Thursday, March 25, 2010

Hsieh OpEd in DP: "Turning Medicine Into Political Football"

Update: Welcome readers! And thanks to Dr. Kevin Pho for posting this piece as "Government-controlled health insurance may politicize health" (with the permission of the Denver Post).

The March 24, 2010 Denver Post has published my latest OpEd, "Turning Medicine Into Political Football".

My theme is that under government-controlled health insurance, medical coverage decisions will inevitably be based on political considerations, driven by special-interest lobbying and the "politics of pull". And ordinary Americans will pay the price.

Here is the piece:
Turning medicine into political football
Paul Hsieh; Denver Post, 03/24/2010

During President Obama's final push for "universal health care" legislation, his biggest obstacle was not Republicans but rather anti-abortion Democrats let by Congressman Bart Stupak (D-Michigan).

Stupak eventually reached a last-minute deal with the White House on federal funding of abortion services. But no one should be surprised that under government-controlled health insurance, medical coverage decisions will be based on political considerations. Rather, the recent wrangling over abortion will be a mere preview of special-interest battles to come as health care becomes a permanent political football.

Abortion has already been a political football in those sectors of health insurance under government control. In 1985, the Department of Defense denied abortion coverage for women with military health insurance unless the mother's life was in danger. In 1988, the DOD issued additional rules prohibiting women from obtaining abortions with their own private money at military facilities overseas. President Clinton reversed this ban in 1993, but anti-abortion lawmakers reinstated it in 1995 through the defense appropriations bill.

Women covered by the Federal Employees Health Benefits Program (FEHBP) have been similarly affected. Over the past thirty years, their abortion coverage has also swung from permitted to highly restricted depending on which political party was in power.

Nor will the problem of politicized health benefits be confined to abortion. ObamaCare gives the U.S. Preventative Services Task Force (USPSTF) the authority to determine which preventive health services must be covered by private insurance. The USPSTF is the same group that recently issued controversial guidelines recommending that screening mammography be restricted to women over age 50, despite the fact that medical organizations such as the American Cancer Society have long recommended routine mammography beginning at age 40, based on years of scientific research.

Due to public outrage, the Senate later amended its bill to override the USPSTF guidelines — in this particular case. As with abortions for military families, mammography coverage under government-controlled health insurance was determined primarily by politics and lobbying. Similar lobbying will occur as Americans start demanding coverage for other procedures not approved by the USPSTF, such as virtual colonography (a new method of detecting early colon cancer which President Obama himself recently underwent).

Such lobbying is already a constant feature under the Massachusetts system of mandatory insurance in place since 2006, which was the model for ObamaCare. Under any system of mandatory insurance, the government must necessarily determine what constitutes an "acceptable" policy. This creates a giant magnet for special interest groups seeking to include their favorite benefit in the mandatory package.

Massachusetts residents must therefore purchase numerous benefits they may neither need nor want, such as in vitro fertilization and chiropractor services. Since 2006, special interest groups have successfully lobbied to include 16 new benefits in the mandatory package (including lay midwives, orthotics, and drug abuse treatment) — and the state legislature is considering 70 more.

Although I am pro-choice on abortion, abortion opponents should not be forced to fund another woman's abortion. More broadly, individuals have the right to spend their own money for their benefit according to their values. ObamaCare would violate that right by forcing each person to spend his own money on terms set by lobbyists and bureaucrats, rather than based on his individual needs and values.

Instead of politically-controlled mandatory health insurance, we need free-market reforms that allow consumers to decide which benefits they wish to purchase. Such reforms include eliminating mandatory benefits, allowing insurers to compete across state lines, and allowing patients to use Health Savings Accounts for routine expenses, and low-cost "catastrophic-only" plans to cover rare expensive events.

Not only would these reforms reduce insurance costs by up to 50 percent, they would respect each individual's right to make insurance decisions for himself.

Government-controlled health insurance will mean politically-controlled medicine — not only with respect to abortion but for health services in general. ObamaCare will turn medicine into a game of permanent political football, where the politically favored perpetually pound ordinary Americans without special "pull." Until we replace ObamaCare with free-market reforms, Americans had better get used to being the permanent tackling dummies for special-interest groups.

Paul Hsieh, M.D., is co-founder of Freedom and Individual Rights in Medicine at He practices medicine in the south Denver metro area.
Update: Welcome, Wolf Files readers!