Health Reform: Futility of Federal Demands

Don’t make commands that require demands that can’t be met.

Anonymous

Whatever in enforced by more imputed to him who exacts than to him who performs.

Montaigne (1533-1592), Essays

February 17, 2013-   President Obama is issuing commands that create demands that ordinary mortals, or even the federal bureaucracy, can’t meet.  

·         Take the Accountable Care Act, the  federal law which would require the states to create health exchanges by February 15, a date which has now come and gone, with the target date now moved up to October 1. Exchanges are one-stop, on-line marketplaces where people will be able to compare and buy government-subsidized insurance.   But will the states or even Washington be ready? Don’t count on it. Both GOP and Democratic senators are openly skeptical.  So far  fewer than 10 states have chosen to partner with CMS and fewer than 20 have said they will build their own exchanges.  Washington will have to construct 32 of their own exchanges, which it is ill-prepared to do. The government cannot meet  its own commands with resulting demands.   

·         Take the thinly-disguised federal commands  that demands doctors must adopt electronic medical records and then connect the results to health exchanges.   Here’s there’s a double whammy.  Despite federal bonuses for meeting “meaningful use criteria” that encourage doctors embrace EMRs,  and threats that theywill receive less Medicare reimbursements if they do not do so, doctors in small practices are resisting on a massive scale. Why?  Because it forces doctors o change their customary workflow from a personal patient-centered  model into a data-oriented manufacturing model whereby they are converted from  independent practitioners into data-entry serfs (Michelle McNickle, “Doctors Push Back Against Health IT’s Workflow Demands, “ Information Week, February 15).

·         Or, on a larger horizon, take the vast array of health reform measures that involve government interventions and regulations that require documentation and monitoring of every patient-doctor-hospital transaction. Government is probing  every deeper into the private economy and society interaction.  It is a command and demand strategy that limits  freedom, choice, innovation, and pursuit of economic gain and, as a practical matter, guarantees no growth and limited economic growth in the general and health care sectors.  

Tweet:   Government is creating demands  requiring states to set up health exchanges and doctors to adopt EMRs that can’t be met even by government