Stanley Feld M.D.,FACP,MACE

Rationing of healthcare services is not new. Medicare presently rations healthcare services. Private healthcare insurance also rations healthcare services. Physicians and patients need medical preapproval for tests, surgery and specialty consultations. If a physician wants a patient to have a simple CBC (complete blood count) and the reason for the test is not documented by an appropriate code the government and the healthcare insurance industry does not allow the charge.

Physicians’ offices spend hours trying to get preapprovals for their patients from people who are trained to look up indications for procedures on a computer.

This week President Obama has denied that his healthcare reform bill will ration healthcare services. The facts of HR 3200 and his own speeches contradict his statement. In his speech to the American Medical Association, President Obama said

“The only way to control health care costs is to get doctors to provide less care — fewer tests, fewer procedures, fewer everything. Of course, the Administration wants to eliminate only that care that is "unnecessary."

Who will determine what is unnecessary? The government will with President Obama’s healthcare reform bills!!

Ezekiel Emanuel M.D. .a medical ethicist, (Rahm Emanuel’s brother and President Obama’s medical advisor) has defined unnecessary in his book and papers. President Obama’s Office of Management and Budget Director Peter Orszag has agreed.

Peter Singer, a medical ethicist, had a long article in the New York Times magazine section defending the fact that healthcare must be rationed.

The Administration has determined that neither you nor your physician should be the judge of the treatment you need. The government will tell physicians how it wants them to practice medicine.

The government, in an attempt to avoid blame for healthcare rationing, plans to set up an independent group of “experts” to set reimbursement fees or not allow payment for services it deems unnecessary. If a physician disagrees with the “experts” because the “experts” might not have all the facts the physician can appeal.

The process will be inefficient. It will generate waste and is doubtful it will improve care.

“ The Administration is asking for independent authority to set reimbursement fees for all providers under Medicare. To assist in this effort, the Administration is proposing a new federal health board to decide whether health care services are "effective" or "appropriate."

The Obama administration has concluded that the best way to discourage "unnecessary care" is not to pay for it. Who is liable for not delivering “unnecessary “ care that might be necessary and life saving? The government is not liable according to HR3200. Malpractice reform for physicians and patients is not to be found in President Obama’s healthcare reform bill. Yet $750 billion dollars are wasted on defensive medicine.

The administration’s new proposal represents an increase in regulations and in turn an increase in healthcare services rationing.

If healthcare is to be rationed how should it be rationed?

The administration’s answer is defined by Dr. Emanuel’s philosophy.

He advocates a system he calls a complete lives system. The complete lives system discriminates against the elderly.

“Emanuel advocated allocating health resources in order to maximize collective life years. He justifies denying care to elderly patients in the following way. Suppose a 25-year-old and a 65-year-old have a life threatening disease. Since the 25-year-old has many more potential years of life ahead of him, he should receive preferential treatment, says Emanuel.”

Even if 25-year-olds receive priority over 65-year-olds, everyone who is 65 years now was previously 25 years. Dr. Emanuel has said health services should not be guaranteed to "individuals who are irreversibly prevented from being or becoming participating citizens."

Think about Ted Kennedy. Think about the treatment he is receiving to save his life. Who is paying for it? Is the government paying for his treatment with Medicare Part C? Should he be denied treatment by a panel of “experts” when his prognosis is so terrible and he has already lived a full and productive life? If Ted Kennedy believes in his own bill shouldn’t he stop treatment that might to save his life? Should he have freedom to choose to live or die? Will Ted Kennedy be a productive citizen in the future?

My view is the individual should decide on his treatment along with his trusted physician. The government position should be to provide patients with appropriate education so they can choose the best treatment options. The government should provide funds for physician education to teach the best treatment options. The government should not decide for us.

Peter Clinch of Silver Springs, MD says it all in the comment section of Peter Singer’s article

“Health care, like all finite resources in the universe, is rationed today and will be rationed in the future. The question is who should be doing the rationing. In a society that respects life and values freedom, that task is best left to a marketplace of individuals making decisions for themselves, which is why health care reform should focus on decentralizing health insurance, not socializing it. Americans should be able to make decisions for themselves as to how much of their resources today they want to set aside for insurance that they may need in the future. To surrender our freedom and dignity to power-hungry central planners in exchange for lofty Utopian promises is an act that will mark us for generations to come as well-meaning but misguided fools”

President Obama, why don’t you attack the healthcare system’s real problems?

You should be concentrating on real malpractice reform and eliminate the need for defensive medicine, administrative waste, the large administrative service fees paid by outsourcing healthcare administration to the healthcare insurance industry, real price transparency, effective electronic medical records and e-prescriptions legislation, real chronic disease management, and public service advocacy to reduce obesity.

This is where government intervention can be effective in reducing costs to the healthcare system. Don’t continue to impinge on Americans’ freedoms. Americans will not tolerate it and you will have lost your opportunity to Repair the Healthcare System.

The opinions expressed in the blog “Repairing The Healthcare System” are, mine and mine alone.