1. One of the principal aims is to supposedly improve quality of care. The administration has committed more than a billion dollars to "comparative effective research." President Obama testified to what this means: "Evaluating what works and what doesn't"
2. The White House is also pursuing "behavioral economics," which attempts to explain pitfalls in reasoning and judgment that cause people to make apparently wrong decisions. The objective is to create new government guidelines and policies that protect against unsound clinical choices.
3. Amos Trevsky and Daniel Kahneman, the original proponents of behavioral economics, wrote: "We are prone to incorrectly weight initial numbers, draw conclusions from single cases rather than a wide range of data and integrate irrelevant information into our analysis. Such biases can lead us astray."
4. Cass Sunstein, a professor and longtime friend of President Obama, is now overseeing regulatory affairs and will have an important voice in codifying the details of any health care reform bill that is passed. He is a "choice architect," which means he believes in redesigning our social structures to protect against the incompetencies of the human mind.
5. Peter Orszag, director of the office of Management and Budget expressed his belief that "behavioral economics should seriously guide the delivery of health care." In testifying before the Senate finance Committee, Orszag expressed his belief that he does not trust doctors and health administrators to do what is "best." He wants to adopt "aggressive promulgation of standards and changes in financial and other incentives."
6. Doctors and hospitals that follow "best practices" as defined by government-approved standards, would receive more money and favorable public assessments. Those who deviate from federal standards would suffer financial loss and would be designated as providers of poor health care.
7. Why does President Obama support restricting potential future care? Because by doing so he can deliver on his promise to save money with his new health care program. "Let's study and figure out what works and what doesn't. And let's encourage doctors and patients to get what works. Let's discourage what doesn't. Let's make sure that our payment incentives allow doctors to do the right thing. If we do that, then I'm confident that we can drive down costs significantly." -President Barack Obama, June 24, 2009.
8. Will treatment be limited because of all this? "I don't think that there's anybody who would argue for us continuing to pay for things that don't make us feel better. That doesn't make any sense." -President Barack Obama, June 24, 2009.
9. What happens when best practices are imposed on patients, doctors and hospitals? Medicare specified that it was "best practice" to tightly control blood sugar levels in critically ill patients in intensive care. This policy was not only shown to be wrong but resulted in a higher likelihood of death when compared to measures allowing a more flexible treatment and higher blood sugar.
10. A study of patients with congestive heart failure concluded that most of the measures prescribed by federal authorities for "quality" treatment had no major impact on the disorder. Medicare specified that all patients with pneumonia must receive antibiotics within four hours of arrival at the emergency room. Many doctors strongly disagreed, pointing out that an accurate diagnosis cannot be made so quickly. For example, many cases of heart failure or asthma can produce an X-ray that can resemble a pulmonary infection.
11. "Best practices" puts an individual patient at great risk and forces a doctor to give up thinking through other possible causes and treatments.
12. Look at what recently happened in November when the United States Preventive Services Task Force reversed a long-standing guideline and recommended that women between the ages of forty and forty-nine do not need to have routine mammograms. The National Cancer Institute strongly disagreed with these findings. Two days later Health and Human Services Secretary Katheleen Sebelius stated: "My message to women is simple. Mammograms have always been an important life-saving tool in the fight against cancer and they still are today. Keep doing what you have been doing for years." The scariest comment was by Dr. Robert Truog of Boston's Children's hospital. He allowed that mammography saves lives, but asked if it is "cost effective." Sounds like policy planners are seriously thinking about setting a price on saving people's lives.
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