Wonder how this will change things?

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Midwest Medic

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  1. Attending Physician
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Don't know if anyone caught this or not, but an interesting post from Bloomberg.com. Here is the link to the article: http://www.bloomberg.com/apps/news?pid=20601039&refer=columnist_mccaughey&sid=aLzfDxfbwhzs



Ruin Your Health With the Obama Stimulus Plan: Betsy McCaughey
Commentary by Betsy McCaughey

Feb. 9 (Bloomberg) -- Republican Senators are questioning whether President Barack Obama’s stimulus bill contains the right mix of tax breaks and cash infusions to jump-start the economy.

Tragically, no one from either party is objecting to the health provisions slipped in without discussion. These provisions reflect the handiwork of Tom Daschle, until recently the nominee to head the Health and Human Services Department.

Senators should read these provisions and vote against them because they are dangerous to your health. (Page numbers refer to H.R. 1 EH, pdf version).

The bill’s health rules will affect “every individual in the United States” (445, 454, 479). Your medical treatments will be tracked electronically by a federal system. Having electronic medical records at your fingertips, easily transferred to a hospital, is beneficial. It will help avoid duplicate tests and errors.

But the bill goes further. One new bureaucracy, the National Coordinator of Health Information Technology, will monitor treatments to make sure your doctor is doing what the federal government deems appropriate and cost effective. The goal is to reduce costs and “guide” your doctor’s decisions (442, 446). These provisions in the stimulus bill are virtually identical to what Daschle prescribed in his 2008 book, “Critical: What We Can Do About the Health-Care Crisis.” According to Daschle, doctors have to give up autonomy and “learn to operate less like solo practitioners.”

Keeping doctors informed of the newest medical findings is important, but enforcing uniformity goes too far.

New Penalties

Hospitals and doctors that are not “meaningful users” of the new system will face penalties. “Meaningful user” isn’t defined in the bill. That will be left to the HHS secretary, who will be empowered to impose “more stringent measures of meaningful use over time” (511, 518, 540-541)

What penalties will deter your doctor from going beyond the electronically delivered protocols when your condition is atypical or you need an experimental treatment? The vagueness is intentional. In his book, Daschle proposed an appointed body with vast powers to make the “tough” decisions elected politicians won’t make.

The stimulus bill does that, and calls it the Federal Coordinating Council for Comparative Effectiveness Research (190-192). The goal, Daschle’s book explained, is to slow the development and use of new medications and technologies because they are driving up costs. He praises Europeans for being more willing to accept “hopeless diagnoses” and “forgo experimental treatments,” and he chastises Americans for expecting too much from the health-care system.

Elderly Hardest Hit

Daschle says health-care reform “will not be pain free.” Seniors should be more accepting of the conditions that come with age instead of treating them. That means the elderly will bear the brunt.

Medicare now pays for treatments deemed safe and effective. The stimulus bill would change that and apply a cost- effectiveness standard set by the Federal Council (464).

The Federal Council is modeled after a U.K. board discussed in Daschle’s book. This board approves or rejects treatments using a formula that divides the cost of the treatment by the number of years the patient is likely to benefit. Treatments for younger patients are more often approved than treatments for diseases that affect the elderly, such as osteoporosis.

In 2006, a U.K. health board decreed that elderly patients with macular degeneration had to wait until they went blind in one eye before they could get a costly new drug to save the other eye. It took almost three years of public protests before the board reversed its decision.

Hidden Provisions

If the Obama administration’s economic stimulus bill passes the Senate in its current form, seniors in the U.S. will face similar rationing. Defenders of the system say that individuals benefit in younger years and sacrifice later.

The stimulus bill will affect every part of health care, from medical and nursing education, to how patients are treated and how much hospitals get paid. The bill allocates more funding for this bureaucracy than for the Army, Navy, Marines, and Air Force combined (90-92, 174-177, 181).

