Thu, 12 Feb 2009

Betsy McCaughey on the Obama Stimulus Plan: A Rebuttal

Betsy McCaughy has written an opinion piece for bloomberg.com titled Ruin Your Health With the Obama Stimulus Plan. In it, she characterizes the stimulus package (as passed by the House) as containing sinister language that will allow the government to control and reduce the quality of health care available to the American public. I took a look at the sections of the bill that she has issues with, and I found that her conclusions are gross distortions at best. More or less everything she points to in the bill is focused on providing a healthcare information technology infrastructure to allow doctors and hospitals easy access to patients' complete medical information--nothing more.

(Since I wrote my analysis, the people at FactCheck.org have done their own analysis, which is more in depth than mine. The conclusions are similar--McCaughey is misunderstanding a lot of the bill--although they allow that some parts of the bill don't necessarily forbid her worst-case scenario. (They also note that much of what she worries about has been in place already, under a program created by George W Bush: the bill just turns an executive order into established law.))

She also makes a lot of comparisons to Tom Daschle's book Critical: What We Can Do About the Health-Care Crisis, drawing sinister inferences from the comparisons. I haven't read the book, so I can't judge how right or wrong she is about its contents, but the contents of the actual bill are not what she says they are.

To begin with, she claims that the government will be overseeing what your doctor does and dictating treatments:

One new bureaucracy, the National Coordinator of Health Information Technology, will monitor treatments to make sure your doctor is doing what the federal government deems appropriate and cost effective. The goal is to reduce costs and “guide” your doctor’s decisions (442, 446).

The actual text of the bill is as follows:

                           page 441
19      “(b) PURPOSE.--The National Coordinator shall per-
20 form the duties under subsection (c) in a manner con-
21 sistent with the development of a nationwide health infor-
22 mation technology infrastructure that allows for the elec-
23 tronic use and exchange of information and that--

                           page 442
 1            “(1) ensures that each patient's health informa-
 2      tion is secure and protected, in accordance with ap-
 3      plicable law;
 4            “(2) improves health care quality, reduces med-
 5      ical errors, reduces health disparities, and advances
 6      the delivery of patient-centered medical care;
 7            “(3) reduces health care costs resulting from
 8      inefficiency, medical errors, inappropriate care, du-
 9      plicative care, and incomplete information;
10            “(4) provides appropriate information to help
11      guide medical decisions at the time and place of
12      care;
13            “(5) ensures the inclusion of meaningful public
14      input in such development of such infrastructure;
15            “(6) improves the coordination of care and in-
16      formation among hospitals, laboratories, physician
17      offices, and other entities through an effective infra-
18      structure for the secure and authorized exchange of
19      health care information;
20            “(7) improves public health activities and facili-
21      tates the early identification and rapid response to
22      public health threats and emergencies, including bio-
23      terror events and infectious disease outbreaks;
24            “(8) facilitates health and clinical research and
25      health care quality;

                           page 443
 1            “(9) promotes prevention of chronic diseases;
 2            “(10) promotes a more effective marketplace,
 3      greater competition, greater systems analysis, in-
 4      creased consumer choice, and improved outcomes in
 5      health care services; and
 6            “(11) improves efforts to reduce health dispari-
 7      ties.

The whole thing is talking about making patients' medical information available by electronic means to hospitals, doctors, and insurance companies while maintaing the patients' privacy. Clause (4), in particular, refers to doctors being able to have all of the information they need when making decisions. It does not imply anything about the government dictating doctors' decisions to them.

She goes on to talk about hospitals and doctors not being "meaningful users" of the system, and she seems to imply that this will result in doctors abandoning treatments that aren't government-sanctioned:

Hospitals and doctors that are not “meaningful users” of the new system will face penalties. “Meaningful user” isn’t defined in the bill. ... What penalties will deter your doctor from going beyond the electronically delivered protocols when your condition is atypical or you need an experimental treatment?

Here's what the bill has to say about "meaningful users":

                           page 511
14     “(o) INCENTIVES    FOR  ADOPTION   AND  MEANINGFUL
15 USE OF CERTIFIED EHR TECHNOLOGY.--
16           “(1) INCENTIVE  PAYMENTS.--
17                 “(A) IN GENERAL.--Subject    to the suc-
18           ceeding subparagraphs of this paragraph, with
19           respect to covered professional services fur-
20           nished by an eligible professional during a pay-
21           ment year (as defined in subparagraph (E)), if
22           the eligible professional is a meaningful EHR
23           user (as determined under paragraph (2)) for
24           the reporting period with respect to such year,
25           in addition to the amount otherwise paid under

                           page 512
 1           this part, there also shall be paid to the eligible
 2           professional (or to an employer or facility in the
 3           cases described in clause (A) of section
 4           1842(b)(6)), from the Federal Supplementary
 5           Medical Insurance Trust Fund established
 6           under section 1841 an amount equal to 75 per-
 7           cent of the Secretary's estimate (based on
 8           claims submitted not later than 2 months after
 9           the end of the payment year) of the allowed
10           charges under this part for all such covered
11           professional services furnished by the eligible
12           professional during such year.

