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NO TO CARE BY COMMITTEE

President Barack Obama is right that the status quo has gotten us to a point where health insurance and medical costs are unaffordable for Americans. That status quo is one in which governments and large insurance companies hold all the money and power - and this would not change under any congressional proposal. In fact, Congress and the president would require every citizen to buy insurance or pay a penalty of 2.5 percent of their income. And Congress will reinforce the status quo with state-imposed rationing.

To save money for themselves, the government and insurance companies will withhold "incentives" to punish doctors who dare to prescribe needed tests and treatment. The president proposes giving congressional powers to an unelected panel of "medical experts,'' the Independent Medicare Advisory Committee, which would make recommendations on annual Medicare payment rates and coverage decisions - which will usually be adopted by insurance companies.

The president claims that including some doctors on IMAC will mean they can be trusted and nonpolitical, but this could not be further from the truth. I have sat on such committees in Washington, and they have been political for decades - pitting one specialty against another for their piece of the budget pie. In the end, the IMAC will issue edicts to penalize doctors who don't "comply" with rationing plans.

Congress would use incentives to pay for "quality" and "efficiency" rather than volume. Unfortunately, current evidence shows us that a political and corporate committee cannot define quality or efficiency. United HealthCare has a government-approved system that awards doctors two stars if they are "efficient." These doctors get access to more patients and the patients pay less. Unfortunately, the doctors are asked to minimize spending on patients to achieve that rating.

I perform delicate spine surgery on the neck. United HealthCare decided that such patients in Tampa Bay should receive no more than about $17,000 worth of care. Three of my seven United patients received about $22,000 worth of needed medical care, tests and treatments. United would reward me if I denied care to my patients by reverting to 35-year-old surgery that used no plate, required an extra incision for a bone graft and denied a night in the ICU. For refusing to ration care, I was punished and I dropped their plan.

When political committees create one-size-fits-all medicine, the wrong medical care is given to large groups of patients. For instance, to get a better report card and incentives, doctors followed the government edict to give antibiotics within four hours to pneumonia patients - but people who didn't really have pneumonia were given antibiotics. Heart attack patients were automatically given beta-blockers to get a better report card, but some ended up with life-threatening drops in blood pressure. This "best practice" had to be dropped after several years of causing damage.

No doctors' committee can properly and efficiently practice medicine. Doctors' committees are common in Canada and British single-payer systems, where they routinely deny life-saving drugs for cancer, ration care, allow long waiting lines and create medical refugees fleeing to America.

The president should make real changes like allowing people to get lower cost health insurance across state lines and tax-free insurance outside work. Place the power for health spending into the hands of patients - not insurance companies and government. When patients have the power, they can demand more time from their doctors, better understand their options and make rational choices for health spending that will benefit them. Government and charity can then help the small percentage of people who are too poor or sick to find affordable health insurance in a fair marketplace.

Each congressional health system reform proposal grants excessive power to federal agencies to control how doctors practice medicine by using penalties to force doctors to ration care. The doctor will work for "the system" to avoid penalties, and patients will have every right to lose trust in their doctor. How can this be viewed as good change in the status quo?

Dr. David McKalip is a St. Petersburg neurosurgeon, immediate past president of the Florida Neurosurgical Society and a senior fellow of the National Center for Policy Analysis.

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