April 8 2013
Today’s must-read: a Wall Street Journal piece headlined “Reflections of a Medical Ex-Practitioner,” by Dr. Ed Marsh. Marsh writes:
A fundamental principle in medicine is that if you get the diagnosis wrong, you'll probably apply the wrong therapy. A corollary is that if the therapy isn't working, increasing the dose may make things worse. That's where we are with ObamaCare.
There are shortcomings aplenty in the health-care field, and changes and improvements are required. But never have I seen so many good intentions leading irreversibly to hell.
Marsh, who graduated from medical school in 1962, set up a pediatrics practice in a small town not far from Boston. Since insurance didn’t usually cover pediatric patients back then, treatment could have a devastating effect on a family’s finances. Marsh had to pay attention to the cost of everything. He knew the prices of the medicines he would prescribe and he would hold off on an X-ray as long as it was safe.
Marsh had relationships with the families in his practice. If he was going on vacation, never more than two weeks, he made arrangements for them. Being a pediatrician was a 24-7 occupation for Marsh. The system was both demanding and rewarding because Marsh enjoyed knowing and serving his patients.
In the 1970s, we “became enlightened” and insurance companies began to insure pediatric treatments. This meant that the insurance company inserted itself between the doctor and patient. It also meant that patients knew that, no matter how Dr. Marsh dealt with their cases, the effect on their finances would be negligible.
The physician’s salary, however, became tied to “efficiencies.” Patients might no longer care about cost but insurance companies were quite interested. Patients even made the choice of which doctor to go to based on insurance company requirements. One casualty was the relationship between physician and patient.
ObamaCare is only going to exacerbate this situation:
The medical economist Rashi Fein observed in 1986 that there are only three ways to limit the extravagant demand for medical care: "Inconvenience," the practice used in the military, where one must wait interminably for care. "Rules," the third-party approach by which layers of rules and thousands of regulations are devised, most recently in a fool's quest to contain costs under ObamaCare. And "Price." This last option elicits gasps and chest-clutching from bien pensants who insist that all financial impediments to care must be removed. Yet it has one incontestably beneficial attribute: It requires the physician to study the true cost and benefits of a course of action, and then to present that data to the patient. Who is better suited than the patient to assess the value to him of the proposed treatment? Kathleen Sebelius? You gotta be kidding.
There is no shortage of evidence. ObamaCare will, deliberately and by design, destroy what—while imperfect—has served very well. We have gotten to this point after years of good intentions making bad problems worse. To double down on the very therapy that has brought the system to its present sorry pass is a toe-ticket to the morgue.
The tag line on Dr. Marsh’s piece says it all: he now raises Christmas trees in Ipswich, Mass.