                           page 540
 6     “(3) MEANINGFUL      EHR USER.--
 7           “(A) IN    GENERAL.--For purposes of para-
 8     graph (1), an eligible hospital shall be treated
 9     as a meaningful EHR user for a reporting pe-
10     riod for a payment year (or, for purposes of
11     subsection (b)(3)(B)(ix), for a reporting period
12     under such subsection for a fiscal year) if each
13     of the following requirements are met:
14                 “(i) MEANINGFUL  USE OF CERTIFIED
15           EHR TECHNOLOGY.--The       eligible hospital
16           demonstrates to the satisfaction of the Sec-
17           retary, in accordance with subparagraph
18           (C)(i), that during such period the hospital
19           is using certified EHR technology in a
20           meaningful manner.
21                 “(ii) INFORMATION  EXCHANGE.--The
22           eligible hospital demonstrates to the satis-
23           faction of the Secretary, in accordance
24           with subparagraph (C)(i), that during such
25           period such certified EHR technology is

                           page 541
 1           connected in a manner that provides, in
 2           accordance with law and standards appli-
 3           cable to the exchange of information, for
 4           the electronic exchange of health informa-
 5           tion to improve the quality of health care,
 6           such as promoting care coordination.
 7                 “(iii) REPORTING     ON   MEASURES
 8           USING      EHR.--Subject  to subparagraph
 9           (B)(ii) and using such certified EHR tech-
10           nology, the eligible hospital submits infor-
11           mation for such period, in a form and
12           manner specified by the Secretary, on such
13           clinical quality measures and such other
14           measures as selected by the Secretary
15           under subparagraph (B)(i).

"Meaningful EHR users" will be given financial incentives to use the electronic system. If a doctor or hospital is not a "meaningful EHR user", that means only that they're not making use of the electronic medical information infrastructure. It has nothing to do with what treatments they offer. Furthermore, non-"meaningful users" don't face penalties; they just don't have the government helping them pay for the upfront cost of implementing the electronic system.

Next, she claims that the bill creates a department to prevent people from using new medical treatments because they're more expensive:

In his book, Daschle proposed an appointed body with vast powers to make the “tough” decisions elected politicians won’t make. The stimulus bill does that, and calls it the Federal Coordinating Council for Comparative Effectiveness Research (190-192). The goal, Daschle’s book explained, is to slow the development and use of new medications and technologies because they are driving up costs.

Again, the bill:

                           page 190
 7 SEC. 9201. FEDERAL COORDINATING COUNCIL FOR COM-
 8                 PARATIVE EFFECTIVENESS RESEARCH.
 9        (a) ESTABLISHMENT.--There is hereby established a
10 Federal Coordinating Council for Comparative Effective-
11 ness Research (in this section referred to as the “Coun-
12 cil”).
13        (b) PURPOSE; DUTIES.--The Council shall--
14             (1) assist the offices and agencies of the Fed-
15        eral Government, including the Departments of
16        Health and Human Services, Veterans Affairs, and
17        Defense, and other Federal departments or agencies,
18        to coordinate the conduct or support of comparative
19        effectiveness and related health services research;
20        and
21             (2) advise the President and Congress on--
22                  (A) strategies with respect to the infra-
23             structure needs of comparative effectiveness re-
24             search within the Federal Government;

                           page 191
 1                  (B) appropriate organizational expendi-
 2             tures for comparative effectiveness research by
 3             relevant Federal departments and agencies; and
 4                  (C) opportunities to assure optimum co-
 5             ordination of comparative effectiveness and re-
 6             lated health services research conducted or sup-
 7             ported by relevant Federal departments and
 8             agencies, with the goal of reducing duplicative
 9             efforts and encouraging coordinated and com-
10             plementary use of resources.

The supposedly sinister Federal Coordinating Council for Comparative Effectiveness Research seems to be more like the Department of Homeland Security for existing federal health care systems. Programs like Medicaid, veteran's benefits, and federal employee health insurance already make estimations on the effectiveness of various treatments, just like every private health insurance company. The new council would share information across the federal programs that already exist.

Following that, she claims that the bill would change the standards for approved Medicare treatments, implying that fewer treatments will be approved:

Medicare now pays for treatments deemed safe and effective. The stimulus bill would change that and apply a cost- effectiveness standard set by the Federal Council (464).

Page 464 contains references to implementing things specified under section 3004, which describes the process for adopting and implementing the previously-mentioned technology infrastructure. I can find no mention of Medicare. It seems very much like this claim is completely fabricated.

Every complaint that the author raises, everything that she claims will affect what care doctors are willing to give, seems to only concern the healthcare information technology infrastructure that Obama has been talking about implementing for months. I see no places where the government will be dictating anything to doctors, aside from providing financial incentives (not punishments) to work with the new infrastructure. None of the author's claims about the government cutting off healthcare seem at all founded in fact. At best, she's consistently misreading the text of the bill. I think it more likely that she has other reasons not to want the bill to pass and is distorting the reality of the situation to steer people in the direction she wants them to go.

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Phil! Gold