Two From the NYT

The New York Times recently published two stories not directly related to ObamaCare, but which do highlight implications for patients if ObamaCare is fully implemented.

A 9/23/2012 story, "Study Divides Breast Cancer Into Four Distinct Types", describes some impressive scientific discoveries that will shake up doctors' understanding of the disease.

In findings that are fundamentally reshaping the scientific understanding of breast cancer, researchers have identified four genetically distinct types of the cancer. And within those types, they found hallmark genetic changes that are driving many cancers... 

Even within the four major types of breast cancer, individual tumors appear to be driven by their own sets of genetic changes. A wide variety of drugs will most likely need to be developed to tailor medicines to individual tumors. 

In other words, advances in genetic analysis could lead to tailored medical treatments.  This is exactly the opposite of the "one size fits all" medical treatment protocols favored by ObamaCare.  It would be a shame to see this promising line of research slowed down (or thwarted) by political considerations.

A 9/19/2012 story on kidney transplants, "In Discarding of Kidneys, System Reveals Its Flaws", describes problems with the current transplant allocation system leading to wasted organs.

One eye-opening excerpt:

Another factor, doctors and organ procurement officials say, is federal scrutiny of transplant success rates. 

In 2007, following revelations of lax government oversight of poorly performing transplant centers, the federal agency that manages Medicare, required that survival data for transplanted organs and recipients be made public. The figures are adjusted for relative risk factors and compared with expected survival rates. 

The penalty for underperformance can be severe. If the number of failures exceeds expected levels by 50 percent, transplant programs are flagged, explained Thomas E. Hamilton, director of survey and certification for the federal Centers for Medicare and Medicaid Services. If it happens twice in 30 months, the program’s administrators are given a brief probationary period to improve, or convince regulators that there were other factors. Otherwise, the program is decertified.

Because Medicare is the primary insurer for kidney transplants, such a ruling can effectively close a transplant program. Commercial insurers also use the survival ratings to make decisions on contracts.

Over five years, through June, 79 organ transplant programs had drawn oversight for repeatedly falling short and seven had been decertified, Mr. Hamilton said.

In interviews, dozens of transplant specialists said the threat of government penalties had made doctors far more selective about the organs and patients they accepted, leading to more discards.

“When you’re looking at organs on the margins, if you’ve had a couple of bad outcomes recently you say, ‘Well, why should I do this?’ ” said Dr. Lloyd E. Ratner, direct of renal and pancreatic transplantation at NewYork-Presbyterian/Columbia hospital. “You can always find a reason to turn organs down. It’s this whole cascade that winds up with people being denied care or with reduced access to care.”

Dr. Michael A. Rees, a transplant surgeon at the University of Toledo Medical Center, said his kidney program was cited by Medicare in 2008 after several unlikely failures. To save the program from decertification, he said he cut back to about 60 transplants a year from 100, becoming far choosier about the organs and recipients he accepted.

The one-year transplant survival rate rose to 96 percent from 88 percent, but Dr. Rees still bristles at the trade-off. “Which serves America better?” he asked. “A program doing 100 kidneys and 88 percent of them are working, or a program that does 60 kidneys and 59 of them are working? It’s rationing health care under the guise of quality, and it’s a tragedy that we are throwing away perfectly good organs.”

Remember that phrase: "rationing health care under the guise of quality". 

Under ObamaCare government "quality measures" will be imposed throughout all branches of medicine, not just transplant surgery.  These metrics will create powerful incentives for doctors to limit care in order to protect their practice statistics.  Doctors will be increasingly hesitant to perform the riskier heart surgeries or cancer surgeries on the sicker patients.  Instead of an incentive to practice medicine, doctors will be soon working under perverse incentives to not practice medicine.

And it will be the sickest patients who will suffer the most.