Human Exceptionalism

Obamacare: Reducing Doctors Into Technocrats

Reason has a very good article by a physician worried about how government control over health care is deprofessionalizing medicine–a big concern of mine.  From “The Coming Medical Ethics Cristis, by Dr. Jeffrey A. Singer:

In 2010 the Patient Protection and Affordable Care Act established an Independent Payment Advisory Board (IPAB). Beginning in 2014, the 15 presidential appointees on this board will determine what therapies, procedures, tests, and medications will be covered by Medicare, using advice provided by the FCCCER. Such determinations will then be used to design the coverage packages for the non-Medicare insurance offered through the government–run exchanges. The decisions of the IPAB are not subject to Congressional oversight or judicial review.

Meanwhile, in an effort to control costs now, CMS has developed practice guidelines and protocols for physicians to follow. Committees of health care academics and statisticians developed these guidelines, using data from large population samples. These protocols govern the therapeutic decisions made by the health care practitioner—right down to the pre-operative antibiotics a surgeon may order. Despite the fact that several recent peer-reviewed studies concluded that the protocols have had no positive effect—in fact, one study showed post-op skin infections increased since the protocols were instituted—CMS imposes financial penalties on hospitals that fail to get protocol compliance from their medical staff.

Medical students and residents are now being trained to follow federally-derived protocols and guidelines as a normal part of medical practice. As a result, this new generation of doctors will be less inclined to challenge the recommendations of federal task forces and agencies. Some academics also worry that “teaching to the protocol” might discourage independent thinking and the use of intuitive knowledge, two traits essential to the practice of good medicine.

No doubt about it: Obamacare and centralized health care bureaucracies have placed a financial conflict of interests between physicians and their patients–one that also involves ideology as we have discussed previously.

But why is the Medical Establishment going along?  In my view, the new regime allows the medical intelligentsia entry into the ruling class–it’s good to be the king! (or at least in the king’s court)–and hence you see powerful publications like the New England Journal of Medicine, and groups like the AMA (which should know better) happy to support policies that reduce doctors into mere technocrats.


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