Fans of Obamacare decry “the death panel” panic as idiocy; critics insist it is inevitable.
I say the model for it is already in operation, silently, and beneath scrutiny. It will be the unfortunate death that informs us.
Friday at 5 pm I was called for an old man who had been hospitalized since early May. He had had an acute MI, and a difficult CABG (coronary artery bypass graft) and a series of medical misadventures. Now he was in renal failure, on dialysis, multiple organs were failing, and he was bleeding from every pore and needle stick, and anemic.
Astute clinician that I am, I elaborate a set of diagnoses, start an empiric therapy (plasmaharesis) and he stabilized. As labs return I am more and more convinced that he has a rare disorder, and by Monday, I am sure of it. He requires a unique medicine, FDA approved for this purpose, once a week: it is life-saving and (the company insists) may be life-long treatment (I happen to disagree.) Oh, btw, the drug company will charge $150,000 retail per year for the drug alone.
I am told by the hospital pharmacy that it is “off-formulary” and I will have to fill out paper work. I do so: this is an FDA=approved medicine for an FDA-approved indication. MediCare patients cannot be denied safe and effective therapy. I am told however, that I am overruled: the medicine is expensive and is “only available as an outpatient infusion.” This is not so; it should be available in any venue, and unless he gets this medicine, he will not survive to be an outpatient. “No,” I am told, and i demand to speak to the supervisor, an unnamed–and apparently ineffable–“ChargeMaster,” who won’t be available anyway for a week. I have to speak to the Chief Hospital Administrator.
Next: I speak to the Drug Company. They are forbidden by the FDA and regulation to speak about MediCare, but the inferred revelation is this: MediCare pays the hospital for a patient’s care by his “DRG” (diagnosis-related group). THe patient has exceeded his payment for heart attack DRG by over $1 million.
So…the hospital wants me to continue ineffective therapy for $10,000 per day rather than give a curative therapy for $8000 per week.
And…they send in the “palliative care specialists” to convince the family to let him die a peaceful death. The patient, incidentally, is mentally clear, can make his own choices, and can converse with me in 3 of of his seven languages (I do not know American sign language or Hungarian.)
Short story: no one will know that a curative expensive medicine is withheld from the elderly because of hospital budgeting policy, in defiance of human rights. The tracks are hidden.
Now: flash forward to Obamacare. A central feature of this mess will be something called the ACO (Accountable Care Organization) or the “Medical Home.” The Orwellian name is designed to funnel money through insurance companies to the ACO (which will inevitably be dominated by the hospitals, which will decide who gets paid for what.) The ACO will have all sorts of regulations and policies.
Can we expect Obamacare to more responsive to the dependent individual in acute need, or to budgeting constraints? There will not be the “death panel” as envisioned by Sarah Palin, but there already is a model in place: the silent euthanasia by regulation.