The next time you visit the doctor for a routine check-up, you may sense there is another person in the exam room with you.
The uninvited guest will not be a physician assistant or a nurse, but the shadowy specter of the National Coordinator for Health Information Technology.
You will not actually see him, though, because he will be hiding inside your doctor's computer.
Of all the hidden agendas that are buried within Obamacare, the one controversy that received the least attention involves the widespread adoption of electronic health records by hospitals and physicians across the entire country.
The lack of furor makes sense. A screaming pack of demonstrators who are foaming at the mouth over "DEATH PANELS!" will always get more media airtime than some Geek Squad conspiracy theorist who is mumbling about "a nationwide interoperable health information technology infrastructure."
Try fitting that one on a cardboard sign. "Infrastructure" doesn't even rhyme with anything scary.
The truth is that the Obamacare program does include financial incentives – bonus payments from Medicare, in other words – to reward health care providers who computerize their patients' medical records.
Under the new law, these forward-thinking providers are called "Meaningful Users." Now there is a euphemism that would make George Orwell's physician roll over in his grave. By definition, the opposite of a Meaningful User must be a Meaningless Waster.
After a few years, the bonus payments will be replaced by penalties for any holdout providers who still elect not to use electronic records. Their
reimbursements from Medicare will be cut. Doctors literally will be forced to comply or pay a price.
Under Obamacare, the Secretary of Health and Human Services is also granted the power to use "increasingly stringent measures to enforce compliance."
"Increasingly stringent measures" sounds an awful lot like "enhanced interrogation techniques."
Is the Surgeon General going to waterboard Marcus Welby, MD?
The mastermind of the new healthcare matrix will be the National Coordinator for Health Information Technology. This unelected political appointee is in charge of making sure that electronic health records fulfill their promise to reduce the wasteful healthcare spending caused by "inefficiency, medical errors, inappropriate care, duplicative care, and incomplete information."
Critics argue that Obamacare is just one step closer to Big Government telling doctors what to do. The most fearsome example would be those now infamous "death panels" who decide whether your grandma will live to see her next birthday.
The real danger is not some bogeyman death panelist who is dressed like the Grim Reaper. Individual decisions on a case-by-case basis will never result in the cost savings necessary to rescue the Medicare program from going bankrupt. Your grandmother's care does not even add up to a rounding error in the Medicare budget.
According to the government's most recent estimate, Medicare is expected to collapse by 2029. In orderto rescue the entire program from going bust, Medicare needs to start squeezing the savings out of millions of grannies.
This is why the real threat to your grandmother's health is the new Czar for Health Information Technology. Big Brother is not going to bother making life-or-death decisions one blue-haired grandmother at a time, not when he has the power to create information technology standards that can affect the treatment of more than 46 million Medicare patients at once.
Eligibility to become a Meaningful User is based on whether providers fully implement and use government-approved health information technologies that meet certain standards of efficiency and effectiveness. That means once electronic medical records have been imposed on providers across the country, the Czar will be in a position to influence the design of the entire health information technology infrastructure.
For example, electronic record systems include programmed clinical alerts to warn doctors of potential safety problems. Sometimes the warnings are based on clinical factors, like a possible allergic interaction with certain medications.
Other types of helpful alerts are based on insurance coverage policies. For example, the system may warn a doctor before he orders a lab test that is not covered by Medicare.
As Medicare creeps closer to the verge of bankruptcy with every passing year, the pressure will become enormous to start using electronic record systems that also warn doctors before they enter orders that are deemed to be inefficient or not cost-effective.
For instance, the Czar for Health Information Technology and an independent panel of experts could recommend that all electronic record systems should be programmed to warn Meaningful Users to consider whether it is reasonable to withhold certain types of treatment from elderly patients.
After all, that expensive artificial hip is designed to last 10-15 years, and the remaining life expectancy for Mrs. Jones is not nearly that long.
According to some studies, as much as one quarter of the entire Medicare budget is spent treating elderly patients in the last year of their life. Academic eggheads point to this as clear evidence of wasteful or ineffective treatment. Presumably, these eggheads do not like their grandmothers very much.
Perhaps the little old lady does not really need a new titanium hip just to spend the rest of her days watching The Price is Right from a nursing home bed. So the computer decides that Mrs. Jones doesn't get anything more costly than two aspirin and warm tapioca.
Asking for a second opinion will be futile, because all clinical information systems will be loaded with the same "age-appropriate" treatment protocols. Mrs. Jones could be seen by a dozen different specialists, but the computers will always spit out the same answer. No hip for you.
You can save untold thousands of dollars with a simple, inexpensive injection of potassium chloride. No fuss, no mess. No more grandma.
Keep in mind that electronic records will be used in the treatment of all patients, not just the elderly. To eliminate all inefficient and inappropriate waste, the Czar will need to look at other types of patients who also require particularly expensive care, such as people with a family history of Alzheimer's or multiple sclerosis.
In fact, the matrix computers could automatically order a genetic screeningtest for all newborns. Based on each baby's statistical predisposition to develop certain conditions in the future, the computers will crunch the numbers and calculate everybody's fair share of limited health resources. Once you exhaust your capped lifetime reserve, the system refers you to a managed care counselor named Kevorkian. Game over.
In order to maximize the overall benefit for society as a whole, the matrix can limit the quality of care for every individual to a cost-effective level. The Czar's matrix will not let doctors order anything above that well-defined level of care, because a team of economists concluded it would be Bad Medicine. Only a Meaningless Waster would dare to practice Bad Medicine. Meaningful Users always deliver pre-approved Good Medicine.
There is another word for "Good Medicine" like that. It is called "eugenics." A fashionable idea among Progressives in the early twentieth century, eugenics is basically the theory of perfecting humankind by selectively weeding out the bad seeds that produce undesirable traits.
Advocates of this theory included Margaret Sanger, the founder of Planned Parenthood. Even Sanger's plan was somewhat less ambitious than the most well-known champion of eugenics, though. Here is a hint. His first name was Adolf.
Back then, the theory of selection was based on prejudice and propaganda. The modern return of eugenics may be based on footnotes in a cost-benefit analysis.
The Czar for Health Information Technology just types a few keystrokes into his matrix, and then lets the computers do all the work.
<< Return to the October 2010 Index