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  • Opening the Door to Health Care Rationing Under Obamacare

    One of the biggest fears Americans have about Obamacare is who will ultimately control health care decisions: the government or patients and their doctors. New research by Heritage health policy analyst Kathryn Nix explains that while the law does not explicitly put those decisions in the hands of the government, it does allow government bureaucrats to unduly influence medical care. Enter comparative effectiveness research (CER), which compares different methods for preventing, diagnosing, or treating a specific disease or condition. In her paper, Nix explores the many ways CER might be used under Obamacare in ways that harm patients more than help them.

    Obamacare creates the Patient-Centered Outcomes Research Institute (PCORI), which as Nix explains in previous research, is responsible for “comparing options for prevention, diagnosis, and treatment for specific health problems; improving health care systems; informing patients and other stakeholders; addressing disparities among patient populations and health outcomes; and designing research to be patient-centered.”

    PCORI cannot use CER to issue coverage recommendations or make payment decisions. However, changes made by Obamacare to the Medicare bureaucracy will impact patients’ ability to make decisions. Obamacare also creates a value-based purchasing program for certain Medicare providers, which will financially reward some and punish others based on federal quality measures. These could eventually be influenced by CER produced by PCORI.

    This new program, Nix writes, “could encourage physician behavior that does not put the patient first, meanwhile treating providers in ways that are unfair, inequitable, and unlikely to truly reflect better-value, high-quality care.” She describes some of the consequences:

    • Doctors may be punished for providing appropriate care. Doctors will face financial incentives to adhere to quality measures, even if they may not make sense in the case of a particular patient. Unlike similar use of evidence in private integrated health systems, Nix explains, “[P]hysicians will not have the oppor­tunity to justify deviations from established standards. Instead, they will have to choose between com­pliance for payment and what they consider to be most appropriate for the patient.”
    • Incentives to cherry-pick patients. Nix writes, “Individuals, their behavior, and several other fac­tors can significantly affect health outcomes. Rewarding or punishing providers based on factors beyond their control is unfair and threatens patient-centered care by altering the way physicians interact with patients and encouraging them to ‘cherry-pick’ patients and treatments that will enhance their performance score.”
    • Impossible to remove bias. As Nix explains, “Only patients can truly and effectively define value in the health care system, and any attempt to do so by the federal government is certain to reflect an Administration’s political priorities and influence from special interests.” Since medicine is an imprecise science, those closest to each case—in other words, the doctor and the patient—should make the final call.
    • Impact on medical innovation. Finally, allowing the government to use CER to influence coverage and payment decisions, rather than as a purely informational tool, can stifle medical innovation. Nix writes, “Since focusing on existing treatments for which data is avail­able stacks the deck against new ones, this reactionary approach would dis­courage further medical innovation.”

    Obamacare fails to take the health care system in a direction that would limit CER use to an informational tool, creating the potential for it to reduce patient choice and physician autonomy. To read the full report, click here.

    Posted in Obamacare [slideshow_deploy]

    6 Responses to Opening the Door to Health Care Rationing Under Obamacare

    1. kitty says:

      This is very concerning. Doctors being punished for providing appropriate care sounds very alarming. Cherry picking patients also very strange. There is already enough bias in the health care system as it is with preferences to insurance coverage. Medicaid especially is a nightmare of discrimination that makes it hard to find places to get even the most basic care, especially dental care. The idea of (more) government involvement in health care doesn't sound like a good one. I am unsure of what all the affordable care act covers…but simply put health care should equally available to all…not based on the insurance you have, your job, your standing in the community, or any other judgement. I would suggest that hospitals, doctors, pharmaceutical companies, etc. all be non-profit organizations. Taking away the greed and favorable and unfavorable treatment of patients that results from a for profit situation.

    2. This has never been about healthcare, that was simply the Statist's mechanism to fool the masses. Seems to have failed with the overwhelming majority desiring repeal of the Leviathan government intrusion upon individual liberty, and the break the bank cost for an already broke nation. It always has been about bigger government, control, and dictatorial powers. The grand goal of the progressive for 100 years. What better way to control the masses than with the power to make life and death decisions?

    3. bulldog says:

      As a physician, very much looking forward to better outcomes evidence, which, like much of biomedical research, is funded by the government. It's ridiculous that the United States is so far behind on this issue, and that I have to rely on foreign sources like the Cochrane Collaboration.

      Also pleased to hear that even Heritage admits that Obamacare doesn't "put [medical care] decisions in the hands of the government" in any direct kind of way. I do some patient education on the side, and I'll definitely be putting that into all of our pro-Obamacare materials.

    4. Tatersalad says:

      Was Breithart on Obama's "agenda"?????

      Breithart/Coroner:
      http://dancingczars.wordpress.com/2012/04/29/brei

    5. Bobbie says:

      obamacare is a violation of great proportions in and of itself. Implying racism, favoritism, preferential treatment, discrimination, catering and the ability to manufacture crisis upon crisis within government controls. It is a direct violation of our Constitution. Let all Americans control one's own health and pay one's own expense like the way it was suppose to come out to be. The only place with no guarantees is everything government controls. The government takes no responsibility or accountability. Ones' health is ones' responsibility and government controlling it is emphatically dangerous! Some people need all the things this make believe government medical field suggests is bad and will price it higher because "it isn't good for somebody, we'll make it bad for everybody." Special interests galore! Stay out of our health and decisions.

      Didn't Mr. Obama say he had the cure for cancer? Interesting since friends of mine with no history died during his term. Both diagnosed during his term! Interesting…

      The government takes on matters and when accountability comes around "gosh, we don't have the resources to give any answers!" All the faults and consequences laid out by the controls of government are ignored by government! They're without principles, morals and ethics. All seen on Obama's side, desperately pestering people for anything to do people have the average mentality to do for themselves!

      • Ed Davis says:

        Yes, you are right.
        The special interest that is in government now are the same people who own "private corporations for profit". Since we only have two avenues to choose from "corporate or government" which do we get to demonize. Same people, same mentality, same aggressive leadership styles, same thieves, etc, etc.

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