Commentary: Doctors Should Outweigh Bureaucrats In Medical Decisions
Who should have control over your medical care: your family doctor, or a bureaucrat you’ve never met whose sole job is to look out for the government’s financial bottom line?
A ruling by a panel of the 11th U.S. Circuit Court of Appeals went a long way toward answering that question. Federal judges ruled in favor of three states that had filed suit to have final medical decision-making authority transferred from doctors to state bureaucrats. (See story on page 1.)
The court decided the states could overrule a doctor’s orders, specifically allowing Georgia bureaucrats to reduce the amount of in-home nursing care that Medicaid had to pay for a girl suffering from multiple disabilities.
Bringing Debate into Open
That case, Moore v. Medows, has thrust into the spotlight the debate about an issue long confined to dark, smoky rooms in state capitals and Washington, DC and to the fine print of legislation members of Congress aren’t bothering—or aren’t being allowed—to read before passage.
From state governments to the federal legislators and bureaucrats who had a hand in writing and passing President Barack Obama’s 2009 “stimulus” bill, more officials are beginning to say openly that the person who should have final say when it comes to patient diagnoses and prescriptions is not a trained doctor with years of experience and personal knowledge of a patient’s medical history. No, they say, that power should be given to cubicle-inhabiting bureaucrats working with agency-developed cost-effectiveness spreadsheets that guide them in determining what is and is not medically appropriate or necessary for patients seen within their jurisdiction.
State as ‘Final Arbiter’
The thrust of the states’ argument in Moore was summed up in a brief written by attorneys representing the state of Florida. “Treating physicians,” they wrote, “cannot be trusted with this sort of decision. When left to their own devices, they advocate for their patients”—which state governments resent due to its interference in the execution of their cost-effectiveness analyses—“and deem all manner of unproven, dangerous, ineffective, cosmetic, unnecessary, bizarre and controversial treatments as ‘medically necessary.’”
While bureaucrats “will consider doctors’ determinations,” said attorney Robert Highsmith in oral arguments on March 24, the “final arbiter” of medical decisions is and should be “the state.” The panel of the 11th Circuit agreed.
As a result of this ruling, doctors within the 11th Circuit’s jurisdiction no longer will be “left to their own devices” to treat Medicaid patients under their care.
Moreover, current events suggest the relegation of medical professionals’ recommendations to the status of mere suggestions pending review by state bureaucrats isn’t likely to be limited to Medicaid cases alone for long.
Growing Problem
As taxpayer-funded and bureaucrat-run health care programs such as Medicaid and the State Children’s Health Insurance Program (SCHIP) are expanded to include more middle-income Americans, and as the federal government’s control over the health care market grows under the guise of “health care reform,” government encroachment on doctor-patient decisions will only increase.
The first steps toward nationalizing this problem already have been taken, when the authors of the American Recovery and Reinvestment Act included funding and authorization for benign-sounding “comparative effectiveness research,” or CER. This term refers to the drawing up of those cost-effectiveness spreadsheets state and federal bureaucrats use to approve or deny care prescribed for patients by their physicians.
Outside of Georgia, where Moore reinforced the state’s right to ration health care to Medicaid recipients, the greatest example of CER at work is in Great Britain, where bureaucrats at the National Institute for Clinical Effectiveness (NICE) have become notorious for denying doctor-prescribed treatments based on their impersonal spreadsheets. Even worse, patients who choose to pay out of pocket to go above and beyond the treatments covered by the National Health Service forfeit, permanently and by law, the state-managed health care benefits their taxes pay for and their fellow Britons continue to receive.
NICE is the organization former U.S. Senator Tom Daschle, Obama’s first choice to serve as secretary of Health and Human Services, pointed to as a model to which America’s health care bureaucracy should aspire. Despite not having an official role in the Obama administration, Daschle is currently advising the president and Congressional Democrats as they work to formulate their health care “reform” policies—a disconcerting fact given the former Senator’s affinity for Great Britain’s rationing-based health system.
Government Encroachment
Government is a jealous mistress. What appears to be simply an issue of who pays for a few extra hours of in-home care today could very well turn into a get-half-coverage-or-none-at-all situation here, as it is in Britain, before long.
The answer is to get government as far away from our health care and medical decisions as possible. We need to be making those decisions on our own with our physicians. When government is given free rein to overrule medical professionals, we and our doctors no longer have our rightful, meaningful role in determining our own health care choices.
Jeff Emanuel (jemanuel@heartland.org) is research fellow for health care policy at The Heartland Institute and managing editor of Health Care News. An earlier version of this article appeared at CBSNews.com. Reprinted with permission.
