Tragically, Repealing ObamaCare Will Not Be Enough; the Seeds of Healthcare Rationing have already been Sown

As of this writing, we are likely only weeks away from knowing how the Supreme Court will rule regarding the constitutionality of the Patient Protection and Affordable Care Act, otherwise known as ObamaCare. As egregious as the legislation is in its disregard for the constitution and the most basic of personal liberties, one would be misguided in believing that its over-turn by the nation’s highest court would guarantee the safety of our healthcare system from the socialist wiles of our current president.

Forging ahead without concern for the very recent Supreme Court hearings, the Obama administration has surreptitiously diverted nearly $500 million of the Department of Health and Human Services’ (HHS) $1 billion “implementation fund” to the IRS, which is responsible for over-seeing the individual mandate provision of the new law.  This money is only part of the IRS’s total planned spending for the implementation phase, and it is being provided outside the normal appropriations process.  It appears that HHS intends to spend the entire sum before the presidential elections this fall, and most of it before the Supreme Court renders its verdict in June.  Republican lawmakers have thus far been unsuccessful in freezing the slush fund until the Supreme Court rules on the legislation’s future.

In addition to spending the pot of implementation monies as quickly as possible, an article published earlier this month in the New York Times revealed some other insights into how the Obama administration plans to mitigate the impact of a potential Supreme Court ruling against the healthcare reform bill.  Perhaps in preparation for its defeat, in part or in toto, the “American Board of Internal Medicine Foundation” (ABIM Foundation) came out with new guidelines aimed at decreasing the performance of a number of common tests and procedures.  Representatives from the foundation claim that these new recommendations are simply an attempt to curb “unnecessary care and overuse of the system”.

The recently published recommendations are part of the ABIM Foundation’s “Choosing Wisely” initiative. According to the group’s website, this involved, amongst other things, physicians, patients and “other stake-holders” meeting to discuss various responsibilities of the healthcare community in “managing finite resources”.

While many of the Foundation’s recommendations are rife with complex medical terminology and explanations, even the average layperson can read others and understand the significant philosophical shift that is being suggested.

Here is one example from the recently released guidelines:

“Don’t perform Pap smears on women younger than 21.”

For decades, the standard of care has been for women to get Pap smears to screen for cervical cancer three years after becoming sexually active or at age 21, whichever came first.  Given that many females are sexually active in their mid-teens, this would mean initiating Pap testing at age 18 or 19, or perhaps younger.  These traditional guidelines also increased the likelihood that young, sexually active females were being seen by a clinician, screened for sexually transmitted diseases, and receiving counseling.  The Foundation’s explanation for this new delayed screening recommendation? 

“Most observed abnormalities in adolescents regress spontaneously, therefore Pap smears for this age group can lead to unnecessary anxiety, additional testing and cost.” 

But what about the abnormalities that don’t regress and are actually cancerous or precancerous? Sexually active women are at increased risk for cervical cancer, regardless of having reached their 21^st birthdays.  To suggest that we put a higher priority on “anxiety” and “cost” (the real issue) rather than on early detection is preposterous.  And this is from the folks who chastised Republicans for not caring about women’s health issues!

Here is an even more frightening new recommendation from the Foundation whose website positions them as focused on “medical professionalism”:

“Don’t perform routine cancer screening for dialysis patients with limited life expectancies.”5

Their reasoning?

“Due to high mortality among end-stage renal disease (ESRD) patients, routine cancer screening—including mammography, colonoscopy, prostate-specific antigen (PSA) and Pap smears—in dialysis patients with limited life expectancy, such as those who are not transplant candidates, is not cost effective and does not improve survival. False-positive tests can cause harm: unnecessary procedures, overtreatment, misdiagnosis and increased stress.”

Apparently, the Foundation has determined that most patients who are on dialysis are no longer worth screening for cancer.  One assumes that these patients are already costing the system too much, and therefore diagnosing a malignancy in time to treat it would simply prolong their time draining the “finite resources” that the ABIM Foundation has set out to protect.

These are just two of an extensive list of new recommendations, aimed at decreasing a broad range of tests and procedures. 

There is no question that unnecessary testing and over-treatment are issues that contribute to the high cost of healthcare in this country.  Studies have indicated that as much as one-third of all medical spending in the United States is not medically necessary.  What has not been shown, however, is that this overage is a result of physicians attempting to “game the system” to make more money, or because previous medical guidelines have been too lax.  Rather, it is “defensive medicine” -- a direct result of serious concerns over medical liability, escalating malpractice awards, and an abject refusal by American trial lawyers to allow critical tort reform. In 2700 pages of new healthcare legislation, any mention of tort reform is glaringly absent.

