Most of the focus in the Obamacare debate has been on HB 3200. But Senator Max Baucus (D-MT) has been trying to forge a compromise package. Instead, he has upset both sides, the Left because it has no public option and the Right because it too contains provisions that would, in the name of cost cutting, put the expensive for whom to care at great medical hazard.
A Washington Times editorial points out one provision that I have been meaning to address. It seems that physicians who spend the top 10% in caring for patients each year will see their compensation reduced—no matter the cause! From the editorial:
Yes, there are death panels. Its members won’t even know whose deaths they are causing. But under the health care bill sponsored by Senate Finance Committee Chairman Max Baucus, Montana Democrat, death panels will indeed exist - oh so cleverly disguised as accountants. The offending provision is on Pages 80-81 of the unamended Baucus bill, hidden amid a lot of similar legislative mumbo-jumbo about Medicare payments to doctors. The key sentence: “Beginning in 2015, payment would be reduced by five percent if an aggregation of the physician’s resource use is at or above the 90th percentile of national utilization.” Translated into plain English, it means that in any year in which a particular doctor’s average per-patient Medicare costs are in the top 10 percent in the nation, the feds will cut the doctor’s payments by 5 percent.
Forget results. This provision makes no account for the results of care, its quality or even its efficiency. It just says that if a doctor authorizes expensive care, no matter how successfully, the government will punish him by scrimping on what already is a low reimbursement rate for treating Medicare patients. The incentive, therefore, is for the doctor always to provide less care for his patients for fear of having his payments docked. And because no doctor will know who falls in the top 10 percent until year’s end, or what total average costs will break the 10 percent threshold, the pressure will be intense to withhold care, and withhold care again, and then withhold it some more. Or at least to prescribe cheaper care, no matter how much less effective, in order to avoid the penalties.
This is simply unacceptable. It places doctors in a direct financial conflict of interest with their own patients, further undermining Hippocratic values, already under intense assault by the bioethics movement’s promotion of a quality of life ethic.
Time to steer a different course. Rather than try to remake everything, let’s focus on the cost of insurance and access to those with pre existing conditions. That can be done faster, cheaper, and without policies that undercut the equal moral value of all human life.
