The Corner

The Face of Obamacare’s Incremental Liberal Fascism?

If anyone was interested in how Obamacare might lead incrementally to the health-care industry’s form of “Liberal Fascism,” look no further than today’s New York Times article on the recently announced disclosure requirements for medical firms (“U.S. to Force Drug Firms to Report Money Paid to Doctors“), The goal, of course, is laudable — make doctors tell their patients if they receive compensation from drug and medical-device makers. After all, doctors respond to incentives like everyone else. But, as they say, the devil is in the details, and it’s the way the transparency effort is being implemented that opens the door to strangling innovation.

Rather than simply require doctors to disclose the information to their patients, Obamacare requires drug companies to provide to the government what payments they make to doctors for research, consulting, travel, and entertainment. This information will then be put on a web site so everyone can access it. And the government will ramp up staff to audit the information for accuracy and, presumably, monitor and enforce compliance. Voila! Instant bureaucracy. One has to wonder where all the “savings” from cheaper (and less effective?) procedures presumably incentivized by this disclosure will go.


But perhaps the most telling part of the NYT reporting on the policy is the complete lack of reference to whether this will improve health outcomes. The Times reports that “researchers” (including its own reporting) have found that doctors that take money from drug companies tend “practice medicine differently” and prescribe more expensive and sometimes riskier medicines. But the real issue is whether there are improved outcomes for the patient, not whether it’s more or less expensive or even more risky. It’s the patient and the doctor that should decide the relative merits of the risk involved with any particular treatment.


Moreover, by opening the door to providing detailed data about individual doctors, and making implicit assumptions about treatment (expensive and risky is presumptively “bad”), the mechanism used for reporting and enforcing transparency is clearly opening up a door to future regulation of doctor-patient relationships.


Notably, the rules apply only to doctors providing Medicaid and Medicare services. It doesn’t take much imagination to see how this will eventually be applied to the entire profession if: 1) the program is deemed successful by politicians (and the nationwide individual mandate under Obamcare is ruled Constitutional), or 2) doctors withdraw from Medicaid and Medicare to avoid disclosure requirements, thereby limiting the services available to seniors and lower income households.”

Samuel R. Staley — Mr. Staley is director of urban-growth and land-use policy at the Reason Foundation and teaches urban and regional economics at the University of Dayton.


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