Obamacare: A Medicaid Decision Giving Bureaucrats Say Over Extent of Care A Preview of Coming Attrations

I was unaware of this case, but it falls squarely into the debate about Obamacare. A cerebral palsy patient on Medicaid will have to fight in court to receive the level of care prescribed by her physician.  From Jeff Emanuel’s blog entry at CBS.Com:

In 2007, citing a disagreement with Callie’s attending physician over just how much care she needed, the state cut the portion of Callie’s care it was willing to pay for by 15%, to 84 hours a week, over the objections of her doctor. Callie’s mother filed suit, arguing the state had no right to contradict the orders of Callie’s personal physician and limit her treatment. However, Georgia officials argued Callie’s care was subject to rationing, as the state bureaucrats’ need to ensure Medicaid resources were allocated “fairly” superseded her doctor’s care prescription or her personal medical needs.

Callie’s mother won. The state appealed.

The thrust of the states’ argument in Moore was summed up in a brief written by the 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” - something 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.

I daresay, that if this had been an HMO, the Left would be screaming, and I don’t think the decision would be the same.

I looked up the case. It is unpublished, meaning it is not precedent.  But it states quite starkly that doctors are not the only ones who can determine proper levels of care in a state-funded system. From the court’s decision:

While it is true that, after the 1989 amendments to the Medicaid Act, the state must fund any medically necessary treatment that Anna C. Moore requires [citation omitted] it does not follow that the state is wholly excluded from the process of determining what treatment is necessary. Instead, both the state and Moore’s physician have roles in determining what medical measures are necessary to “correct or ameliorate” Moore’s medical conditions. [Citation omitted] The agency may place appropriate limits on a service based on such criteria as medical necessity or on utilization control procedures. [Citation omitted] A private physician’s word on medical necessity is not dispositive.

The  ruling means that the state and the mother will duke it out in trial over whether the extent of care the doctor prescribed is appropriate in a state-funded system.

The real point Emanuel is making here—and I think it is a good one—is that the court’s and state’s thinking about this bely all the president’s promises about levels of care not changing under Obamacare. Pointing to the UK’s list of horrors (search SHS under “NHS Meltdown” for scores of examples), Emanuel makes a vivid argument:

Government is a jealous mistress. What simply appears to be 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, like it is in Britain, before too long.

Obamacare will be rationed care, controlled by bureaucrats and utilitarian bioethicists who would man the cost/benefit boards and make the treatment coverage decisions. This is an important case, even if it is not binding, that—along with the Oregon travesty to Barbara Wagner and Randy Stroup, who were offered assisted suicide in place of chemotherapy—gives us a glimpse of a disturbing future—unless we push back Obamacare with its public option and centralized control boards and move in a different direction.