Who is Left to Advocate for the Patient?

       by Diane Rufino, April 26, 2011

Dr. C.L. Gray, founder of Physicians for Reform, understands the risk posed by Obamacare

People don’t like the healthcare bill for many reasons – such as its cost, its mandate to buy insurance, its centralization of power in Washington, and its likelihood to bankrupt the country. But Dr. C.L. Gray, founder of Physicians for Reform, perhaps gives us the best reason of all to be mistrustful of it and its architects.  Under the guise of “healthcare for everyone,” Obama and his healthcare advisors have in fact adopted a progressive rationed care approach – the kind that is limited by resources which are needed elsewhere. Patient-centered healthcare is becoming a thing of the past.  Dr. Gray gave two presentations in Greenville, NC, last week (April 20-21) and appeared on Henry Hinton’s “Talk of the Town” radio show, and his message was widely embraced. It was embraced because it made sense.

With great stealth and determination, our government has seen fit to take over healthcare and remove power and control over healthcare decisions from the doctor and patient to beaurocrats in Washington DC.  A humanistic approach has quietly given way to a cold and calculated approach.  The once-private equation now includes the government and the needs of OTHERS.  Decisions about human worth and dignity are made in our nation’s capital by people who don’t think like you, who don’t know you, who could care less about you, and only know you as a list of notes and dates and as a member of a “category.”  What is happening is a fundamental shift in the perceived role of the physician in our society – from one who “preserves life and health” and who acts “in purity and according to divine law” to “benefit patients according to my greatest ability and judgment, and to do no harm” (Hippocratic oath) to one who is an agent of the federal government, serving its collective goals. The shift is from an intrinsic view of ethics to a utilitarian or consequentialist view of ethics. The former looks to the intrinsic value of each human being and has its roots in religion. Actions are judged to be inherently good or evil.  The latter, on the other hand, disregards religious principles and “good and bad” is no longer evaluated according to moral views but rather according to “consequences” (usefulness or utility).  If a policy works towards the collective good, then it is moral or “good” according to the “utilitarian” view of ethics.  After all, the ends must justify the means.

Dr. Ezekiel Emanuel, a bioethicist chosen by President Obama as a special advisor to the Director of the White House Office of Management and Budget (OMB) for health policy, has written about his views.  In 2008, he wrote in the Journal of American Medical Association (JAMA): “A ‘perfect storm’ occurs when a confluence of many factors or events—no one of which alone is particularly devastating—creates a catastrophic force.  Over time and through disconnected events, US healthcare has evolved into a ‘perfect storm’ that drives overutilization and increases the cost of health care. The US spends substantially more per person on healthcare than any other country, and yet health outcomes are the same as or worse than those in other countries.”  (JAMA, Vol. 299, 2008).  To cut costs, he supports and defends limiting funding for the elderly. As he wrote in another medical journal, The Lancet: “Unlike allocation by sex or race, allocation by age is not invidious discrimination; Every person lives through different life stages rather than being a single age. Even if 25-year-olds receive priority over 65-year-olds, everyone who is 65 years now was previously 25 years.” (Lancet, Vol 373, Jan. 31, 2009).  He says doctors take the Hippocratic oath too seriously. He doesn’t believe that doctors should “do everything for the patient regardless of the cost or effects on others.” (JAMA, June 18, 2008).

Emanuel also advocates “The Complete Lives System” as a means to ration care. This system would reserve the most aggressive treatment for individuals 15-40 (the most productive human beings): “We recommend an alternative system – The Complete lives system—which prioritizes younger people who have not yet lived a complete life… Youngest-first.  When implemented, the complete lives system produces a priority curve on which individuals aged between roughly 15 and 40 years get the most substantial chance, whereas the youngest and oldest people get chances that are attenuated.”  This would explain the $5 billion cut in Medicare services and it would explain the new Medicare provision, issued by the 2010 winter recess-appointed Dr. Donald M. Berwick, administrator of the Centers for Medicare and Medicaid Services, which will pay doctors who advise patients on options for end-of-life care, which may include advance directives to forgo aggressive life-sustaining treatment.

To understand where healthcare is headed, look to the recent case of Barbara Wagner in Oregon.  As Dr. Gray explains in his presentations: “The powerful story of Barbara Wagner demonstrates why this discussion (of rationed healthcare) is of utmost importance.”  Barbara Wagner, a 62-year-old woman, was diagnosed with lung cancer and after treatment with chemotherapy, the cancer went into remission. When it reappeared in the spring of 2008, her doctor told her it would likely kill her.  Her last hope, the doctor advised, was an aggressive  treatment with a new and promising lung-cancer drug called Tarceva (erlotinib). The problem was that it cost 4,000-a-month.  Barbara’s healthcare carrier, Oregon’s state run health plan, denied the potentially life altering drug because they did not feel it was “cost-effective.”  In fact, the health plan sent her a letter, denying coverage for the medication, but instead, offering to pay for physician-assisted suicide. As Barbara Wagner told ABC News, ” I got a letter in the mail that basically said if you want to take the (suicide) pills, we will help you get that from the doctor and we will stand there and watch you die. But we won’t give you the medication to live.”

How can this happen in America – the most resourceful and prosperous nation on Earth, you ask?  Dr. Gray is not surprised.  He writes: “The answer is simple. Oregon state officials controlled the process of healthcare decision-making—not Barbara and her physician. Chemotherapy would cost the state $4,000 every month she remained alive; the drugs for physician-assisted suicide held a one-time expense of less than $100. Barbara’s treatment plan boiled down to accounting.”  Dr. Gray had already spent years watching the trend in the medical field move from the intrinsic value approach.

