Who should have control over your medical care: your family doctor or a bureaucrat you’ve never met whose sole job is to look out for the government’s financial bottom line?
That question is being debated in court right now, as three states are currently seeking a ruling from a federal judge that the final say in an individual’s medical treatment lies with the government and not with that patient’s doctor.
In March, Georgia, Florida, and Alabama joined in an appeal of a 2008 U.S. District Court ruling that a patient’s physician was better positioned — and better qualified — to make decisions about that patient’s medical treatment than state bureaucrats.
The case centers on Callie Moore, a disabled teenage girl living in Georgia. A stroke Callie suffered in utero left her suffering from multiple conditions, including cerebral palsy and mental retardation. For the last decade, she has received around-the-clock in-home nursing care for her medical conditions.
In 2007 though, the state of Georgia cut coverage of Callie’s in-home care by 15%, from 94 hours a week to 84 over the objections of her attending physician, who was intimately familiar with her case and her needs. State officials (who were not medical professionals) cited disagreement with the attending physician about just how much care Callie needed as the primary reason for this reduction in care.
Callie’s mother filed suit in 2007, arguing that the state had no right to contradict the orders of her personal physician and limit her treatment. However, because Callie receives her medical treatment under Medicaid (the joint federal and state health coverage program for low-income individuals and families), Georgia officials argued that Callie’s care was subject to rationing, as the state bureaucrats’ need to ensure Medicaid resources were allocated “fairly” superseded her doctor’s care prescription or her personal medical needs.
On June 4, 2008, U.S. District Judge Thomas Thrash ruled that Callie’s doctor, not state bureaucrats, had the right to prescribe just what medical treatment and care his patient required. Georgia was ordered to raise Callie’s skilled home nursing care back up to 94 hours a week, as prescribed by her doctor.
Rhonda Meadows, commissioner of Georgia’s Department of Community Health, immediately appealed the ruling to the 11th U.S. Circuit Court of Appeals on behalf of the Peach State. Her argument was that state officials, not doctors, should have final say in what treatments and care patients within their purview require. Florida and Alabama, which fall under the 11th Circuit’s jurisdiction and will have to abide by its ruling, filed an amicus brief with the Atlanta-based court.
This case has thrust into the spotlight the debate about an issue that has long been confined to dark, smoky rooms in state capitals and Washington, D.C., and to the fine print of legislation that members of Congress aren’t bothering — or being allowed — to read before their passage.
From state governments to the federal legislators and bureaucrats who had a hand in writing and passing President Barack Obama’s 2009 “stimulus” bill, more and more officials are beginning to make the public argument that it is not a trained doctor with years of experience and personal knowledge of a patient’s medical history and needs who should have final say when it comes to patient diagnoses and prescriptions. Rather, they argue, the deciding individual should be some nameless bureaucrat inhabiting a cubicle in some nondescript government building, with nothing but an agency-developed cost-effectiveness spreadsheet to guide them in determining what is and is not medically appropriate or necessary for every patient seen within their jurisdiction.
The case currently being decided in Atlanta, Moore v. Medows, is evidence of this. In oral argument before a panel of the 11th Circuit on March 24, attorney Robert Highsmith contended that, while bureaucrats “will consider doctors’ determinations,” the “final arbiter” of medical decisions is “the state.”
The thrust of the states’ argument is summed up in a brief written by the attorneys representing the state of Florida in the case. “Left to their own devices,” they write, doctors “advocate for their patients” — something the state governments resent due to the interference in the execution of their cost-effectiveness analyses.
It is difficult to overstate the impact a decision in the states’ favor would have in this case. Medical professionals and health care advocates rightly fear that a doctor’s evaluation, diagnosis, and recommended course of treatment would sink to the status of mere suggestions pending review and approval (or disapproval) by state bureaucrats.
Imagine, if you will, every decision made about your personal motor vehicle — from the gas you put in it to the recommendations the mechanic makes for fixing your worn-out brakes or broken transmission — was subject to final review by a state bureaucrat with no experience in the automotive industry. Now extrapolate that scenario to your health care. Are you concerned yet?
Even if the judges of the 11th Circuit disagree with the appellants’ argument, the fact that three states are currently in federal court seeking official validation of their “right” to overrule physicians and arbitrarily ration medical care is frightening enough.
When government is given free rein to overrule a medical professional’s judgment of care based on their analysis of cost, physicians and their patients no longer have a role in making decisions about those patients’ care.
The battle is also being fought at the federal level, where funding and authorization for “comparative effectiveness research” was included in the American Recovery and Reinvestment Act (or “stimulus” bill). That benign-sounding term refers, quite simply, to the drawing up of those comparative-effectiveness spreadsheets bureaucrats will use to approve or overrule physician diagnoses and prescriptions once the federal government’s power to do so has been affirmed, be it by legislative action or judicial fiat.
Given the track record of the faceless bureaucrats who make the majority of the government’s day to day judgments, the idea that they, rather than the doctor you know and trust, should have control over your health care is a very frightening prospect indeed.