Presidential aspirant Mitt Romney may not have intended that the mandatory health insurance law he signed in 2006 would look like the Obama health law. But the Massachusetts law does a lot more than cover the uninsured (a worthy goal). The law broadens the powers of government to dictate treatment decisions and even interferes in where and how patients die. The result will be a breathtaking shift of decision-making from the doctor at bedside to the state.
The Massachusetts law has come under fire for soaring premiums, now the highest in the nation. A 2011 Beacon Hill Institute study concluded that 18,000 fewer people were employed in the state, because employers required to provide coverage left the state or stopped hiring to avoid the cost. But the cost cutting has begun, and the results are alarming.
Chapter 305 of the 2006 law created councils and regulatory bodies charged with cost-cutting, and after several years they have produced a plan. Here are key components:
Mandatory electronic medical records: All physicians must comply by January 2015 as a condition of keeping their medical license.
Comparative effectiveness: A state board — with unions, consumers, employers and other nonphysicians on it — will synthesize medical research into guidelines and ensure that all insurers and doctors follow them. These guidelines will lay out what care is “medically necessary” and include “how to address individual patient cases and circumstances.” Massachusetts says it and its bureaucrats can make better decisions than highly trained physicians at bedside. (Roadmap to Cost Containment pp. 10, 21,36)
Massachusetts’ End of Life Program: Sec. 41 of Chapter 305 of the Massachusetts law creates an expert panel to deal with how and where people die. The state will launch an aggressive public relations campaign to get hospitals and doctors to encourage palliative care, hospice care, and death at home. In Massachusetts, only 24 percent of people die at home. The state says that is too low. (Roadmap, pp.32,33, 41,90,)
Sometimes a patient doesn’t die at home because the doctor doesn’t foresee that death is imminent. A 2006 Emory University study found that doctors treat patients who are expected to die less intensively than patients who are expected to survive, but often doctors can’t predict who is near the end.
The benefits of hospice care are obvious. But physicians also worry that some patients will break down at the mention of hospice care and lose the will to fight their disease. Ultimately, the question is how involved should government be in how we die, especially when the goal is to cut costs?
Ending fee-for-service insurance options: Massachusetts will push patients into “medical homes,” to limit access to costly specialists and diagnostic tests, and substitute nurse practitioners and physicians assistants for doctors.
A 2008 Congressional Budget Office report noted that. if cost control is the priority, medical homes are likely to present the same problems as those HMOs of 20 years ago.
HMOs would withhold physicians’ fees until the end of the year and give it back only to the physicians who met targets for limiting referrals or diagnostic tests. Ultimately, what a doctor prescribed for a patient came out of the doctor’s own pocket at the end of the year, setting up a conflict between you and your doctor. (Roadmap, p. 14)
Individual mandate Individual mandate
Employer mandate Employer mandate
Mandatory electronic records. Mandatory electronic records
Comparative effectiveness Comparative effectiveness
End of life program End of life program
Medical homes Medical homes
Perhaps Governor Romney didn’t read Section 305 of the health law he signed, or couldn’t anticipate how it would undermine the doctor-patient relationship.
The Massachusetts cost-cutters claim that care could be cut by 20 percent to 30 percent without doing harm. President Obama’s former budget director Peter Orszag made the same claim to defend deep cuts to Medicare funding.
Don’t believe it. Wherever these cost cutting strategies — the same ones that are in Romneycare and Obamacare — are used, the results are deadly. An important study in the Annals of Internal Medicine (February 2011) based on all hospitals in California shows that seniors treated in hospitals providing more intense care and spending more have a better chance to recover and resume their lives. In fact, 13,813 elderly patients with pneumonia, congestive heart failure, stroke and hip fractures who died at low spending hospitals would have survived and gone home had they received more care. That’s a lesson for Massachusetts and the nation.
Betsy McCaughey, Ph.D., is a former lieutenant governor of New York and author of "The Obama Health Law: What It Says and How to Overturn It."
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