There is no doubt that significant changes in our health care system are inevitable and needed. The changes that are ahead of us will unfortunately change the lives of the elderly, disabled, chronically sick, terminally ill, and those people with serious health problems such as cancer.  These populations share in common.. To advisors like Emanuel, they are expensive and their lives are not valued.  This is a Godless approach, which is exactly what a society would expect when it gradually turns its back on God and takes him out of society and public life.  Human life is no longer sacred and valued. There once was a time where our nation believed that all human beings were valued by our Creator.  Now, humans are viewed in terms of social and economic problems.

There is a reason why healthcare in the US has become “a perfect storm and it certainly isn’t a good enough reason for the government to take control over the entire healthcare field.  Our spiraling healthcare costs (healthcare crisis) is the result of two things, and Dr. Gray speaks clearly to this:  (1) Preventative medicine (which is what doctors NEED to do in order to limit the number of medical malpractice claims and cases against him) and (2) “Third Party Payor Syndrome” (where people have all possible tests done and medicine prescribed, without caring about cost, because “my insurance will cover it”).  Doctors are so worried about frivolous lawsuits that they order unnecessary, and expensive, tests and procedures for their patients. They know that, for the most part, such tests and procedures are really not necessary. Defensive medicine is practiced by almost all doctors.  The costs of litigation and defensive medicine, as well as the exorbitant costs of medical malpractice insurance, are passed on to the patient in the price of health care.  Furthermore, the costs of malpractice insurance often preclude doctors, and certainly medical specialists, from opening up medical practices in rural counties.

The key to  meaningful reform and lower medical costs is tort reform.  The courtroom is where patients should seek compensation for negligent medical care but it shouldn’t be the place where lawyers are enriched first and foremost. Frivolous and wasteful litigation against doctors increases the overall costs of health care for patients and already costs Americans billions of dollars annually.  According to the Harvard School of Public Health, 40% of medical malpractice suits filed in the U.S. are “without merit.”  And a Department of Health and Human Services study found that unlimited excessive non-economic damages (“pain and suffering,” the kind that John Edwards made a lucrative career out of ) adds between $70 billion and $126 billion annually to health-care costs.  As Texas Rep. Lamar Smith wrote “These predatory suits amount to legalized extortion and require doctors to purchase malpractice insurance at great expense.”

Tort reform and individual restraint in ordering medical tests can be accomplished at the state and at the individual level. Texas has already accomplished meaningful tort reform (limits non-economic damages to $250,000).  Adopting similar reform simply requires legislators to honor the needs of their constituency rather than the wishes of powerful attorney lobbyists. Individuals can start acting like medical costs come out of their own pockets and can start asking their doctors such questions as: “How much does this test/procedure cost?”  “Is it really necessary?” and “Is there a generic drug I can get instead?”

The answer is certainly not a new and massive entitlement program, one that is so fraught with exemptions and double standards that it calls into question the very rationale for uniform healthcare in the first place.  The most problematic provision of the healthcare bill is the one which gives government subsidies to help individuals and families purchase health insurance. This new entitlement, which the chief actuary of the Centers for Medicare and Medicaid Services, Rick Foster, estimates will cost more than $100 billion per year once it is fully implemented, will damage the country’s long-term fiscal outlook and potentially bankrupt the country.  Furthermore, the social impact will be enormous. Government subsidies will further erode the work ethic in this country and will introduce new inequalities into American life.  There will be less of a reason to seek the rewards that employment offers and consequently, less of a reason for adolescents to see the value in education.  There will be less of an incentive for adults to make sure they can afford their children before reproducing at an  irresponsible rate. As the government continues to socially engineer an “even playing field,” incentives for honest hard work and ingenuity and personal responsibility are even further removed.

There are three reasons why we have been able to evolve to a “rationed” care system for our health service professionals: (i) the diminution of God in our society, public life, and in government; (ii) our nation’s open door borders policy; and (iii) the concept that otherwise healthy people are “entitled” to the same things that people who go to school and work hard have without having to invest the same energy and forbearance. After all, at some point, you do run out of other people’s money.  When a society constantly punishes good, productive behavior, there is no investment in the type of human beings you need for a successful country. What you end up with is a once-vibrant capitalistic society being replaced by hoards of looters.

References: “Dr. Ezekiel Emanuel and Obamacare – Angel(s) of Death!,” by Liberally Conservative, July 28, 2009.  Referenced at:  http://www.liberallyconservative.com/dr-ezekiel-emanuel-and-obamacare-angels-of-death/

Ezekiel Emanuel, “The Perfect Storm of Overutilization,” Journal of American Medical Association (JAMA), June 18, 2008; 299(23): 2789-2791.  Referenced at:  http://jama.ama-assn.org/content/299/23/2789.extract

Ezekiel Emanuel, “Principles for Allocation of Scarce Medical Interventions,” The Lancet, Volume 373, Issue 9661, Pages 423 – 431, 31 January 2009.  Referenced at:  http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(09)60137-9/fulltext%5D

Rep. Lamar Smith (R-Tx), “Tort Reform Key to Cutting Soaring healthcare Costs,” The Hill, March 19, 2010.  Referenced at:  http://thehill.com/opinion/op-ed/87901-tort-reform-key-to-cutting-soaring-healthcare-costs

Susan Donaldson James, ” Death Drugs Cause Uproar in Oregon,” ABC News, Aug. 6, 2008.  Referenced at:  http://abcnews.go.com/Health/story?id=5517492&page=1

Dr. C.L. Gray, “What This Means for You,” Physicians for Reform.  Referenced at:  http://www.physiciansforreform.org/index.php?id=30

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