In particular, he describes how rigid clinical practice protocols will be foisted on doctors and patients under the guise of "evidence based care". This will happen through the following steps:
1) The ObamaCare exchanges will only allow health insurance plans that cover "evidence based care". Over time, these will likely be the only plans that survive.While "evidence based" sounds scientific, there are many problems with what is currently called "evidence based". Often these guidelines are based on inadequate, outdated, or biased data.
2) Because doctors will want to get paid, they'll have to adhere to care that follows government guidelines.
3) Doctors who follow these guidelines will have protection from malpractice suits, whereas doctors who stray will have to take their chances in court if anything goes wrong.
[E]ven where there are well established guidelines, they are inevitably written for the average patient. But suppose you are not average. Is your doctor free to step outside the protocols and give you care based on her training, knowledge and experience? Or will she be pressured to stick to the cookbook, regardless of how the patient fares? Health plans always say that doctors are free to step outside the guidelines if they have good reason for doing so. But if the doctor is forced to fill out multiple forms and jump through lots of hoops, many will conform to the guidelines even if that’s bad for you.And finally, guidelines are too-often wrongly applied to patients for whom they were not intended:
For example, a large number of studies of patients with heart failure excluded elderly patients, even though most of the people who have this problem are elderly! If you are an elderly patient do you want your doctor to follow procedures that were based on studies of patients 30 or 40 years younger than you are? According to Don Taylor, a health policy analyst at Duke University, it is not at all unusual to exclude patients with characteristics and conditions from clinical trials who are then subjected to the guidelines after the trial is over.In effect, these guidelines represent the "central planner fallacy" as applied to health care. Bureaucrats in Washington DC regard themselves are more qualified to decide what medical care you should receive than your doctor who actually knows your medical condition.
Is this the kind of health care you want?
(Read the full text of "Worse Than Death Panels".)