Hiding health legislation in a stimulus bill is intentional. Daschle supported the Clinton administration’s health-care overhaul in 1994, and attributed its failure to debate and delay. A year ago, Daschle wrote that the next president should act quickly before critics mount an opposition. “If that means attaching a health-care plan to the federal budget, so be it,” he said. “The issue is too important to be stalled by Senate protocol.”

More Scrutiny Needed

On Friday, President Obama called it “inexcusable and irresponsible” for senators to delay passing the stimulus bill. In truth, this bill needs more scrutiny.

The health-care industry is the largest employer in the U.S. It produces almost 17 percent of the nation’s gross domestic product. Yet the bill treats health care the way European governments do: as a cost problem instead of a growth industry. Imagine limiting growth and innovation in the electronics or auto industry during this downturn. This stimulus is dangerous to your health and the economy.

(Betsy McCaughey is former lieutenant governor of New York and is an adjunct senior fellow at the Hudson Institute. The opinions expressed are her own.)

To contact the writer of this column: Betsy McCaughey at [email protected]

Last Updated: February 9, 2009 00:01 EST


Could be an interesting change, but hopefully this will get shut down before anything comes of it.
 
Read the same on Sermo.

Unfortunately, looks like Obama is signing the bill on Monday. Not sure if any of this was modified. I'm doubting it.

The next four years are going to be interesting for physicians.
 
Read the same on Sermo.

Unfortunately, looks like Obama is signing the bill on Monday. Not sure if any of this was modified. I'm doubting it.

The next four years are going to be interesting for physicians.

I don't necessarily have a problem with government rationing health care, as long as the final decision on care is made by doctors. Rationing is incompatible with a legal environment that demands we "do everything" for every patient, and never make a mistake.

I'm not sure how government can prevent us from ordering tests/admissions/treatments while at the same time doing nothing for malpractice reform.
 
I don't necessarily have a problem with government rationing health care, as long as the final decision on care is made by doctors. Rationing is incompatible with a legal environment that demands we "do everything" for every patient, and never make a mistake.

I'm not sure how government can prevent us from ordering tests/admissions/treatments while at the same time doing nothing for malpractice reform.

Actually, the government will not have to "prevent us from . . ." They just won't pay for those things they think not cost-effective or utile. The hospitals will then try to rein us in to keep themselves afloat.
 
Actually, the government will not have to "prevent us from . . ." They just won't pay for those things they think not cost-effective or utile. The hospitals will then try to rein us in to keep themselves afloat.

Which will just lead to the collapse of more hospitals, that cannot sustain themselves by providing unreimbursed care.

As I said, the two concepts of high malpractice and rationed care are not compatible.
 
Which will just lead to the collapse of more hospitals, that cannot sustain themselves by providing unreimbursed care.

As I said, the two concepts of high malpractice and rationed care are not compatible.

I agree with GV (for once 😉) - we can't be expected to both do everything and only do what's reasonable and necessary at the same time - it's impossible. We (and by "we" I mean both physicians and lawmakers) need to start seriously reexamining our priorities when it comes to health care; continuing on our current path is just going to make things worse, regardless of what bureaucracy we throw on top of the mess to make ourselves feel better.
 
As if we needed more proof that Daschle is a scumbag. Hmm...he inserted this provision to give the HHS MORE power when he was a nominee for HHS. Nice. Thankfully Obama dumped this guy and limited his abililty to affect us. Unfortunately, his sneaky, despicable act will still get passed as a side-effect of the stimulus bill. This is exactly what's wrong with Congress. Nothing can get done without everyone putting their grubby little hands into a bill that has nothing to do with what they want.

Sigh

Now that I've gotten that off my chest, all I have to say is "Big Brother is Watching." Although it would be nice to think that doctors will be the ones making the decisions of who is a "meaningful user," we all know that won't be the truth. As always, it will be greedy politicians seeking only power and votes, leaving physicians to be the ones to suffer.
 
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A big question is, as emergency physicians, how do we ration health care? Do we go ahead and code the 92 year old who is not a DNR, the 65 year old, or the 12 year old? Now to adda twist, let's say all have end stage CA, do we code any of them? Or if the 12 year old is a wheelchair bound CP patient. Do we ration our health care dollars to further his life, or do we spend that money on preventative medicine?

