This week marks the one-year anniversary of Obamacare, and there has been no shortage of Washington rhetoric on the goals of the legislation for the occasion: Bending the cost curve. Reducing health insurance premiums. Expanding the number of insured Americans. But as we mark this anniversary, it’s important to note the other agenda that has been missed in the debates of the past two years: reining in our doctors. Look carefully at the legislation signed into law by President Obama last March, and you’ll discover a not-so-subtle campaign to dramatically reshape the doctor-patient relationship. From compensation to autonomy, Obamacare represents something of a war on doctors.
Skeptical? Consider key aspects of the legislation. The newly established Patient-Centered Outcomes Research Institute (PCORI) is mandated to fund research comparing the efficacy of medical and surgical interventions. At first glimpse, PCORI seems reasonable enough. If taxpayers are footing the bill, after all, let’s ensure that we’re paying for effective treatment. However, the body could easily and quickly become a way to favor certain treatments while restricting others.
In other countries, such bodies tend to make politicized and highly controversial decisions, often opposed by physicians. In Great Britain, as an example, the National Institute for Health and Clinical Excellence (NICE) has no hesitation in intervening in medical decisions - decisions that would be controlled by doctors and their patients here in America. The results of years of experience with NICE also show that the PCORI approach by itself does not guarantee lower costs but does decrease options while undermining patient care. It’s one reason British cancer outcomes trail ours.
PCORI is only one agency of more than 159 that were created in the 2,800 pages of Obamacare, and virtually all of them will move power and control to Washington and impinge on physicians’ ability to provide for their patients. This is part of a larger trend in Obamacare - treating doctors as tradesmen in need of guidance and restraint.
Still skeptical? The health overhaul law also establishes the Independent Payment Advisory Board (IPAB). The 15 members of this independent board, appointed by the president and confirmed by the Senate, will keep Medicare’s growth in line, with the power to dictate payment for specific treatments and interventions. In nontechnical language: This unelected body will have the unprecedented ability to single-handedly change the allocation of health care resources should Medicare spending exceed medical inflation - which, for the record, it consistently does. IPAB’s recommendations, incidentally, are beyond congressional reach unless overturned by a supermajority of Congress.
Many Americans may not see this as being particularly problematic. Hit by the recession, they may be unsympathetic to the woes of the caricatured neurosurgeon driving his Mercedes. But pause for a moment: The doctor-patient relationship is the cornerstone of modern medicine. As Washington bureaucrats are empowered, patients will spend less time with their physicians to understand their illness, its significance and the treatment plan. It also will mean fewer treatment options for their physicians. Americans disliked the corporate decision-making of managed care in the 1990s. Will government decision-making be any more appealing?
Looking to the future, these problems are likely to worsen. As the new mandates and regulations kick in, physicians and hospitals will be forced to form bigger groups and bigger networks to lower costs, creating vertical organizations that are easier to regulate and influence.
Let’s be clear: Obamacare did not fire the first shot of this war on doctors, but it certainly will expand and accelerate it. The profession will survive - doctors have demonstrated enormous flexibility. Though these policies certainly are a nuisance, like any government contractor, doctors will change and adjust their behavior to successfully navigate the battlefield. Ultimately, the brunt of these regulations will be passed along to patients in the form of access problems and compromised quality of care - just as they have in other countries.
Perhaps the greatest irony is this: As health care costs continue to soar and promised savings fail to materialize, Washington surely will look to further rein in physicians. Britain would be a case in point. Years of restrictions and rationing have resulted in low standards, yet health care cost inflation is higher on the other side of the Atlantic.
But reining in spending doesn’t necessarily mean reining in doctors. In five-sixths of the economy, we look to individual choice and competition. The alternative to Obamacare, then, is clear: Empower individuals and families with better information, foster competition, and move decisions (and their financial consequences) closer to the patient. That would be better than escalating the decades-long war on our doctors.
Dr. Jason D. Fodeman is an internal-medicine resident at the University of Connecticut and a former fellow at the Heritage Foundation. Dr. David Gratzer is a fellow at the Manhattan Institute.
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