Saturday, October 31, 2009

Four Health Care Never-Nevers

As I watch the Washington health reform merry-go-round, where it stops no one knows, four never-nevers among the D.C. elite spring to mind.

One, health care reform is too important to be left to patients or health care consumers. Goodness knows, patients might make the wrong decision, they might forego preventative tests, they might trust the decision of a physician, who knows even less than they do about health care, and who has incentives to do more rather than less for personal enrichment. Never, never let patients or health consumers judge what is good for their health or their sickness. Never let them pick or own their own health plan across state lines, one suited for their needs, or related to their present health status. The Will of Congress, not the Will of the People is what counts.

Two, health care reform is far too important to be left to the clinical judgment of experienced physicians. Everybody knows physicians don’t have results from a national database on the comparative effectiveness of treatments they recommend. Doctors are too specialized, might recommend what they do well, and be paid for what they do. Heaven forbid, they might be paid on a fee-for-service rather than a salaried basis. Don't try to rebuild our primary care base. These doctors are too close to patients. Their desire to please patients and meet their expectations and those of their families is too anecdotal, personal, and emotional in this data-driven age. Never, never let individual doctors serve as trusted advisors to individual patients. Neither patients or their doctors, separately or together, know as much at decision-makers in D.C., who stand for the common good, not the individual good.

Three, never let talk of money or costs of care enter into the patient or doctor equation. Comprehensive health care is a free entitlement, a right, and should be devoid of financial considerations. A patient should never have to ask, “ What does this cost” Or “What will be my personal financial obligation?” And goodness me, never have to ask, “What does this cost my employer?” Take it for granted, access to comprehensive care without limits is a given. Somehow the “system,” rather than common sense of people receiving and delivering care, will provide for you. Never take into account that money you save from doctor or hospital shopping might be money saved for your retirement. If you’re a doctor, never ask what the drug you’re prescribing or the treatment you’re recommending, might cost at the local pharmacy or local hospital, or what the low cost alternatives might cost.

Four, never question the judgment of Congressmen or Senators. Yes, these politicians have 3300 lobbyists - six for every Congressman or Senator - lobbing special interest money at each and everyone. Yes, they are weighing pros and cons of getting elected. Yes, they are weighing the effects of government-directed public options, employer mandates, increased taxes on providers and the middle class , and individual and employer mandates on the uninsured and businesses on the national debt, unemployment, the economy, but they are not influenced by any of these factors. Politicians are elitists with detached objective, and repositories of collective wisdom not known to common folk. Their historical legacy of bringing health care to all moves them most, no matter what the possible adverse consequences on patients and doctors, or how to pay for it all. Trust Congress. They are from the government.

No comments: