License Bureau, Post Office...Healthcare???

As Barack Obama rolls out his ambitious agenda for the USSA and continues to spend our way to oblivion, some have questioned whether he will have to put some of his projects on the back burner as public sentiment and buyer's remorse starts to set in. Some have said that Cap and Trade may have to go on the back burner for the time being, but that health care may be "fixed" this year.

The issue of health care in the USSA has been a topic of great debate for literally decades. My father passed away in 1989 and years before that, in the early years of my career in medicine, he gave me a bumper sticker that said "If You Like the Post Office You Will Love National Health care." The issue of health care and what is wrong with it is complicated, crosses multiple sectors of the economy and I don't have the solution. What I do have is a caution.

Friday, 4/17/09, Red State's Jeff Emanuel had a post entitled, "Who Should have the Final Say About Your Medical Care: Your Doctor, or Government Bureaucrats?" In the article a young woman in Georgia who was severely disabled from birth and required intensive home care had her benefits cut by 15% over the objections of her physician. These benefits were from federal and state medicaid. The suit has been in the courts for several years and has worked its way to the 11th US Circuit Court of Appeals where the ruling was overturned and the courts ruled that the physician and not the bureaucratic machine should determine the patient's care.

Rhonda Meadows, commissioner of Georgia’s Department of Community Health,
immediately appealed the ruling to the 11th U.S. Circuit Court of Appeals on behalf of the Peach State. Her argument was that state officials, not doctors, should have final say in what treatments and care patients within their purview require. Florida and Alabama, which fall under the 11th Circuit’s jurisdiction and will have to abide by its ruling, filed an amicus brief with the Atlanta-based court.

Is this a glimpse of what government health care would look like? Those who are heavy weight on the system are cut back and left to wither and die?

Many hospitals today are employing ethicists. These ethicists are doctors who are employed to "help" families faced with end-of-life issues work through the emotional mine field of decision making . While at times, these decisions may seem clear, they become muddled when the ethicist is called in on behalf of the hospital to meet with the families because the patient's care has become long and costly...those high ticket patients whose hospitalizations have languished over long times, without an end in sight....these are patients who have become respirator dependent after a catastrophic event like a heart attack or stroke, who have had multiple complications after emergency major surgery or who have multiple comorbid conditions complicating what otherwise would have been a much simpler procedure. Many of these patients have Medicare or Medicaid and the reimbursement for their care is low. Many of these patients are patients for whom the hospital will have to eat large amounts of the bill. The growing use of the ethicist physician is in some ways a disturbing trend that could become more widely used in a government health system where rationing of resources must, by default, be used. What better group to ration but the "big ticket" patient who is burning through resources without an end in sight. The ethicist can be used to gently "help" the family see the folly of continuing the fight for an unworthy life and justify withholding of supportive measures. Where the line is to be drawn is anyone's guess, but it could well be a line that moves depending on the number of people to be served and the amount of resources available. Is a preemie's stay in the NICU justified? How about a 60 year old patient who needs coronary artery surgery? What if that same patient also is obese? What if that patient also has Type II diabetes? Where is the line drawn when a patient has a hip fracture or needs a hip replacement? What about a 300 pound woman who needs knee replacement due to wear and tear from chronic obesity? And where do organ transplants fall in the rationing plan? What about infertility treatments?

We have the best health care system in the world and we serve people from many countries who come here to have their medical care because they can't get it in a timely manner in their own countries. This has to say volumes about the present state of health care in America. Fixing it, like we have just "fixed" Chrysler and GM, will put government bureaucrats in charge of what you can get, where you can get it and when you will be able to get care. What will government single payer health care do to the access to drugs? Will we be regimented to a strict formulary where one medication fits all? As a resident, I trained in the City and County Hospitals where there was a government formulary and the number of medications available for our patients was severely limited. For example, there was one hormonal replacement medication. There was one brand of birth control pills available to patients. There were charcoal pills for post-op gas relief. If they worked, it was fine, but if not, too bad.

I hardly think that this kind of regimentation will be acceptable to the vast majority of American consumers who are accustomed to individualized treatment for most conditions and are accustomed to rapid access to expensive technology and diagnostic tests, but unless we wake up and smell the coffee, this could be your lot in life in the not too distant future.