- - Friday, August 3, 2012

National health care reform is not at all like being fitted for a pair of eyeglasses. The eye doctor patiently tries one lens, then another, each time asking, “Is it better, or worse?” If, when you get the final product, you don’t see better, you always have the option of going back to your old prescription or trying again.

Congress, on the other hand, is prescribing radical, universal (one-size-fits-all) changes. It is quite capable of ignoring a deluge of phone calls, or even thousands of people standing in the streets in opposition, as in the drama leading up to passage of Obamacare. The better-or-worse exercise is occurring behind the scenes — with Big Hospitals, Big Pharma, Big Insurance, Big Unions and other big campaign contributors.

After the plan is fully implemented in 2014, there may be no going back — at least, that’s the reformers’ intention. They would like to annihilate private medicine. The Obama administration is feverishly spending money to set up bureaucracies and bribe states into implementing state exchanges and expanding Medicaid, each step creating more special interests that will resist repeal.

Congress never takes a serious look at the results of its massive, non-consensual experiments, not even when it requires a report, as it did with the Clinical Laboratory Improvement Act. If there was ever a study to determine how much costs went up, access went down and hassles for patients and doctors multiplied, the results are buried in an archive somewhere. Small physicians’ office labs are gone, and urgent specimens often have to be shipped out of state. Did anything improve? Congress doesn’t know and doesn’t care.

The “outcomes” that will be monitored in Obamacare have nothing to do with improving your child’s treatment or saving your mother’s life. They are all systemwide aggregate measures. How many people got anti-tobacco counseling? How many are enrolled in a plan? Did Ethnic Group A get as many joint replacements as Ethnic Group B? Did expenditures stay within the pre-set bounds? How well did physicians follow the guidelines? Did all the required, formerly confidential patient data get entered into the database?

It is quite likely that some people will benefit. If you hand out the standard eyeglass prescription, some people will see better. The press acolytes of Obamacare will report on them. On those who are running into walls, we will hear not so much.

We’ll hear about the 25-year-olds who get another year on their parents’ insurance, but not about the premium increases paid by all or the children who lose coverage because employers stop offering insurance to all dependents. We’ll hear about the newly insured persons who can go to a “provider” to get a “free” screening. But not about the sick people who get less attention, the increased premiums to pay for the freebies, or the physicians who close their practices owing to the unfunded mandates.

We’ll see reports on what the government forces us to measure, not on the ruins the government ignores. We’ll never see what might have been: the innovation, vitality and efficiency that are the fruits of freedom in medicine. That is why socialism always demands to be universal. It can’t survive if there is competition. Advocates of socialism want us to be fitted with blinders, not better eyeglasses.

National health care reform is like a forced marriage to government — for better or for worse.

For the unfavored, it will be for worse — until death.

Dr. Jane M. Orient practices internal medicine in Tucson, Ariz., and is executive director of the Association of American Physicians and Surgeons (aapsonline.org).

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