Are you in favor of “quality” health care?
It seems the more we learn about Universal Health Care, the less there is to like. Two physicians who are on the staff of Beth Israel Deaconess Medical Center in Boston, and on the faculty of Harvard Medical School have written an article that provides a glimpse of what health care will be like should Congress get its way.
The program that the Obama administration wishes to mandate, now, for Medicare, but which would, no doubt, become part of our Universal Health Care proposal is called “quality metrics/pay-for-performance”. Translation… health care providers are rewarded for meeting “quality” metrics.
As is the “road to hell”, this plan was originally “paved with good intentions”. The theory was, if certain procedures and treatments were standardized, patient safety could be enhanced. The standards became known a “quality metrics”. Initial successes in things like stringent rules for hand washing, for example, greatly reduced patient infections. But, as with any government success, things soon spiraled out of control. The quality metrics quickly became mandates for doctors under a “pay for performance” program.
Massachusetts has implemented the program as part of it’s mandatory health care system. Clinical guidelines for treatment have been turned into iron-clad rules. Your treatment has been taken out of your doctor’s hands and turned over to “experts”, who don’t know you, have never examined you, and, who may, or may not be physicians.
In Massachusetts, there are not only carrots but also sticks; physicians who fail to comply with quality guidelines from certain state-based insurers are publicly discredited and their patients required to pay up to three times as much out of pocket to see them.
And, it gets worse than that.
A colleague who works in an ICU in a medical center in our state told us how his care of the critically ill is closely monitored. If his patients have blood sugars that rise above the metric, he must attend what he calls “re-education sessions” where he is pointedly lectured on the need to adhere to the rule.
There are two obvious problems with this inflexible approach to medical treatment. First, it assumes that all patients are “created equal”, and, the second problem comes when the “quality” guidelines are just plain wrong. As this article points out, wrong guidelines can be deadly.
But this coercive approach was turned on its head last month when the New England Journal of Medicine published a randomized study, by the Australian and New Zealand Intensive Care Society Clinical Trials Group and the Canadian Critical Care Trials Group, of more than 6,000 critically ill patients in the ICU. Half of the patients received insulin to tightly maintain their sugar in the normal range [per the guidelines], and the other half were on a more flexible protocol, allowing higher sugar levels. More patients died in the tightly regulated group than those cared for with the flexible protocol.
Yet another study of the stringent guidelines for treatment of ambulatory diabetics was discontinued 17 months earlier than intended because so many people in the “tightly regulated” study group died.
And, were that not enough, other research is showing that some patients are being denied treatment for fear that a bad outcome would hurt the health care provider’s rating.
…research by the Brigham and Women’s Hospital published last month in the Journal of the American College of Cardiology indicates that report cards may be pushing Massachusetts cardiologists to deny lifesaving procedures on very sick heart patients out of fear of receiving a low grade if the outcome is poor.
So, if anyone asks you how you could possibly be opposed to Universal Health Care, you’ll be prepared to answer. Aside from what will eventually become a massive tax increase to support the program, you can explain that “cost effective” treatment, is actually rationing, and “quality metrics” treatment provides anything but quality.
"Quality" is such an easy word to use, or should I say, misuse. "Quality" is a word that needs its own qualifier, i.e. "high or good quality" vs. "bad or low quality."
While it is fine in sloppy advertising, in Obamaspeak, it needs to be parsed for that qualifier, which I am sure, given the history of "universal health care," will be on the "low and bad" end of the scale.