Under ObamaCare, the federal government will inevitably decide what kinds of care will get funding and who will get it. Comparative clinical effectiveness research is now a reality as a part of the U.S. government reform of the health care system. As a Canadian Physician, I know this research leads to only one thing – rationing.
Imagine the nightmare I experienced as a radiologist in Canada arbitrating who would be scanned and who would be sent to the end of the line. Sometimes I would read a scan and discover the patient had a huge tumor or rampant infection and I had personally sent them to the end of the waiting list when waiting times were as long as 13 months.
Harsh reality caused a complete turn-around in my views, which led me to move with my family from Canada to the U.S. in 2001. I now believe that government has no justifiable role in the delivering of health care. Hippocrates was correct. Health care is a matter entirely between the patient and his doctor. Those in need should be treated with compassion, as they were prior to the government getting involved during World War II.
It used to be a matter of medical ethics to care for the poor. Government horning its way into such benevolent transactions does not improve them. The involvement of government and other third parties has driven costs sky high and then doctors and hospitals are compelled to accept fees that cannot cover those costs. In the United States, “benevolent” government makes it illegal to perform charity scans in our imaging centers.
I have actually had opponents tell me that an American system of government medicine would not entail rationing. This is pure fantasy. As Thomas Sowell succinctly states, “The key task of any economy is the rational allocation of scarce resources.” We all hold a piece of responsibility for this each time we spend money. We assess price and value to allocate resources efficiently.
In health care systems, when someone else is paying, we do not make rational choices and over-consume medical goods and services. As a diagnostic radiologist reading over 100 imaging cases daily, every hour of every day that I work, I read cases that are discretionary expenses that the patient and physician likely would not have pursued if the patient had to pay themselves. Furthermore, the patient would not have suffered any negative consequence with a “wait and see” approach.
In health care, wishing that the laws of supply and demand do not exist does not make them go away. Since we do not restrain our own health care purchases, and since resources are “scarce,” to use Sowell’s terminology, we must be restrained by someone else. Therefore third-party payers limit coverage and deny claims. Restated, they ration.
Rather than sending our money to third parties (government and insurance companies) and then letting them decide how our money is spent, we should hold onto that money and decide for ourselves. Furthermore, this would save the monetary inefficiencies of third-party payment. It does not eliminate the role of insurance. Most types of insurance exist to replace large financial losses for unexpected events. I have used my auto insurance once in thirty years. Auto insurance is cheap. It wouldn’t be if it paid for routine maintenance and oil changes. Perhaps the health care reformers should learn a lesson from this.
We need preventative care, and we’ll all have minor illnesses and injuries that need attention. What we don’t need is someone else telling us what and how we will have access to, simply based on the cost. I want insurance for heart attacks and cancer; not hangnails.
Eventually the nightmare scenarios in Canada will be relived here if action is not taken. Misuse and overuse from the illusion of entitlement out of payment into obligatory health care will always lead to rationing.
Lee Kurisko, MD is a Canadian physician specializing in Diagnostic Imaging and Fellowship trained in Neuroradiology. He is Chief Medical Officer of MediBid.com and the former Medical Director of Diagnostic Imaging for Thunder Bay Regional Hospital in Thunder Bay, Canada. A former believer in the superiority of government delivered healthcare, he no longer holds this view and is an advocate of free markets in health care. Dr. Kurisko is also on the Minneapolis-based Board of Directors of Consulting Radiologists Ltd and author of Health Reform – the End of the American Revolution (2009).