by Robert Weinmann, M.D

Nothing quite reveals the laughable duplicity of Congressional venality as their collection of tithes. The latest saga is already being called the second Louisiana Purchase. United States history buffs know that the first Louisiana Purchase was made in 1803 when Napoleon sold Louisiana to the USA for just under $20 million. The purchase included the entire Mississippi Valley from the Gulf of Mexico to Canada and from the Mississippi to the Rocky Mountains — the price was about three cents per acre.

Now comes Senator Mary Landrieu (D-LA) who — thanks to the $100 million dollars for Louisiana included in the recently passed health care bill — found it possible in her heart to vote to start debate on the Senate health care bill. The pirates of managed care came up short to Landrieu’s shrewd maneuvering and agile ability to fight for her state. She put the puffed-up suits and their private jets in their place. Political pundits are already guffawing about Landrieu’s assertion that although she accepted the $100 million tithe for her state, that did not mean she would vote for passage of the final bill. It turns out that Landrieu has reservations about the public option. But when push comes to shove, we’ll see what Landrieu does should a second cash payout be offered to Louisiana.

In the meantime, rather than addressing the concerns of the Landrieus on Capitol Hill, Congress seems perfectly content paying them. Congress has continued to ignore the same actual health care options that they blithely ignored in previous legislation discussed in these pages (“Congress should be sued for malpractice over alleged ‘death panels,’” HCJNC, Sept./Oct. 2009). Congressional concern is far more directed to redistributing power than it is to dispensing health care.
Rationing of health care and the tricky ways in which it can be slipped into law is still a flash-point, even though President Obama assured us, “I will ensure that no government bureaucrat gets between you and the care you need.” Nevertheless, page 30 of HR 3200 announced a “private-public advisory committee” to “recommend” treatment options for the rest of us.

President Obama supported HR 3200 inclusive of this “committee” to “recommend” allowable treatment options. Speaking for myself, I want my own doctors to decide on my treatment, not bureaucrats in Washington. While my wish in this regard is consistent with what President Obama said, it is not consistent with the bill President Obama supported (HR 3200) or with the bill he currently supports (HR 3962).

Section 223 of HR 3962 sets up a Health Benefits Advisory Committee to be chaired by the Surgeon General with private members appointed by the President, the Comptroller General and representatives of federal agencies. This committee’s job is to recommend to the Secretary of Health and Human Services details of covered health benefits in Section 222, which outlines the broad categories and proposed three tiers of benefits (basic, enhanced and premium).

It turns out that Sec. 223 of HR 3962 also announces “a private-public advisory committee which shall be a panel of medical and other experts to be known as the Health Benefits Advisory Committee to recommend covered benefits and essential, enhanced, and premium plans.” Pages 111 to 114 say that the appointees to this committee will include “nine members … appointed by the President.” There will also be “nine members … appointed by the Comptroller General,” and, per page 113, “at least one practicing physician or other health professional.”

So, Doc, how d’ya like them apples? There is no mandate, no mandate at all, that any of the appointees shall be a practicing physician. The bill does not contain language to implement President Obama’s promise that “no government bureaucrat gets in the way of the care that you need.”

What doctors need to decide upon is to what extent broad parameters of public policy should be allowed to influence or ration direct care to patients. We have recently seen how insurance companies and government alike seized upon the recent mammogram controversy to delay, deny, and, some would say, ration care.

A neatly camouflaged first step toward real rationing in the Senate bill includes a new 5 percent tax on cosmetic surgery and procedures. What one person may think is “cosmetic” may be life-changing to others. We will learn to expect specially appointed government committees to expand the list of what’s called “cosmetic” and to enlarge the list of “procedures” to which the application will apply. It’ll be “rationing” by another name with the same sock-it-to-the-patient mentality.

Mr. Sucker, do you want your carpal tunnel done with a “cosmetic” or “non-cosmetic scar?” How about you, Mrs. Fleeced, do you want your mastectomy done with a “cosmetic” or “non-cosmetic” scar?

Doctors do not need to dump the Hippocratic Oath on the heap of Silicon Valley obsolescence. While some doctors may be willing to shut up and sell out, the profession as a whole should engage the battle for control of medical care head on. Doctors should realize that the time is propitious for physicians and their patients to fight to regain control of medical care.

Otherwise we should prepare to buy Louisiana a third time.

Robert Weinmann, M.D, maintains a private neurology practice in San Jose. Though he is a past president of the Union of American Physicians and Dentists (UAPD), and is affiliated with AFSCME, AFL-CIO, the views stated in this Op-Ed are the author’s own and do not reflect the views of any organization or political party. Weinmann states he is happily bipartisan on health care issues.