Part II: The Imminent and Assured Failure of "The Patient Protection and Affordable Care Act", or...
"The beginning of wisdom is to call things by their right names." -Chinese proverb
My first hospital office more than forty years ago was in a Midwestern teaching hospital situated directly across the hall from that of the Chief of Medicine. His stock introductory message to each new crop of first-year residents was direct. "Eighty percent of all human disease is self-limiting," he would say, leaning back in his chair with his feet up on his desk. Most of your patients will get better with or without your efforts-just don't screw it up!"
Now I don't pretend to know if Fred's "eighty percent" number was accurate. I do know that his comment was in no way intended as a disparagement of sick people who truly need medical care. However his central point-that most patients will recover without medical intervention-is not only true but essential to understanding one of the principle reasons that national health care costs have exploded. Much clinically unnecessary care demand-and the costs associated with meeting that demand-is generated by patients who don't have to pay for it. It is necessary to spend only a few minutes in any hospital's Emergency Department to confirm this observation's validity.
Because "The Patient Protection and Affordable Care Act" inflates public perceptions of entitlement and expands the number of people who have "insurance", it will produce increased demand for health care service. As a result, the only way that national health care costs can be reduced is to dramatically constrain the actual delivery of health care. This is accomplished by simply refusing to pay1 for any delivered health care that is not "officially approved". This politically-brilliant strategy allows elected officials to appear caring and generous in their promises to voters while shifting the unpopular onus of health care rationing to physicians and hospitals.
The partial menu of "health care reform" initiatives and program mandates shown below2 outlines the shape of the rationing mechanism.
It all sounds so "scientific" but, as the "readmission penalty" footnote at the bottom of this page points out, even patients who share CPT and ICD codes, present with tremendous variation in care needs. Moreover, treatment results also vary and real-world results for an individual patient cannot be predicted from aggregate data. "The Patient Protection and Affordable Care Act" simply ignores these realities. It transforms physicians into clerks whose compensation depends upon their willingness to subordinate professional judgment to statistically-determined and centrally-administered rules. It treats each patient as a dehumanized aggregation of ICD and CPT codes and permits or withholds treatment based on those codes. It perversely incentivizes physicians and hospitals to avoid providing care to the most ill, those patients whose conditions are more likely to produce an unfavorable outcome.
Concealed within the lofty promises amid the fine print is a dehumanizing, amoral, and technically incompetent rationing scheme that grants to faceless bureaucrats the power to decide not only who may receive health care but what the course of that care must be. Mussolini wrote in Fascism: Doctrines and Institutions, "The fascist conception of life stresses the importance of the State and accepts the individual only in so far as his interests coincide with the State." It is not too much to say that "The Patient Protection and Affordable Care Act" operates on exactly this same principle because it places the financial interest of the State above the value of human life.
1 This is nothing new. Medicare denied payment for health care provided to 99,546 patients in 2008 because the service provided was "not deemed a 'medical necessity' by the payer."
2 Quoted language is taken directly from CMS documents and other official program sources.
3 Perhaps nothing better illustrates the profound absurdity of efforts to ration health care through statistics than the imposition of "readmission penalties". Patients, even those who share CPT and ICD codes, present with tremendous variation in care needs and in their willingness and/or ability to comply with post-discharge instructions. Neither physicians nor hospitals have control over these factors. The inevitable consequence of statistically-dictated "readmission penalties" will be that some patients, potentially those most in need of care, will not receive it.
"Estimate of the Situation" is a reality-based information resource for hospital decision makers. With each issue, subscribers receive candid "unspun" news and informed opinion to help navigate within the short reaction time frames that characterize today's unprecedented and unpredictable times. To subscribe (there is no cost), just send us an e-mail with your name, title, and organization. Please feel free to forward a copy to anyone that might benefit from its content.
Brady & Associates 7667 N.W. Prairie View Road, Suite 204 Kansas City, Missouri 64151 (816) 587-2120 • http://bradyinc.com
© Brady & Associates 2012