Monday, November 23, 2009

Jane Orient: View From 35,000 Feet

Dr. Jane Orient, author of Your Doctor Is Not In, has posted a good analysis of the health care debate taking a "view from 35,000 feet".

Here's an excerpt from her essay, "Forget the Trees; Look at the Forest on Healthcare":
...The question is whether we want to put the federal government in control of American medicine. And about the related question of what medicine should be.

Traditionally, medicine is practiced by physicians, one patient at a time. The outcome is assessed by that patient. The right decision is the one chosen by the patient, in consultation with the physician, based on what is optimum for that patient, considering all aspects of his circumstances. The standard of care is the Oath of Hippocrates: providing treatment for the good of each patient according to the best of the doctor's ability and judgment.

In the "reformed" delivery system, healthcare is practiced from on high by committees of "experts" pulling the strings of marionette physicians (rankings, payment rates, other incentives and disincentives) who are judged on how well they achieve population-based outcomes. Patients are like sheep in the flock, categorized by race, income level, quality-adjusted remaining years (QARYs), compliance, functional ability, diversity score, or whatever metrics the rulers adopt. Any individual can be sacrificed for the good of the whole.

All information is to be coded and fed into a huge database, so that the herd's behavior and health can be monitored on a "granular" (minutely detailed) level. Non-reporting is punishable by fines or exclusion or worse.

One of the most common words in the House healthcare reform bill is "eligible." Obviously if you have to be eligible, you can also be ineligible -- and probably are, until proved otherwise. If subsidies can be given, they can be denied, or taken away. If the price-fixers can raise the doctor's pay, they can also cut it. If a committee can mandate coverage and level of payment for a service, it can refuse coverage or set the allowable charge below cost. If it has to certify need, it can declare that there is no need.

There is no need to report something to an official, unless the official has the power to act on the report: by allowing, disallowing, punishing, or making additional demands.

There is no need for a 2,000-page bill unless it is enabling government control over formerly private matters.

There is no need for a "place at the table" unless the czars can serve you a share of the collective goods -- or carve you up.

There is no need to read the bill -- unless it will affect your life. And a bill that creates winners and losers on every page, and that concerns everyone who is born, lives, and dies, will affect your life.

Some Americans may gain something from the bill, at least temporarily. But all lose freedom.
(Read the full text of "Forget the Trees; Look at the Forest on Healthcare".)