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David McKalip

Rationed care is bad care

For decades, American physicians have provided the best medical care in the world to Americans and others who come to our shores to escape the medical systems established by their governments. Patients have enjoyed confidence in their doctors through the sacred patient-physician relationship designed to minimize their suffering and prolong their lives. In short, they have been able to trust their doctors. But if Congress has its way, patients may leave their doctor's office wondering if the doctor is working for them or serving a rationing plan.

Hidden within the last stimulus plan is the creation of a "Federal Coordinating Council on Comparative Effectiveness." This group of 15 government agency heads and bureaucrats will decide what medical treatments are deemed effective, and cost of care will be a primary concern. Only two council members are exposed to patients as part of their administrative jobs, and none are in private practice where the vast majority of Americans receive their care. Nevertheless, they will write the rules for government-approved medical care.

The group is modeled after another group euphemistically titled "NICE" in England. NICE arbitrarily creates a threshold of $45,000 for a "Quality Adjusted Life Year." Medical care above that cost is denied, like the life-saving drug Herceptin for breast cancer. This drug saved the life of Virginia Postrel, who recently wrote in the St. Petersburg Times that she survived cancer only because she lives in America. That is not surprising since it is the American system of medicine that has created the highest cancer survival rates in the world.

Why would Congress and the president create a panel designed to ration medical care? The president said in his inaugural address that "health care is too costly." Medical care costs more than the government can afford, and it is eating into corporate profits as well.

For instance, Congress has committed the American taxpayers and their children to an unfunded liability of $86 trillion for Medicare. There are two ways for Congress to solve this problem: Change Medicare to an economically sustainable program through sensible reforms that respect patients' rights and individual savings, or ration health care. Congress has chosen the latter. National priority lists now exist to deny valuable medical tests and treatments for cancer, spine disorders, hip replacements and consultations with specialists. The Oregon Health Plan has reprioritized money for treatment of "brain injuries" from No. 1 to No. 101.

How could the government or an insurance company deny care to patients? They will simply follow the advice of the coordinating council and pay doctors less who don't comply with the bureaucrats' thresholds. The president also seeks to "wield technology's wonders to raise health care's quality and lower its cost." Congress will force doctors to use computers to report their compliance with government mandates. Hospitals are already paid less if patients are given antibiotics for more than 24 hours after surgery, if they don't give antibiotics within four hours of a suspected pneumonia or are not paid at all if patients get certain infections.

Unfortunately, protocols like these have led doctors and hospitals to avoid high-risk patients, give antibiotics unnecessarily to patients who don't really have pneumonia and stop antibiotics too early in others. The bureaucrats claim that this improves "quality" and "efficiency," but the data are clear that this does not occur and patients are hurt. This is the kind of cookbook medicine that American physicians have fought for decades to prevent since FDR.

There are certainly many problems in health care that need careful attention and innovative solutions. Yet today's problems with high costs and access to care have occurred during the domination of medical payments by the government and insurance companies. Congress and the president are trying to use myths to convince you to further trust the government. For instance, they claim there are 47 million uninsured Americans when 9.7 million of these people are not American citizens. While there are less than 5 percent of people who declare bankruptcy for medical reasons, the president claims there is a "medical bankruptcy every 30 seconds." This would mean more than 1 million per year when there were less than 825,000 actual American bankruptcies! Some claim we are 37th in the world for infant mortality when many countries don't count premature babies that Americans try to save.

There are better ways to provide high quality medical care at the lowest cost. They are based in the traditions of American freedom and ownership of an individual's savings to pay for their own health care. Unfortunately, Congress wants to create larger, government-funded programs for health care and more bureaucracy that ration care and impose cookbook medicine. Americans deserve, above all else, the most vital feature of the patient-physician relationship: to trust your doctor.

Dr. David McKalip is a solo practice neurosurgeon in St. Petersburg, president-elect of the Pinellas County Medical Association and chair of the FMA Council on Medical Economics.

Rationed care is bad care 04/10/09 [Last modified: Friday, April 10, 2009 11:10pm]
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