Will You Have Bill Clinton’s Choice on Health Care? Obamacare on the Frontlines – a Series

As the Sun Beam Times continues to report on the active rationing occuring in this town due to Obamacare, articles are being re-run I have written in the past on  Health Care reform.  Since this article was publishd in 2010, I TOO had a stent for a heart attack at age 46.  It was this stent that allowed me to return to a normal active life supporting my family a few days after the event. Within a week of my heart attack, I was in the operating room taking the pressure off the spinal cord of a woman who was becoming slowly paralyzed.

Under the Obama rationing scheme, I would be denied the right to get the stent unless I waited and may be denied even at the end of that time.  Some bureacrats feel it is acceeptable for productive people to become unproductive and live in pain as long as it serves the interests of the state (and the state-sponsored health insurance companies).



Will You Have Bill Clinton’s Choice on Health Care?
By David McKalip, M.D.
View all 22 articles by David McKalip, M.D.
Published 02/26/10

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Will You Have Bill Clinton’s Choice: 18 hours to end 12 months of chest pain with a stent?

“… .we are concerned that the current requirement to submit this measure for the RHQDAPU and other reporting initiatives may adversely affect the way physicians practice medicine and ultimately harm patients… .” email announcement of retirement of AMI-6 beta blocker requirement by Joint Commission on Accreditation of Health Care Organizations (JCAHO), 12/31/2008.

“If the law says that such a board or authority may do what it pleases, anything that board or authority does is legal — but its actions are certainly not subject to the Rule of Law. By giving the government unlimited powers, the most arbitrary rule can be made legal; and in this way a democracy may set up the most complete despotism imaginable“. Friedrich Hayek, The Road to Serfdom: “Planning and the Rule of Law”. 1944.

Friedrich Hayek’s observations on the dictatorial power of appointed committees was a forecast of health financing models currently supported by numerous politicians in both parties. Such medical committees exist now, are operating in an untouchable way outside the rule of law and are being used to create so called “best practices”. They will be used to arbitrarily deny choice of medical care to all patients be they in a private or government insurance plan. Left unchecked, these expert panels will deny to most Americans the choice that was made by President Bill Clinton to end his suffering and return him to an active life in as rapid a way as possible. These committees have a simple message for most people who are not Presidents: suffer for your country so we can use the saved money to help people besides you, enable politicians avoid politically unpopular choices and allow insurance cartels to make unnaturally high profits.

President Clinton went to his cardiologist at 11:30 a.m. on Thursday, 2/11/2010 with several days of chest pressure (angina). He was immediately admitted to the hospital and chose to have two stents placed in his coronary arteries. This restored blood flow to his heart muscle and relieved his chest pain. He left the hospital for home at 6 am the next day, ready to return to his busy lifestyle free of chest pain to help Haitian relief efforts. It is a good thing he was a well connected public figure who had the financial means to pay for his health care. John Goodman has described the well known phenomenon of queue jumping by the rich and powerful in single payer systems and the Clinton example would be more common if we move toward more government control. Under plans sought by politicians from both parties in D.C., committees will use cleverly created financial incentives and penalties to force doctors to deny these choices to patients. They will force doctors to operate within a “global budget” such that they dare not prescribe treatment a patient may desire for fear of going “over budget”. In other words, the doctors will be locked in a central planning cage for health care that will have them act more like cogs in a system than professionals who listen to their patients. Their patients will be in the cage with them.

The current committees in D.C. (the Ambulatory Quality Alliance, the National Quality Forum, the Federal Coordinating Council for Comparative Effectiveness and others) have already begun using cost to determine when treatments like these will be approved. Since the Bush administration, committees like these have carefully laid the ground work for a pay for performance (PFP) programs that claim to improve “quality and efficiency”. They started by forcing hospital compliance with guidelines. For instance, they withheld incentive payments from hospitals if they didn’t report on their compliance rates on giving patients with heart attacks beta-blockers within 24 hours. Sadly, they had to end this particular goal when they discovered four years too late that some patients were entering shock and dying when inappropriately given the drug — merely so the hospital could get a good score and avoid a financial penalty (“payment update”)1. The PFP model is envisioned for nearly every medical decision doctors make and is more appropriately labeled “punishment for physicians”.

The Clinton episode could not have occurred at a better time while this model is being pushed in Washington. That very day, the Wall Street Journal published a story called “Simple Health Care Fix Fizzles” describing how patients are receiving stents for coronary artery disease despite the findings of the COURAGE trial published in 2007. The Wall Street Journal implied that the stents may be “unnecessary” or produce results that are no different than management by medication alone. Sadly, those are the conclusions that central planners of their utopian medical economy would like you to believe, but many in the Pay for Performance movement ignore the most important results of the study. The Stents reduce chest pain faster, return people to active, productive lifestyles and overall make people happier. Sadly, ending suffering in patients is not viewed as a desirable or necessary result when it costs more money and there is no change in the death or heart attack rate.

