th surgery. Other patients (including cash paying patients from the United States!) may jump the queue and get their surgery first.

Imagine a preacher, a priest or a rabbi who gets up in front of the congregation and gets a lot of things wrong. Say he misstates facts, distorts reality, or says other things you know are not true. Do you jump up from the pew and yell, “That’s a lie”? Of course not. But if those same misstatements were made by someone else during the work week you might well respond with considerable harshness. What’s the difference? I think there are two different thought processes that many people engage in. Let’s call them “Sunday morning” thinking and “Monday morning” thinking. We tolerate things on Sunday that we would never tolerate on Monday. And there is probably nothing wrong with that, unless people get their days mixed up.

In my professional career I have been to hundreds of health policy conferences, discussions, get-togethers, etc., where it seemed as though people were completely failing to connect with each other. One day it dawned on me that we were having two different conversations. Some people were engaged in Monday morning thinking, while everyone else was engaged in Sunday morning thinking.

Here’s the problem. Whether the beliefs are true or false, if people didn’t come to their religious convictions by means of reason, then reason isn’t going to convince them to change their minds.

This same principle applies to collectivism and health care. If people didn’t come to the false religion of collectivism by means of reason, you are not going to talk them out of it by means of reason. If you remember this principle, you will save yourself the agony of many, many pointless conversations.

Related articles

• Liberal Myths – John C. Goodman – Townhall Conservative (gds44.wordpress.com)
• Obamacare- They Way of the Dodo – Michael F. Cannon – Townhall Finance (gds44.wordpress.com)
• Obamacare is Self Destructing – Bob Beauprez – Townhall Finance (gds44.wordpress.com)
• WOLF: Bye-bye, Berwick – Washington Times (gds44.wordpress.com)
• Obama’s Drug Shortage Demagoguery – Michelle Malkin – Townhall Conservative (gds44.wordpress.com)
• Alice in Liberal Land – Thomas Sowell – Townhall Conservative (gds44.wordpress.com)