These are examples of a much larger trend: Washington telling the medical community how to practice medicine. Even though a recent study finds little relationship between the inputs Medicare wants to pay for and such outputs as whether the patient gets well or lives or dies, and even though the latest pilot programs show that paying doctors and hospitals for performance doesn’t improve quality, we are about to usher in the era of big brother medical care.
To be fair, a lot of medical practice these days is haphazard and mediocre. Doctors don’t do everything they should do. They do a lot of things they shouldn’t do. Medical practice guidelines that serve as a handy checklist can be an aid to good medical care. As I explain in Priceless, however, the danger is that high-quality medicine will take a back seat to "cookbook medicine." That’s what happens when the checklist substitutes for the doctor’s best judgment. It’s what happens when the checklist becomes the master rather than the servant.
That’s why the most recent survey of doctors finds that almost half think the new guidelines will be bad for patients. That’s twice as many as the number who think patients will benefit.
One of the real ironies in all of this is some of the outlandish rhetoric that has surrounded every attempt to reform Medicare in a reasonable way. Many Democrats in Congress have attacked Paul Ryan (R-WI) and the House Republicans for trying to "destroy" Medicare by "privatizing" it. Yet every Democrat who voted for the Affordable Care Act (ObamaCare) voted for a much more radical and dangerous form of privatization.
The Republican plan would rely on competition and would give seniors choices — including the choice to remain in traditional Medicare. The Democratic supporters of ObamaCare, by contrast, voted to herd seniors — without competition and without their knowledge or consent — into private sector health plans that have perverse financial incentives to withhold care.
To be fair to the Democrats, I think most of them had no idea what they were voting for when they were pressured to vote for the health reform law. As Nancy Pelosi explained, "we have to pass the bill so that you can find out what is in it."
We are all beginning to find out.
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