- The Washington Times - Sunday, October 4, 2009


What happens in a government-run health care system when the money runs out for the year? Only two things can happen: Either the providers work for free or the patients wait until the new year.

But this only happens in Canada or England, or some other country, right? How about at the Phoenix Veterans Affairs hospital in Arizona?

Two of my colleagues work part time at the Phoenix VA providing orthopedic services not adequately covered by the full-time doctors there. With the low productivity of the employed physicians (as compared to orthopedic surgeons in the area generally), the surge in returning veterans from Iraq and Afghanistan, and the recession, the part-time doctors have been very busy.

But in August, they were notified that they had reached their quota on work and would not be paid for any more care provided in 2009.

Perhaps the patients could be seen outside the VA at private clinics and offices? Unfortunately, few veterans seeking care at the VA have any benefits for nonemergency treatment anywhere but the VA.

The physicians were told they could work for free, make the patients wait until 2010, or perhaps some money could be found if they were willing to take an 80 percent pay cut.

You see, when the bureaucrats make the rules, it is never the system’s fault, or heaven forbid, a bureaucrat’s fault, that health care will be delayed or denied.

If the doctor makes a rational decision not to give away his expertise and services for free for four months, some might call him “greedy” and more interested in money than patients. But think about it: How many of you would work for free from September through December this year? Is it really greedy to expect to be paid for work you do?

On the other hand, the doctor can decide to try to work something out so the patients can still get somewhat timely care by working for a massive discount. Again, the question would be: How many would be willing to work for only $2 when what is actually owed is $10?

If the doctor says, “See you in January,” the bureaucrats blame the provider. If the doctor is willing to donate some time this year, what are the chances that next year’s payments from the government will look a lot more like the reduced pay rate? Eventually, the doctor will leave the VA system for good, leaving the patients to fend for themselves either way. And the bureaucrats can claim their hands are clean.

At its core, this basic understanding - that the current health care reform proposals will ultimately lead to increased power over individual health care decisions to be placed in the hands of unaccountable bureaucrats - is the reason behind the massive and passionate opposition movement that has swept the country.

Equally important, it explains why a recent Rasmussen survey demonstrated that only 11 percent of respondents - including Democrats and Independents - believe Congress understands the health care legislation better than they do. Never mind that many elected officials have seen fit to spend their August recess inventing explanations as to why they cannot meet with their constituents to discuss health care.

The president has chosen simply to dismiss rationing as a possibility if the proposed reforms pass. The American people do not believe him.

In health care, the details matter. Pretending that the proposed reforms will not be the driving force behind who gets care and when is beneath the intelligence of all Americans. Blaming the providers of care while denying any governmental responsibility for writing and implementing the policies that result in delayed treatment will fail.

Meanwhile, Phoenix-area veterans will have four months added to their wait time for treatment.

Dr. Eric Novack, an orthopedic surgeon, is senior fellow in health policy for Americans for Prosperity and chairman of Arizonans for Health Care Freedom.

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