So what explains the somewhat conspicuous timing of these new recommendations? The “American Board of Internal Medicine Foundation”, despite its very official sounding title, is a self-appointed group whose charter is aimed at “advancing medical professionalism”. 

Just a cursory review of the resumes of the board of the ABIM Foundation reveals some interesting backgrounds. Dr. Christine K. Cassel, president and chief executive officer of the Foundation, is one of 20 scientists chosen by President Obama to serve on the President’s Council of Advisors on Science and Technology (PCAST). She is also co-Chair and Physician Leader of a PCAST working group that makes recommendations to the President on issues relating to health information technology.

ABIM Foundation Chairman, Glenn Hackbarth, is a lawyer with no medical training whatsoever.  He is also the current Chairman of the Medicare Payment Advisory Commission in the Obama administration.

Coincidence?  Not likely.

Speaking of an “unelected group of people”, this group has made some rather radical recommendations for rationing healthcare and has slyly tucked them in under the banner of something called “medical professionalism”.  While it is true that the American Board of Internal Medicine Foundation has no legal authority to set policy, their recommendations certainly hold sway over Medicare, Medicaid and private insurance companies.  When panels of medical “experts” make broad sweeping recommendations that physician should eliminate certain tests, treatments and procedures, it becomes more and more likely that payers of all types will refuse to cover those same items.  These newly published guidelines are therefore likely to alter treatment standards in hospitals and doctors’ offices nationwide.  Furthermore, they will remain in place, even if the healthcare reform bill is repealed. 

It is this last fact of which Americans need to be most cognizant: the Obama administration has launched an all-out assault to dismantle U.S. healthcare as we know it.  The massive Patient Protection and Affordable Care Act is the body of Obama’s machine  – But there are tentacles and independent offshoots that can and will proliferate like malignant cancer cells left behind even if the larger tumor is removed.  

Should the Supreme Court justices makes the correct decision to over-turn the healthcare reform bill as unconstitutional, we will still need to deal with all of the new IRS agents already hired through the HHS “implementation fund”, as well as with these insidious panels of experts who have been working over-time to craft new guidelines clearly aimed at saving money at the cost of human lives.  This is truly sinister government; if Obama remains in office, repealing the healthcare reform bill will never be enough.

                                              blog founded by Kelly Victory MD
                                      story developed with Kelly Victory Steamboat Springs

The Contraception Mandate: Obama’s Latest Trojan Horse

Unfortunately, controversy over the Obama administrations recent “contraception mandate” has virtually consumed the presidential primary over the past several weeks.  This is the mandate that states that virtually all employers, including Catholic and other religious institutions, would be forced to pay for free preventive services, including sterilization, contraceptives and drugs that cause abortion, and that all insurers would have to cover these services without additional cost to the patient. 


It’s not that the topic is unworthy of discussion and outrage, but conservatives have quickly allowed the arguments to go precisely where liberals directed them – to a perceived Republican assault on contraception itself, and a frenzied uproar about attacks on “religious freedoms”.  As a woman, a physician and a Catholic, I find this both disingenuous and absurd. 

There is nothing about contraception that is a pressing “women’s health issue”. Pregnancy is not a disease.  And without detailing the obvious, there are adequate ways to prevent it with absolute certainty.  Furthermore, multiple big-box pharmacies sell contraception for less than $10/month, rendering this hardly a “healthcare crisis” demanding the kind of national outrage that many Democrats and at least one outspoken Georgetown law student have suggested.

And try as they might, Democrats would be hard pressed to find more than a handful of conservative Christians whose stance is that access to contraception, in and of itself, should be limited or banned – Theirs is simply an issue of who should be expected to provide and pay for that contraception.

The outrage over the contraception mandate is well justified – But the focus should be on the real issues at hand: Firstly, that it is part of the government’s bigger plan to control healthcare costs by engineering healthcare guidelines and implementing social programs that meet that goal, independent of the overall impact on health and wellness; and secondly, that it represents yet another egregious intrusion of the federal government into the affairs of private companies and private citizens, and reflects a highly concerning level of control over our private lives, extending far beyond an affront to religious freedom. 

Consider first the Democrats’ contention that contraception is a “women’s health issue”. Health and Human Services Secretary, Kathleen Sebelius, told the House in mid-March that contraception is "a critical preventive health benefit for women and for their children."

This argument is particularly interesting given that at the same time Democrats are claiming that contraception is a “critical women’s health issue”, and are attempting to paint Republicans as cold and heartless in that regard, the Obama administration’s Preventive Services Task Force has come out with new recommendations that women should not start regular breast cancer screening until age 50 rather than the previous recommendation of age 40. The new guidelines came out in November 2009, from the group that has significant influence over doctors, insurance companies and policy makers. The Task Force’s new recommendations also state that women between ages 50 and 74 should only have mammograms every other year, rather than every year. And it recommends that doctors stop advising women to do breast self exams.

