December 6 2009
Congress is still considering health care reform. Unfortunately, legislators appear ready to push our medical system in the wrong direction, and to empower government to ration access to potentially life-saving treatment.
The U.S. medical system needs serious attention. But the objective should be to improve the care received by all Americans. The bills being debated by Congress will not do that.
Although some criticisms of reform proposals have descended to hyperbole -- there are, strictly speaking, no "death panels" in the pending legislation -- federal control over benefits would, in fact, make death more likely for some unlucky patients.
Health care reform will be expensive. Do not believe politicians who promise simultaneously to insure more people, expand medical coverage, and cut the deficit. It cannot be done without increasing costs. As costs skyrocket, politicians will be desperate to reduce spending. That means cutting services.
Consider preventive care. Expanding the access of Americans to preventive procedures should make all of us healthier. But preventive care is not free, and will thus become a target for budget cutters.
The U.S. Preventive Services Task Force recently recommended that women cut back both on mammograms and self-exams, despite evidence demonstrating that mammograms save lives. It takes about 2000 mammograms to save one life for women from 39 to 49, 1300 for women from 50 to 59, and 337 for women between 60 and 69.
That would seem to be a good deal by most any measure. Nevertheless, the task force recommended fewer mammograms across the board in order to reduce women's "anxiety." The panel said cost was not a factor. But three-quarters of women polled believed otherwise. And the $5 billion spent every year on mammograms is an obvious target for anyone with a green eye-shade mentality.
Cost obviously matters, especially today, at a time of economic challenge. Breast cancer is estimated to kill more than 40,000 women annually. Testing to prevent cancer might be expensive in financial terms, but failing to prevent cancer is even more expensive in human terms. After all, America remains a wealthy nation.
Men also are threatened by the attack on preventive care. The task force recommended against employing a routine test for heart inflammation. Robert Goldberg of the Center for Medicine in the Public Interest complained that in doing so, the panel ignored "three recent studies demonstrating" the test's importance.
Other groups similarly have suggested cutting back on prostate-specific antigen screening for prostate cancer. Noted USA Today: "You won't find many 50-plus urologists opting not to test themselves."
Unfortunately, when the government becomes the financial gatekeeper of the medical system, it automatically controls access to care. That is evident in Medicare and Medicaid, both of which promise broad coverage to the elderly and needy, respectively, but which do not pay doctors and hospitals enough to ensure access to the treatments promised.
Even more obvious is rationing by foreign government-run systems. In America, new technologies and treatments are readily available. In contrast, it is easier to get a computerized axial tomography scan ormagnetic resonance imagingfor your pet than for yourself in Canada, since you directly pay for the former.
Nearly two million people are waiting for treatment in Great Britain. In Canada, the average median wait for surgery and other treatments isfour months. Despite constant promises of reform, that number remains largely unchanged since 2000.
The delays are even longer for some procedures. Neurosurgery and orthopedic surgery typically takeeight monthsafter referral from a general practitioner. The delay in government-run systems can be more painful and dangerous than the actual treatment.
Unfortunately, the proposed "reforms" on Capitol Hill would inevitably give government the power to decide who receives what kind of medical attention. First, the legislation would expand Medicaid well above the poverty line; costs would jump, encouraging Congress to tighten reimbursements still further.
Second, the legislation would turn Medicare benefits over to a panel not unlike the U.S. Preventive Services Task Force. Congress could overturn a commission ruling -- the glare of publicity caused the U.S. Senate to vote against the mammogram recommendation -- but the purpose of this provision is to put political distance between politicians and painful cuts in Medicare, making those cuts possible.
Finally, government's control would affect the rest of us, too. Once Washington imposes a health insurance mandate, it has to decide what benefits fulfill its requirements and what it is willing to subsidize. Many of these decisions would be delegated to the secretary of health and human services, who would become, in effect, America's doctor in chief.
The essence of nationalized health medicine is not expanding access to care, but empowering government to decide who gets what. Today proponents of government-run care are attempting to win votes by promising improved coverage and better preventive services.
However, those promises will last only until the measure is passed. Then legislators would have the much less pleasant task of figuring out how to pay for all the new benefits they had promised, which is when the cuts would begin.
Obviously, we can't provide everyone with everything when it comes to health care. Tough trade-offs have to be made. But individuals should be the ones making the decisions for ourselves. Not politicians. And certainly not unaccountable bureaucrats.
American health care needs fixing. But in attempting to nationalize the medical system, Congress has forgotten the Hippocratic Oath: First, do no harm.
Sunday Reflection contributor Michelle Bernard, author of "Women's Progress, How Women are Wealthier, Healthier, and More Independent Than Ever Before," is president and chief executive officer of the Independent Women's Forum and Independent Women's Voice and is an MSNBC political analyst.