by Linda Halderman, M.D.<\/p>\n
Private Papers<\/em><\/p>\n Three House committees just choked down the bitter pill of a compromise version of a healthcare reform bill, HR 3200.\u00a0 But for vulnerable patients \u2014 and taxpayers \u2014 the cure may be worse than the disease.<\/p>\n Problematic policy recommendations by proponents of rationing and socializing costs may be part of why the bill is so unpalatable to opponents of government intervention in healthcare decision making.<\/p>\n President Obama\u2019s director of the Office of Management and Budget, Peter Orszag, is himself advised by Ezekiel Emanuel \u2014 brother of White House Chief of Staff Rahm Emanuel.<\/p>\n In addition to serving as a Special Advisor in the Obama Administration, Dr. Ezekiel Emanuel is a fellow at the Hastings Center.\u00a0 The Hastings Center, a bioethics research center, has published articles and books on the patient\u2019s right to die, as well as promoted \u201cAssisted Dying\u201d policy as a component of healthcare reform.<\/p>\n Dr. Emanuel\u2019s June 2008 article in the\u00a0Journal of the American Medical Association<\/em>\u00a0criticized the Hippocratic Oath as an unwelcome \u201cimperative [for physicians] to do everything for the patient regardless of cost or effect on others.\u201d<\/p>\n In the article, titled \u201cThe Perfect Storm of Overutilization,\u201d he instead encourages a \u201cmove toward more socially sustainable, cost-effective care.\u201d<\/p>\n This philosophy of \u201csocially sustainable care\u201d for older Americans is reflected in nine pages of the bill devoted to a description of a new Medicare benefit: \u201cAdvance Care Planning Consultation.\u201d<\/p>\n Concerns with these provisions (quoted below from pages 425-434 of HR 3200) have been dismissed as spin and minimized by the Administration and supporters of the bill.<\/p>\n HR 3200 describes what a private discussion between a patient and doctor should include: \u201can explanation by the practitioner of the continuum of end-of-life services\u2026and an explanation of orders regarding life sustaining treatment\u201d with \u201cthe reasons why such an order should be updated periodically as the health of the individual changes.\u201d<\/p>\n The discussion of end of life choices would be further detailed by the federal government to address an individual\u2019s desire for \u201cthe intensity of medical intervention if the patient is pulseless, apneic, or has serious cardiac or pulmonary problems\u201d and whether or not the individual will allow \u201cthe use of antibiotics\u201d or \u201cartificially administered nutrition and hydration.\u201d<\/p>\n The President refuses to say if he specifically supports Medicare reimbursement for end of life counseling sessions or the wisdom of allowing the federal government to dictate the content of medical discussions. According to his aides, he is unconcerned that such reimbursement might lead to government interference in life or death decisions about healthcare.<\/p>\n Also informing healthcare policy is Dr. David Blumenthal, the National Coordinator for the Obama Administration\u2019s new Health Information Technology $19 billion bureaucracy. Dr. Blumenthal is the author of \u201cControlling Health Care Expenditures,\u201d published in the\u00a0New England Journal of Medicine<\/em>\u00a0on March 8, 2001.<\/p>\n In the same article, Dr. Blumenthal extols the virtues of government cost controls for healthcare, though he concedes the inevitable result of this intrusion into patient-doctor decision making: “Longer waits for elective procedures and reduced availability of new and expensive treatments and devices.\u201d<\/p>\n Government cost controls would need to be extreme to prevent HR 3200\u2019s assault on taxpayers. How much green can a taxpayer\u2019s wallet hemorrhage? The House bill aims to find out. Current estimates for the bloated legislation \u2014 over 1,000 pages and counting \u2014 reach nearly $1 trillion.<\/p>\n In a classic example of government mathematics, legislators involved in negotiations bragged that the most recent amendments would cut the bill\u2019s cost by about $100 billion over 10 years.\u00a0 These same dealmakers carefully omitted reference to additional new amendments that would actually RAISE the fiscal burden \u2014 by about $100 billion.<\/p>\n It is possible that the same economic logic was used to draft page 203, lines 14-15 of HR 3200: \u201cThe tax imposed under this section shall not be treated as tax.\u201d<\/p>\n Complaining about critics, the President scolded, \u201cThese folks need to stop scaring everybody, you know?\u201d<\/p>\n He may be right.\u00a0 The President\u2019s plan is frightening enough on its own.<\/p>\n