I will leave it to the economists to figure out how using the present day credit crisis as an excuse to increase government spending will solve the world’s problems.

But as a doc, I hate to tell you that there are a few worrisome items in that spending bill that you need to know about.

The first item is that we all are going to have electronic medical records. In the long run, this will save money, which is why it it included as an “economic stimulus”.

The AMA is ecstatic about the bill, which includes money for patient care, and money to encourage docs to work in underserved areas (programs like this date back to the 1970s). But the real excitement is by bozos who think electronic medical records will revolutionize medicine.

Our Federal Clinic was changing over to them about the time I retired. We had tacky pastel paint on cinderblock walls, thin shoddy rugs, and computers that used a MSDOS system ten years after Windows had been invented, but by golly, we were going to computerize everything.

Having electronic records means that patients who go to other doctors won’t lose their letters of referral, and a lot of the tests won’t have to be repeated.

On the other hand, do you really want the world to know that you were found to have a pilonodal cyst that kept you out of the military in 1970? Celebrities have always had their intimate details gossiped about, but what fewer people know is that clerks and others, despite strict privacy laws, do find out all sorts of things about you, and heaven help you if they gossip about it to your ex wife during a custody battle.

Because despite all the safeguards, I just don’t trust the privacy of electronic records. It’s hard enough to keep delicate medical facts out of written records nowadays.  Indeed, the privacy issue was why the NYTimes harshly criticized the Bush administration for it’s suggestion that hospitals change over to electronic medical records, noting that

the Government Accountability Office, an investigative arm of Congress, said the administration had a jumble of studies and vague policy statements but no overall strategy to ensure that privacy protections would be built into computer networks linking insurers, doctors, hospitals and other health care providers.

Presumably all these issues are now magically solved under the new President’s administration.

But a more worrisome part in the “economic stimulus package” is a little proviso about how the government is going to check what treatments work best.

From American Medical News:

The bill would charge the National Coordinator for Health Information Technology and a Health IT Standards Committee under the Dept. of Health and Human Services with guiding spending by developing health IT standards to improve health care quality, efficiency and consistency.

This is, of course, reinventing the wheel: studies do this all the time, but sometimes several treatments work, and part of the art of medicine is to craft the treatment to the patient.

But in this case, it will be big brother doing the deciding on who gets what treatment.

As  Betsy McCaughey at Bloomberg.com notes that the bill contains provisos from Senator Daschle’s book on reforming health care, a proposal that hints of government fiat to docs on how to treat patients or else:

One new bureaucracy, the National Coordinator of Health Information Technology, will monitor treatments to make sure your doctor is doing what the federal government deems appropriate and cost effective. The goal is to reduce costs and “guide” your doctor’s decisions (pp442, 446)…

Hospitals and doctors that are not “meaningful users” of the new system will face penalties.  “Meaningful user” isn’t defined in the bill. That will be left to the HHS secretary, who will be empowered to impose “more stringent measures of meaningful use over time” (pp511, 518, 540-541).

There are arguments pro and con about setting up a huge bureaurocracy to decide on medical treatment, but, uh, aren’t such things supposed to be discussed beforehand in a democracy?

Senator Coburn, an Oklahoma physician who is called “Dr. NO” for his opposition to porkbarrel projects in previous congresses, is even more blunt about the implications of the bill:

Coburn said, “A comparative effectiveness formula will replace the professional judgment of doctors and nurses — which is developed over many years — with the political judgments of politicians and bureaucrats.

“A comparative effectiveness formula will only save money by rationing care and ending lives.”

Coburn is blunt about the last part, but it is a dirty little secret that for years too many “bioethicists” with health care plans essentially were planning to ration your care if your “quality of life” is not high enough to waste money on you.

It’s never put that way, of course: such rationing is made smooth by an Orwellian language that calls slowly and painfully dehydrating people to death the “right to die” and the refusal to give medical treatment to the critically ill in Texas is covered by a so called “futile care law”.

But to see the future of the US, you might want to read this gentle article in the New York Times, which broadly praises the Orwellian-named bioethics board National Institute for Health and Clinical Excellence (NICE) in England for refusing to fund a breakthrough drug that could prolong a man’s life because it cost too much.

But skyrocketing prices for drugs and medical devices have led a growing number of countries to ask the hardest of questions: How much is life worth? For many, NICE has the answer.

Top health officials in Austria, Brazil, Colombia and Thailand said in interviews that NICE now strongly influences their policies.

“All the middle-income countries — in Eastern Europe, Central and South America, the Middle East and all over Asia — are aware of NICE and are thinking about setting up something similar,” said Dr. Andreas Seiter, a senior health specialist at the World Bank.

The problem? The medicine that NICE says the patient doesn’t need is not “experimental” but a miracle drug that can allow prolonged remissions in kidney cancer.

I’ve worked with the medical rationing of the Federal government hospitals, so I’m not especially afraid of “socialized medicine” per se.

But pushing these laws through under cover of an “emergency stimulus” package suggests that either those promoting these ideas have either not thought the whole thing through, or else, as Mc Caughey suggests, they have thought the whole thing through, and did it because they know that it would be rejected if subjected to the normal wasteful discussions that are part of the democratic process.


Thanks for the headsup from Secondhand SmokeBlog.

Nancy Reyes is a retired physician living in the rural Philippines. She has published articles about medical ethics. Her website is HeyDoc Xanga blog.

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