It is worth noting that many reputable cardiologists in academics have questioned the conclusions and the quality of the study. One glaring problem is that 33% of people in the “Optimum Medical Therapy” (OMT) study group were allowed to cross into the group of patients receiving a stent but were analyzed as if they had no stent! The lead investigator, Dr. William Boden, published a powerpoint on COURAGE that elucidated the real motivating factor of committee use of such studies: to save money for third party payers. In the WSJ article he is quoted as projecting an $8 billion savings of annual medical spending in the country. In his presentation he states: “Cost-effectiveness analysis can help allocate resources rationally”. He points out that it costs $299,000 per “Quality Adjusted Life Year (QALY) gained. In fact Dr. Boden apparently has influenced Blue Cross Blue Shield in New York where stress tests and 12 weeks of drug therapy will be required prior to receiving a stent. Bill Clinton must not have gotten the memo: it would have been better for him to waste money on an unnecessary stress test and undergo 12 weeks of drug therapy prior to getting the stents that would relieve his chest pain in New York.

So the tale of Bill Clinton and his stents should lead us all to ask these important questions. Do we want to leave the choices for medical care in the hands of committees existing above the rule of law or would we rather have the choice? Do we want choices limited by technocrats and academicians that have their own academic agenda and a goal of saving money for political purposes? Or would we rather be a patient informed by our own doctor when we make the choice?

If you want a choice as a patient, it will require some hard choices now on how medical care is financed overall. It will require rejecting the concept of gaining all medical benefits for routine annual medical care from a third party payer like an insurance company or government program and unsustainable government programs for all. It will require demanding control of your own medical dollar so you can decide if you would rather spend it on drug treatment or stents. It will require demanding minimally regulated, lower cost catastrophic insurance that covers you rarely in your life. It will require you to stand up for yourself and demand to be an economically empowered patient. The opportunity for individual liberty in medicine is upon us all now. It will require that you tell Republicans and Democrats: no to committee medicine, pay for performance and centrally planned medical economies. Say yes to patient power, free markets, minimal government regulation and financial help limited to the poor from government and charity.

It we fail to reject this medical Road to Serfdom where expert panels rule, we will be subject to another phenomenon Hayek Predicted in the chapter “Economic Control and Totalatarianism”: rationing for the benefit of the state or their corporate surrogates.

“The authority directing all economic activity would control not merely the part of our lives which is concerned with inferior things; it would control the allocation of the limited means for all ends. And whoever controls all economic activity controls the means for all our ends and must therefore decide which are to be satisfied and which are not”. (ibid, Hayek)

As an American physician, I make this medical recommendation to you: choose not to suffer for the benefit of others. Treat your pain and return to beneficial activities you choose. That will benefit others far more than any centrally planned medical economy.

Copyright © 2010 Campaign for Liberty

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One Reply:

  1. Dr. David McKalip

    Tom, this is active rationing. Their is intended denial of care coming from committees created by Obamacare and legislation that created the Federal Coordinating Council on Comparative effectiveness under Obama the first months he was in office.

    This is not the same as “rationing” that is often referred to for “insurance” when people don’t have insurance.

    This is a new level of rationing never seen before and it is quite real.

    This is fully supported by Donald Berwick, Tom Daschle, Ezekial Emmanual, Paul Krugman, Tom Friedman and all the progressive elite who will sit in judgement over who lives and dies.

    What Obamacare did was create the tools, the power and the “right” for insurnace companies to do these things. I have described the denial of Avastin by the FDA for metastatic Breast Cancer, the denial of stents for heart attacks, the denial of MRI’s ordered by qualified neurosurgeons.

    The question should not be “Did the Republicans do this too?” (Ofcourse they did, just NEVER to this degree and always balanced by the protests and legal challenge of the American people).

    The question should be this :  “Do you support rationing?” Many do.  They think it is appropriate to deny care to save money for the state.

    I agree costs should be controlled, but it should be through individaul choices made by people spending their own money. That system can work. If you click on the “22 articles” link in the re-post of this article, you will go to a three part series I did on some good ideas for health reform.

    Let’s not resort to politics of accusing people of things that are not important. Let’s actually decide:  DO YOU WANT THE GOVERNMENT AND INSURANCE COMPANIES TO RATION CARE?  I don’t!

    David

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