Human Exceptionalism

The Bureaucrat Looking Over Your Doctor’s Shoulder

The bureaucrats are coming!  The bureaucrats are coming!  Where? Right into your doctor’s office and examination rooms, as may soon be required under the Affordable Care Act via required use of government certified ”shared decision making” educational materials. From, “Shared Decision Making to Improve Care and Reduce Costs,”co-authored by Obamacarian Ezekiel Emanuel in the New England Journal of Medicine:

…decision aids should include questions to help patients clarify their values and understand how those values affect their decisions; information about treatment options, presented in a balanced manner and in plain language; and up-to-date data from published studies on the likelihood of achieving the treatment goal with the proposed intervention and on the nature and frequency of side effects and complications. In addition, it would be helpful to include validated, institution-specific data on how often the specified procedure has been performed, the frequency of side effects and complications, and the cost of the procedure and any associated medication and rehabilitation regimens. We believe that decision aids should be written at an eighth-grade level and should be brief.

I am not sure dumbing down complex issues and physician/patent communication serves either’s best interests.  Be that as it may, doctors and patients should already be engaged in “shared decision making.”  Moreover, no one is opposed to improving patient education materials.  But I worry that government “certified” patient education documents could easily be written to persuade patient’s into making the bureaucrat-preferred decision–not necessarily the right decision for the individual–much in the same manner that some advance directives make it very easy to refuse treatment than request it. 

If the use of the materials were optional, I wouldn’t complain.  But that isn’t what the authors propose. 

Many decision aids have already been rigorously evaluated, so CMS could rapidly certify these tools and require their use in the Medicare and Medicaid programs. To give such a requirement teeth, full Medicare reimbursement could be made contingent on having documentation in the patient’s file of the proper use of a decision aid for these 20 procedures.

I would think any doctor worth his or her MD degree would object to being required to engage in decision-making discussions in a connect-the-dot, bureaucrat-prescribed manner.

Worse, to coerce compliance, doctors who don’t use the required materials would be punished:

Providers who did not document the shared-decision-making process could face a 10% reduction in Medicare payment for claims related to the procedure in year 1, with reductions gradually increasing to 20% over 10 years.

Medicine should be a profession, not a technocracy. But Obamacare was designed to drive health care away from the former and toward the latter. As the experience of the NHS shows–oft documented here, for example with the Liverpool Care Pathway–centralized control of health care is neither good for patients or their physicians.

I have a better idea: Let’s tell the government to stand back and let doctors practice medicine without the bureaucrat in the room.

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