Viewpoint: Fed. gov’t. Rx: ‘Cookie cutter’ medicine?

Talk about it

That unwelcome clunking sound comes from your washer. Moreover, you find water on the floor. The repair service tells you that the price of fixing the thing is not worthwhile. You decide to buy a new washer.

You get into an accident that leaves some ugly dents on your car. The body shop tells you that getting the dents removed will cost you a bundle. You decide to continue to drive your car, dents and all.

Most of us make such decisions from time to time, decisions which, although probably not thought of as such, are, in reality, homespun utilitarian cost-benefit or cost-effectiveness calculations.

Yet, when you go to see your physician, you do not typically consider the costs (especially if a third party is paying for your care): you think, rather, of benefits (e.g. alleviation of pain, the promise of a cure, etc.).

However, tucked away in the thousand pages of the Obama-Pelosi-Reid “stimulus” package there is — at least so far as I am able to determine — language which, in effect, roughly equates medical decisions with the utilitarian decision that you made when you decided to drive the dented automobile.

Worse, the language in question seems to assume that the federal government will eventually decide whether or not the benefits received warrant the outlays involved in providing the care that you and your physician think that you need.

The bottom line: the government may tell you that your dented body — especially if it is old and well worn — is not worth fixing. Not surprisingly, then, some commentators predict that the Medicare and Medicaid programs will be the first programs to feel the impact of the Obama health care initiatives.

Predictably, the language at issue — language which is said to reflect the health care philosophy of ex-senator Tom Daschle — plants its flag on the high ground. Its objective we are told is to make American health care more efficient, more effective and less costly than it is now thought to be.

Again so far as I can determine, the new law purports to achieve its ostensibly noble ends by creating bureaucratic entities which, among other things, will, sooner or later, probably monitor treatment protocols to ensure that physicians are doing what the federal government deems to be “appropriate” and cost effective.

Health care providers will be required to give up a substantial degree of what is pejoratively called “autonomy,” meaning that they (the providers) will be increasingly subject to the dictates of the federal government. (And/or the state government: proposals similar to the federal schema are now being considered at the state level.)

Or, in other words, the Washington aparatchiks — given their notions of “effectiveness” and “efficiency” — will burden the health care system with what is commonly called “cookie cutter” medicine: bureaucratically imposed standards of care which would “guide” physician-patient treatment decisions. And worse, the notion that, in the name of efficiency and effectiveness, medical resources should not be “wasted” on patients with unfavorable prognoses.

Or, to put it bluntly, there is the real threat of overt rationing of health care based on utilitarian quality of life criteria, weighing the patient’s presumed “worth” against the cost of treatment, high cost or “cutting edge” treatments especially.

As I have already suggested, these goals will probably be achieved largely by the application of indirect measures. Health care expenditures would be reduced by squeezing the providers, reimbursing them, not on the basis of procedures performed, but on the basis of patient “outcomes.” Providers who did not conform to the government’s definition of desired outcomes would then suffer financially, forcing them (the providers) to effectively discriminate against “marginal” patients, elderly or seriously ill patients especially.

Moreover, it should be obvious that whatever health care policies are set in motion by Obama’s economic “stimulus” legislation will be expanded and “hardened” by future legislation, federal budget provisions, executive orders and court decisions. All of which will happen just as the Baby Boomer generation demands more and more medical services, only to find an increased demand pushing against a bureaucratically inhibited supply.

And to think that there were those who complained about the shortcomings of a system dominated by insurance companies and health maintenance organizations!

St. Martin is a Woodbury resident.

Tags: opinion, martin, woodbury, health, care, physician