Op-Ed: Obamacare

Medicine by bureaucrats

By Robert Goldberg | Tuesday, June 17, 2008

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"My plan begins by covering every American. If you already have health insurance, the only thing that will change for you under this plan is the amount of money you will spend on premiums. That will be less. If you are one of the 45 million Americans who don't have health insurance, you will have it after this plan becomes law. No one will be turned away because of a preexisting condition or illness."

That sounds very reassuring. But if you think you will be getting the state-of-the-art treatment Sen. Ted Kennedy is now receiving for his brain cancer, Obamacare is not the sort of change you can believe in. Rather, Mr. Obama plans to make Medicaid and State Children's Health Insurance Program (SCHIP) expansion the foundation of his proposal to expand coverage. He would make private health insurance affordable by having the government force doctors to accept below-cost rates for their services and impose a 4 percent tax on physician earnings. Then he would have a national health board determine which drugs and procedures the government would pay for under his new plan.

Many states have used the same approaches to cover the uninsured and to make existing premiums less expensive. Instead of doing so, such proposals have driven many doctors out of government-run programs and have rationed access to new medicines. Private insurers are leaving markets. And patients who are forced to wait months for needed care often wind up not getting the medicines they need.

For example, Nicole Garrett's three teen-age children lost their private coverage, so she lost her private coverage and enrolled them in Michigan's managed-care Medicaid program.

According to a 2007 article in the Wall Street Journal by Vanessa Furhmans, when Nicole's 16-year-old daughter, Jada, needed to see a rheumatologist, the one listed in her managed-care Medicaid plan's network would not see her. Nicole notes, "When we had real insurance, we could call and come in at the drop of a hat."

Mr. Kennedy was rushed into surgery less than two weeks after his diagnosis. Jada's wait just for an appointment was a bit longer: The wait to get into a public clinic was more than three months. By the time she found a Medicaid-approved rheumatologist in a nearby county to take her in months later, Jada's debilitating pain had caused her to miss several weeks of school.

Edith Andrews of Zanesville, Ohio, faced the same problem when her twin girls, Sara and Samantha, were born prematurely nearly four years ago. Each weighed less than 3 pounds and needed a ventilator to breathe.

According to an article in the Cinncinnati Enquirer: "To get care she had to take her infants to a Zanesville clinic or an emergency room, where they saw a different doctor every time, if they saw a doctor at all."

When Sara's lung collapsed, Edith couldn't find a Medicaid pediatrician to care for her. "Sarah's complications got worse and worse, and there was never a doctor around when I needed to talk to somebody." She finally found a doctor to take her daughters on as patients after a year of searching.

Mr. Obama would also create a new health board to create lists of "cost effective" new drugs and medical devices, and set prices for their payment. Similar review boards in Canada and Europe delay access to new medicines by months or years and are biased by cost-containment considerations.

In the Medicaid and SCHIP programs, such "preferred lists" have made it harder for people like Melissa Brown of Cincinnati to get the right drugs for her 6-year-old son, Max, who suffers from bipolar disorder and other psychiatric illnesses. Under private insurance, her doctor was able to choose a drug that controlled unpredictable and violent behavior. The drug treatment she got for Max "changed his life."

But now Melissa and Max are in Medicaid and bureaucrats, not doctors, will decide which drugs he will get, based on the cost-effectiveness standards Mr. Obama wants to impose on us all. Max will have to change his prescriptions and get authorizations for new medications.

The change has Melissa worried: "This is a day-to-day, minute-to-minute struggle. She told Ohio legislators, "Please don't make it any more difficult for me." That's a message we should all send to Mr. Obama before November. Affordable coverage should not be difficult or substandard. Under Obamacare, it will be both.

Robert Goldberg is vice president of the Center for Medicine in the Public Interest.

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