The Task Force’s stated reasoning behind these new guidelines is that that only one person was saved for 1,900 screened – A conclusion that has been heavily contested by a number of groups, including the American Cancer Society. The panel felt the cost of all these screening mammograms and the potential for false positives outweighed the impact of early detection.

For years both self-examination and mammograms have been essential parts of regular preventative breast care for women.  According to the American Cancer Society "death rates from breast cancer have been declining since about 1990, with larger decreases in women younger than 50." A combination of early detection and improved treatment regimens are cited as the primary reason for improved survival rates.

U.S. government-run insurance plans and companies will now likely use these new federal Task Force guidelines to eliminate coverage for yearly mammograms. In addition, the Task Force has released new guidelines on cervical cancer screenings suggesting that women should wait until their 20’s to have their first pap smears and that they should be re-screened less often.  After years of educating women and the public to participate in early detection screening, the Obama administration has just done an about-face when it comes to breast and cervical cancer.  Many on the right have correctly concluded that the changes in guidelines are nothing more than rationing intended to save healthcare dollars.

When asked who will pay for the new HHS contraception mandate, Secretary Sebelius finally showed her hand: She replied that a reduction births will compensate employers and insurers for the cost of complying with the new requirements.  “The reduction in the number of pregnancies compensates for the cost of contraception,” Sebelius said. She went on to say the estimated cost is “down not up.”  In other words, it’s important that we provide contraceptives because pregnancy is more expensive to the federal government than the cost to prevent pregnancy.

This all begs the critical question: “Who is really the strong proponent of women’s health, and who is simply trying to cut healthcare costs with rationing of services and social engineering maneuvers?”  Just imagine how much money we will save when we stop diagnosing breast and cervical cancers when they’re still early enough to treat!

Now look at point number two -- The over-reaching impact of the mandate on our personal liberties: While many are focusing on the contraception mandate as a violation of religious freedom -- which is real -- and the associated affront to our constitutional, First Amendment guarantee of religious liberty, the bigger issue is being obfuscated: when the government takes over control of our health-care system, it takes control over our most private, personal decisions.  It also assumes control of everything that private companies and organizations – religious or otherwise -- can do.  Business models, plan designs, revenue streams, and customer relationships are totally at the whim of the government. This is about ultimate control of very aspect of society: religious, social and economic.

One of the first critical steps to implementing the single-payer government healthcare system that President Obama and so many on the left promote, is to force consistency in coverage and homogeneity in plan design; in other words, to force removal of all customization and personalization.

In a free market, insurers are able to customize plans and tailor coverage to meet the needs of employers and individual buyers vs. the government dictating a one-size-fits-all plan. Amongst other things, free-market competition and the ability to provide a better product drives innovation and keeps costs down.

If the government can now dictate that employers and insurance companies have to provide contraception for the prevention of pregnancy, what’s its next mandate: Car seats for infants?  Bicycle helmets?  Football pads?  Perhaps sun screen?   In this way, the contraception mandate defines the proverbial “slippery slope” in the take over of healthcare, and ultimately in controlling society.

 At what point does the relationship between the insurer and the insured, the employer and the employed, the doctor and the patient, lose all semblance of humanity and become a prescribed set of governmental rules and mandates aimed at driving the populace to the lowest common denominator?

In one fell swoop, the United States will go from the country that has the best cancer and trauma survival rates, and has made more discoveries and advances in healthcare than any other nation on the planet, to the one that is crippled with mandates and onerous regulations that effectively stifle innovation and progress, and one where critical screenings and services are rationed based on actuarial calculations rather than medical science.

Democrats have effectively skewed the optics of the contraception argument to appear that it is about the value of protecting women’s health and whether or not religious freedom should supersede the sanctity of sexual freedom.  If we can see beyond the affront to Catholic social thought, the discussion is really about government mandates aimed at rationing healthcare dollars, controlling costs, and applying an artificial coda of social “equality”. It reflects a continued march down the path to increased intrusion and control by the federal government into the private lives of its citizens.

If we believe that the Constitution’s protection of our lives and liberty is valid, then the Supreme Court must declare the Patient Protection and Affordable Care Act unconstitutional, and ultimately stop the limitless control of the government over our lives, such that we can return our country to the path to liberty and prosperity.

                                                     blog founded by Kelly Victory
                           written by Kelly Victory MD copyright 2012 all rights reserved