If the president has his way . . . the art of medicine will be lost.
THE most frightening thing about Washington’s idea of “health- care reform” is how it will interfere with the doctor-patient relationship.
The language in these bills has the self-imposed authority of George Orwell’s “1984.” The House bill, in particular, creates new committees and commissioners with undefined but far-reaching powers — a Health Choices Commissioner, a Health Benefits Advisory Committee, a Comparative Effectiveness Committee . . . .
All this oversight threatens to destroy the art of medicine, which exists purely one-on-one, between me and my patient.
A prime example comes in the section starting on page 425 of the House bill. This dictates that an Advanced Care Planning Consultation must take place every five years from the age of 65 — with the intervention of so-called counselors, trained and appointed by the government.
The clear goal of the consultation is to decrease unnecessary care to the elderly. But, while a lot of resources are too often wasted in the last days of life, there are many vigorous and engaged senior citizens who shouldn’t be shortchanged or pushed prematurely to euthanasia.
My father is such a patient. He’s 85 and has heart disease — but is completely independent and gives me advice on how to run my practice and my life. An 86-year-old I know well is still one of the top internists practicing medicine in New York.
Whose decision should it be to phase out such people? The government’s?
It takes a careful doctor-patient relationship to determine what care is appropriate. Too much government oversight will directly threaten that.
Another worry is created by Section 123 (page 30) of the House bill. This establishes a Health Benefits Advisory Committee, chaired by the Surgeon General, which makes recommendations to the HHS Secretary on what should be covered and what shouldn’t.
These rulings from on high are problematic, since useful treatments or tests for one patient are not appropriate for another. Appeals are bound to be time-consuming and largely ineffective. This is the government interfering directly with the practice of medicine.
Then there is the Task Force on Clinical Preventative Services (page 937), whose stated purpose is to “review the scientific evidence related to the benefits, effectiveness, appropriateness and costs of clinical preventive services . . . for the purpose of . . . disseminating evidence-based recommendations on the use of such services.”
The most disturbing word, of course, is “appropriateness.” Where is the government and its board of political appointees going to get the insight needed to advise me on what’s appropriate to prevent disease in a given patient?
Many of my patients use me as a guide to direct them to the best possible care. I’m not alone in this — it’s part of what makes medicine worthwhile to practice. I’m constantly e-mailing colleagues to ask their opinions (known as a curbside) on patients they haven’t seen and will never be paid to see. I ask a nutritionist — what’s the best diet for patient A? I e-mail a cardiologist — how do we prevent patient B from getting sicker and needing the hospital?
But if the president has his way — cutting costs through regulatory rationing and decreased reimbursements — doctors will soon be so busy filling out government forms and seeing more and more patients for less and less pay that none of us will have the time to do a preventive curbside.
My McDonald’s-eating couch-potato patient will have to turn to a government committee for advice. The art of medicine will be lost.
Yes, the system has a lot of waste; insurance is expensive and overused for minor complaints. But this is especially true for public insurance.
A report just released by PricewaterhouseCoopers, titled “Jammed Access,” found that Medicaid patients are more than twice as likely to overuse the ER as patients with no insurance at all.
The government has a poor track record when it comes to efficiency. Attempts to create a one-size-fits-all insurance under federal control won’t remove the waste or cure the problem, it will only destroy quality and replace a problem with a bigger one.
If only the feds were bound by the same Hippocratic vow that I follow: “First, do no harm.”
Marc K. Siegel is a practicing internist, an associate professor of medicine at NYU Langone Medical Center and a Fox News medical contributor.