Tuesday, August 18, 2009

Hopes Obamacare Would Kill

Prelude: I make a practice of reprinting what other doctors say about health reform when their comments resonates with me. Marc Siegel MD is a practicing internist , an associate professor of medicine at NYU Langone Medical Center. and a Fox News medical contributor. This Op-Ed piece is from the New York Post on August 18, 2009. I may be sensitive to this particular piece because I had drug-coated stents put in place after I suffered a myocardial infarction and have been well and asymptomatic since.

FOR generations, we doctors have promised our patients that medical advances will allow us all to live longer, more comfortable lives. Now that these results are finally arriving, "health-care reform" -- or "insurance reform," as they're now pitching it -- could snatch the rug out from under us.

Cost-control is central to any health-care "reform" along the lines favored by President Obama and congressional Democrats. But new treatments, while ever more precise and personalized, are also costlier.

Anyone who's been saved from cancer by the latest targeted chemotherapy treatment, had a lung or breast cancer diagnosed early by a CT scan or MRI or returned from the brink of a heart-related death thanks to the newest drug-treated stent, understands that some expensive care is well worth the price.

Over a million American patients a year get cardiac stents to keep their coronary arteries open, at a cost of billions. Is that too much to pay to keep patients alive, or at least save them from intractable pain?

The president has largely stopped promoting "cost control" as one of the virtues of his reforms -- but every nation that has adopted anything like that has also adopted measures that kill medical innovation. They buy less cutting-edge technology; won't pay for new, expensively researched drugs -- saving government money at the cost of future patients' lives.

Which recent advances would have been aborted if we'd adopted "reform" years ago? Anti-inflammatory treatments such as Enbrel for corrosive arthritis? Major surgeries made far less invasive through use of a 'scope? More precise and powerful lasers to treat the skin and eyes?

As a practicing physician, I've made a promise to my patients to maintain their quality of life and keep them in good shape as long as possible. But this promise can only be kept with the help of modern discoveries. Pills such as Lipitor help me prevent heart disease, and the latest heart procedure helps me to treat the disease once a patient has it.

I'm bound by the Hippocratic Oath, which tells me to "prescribe regimens for the good of my patients according to my ability and my judgment." Will I see my ability to follow my oath compromised or restricted by the cost-cutting of essential services?

Even current treatments are at risk. Would the proposed one-size-fits-all insurance pay for breast reconstruction for my vital 85-year-old professor patient? I don't think so. Would my 75-year-old artist still get his dialysis? Would my 68-year-old hepatitis patient still get his liver transplant?

Almost half of my patients have worked for decades before they were 65, waiting for the day when they would proudly receive their first Medicare card, testament to their years of hard work. But how much care will the Medicare card buy in the near future, when every "reform" relies on "savings" from Medicare?

How much can Medicare cover if the government reduces payments to hospitals and physicians by hundreds of billions of dollars, as the majority in Congress proposes?
Many of my seniors are now frightened by the prospect of long lines or frank denials, that doctors will be "treating them differently because they have already had more life years," as Dr. Ezekiel Emanuel, an Obama health-policy adviser, coolly recommended in a recent article.

My patients are right to be concerned. I'm concerned, too, not knowing if I'll still have the tools I need to take care of them.


patti said...

Thank you Doctor for your insights into "Obamacare".
I deal with women every day who are victims of Inflammatory Breast Cancer (IBC). If Obama gets his way, these women will be in the same predicament that the Canadians, Australians, New Zealanders and Brits are in now. Women come from all over the world to get the targeted therapies that will help them, because in their countries it ISN'T cost effective to get the drugs, like Herceptin, that prolong their lives.
People don't understand we are the last best hope on the planet of countries that have the best health innovations, and we need to keep it that way.

Patti Bradfield, President
Inflammatory Breast Cancer Foundation

The IBC Foundation Radio Show live and podcasts from previous shows


Richard L. Reece, MD said...

Thank you. In this health reform climate. Americams are starting to recognize we have the most innovative health system in the world.