Dr. Elaina George, MD
The Healthcare Reform Bill: Truth & Consequences
November 10, 2009

The healthcare reform bill (HR 3962) that just passed the House of Representatives is bad on so many levels it is difficult to explain. As it stands, it will destroy both the doctor-patient relationship and change the practice of medicine as we know it.

We have one of the finest healthcare systems in the world. It has been built on a foundation of choice. Doctors were free to choose the care that they deemed necessary to treat their patients, and patients were free to seek the medical care of their choice. Initially, the foundation was shaken by the rise of the managed care system with capitation. However, over the past 10 years, capitated plans, which limit access to specialists, have given way to the rise in power of insurance companies. They have used their anti-trust exemption to craft a system that has used monopoly to increase profits on the backs of both doctors and patients.

Unfortunately, the House does not address necessary changes that would lead to meaningful reform, such as breaking the monopoly strangle hold that insurance companies enjoy, reigning in the enormous profits of the pharmaceutical industry, tort reform, or crafting a healthcare system based on wellness and prevention and not the management of disease. Instead HR3962 creates a layer of government bureaucracy that inserts itself between the doctor and the patient by creating a national health commissioner and task forces that will evaluate and decide everything from what medications a physician is allowed to prescribe to a patient, to what surgery will be approved, to what outcomes will be expected for a particular medical condition.

Taken to its logical extent, this bill will create a world where the good of the many by definition must outweigh the needs of the few because to spend large sums of money on a limited number of patients will increase costs without the guarantee of a good outcome. It only makes sense as long as you are not the senior citizen that needs a hip replacement, the premature infant with multiple medical problems or the person with a chronic disease that statistics show has a limited time left on this earth.

The House bill sets up a health care system with a finite number of resources (e.g., doctors, hospitals, expensive medical equipment). Because of these limitations, the system must be used to help those who the government determines to be the most productive people. A principle that has been advocated by senior White House health adviser, Dr. Ezekiel Emanuel, brother to Chief of Staff Rahm Emanuel, called "the complete lives system." This system will prioritize healthcare for those who are younger on the theory that they have not yet lived a complete life by using tools such as lottery and prognosis to determine who receives care.