Bureaucratic Barriers To Medical Care

Stanley Feld M.D.,FACP,MACE

The greatness of America lies in the freedoms provided by the constitution and the bill of rights.

These freedoms have stimulated Americans to be innovative, creative and inventive.

The constitution promotes individual freedoms with the federal government being held in check by the states.

Many feel that over the last 50 years as society has become more complex the power of Federal government has increased. The central government has increased its power, limited individual freedoms and increased control over the people.

The usurping of power by the Federal government seems to have accelerated over the last 5 years.  President Obama has even usurped power over the congress and might have intimidated the Supreme Court. He has decreased the effectiveness of the checks and balance system.

It could be argued that congress has given President Obama and his administration the power and control in the checks and balances system that congress is supposed to have.  

Obamacare is the best example of this. When Sarah Palin screamed about the Independent Physician Advisory Board (IPAB) being a “Death Panel” she was ridiculed as being ignorant.   

Sarah Palin’s fear was that government bureaucrats, opposed to individuals making that decision, would usurp the individuals’ right to make their own life-and-death medical decisions.

The argument for the formation of the IPAB is that this board will make rational and cost effective medical treatment decisions that individuals are incapable of making.

The IPAB will take the freedom of treatment choice out of the individual’s hands.

I contend that the ultimate goal of Obamacare is to work toward a single party payer system. The government will be the single party payer.

Since the government is the payer, the government will say it is entitled to make the best and most cost efficient treatment decisions for patients.

I have heard cries from Democrats that this is not President Obama’s intention.

The irony is that it is happening right now. CMS is issuing regulations to restrict care even before the IPAB has been formed.

“The introduction of a powerful and largely unaccountable board into health care merits special scrutiny.”

In the Affordable Care Act unfettered power to make policy decisions has been given to the Secretary of Health and Human Services by a partisan Democratic congressional vote.

Last year (2013) government bureaucrats had already usurped a life-and-death medical decision. Health and Human Services Secretary Kathleen Sebelius refused to waive the bureaucratic rules barring access to the adult lung-transplant list by 10-year old Sarah Murnaghan.

 A judge ultimately intervened and Sarah received a lifesaving transplant June 12,2013. 

There will not be recourse for patients to any IPAB decision once the IPAB is formed. Obamacare also stipulates that there "shall be no administrative or judicial review" of the board's decisions. Its members will be nearly untouchable, too.

 “But the grip of the bureaucracy will clamp much harder once the Independent Payment Advisory Board gets going in the next two years.”

“An Obamacare Board Answerable to No One.”

The IPAB is directed to:

1. Develop detailed and specific proposals related to the Medicare program.
2. Include proposals cutting Medicare spending below a statutorily prescribed level.
3. Encourage to make rules "related to" Medicare.

 The IPAB will control more than a half-trillion dollars of federal spending annually. After the health insurance exchanges failure the IPAB will control the 2.7 trillion dollar healthcare industry.

Once the board acts, its decisions can be overruled only by a three-fifths supermajority in Congress. If the IPAB fails to implement cuts in spending, all of its powers are to be exercised by the HHS Secretary.

None of the Republican congressmen have made a stink about this board since Democrats shot down Sarah Palin for being so ignorant as to call the IPAB “Death Panels.”

The Obama administration is feeling its oats even before the IPAB has been formed.

CMS created its own panel to restrict access to care. The panel is called Medicare Evidence Development and Coverage Advisory Committee.

A Medicare panel determined that there is not enough evidence to justify annual CT scans to detect early lung cancer in heavy smokers. The nine-member panel is against Medicare paying for the screening tool.

 A December 2013 recommendation by the U.S. Preventive Services Task Force said current or past heavy smokers ages 55 to 80 should get the scans. The two government agencies have contradicted each other.

I wonder if there was a pulmonologist or lung cancer special on either panel. Is this what we are to look forward to with the IPAB?

Under Obamacare, the U.S. Preventative Services Task Force's recommendation means that private insurers are required to cover the screening with no out-of-pocket obligation for their non-Medicare members.

The reason is Obamacare offers better insurance policies through the health insurance exchanges than insurance coverage pre Obamacare. The increased cost is passed on to the consumer in higher premiums.

This is called redistribution of wealth.

The CAT scan should typically cost $300 to $400. If the patients were responsible for the bill under present law, it might cost $1,000- $2,000 dollars.
 
The Medicare Evidence Development and Coverage Advisory Committee advises CMS on coverage determinations. The committee gave a lame explanation for the reason to discontinue coverage.

 The committee members said they had little confidence that the benefits of subjecting Medicare beneficiaries to regular scans outweighed the risks of the psychological trauma or unnecessary surgeries that could result from false positives.

The USPSTF made their decision based on the National Lung Screening Trial, which found a 20% reduction in deaths among current and former heavy smokers over age 55 who were screened using CT scans versus those screened using chest X-rays.

“Smoking-related lung cancer kills about 130,000 Americans each year.

 The five-year overall survival rate for lung cancer patients in the U.S. is 16.8%. That low rate has been attributed to the late stage of diagnosis for the disease.

The Preventive Services Task Force estimated that as many as 20,000 lives could be saved each year if its recommendation was fully implemented.” 

Which government agency is right?

It is not enough for the Medicare panel to say, “they agreed the study was impressive in its implementation and results, they concluded it was not enough to recommend a new coverage policy to the CMS.”

Is the makeup of the committee qualified to make that judgment that will affect 20,000 patients’ lives?  Unknown.

Please note that patients (consumers) had no input on the decision. We are told that President Obama is an advocate of disease prevention.

This recommendation contradicts President Obama’s pledge to prevent the onset of disease or to catch disease early in order to cure the disease.

 The two agencies even contradict each other. Which one is right? Where is the scientific discussion?

Should Americans give up their freedom of choice to inconsistent government bureaucrats who might not be qualified to make the personal decisions for them?

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

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