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Dr. Orwell Will See You Now

Don’t be fooled by their health care Newspeak.

by
Paul Hsieh

Bio

May 21, 2012 - 12:02 am

George Orwell may have invented “Newspeak” for his novel, 1984. But in their discussions of health care, the Obama administration and their political allies have elevated the deceptive use of language to new heights.

Consider the very title of the ObamaCare law, “The Patient Protection and Affordable Care Act.”

New estimates from the Congressional Budget Office show that ObamaCare will cost $1.76 trillion over 10 years, nearly double the earlier estimated $940 billion. Rather than being “affordable,” ObamaCare will worsen our massive budget deficit.

Nor does ObamaCare provide much “protection” for patients, especially senior citizens. Rather, one of the biggest dangers to seniors’ health care will be the new Independent Payment Advisory Board (IPAB). The IPAB would consist of 15 unelected members appointed by the president empowered to determine what medical procedures Medicare would cover and how much it would pay providers. IPAB decisions would not be subject to judicial review and could not be overturned unless overridden by a nearly-impossible two-thirds majority of both houses of Congress.

Although the law states that IPAB will not be used for rationing, its authority to set prices will give it de facto rationing power. If the IPAB sets the reimbursement rates for services below the costs of providing them, doctors would no longer offer them and patients would no longer be able to receive them.

ObamaCare supporters are also selling a version of Orwell’s slogan, “Slavery is freedom,” by claiming that greater government controls over doctors will enhance their freedom to practice.

In the Journal of the American Medical Association, former White House health policy advisor Dr. Ezekiel Emanuel advocates replacing standard fee-for-service payments with “bundled payments” where hospitals and physicians receive a fixed fee to take care of Medicare patients’ conditions (e.g., a stroke or a heart attack) regardless of how much the care actually costs.

Emanuel argues that bundled payments will give doctors more “autonomy” because it will allow “physicians to develop and deliver new approaches to care without being concerned about whether Medicare will pay for a specific service.” But in reality, bundled payments will pressure doctors and hospitals to skimp on care, just as patients experienced with “managed care” and HMOs in the 1980s.

Suppose the government outlawed restaurants from charging for each separate menu item. Instead, it only allowed restaurants to charge a single “bundled payment” of $10 for meals that had to include an entree, vegetable, dessert, and drink. Would the quality and quantity of food go up or down as the government set ever-stricter limits on what restaurants could charge?

In a recent New York Times interview, Stanford health economist Victor Fuchs similarly compared government-imposed bundled payments to “the emancipation of slaves.” This is the ObamaCare version of “Slavery is freedom.”

The New England Journal of Medicine adopted a similar Orwellian tactic, when it argued that policymakers avoid the word “rationing” when discussing government-driven restrictions of medical care to cut costs. Instead, they should couch such restrictions in terms of “frugality.” But this terminology obscures a critical distinction. “Frugality” is when people are prudent about spending their own resources for themselves. If you decide steak is too expensive and you instead purchase chicken, that’s being frugal. But if the government limits how much meat you can purchase each week, that’s rationing.

Similarly, Medicare officials are considering rebranding the government-run insurance “exchanges” under ObamaCare as “marketplaces.” Medicare communications director Julie Bataille explained, “Words like ‘marketplace’ resonate much more with the consumer.”

However, a true marketplace is when consumers can freely purchase goods and services (or not) from sellers without compulsion

In contrast, ObamaCare will push many employers to stop offering private health insurance. Instead, employers will dump their employees onto the government-run exchanges where they must purchase insurance on government terms at government prices. Calling these mandatory purchases a “marketplace” is like calling it a “negotiation” when the Godfather makes you “an offer you can’t refuse.”

A final example of deceptive language is politicians’ constant talk of providing “coverage” for all Americans. But there’s an enormous difference between theoretical “coverage” and actual medical care. Patients in Canada and the UK all have “coverage,” but they must often wait weeks or months for services such as MRI scans or chemotherapy that Americans can receive within days.

One of the methods ObamaCare attempts to guarantee “universal coverage” is by expanding Medicaid. But as the New York Times reported, Medicaid patients often have a difficult time receiving care because Medicaid pays doctors and hospitals so poorly (typically well below the cost of the service provided). As one patient said about her Medicaid card, “It’s a useless piece of plastic. I can’t find an orthopedic surgeon or a pain management doctor who will accept Medicaid.”

Under ObamaCare, “coverage” does not equal care. It’s like having a cellphone plan, which promises “coverage” for your area, but never gives you a decent signal.

The Obama administration can’t fix the actual substance of their health plan. Hence, their strategy is to obfuscate its problems with deceptive language and hope that voters don’t catch on. If you value your lives, don’t be fooled by their health care Newspeak. Otherwise, you may soon be getting your medical care from Dr. Orwell.

Paul Hsieh, MD, is a member of the Colorado chapter of Docs4PatientCare (www.Docs4PatientCare.org) and co-founder of Freedom and Individual Rights in Medicine (www.WeStandFIRM.org).
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