The debate over the economic stimulus package is shaping up as an early contest between Democrats and Republicans over the direction of health-care reform. One indication of that is a recent blog on Bloomberg.com by Betsy McCaughey, a former lieutenant governor of New York and a fellow at the Hudson Institute. This commentary, championed by Rush Limbaugh and Fox News, is as wrongheaded as the Republican opposition to the stimulus legislation as a whole.
McCaughey argues that the health-reform sections of the House stimulus bill “reflect the handiwork of Tom Daschle,” the former nominee for Secretary of Health and Human Services. She uses this unproven assumption to frame these provisions—which have broad mainstream support--as a Trojan horse concealing dangerous elements of socialized medicine. For example, here’s what she writes about the bill’s promotion of health information technology:
“One new bureaucracy, the National
Coordinator of Health Information Technology, will monitor treatments
to make sure your doctor is doing what the federal government
deems appropriate and cost effective. The goal is to reduce costs and
‘guide’ your doctor’s decisions. These provisions in the stimulus bill are
virtually identical to what Daschle prescribed in his 2008 book, ‘Critical: What We Can Do About the Health-Care Crisis.’
According to Daschle, doctors have to give up autonomy and ‘learn to operate
less like solo practitioners.’”
The Office of the National
Coordinator of Health IT, which is not new, would
receive substantially increased authority under this bill. But the intent
is not to make sure that physicians are following government-approved
guidelines. Instead, the bill’s authors want to ensure that physicians are using the electronic health records that
$20 billion of taxpayer money is helping to purchase. The kind of quality data
that doctors who accept government subsidies would have to provide might
eventually be used in a pay-for-performance program that could improve the
quality of care for Medicare patients. But this does not mean that the
government will tell physicians how to practice.
The sentence from Daschle’s book
that McCaughey quotes out of context bears no relation to the health IT
provision. Daschle is talking about how physicians will have to learn how to
provide better value by working with other providers as members of a care team,
rather than working alone and coordinating care poorly, if at all.
McCaughey also assails a clause in the bill that, she says, would penalize doctors who are not “meaningful users” of electronic health records. It is true that physicians who don’t acquire EHRs and use them by 2016 will see a slight decrease in their Medicare payments. But McCaughey is simply wrong when she says that the bill does not define “meaningful user.” To meet this requirement, a doctor must prescribe electronically, exchange data with other providers, and submit quality data to the government.
McCaughey raises and attacks this straw man in order to suggest that the quality measures—which would probably be vetted by a respected body like the National Quality Forum—will be designed to discourage the use of new technologies. Of course, there is no evidence of this in the legislation.
Not surprisingly, she also objects
to the bill’s provision for funding comparative effectiveness research, which
would find out which healthcare interventions work best. She asserts that a new
Federal Coordinating Council for Comparative Effectiveness Research would be
equivalent to the Federal Health Board that Daschle proposes in his book. That
board would make decisions on benefits and other elements of federal health
programs. But the Federal Coordinating Council described in the House bill is
an inter-agency body that would advise the President and Congress on
infrastructure requirements and expenditures for comparative effectiveness
research. Nowhere in this bill is it suggested that the Federal Coordinating
Council would make benefit decisions. Nor is it modeled after the U.K.’s
National Institute for Clinical Effectiveness (NICE), as McCaughey claims.
While Republicans like former
Medicare chief Gail Wilensky support comparative effectiveness research,
McCaughey sees it as a slippery slope that will lead to a government-run,
European-style system of socialized medicine. Ignoring the fact that the Blue
Cross Blue Shield Association, Kaiser Permanente, and other private-sector
entities already study comparative effectiveness, she sternly warns us that
NICE rations health care by prohibiting coverage of treatments that are deemed
too expensive in relation to their benefit. But nothing in the economic
stimulus package requires either Medicare or private health plans in the U.S.
to take cost into account in making coverage decisions.
McCaughey is not the only right-wing
pundit to assert that the $1 billion down payment on comparative effectiveness
research in the stimulus package would be a step toward rationing. Michael Cannon, director of health
policy studies at the Cato Institute, a libertarian think tank, has been quoted
as saying, "The intent is to use that information to ration care. Why else
would you come up with the research to help people choose what provides a lot
of value for the money and what doesn't?"
In many ways, the socialized systems
that McCaughey and other conservatives want us to fear deliver higher-quality
care than the American system does, at much lower cost. Moreover, everyone in
those countries is guaranteed access to care. In contrast, millions of
Americans are denied care because they can’t pay for it—which certainly
qualifies as a form of rationing. And a major reason for this, as Daschle
explains in his book, is the high cost of care. That, in turn, can be partly
attributed to the wasteful use of technology and the huge amount of
inappropriate care that is provided in this country, notes Daschle.
But McCaughey doesn’t get it. “The health-care industry is the largest employer in the U.S.,” she says. “It produces almost 17 percent of the nation’s gross domestic product. Yet the [stimulus] bill treats health care the way European governments do: as a cost problem instead of a growth industry. Imagine limiting growth and innovation in the electronics or auto industry during this downturn. This stimulus is dangerous to your health and the economy.”
In other words, she views any effort to restrain health costs as inimical to economic growth. Tell that to the auto industry as it faces bankruptcy, partly because of its over-the-top health spending. Tell that to the government, as Medicare and Medicaid threaten to swallow the entire federal budget and strangle the states. And tell that to people who have lost their health insurance and can’t get a doctor to treat them outside of an overcrowded emergency room.
Wake up and smell the
coffee, Betsy.
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