The Danger of a New Medical Care 'Bioethics'

The Patient Protection and Affordable Care Act (PPACA, ACA, or "Obamacare"), signed into law March 2011, in the near term creates more than 100 new health care bureaucracies, a large increase in taxes, and new government expenses of $500 billion. Most importantly, however, it will create an incentive and penalty regime for health care institutions and professionals that will compromise traditional professional medical ethics.

Embedded in PPACA is a system of mandates and incentives derivative of guidelines for efficient patient care that means some rationing. An example most often raising objections in the public discussion of PPACA is the Patient Centered Outcomes Research Institute, a part of the bill intended to address "end of life" resource utilization, but other entities created by the PPACA, such as the Independent Payment Advisory Board (IPAB), will promote care guidelines intended to reduce resource utilization or withhold care for patients based on guidelines composed for promoting resource efficiency.

The basis for the claims that Medicare costs will be reduced by hundreds of billions for the next decade is driven by the research of Jack Wennberg, M.D. of Dartmouth called the "Small Areas Analysis" that compares medical care in different parts of America to identify the least expensive practice patterns.

PPACA introduces a heavy emphasis on social engineering and state-imposed patterns for care and resource utilization. The major casualty will be the quality of the individual patient-physician relationship -- physicians will be incentivized and provided guidance and asked to become agents of a monolithic, centrally directed health care system to produce efficiencies in medical resource utilization -- that some would translate such developments as rationing...

To see how health care will be administered all one has to do is spend some time at a regional airport watching TSA workers. Many times I note during the early morning rush at my local airport only 2 of 4 lines will be open while a huge line forms. As I pass through the X-ray area there will be enough extra TSA workers standing around talking to staff another line. Plus if the door opens to the office off to the side there seem to be 5 to 6 unifiormed “workers” hanging out talking and eating donuts.

For some reason when I go on a late morning flight, when the airport is not busy, there will be 3 or 4 screening lines open and fully staffed. The screener will be bored, listless, and barely paying attention to what they are doing.

We will see the same bloated bureaucracy with make work jobs for a disproportionately minority worker population in health care. The employee unions will demand extraordinary pay and benefits for the workers. The cost of the bureaucracy will be covered by reducing care. Without competition, the will be none of the promised efficiency and productivity gains. Layering the new bureaucracies on top of the bureaucracies of the private health insurers will add tremendous cost to the total system which a shrinking economy cannot sustain. The obvious answer for our politicians, once the federal bureaucracies are fully staffed, will be getting savings by going to a government administered single payer system like the “highly successful” government run student loan program. Of course once the private insurers are gone the bureaucrats will demand thousands of new workers to handle the unanticipated workload.

The fix is in. Boehner and the Republican House have done nothing to roll back Obamacare despite the majority of the people wanting it ended. After the 2012 election it will be too late. A President Romney or President Gingrich will only tinker with Obamacare. If Obama is reelected he’ll accelerate it’s implementation. Even if the Republicans control both the House and Senate it is clear neither Boehner nor McConnell have the backbone for the nasty fight required to repeal Obamacare.

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