I do agree that a rationed health care system and malpractice can not exist together, that is why I am not really too worried about the rationing system ever taking place. The trial lawyer scum have too big of a lobbyist group and too many of them are in congress to ever let anything like this pass. If it does however, it might be time to buy a tattoo removal laser and start taking cash for removing all the tramp stamps in a few years!
 
People ask why this has to be "hidden" in another bill and why we can't have this discussion out in the light. Why? Because while it has become increasingly apparent that our appetite for healthcare is bigger than our ability to pay for it. But nobody wants to acknowledge this. As a nation, nobody here is interesting in facing the music. The previous president did nothing to disabuse people of this notion, passing the buck for another 8 years.

Our system is broken in profound and fundamental ways when the system will pay for you to die in the ICU when you're a dialysis-dependent 85 year-old with dementia who hasn't recognized a loved one in two years who's "full code" but won't pay for routine preventative care which can keep people from getting sick in the first place. People want "everything done" and expect an MRI of their knee after a slip and fall on the ice, but then get pissed off when their premiums rise 10% year over year.

An organization which links evidence-based care to reimbursement would be a good thing for both patients and doctors. EM is a bit different in how we already tend to expect to examine things through the specter of EBM, but in 2009, I think that we can do a whole lot better for our patients than "this is how I've always done it".
 
People ask why this has to be "hidden" in another bill and why we can't have this discussion out in the light. Why? Because while it has become increasingly apparent that our appetite for healthcare is bigger than our ability to pay for it. But nobody wants to acknowledge this. As a nation, nobody here is interesting in facing the music. The previous president did nothing to disabuse people of this notion, passing the buck for another 8 years.

Our system is broken in profound and fundamental ways when the system will pay for you to die in the ICU when you're a dialysis-dependent 85 year-old with dementia who hasn't recognized a loved one in two years who's "full code" but won't pay for routine preventative care which can keep people from getting sick in the first place. People want "everything done" and expect an MRI of their knee after a slip and fall on the ice, but then get pissed off when their premiums rise 10% year over year.

An organization which links evidence-based care to reimbursement would be a good thing for both patients and doctors. EM is a bit different in how we already tend to expect to examine things through the specter of EBM, but in 2009, I think that we can do a whole lot better for our patients than "this is how I've always done it".
You make several good points and I'm always for reducing costs of healthcare. Something several of my EM mentors have always taught me is to have a good reason for every test. For example, many people order a CBC, "just because that's what we do," but don't think about the extra cost to the patient. What gets me is the fact that politicians are making these decisions. You and I both know that the proper way to do this would be to take the top physicians in each field and let them act as a committee to make these decisions.

Instead, we'll get career politicians, some of them with MDs to make things look proper, who care more about big headlines and getting votes than patients or physicians. This is similar to the current problem of MBAs making payment decisions for insurance companies. If anything, politicians are worse. MBAs can be convinced by the bottom line and a good argument. A family physician really can't call up his senator and plead for payment for something his individual patient needed, but didn't fit into what the legislature thought was "meaningful."

Anytime you let government make an arbitrary decision about something like this, they essentially get to control whether your patients live or die. This is already true in some countries in Europe, where certain treatments aren't given past the age 65, regardless of life expectancy, quality of life, etc.
 
Our system is broken in profound and fundamental ways when the system will pay for you to die in the ICU when you're a dialysis-dependent 85 year-old with dementia who hasn't recognized a loved one in two years who's "full code" but won't pay for routine preventative care which can keep people from getting sick in the first place. People want "everything done" and expect an MRI of their knee after a slip and fall on the ice, but then get pissed off when their premiums rise 10% year over year.
.

You just made the case for why we shouldn't have government rationing of healthcare, and why we should get rid of the trial lawyers. If left to our own devices, I think most physicians would make the appropriate choices. I for one would never code a demented nursing home patient again if I had the choice.
 
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