Health Refrom and Loss of Individual Liberties
There is no such thing as a little freedom. Either you are all free, or you are not free.
Walter Cronkite
This blog is about loss of individual liberties under the best of intentions. In The Road to Serfdom, conservative economitis Friedrich Hayek argued you cannot control or comprehend market transactions between individuals from the top-down through centralized planning or restrictive government rules and regulations.
Hayek’s thesis in The Road to Serfdom is that one intervention inevitably leads to another. The unintended consequences of each market intervention are economic distortions, which generate further interventions to correct them. That interventionist mindset leads us down the road of individual and clinical serfdom in which we become subservient to government.
As Friedrich Hayek observed in The Road of Serfdom centralized planning always fails because it lacks the flexibility, efficiencies, and freedoms of the marketplace. You simply cannot control marketplace transactions through central command and control rules and regulations.
The current reform bills put the federal government in charge of individuals’ insurance choices and data privacy. This is all done, of course, in the name of covering the uninsured. It is also being done without the consent of the governed –only 35% to 40% approve of what Obamacare proposes.
Buried, for example, in the Senate’s 2,074 page health bill are provisions that undermine the patient’s health freedoms and privacy, The bill contains sections that mandate insurance for individuals, force them into those plans dictated by government, reveal financial data of patients to third parties, use personal data without consent of individuals, and requiring individuals to be seen by only those doctors using electronic medical records.
Not only are these government invasions into personal freedoms and privacy being done in the name of covering the uninsured but also in the names of reducing waste and overuse and, of course, in improving quality, safety, efficiency.
An organization called the National Priorities Partnership, convened by the National Quality Forum, proposes to health President Obama achieve his goals within 3 to 5 years by reforming payment, introducing a national interoperative medial records, accrediting and certifying providers, measuring performance, implementing comparative effectiveness measures, and publicly reporting quality outcomes.
To reduce waste and overuse, the National Priorities Partnership recommends reducing,
1. inappropriate medication use, such as antibiotics or multiple drugs
2. Unnecessary laboratory tests, such as panels of tests or special tests for Lyme disease
3. Unwarranted Cesarian sections
4. Unwarranted CT and MRI scans, bone or joint x-ray, endoscopies
5. End of life nonpalliative services
6. Unwarrated procedures – spin surgerys, knee-hip reppalcments, coronary artery bypasses, hysterectory, prostatecy
7. Unnecessary consultations
8. Preventable ER visits and hospitlaization
9. Potential harmful preventive services, BRCA mutations to screen for breat and ovarian cancer, coronary artery screening, carotid artery screening, paper smears over 65, PSA tests over 75
As I read this list, I frankly found it unpersuasive – even laughable . To begin with, those who compose these lists have never practiced medicine and who are unaware of patient pressures and expectations, Secondly, patients rarely if ever complain of overtreatment. Thirdly, patients have come to expect many of these tests to be done. Fourthly, many of these tests, e.g, laboratory lipid panels, SMA panels, CT and MRI scans yield valuable diagnostic and treatment information, and fifthly, who is to judge retrospectively if tests or procedures done prospectively at the point of care are inappropriate, unnecessary, unwarranted, harmful, or lead to preventable events, such as ER visits or hospitalizations.
