Forging ahead without concern for the very recent Supreme Court hearings, the Obama administration has surreptitiously diverted nearly $500 million of the Department of Health and Human Services' (HHS) $1 billion "implementation fund" to the IRS, which is responsible for over-seeing the individual mandate provision of the new law. This money is only part of the IRS's total planned spending for the implementation phase, and it is being provided outside the normal appropriations process. It appears that HHS intends to spend the entire sum before the presidential elections this fall, and most of it before the Supreme Court renders its verdict in June. Republican lawmakers have thus far been unsuccessful in freezing the slush fund until the Supreme Court rules on the legislation's future.
In addition to spending the pot of implementation monies as quickly as possible, an article published earlier this month in the New York Times revealed some other insights into how the Obama administration plans to mitigate the impact of a potential Supreme Court ruling against the healthcare reform bill. Perhaps in preparation for its defeat, in part or in toto, the "American Board of Internal Medicine Foundation" (ABIM Foundation) came out with new guidelines aimed at decreasing the performance of a number of common tests and procedures. Representatives from the foundation claim that these new recommendations are simply an attempt to curb "unnecessary care and overuse of the system".
The recently published recommendations are part of the ABIM Foundation's "Choosing Wisely" initiative. According to the group's website, this involved, amongst other things, physicians, patients and "other stake-holders" meeting to discuss various responsibilities of the healthcare community in "managing finite resources".
While many of the Foundation's recommendations are rife with complex medical terminology and explanations, even the average layperson can read others and understand the significant philosophical shift that is being suggested.
Here is one example from the recently released guidelines:
"Don't perform Pap smears on women younger than 21."
For decades, the standard of care has been for women to get Pap smears to screen for cervical cancer three years after becoming sexually active or at age 21, whichever came first. Given that many females are sexually active in their mid-teens, this would mean initiating Pap testing at age 18 or 19, or perhaps younger. These traditional guidelines also increased the likelihood that young, sexually active females were being seen by a clinician, screened for sexually transmitted diseases, and receiving counseling. The Foundation's explanation for this new delayed screening recommendation?
"Most observed abnormalities in adolescents regress spontaneously, therefore Pap smears for this age group can lead to unnecessary anxiety, additional testing and cost."
But what about the abnormalities that don't regress and are actually cancerous or precancerous? Sexually active women are at increased risk for cervical cancer, regardless of having reached their 21st birthdays. To suggest that we put a higher priority on "anxiety" and "cost" (the real issue) rather than on early detection is preposterous. And this is from the folks who chastised Republicans for not caring about women's health issues!
Here is an even more frightening new recommendation from the Foundation whose website positions them as focused on "medical professionalism":
"Don't perform routine cancer screening for dialysis patients with limited life expectancies."5
"Due to high mortality among end-stage renal disease (ESRD) patients, routine cancer screening -- including mammography, colonoscopy, prostate-specific antigen (PSA) and Pap smears -- in dialysis patients with limited life expectancy, such as those who are not transplant candidates, is not cost effective and does not improve survival. False-positive tests can cause harm: unnecessary procedures, overtreatment, misdiagnosis and increased stress."
Apparently, the Foundation has determined that most patients who are on dialysis are no longer worth screening for cancer. One assumes that these patients are already costing the system too much, and therefore diagnosing a malignancy in time to treat it would simply prolong their time draining the "finite resources" that the ABIM Foundation has set out to protect.
These are just two of an extensive list of new recommendations, aimed at decreasing a broad range of tests and procedures.
There is no question that unnecessary testing and over-treatment are issues that contribute to the high cost of healthcare in this country. Studies have indicated that as much as one-third of all medical spending in the United States is not medically necessary. What has not been shown, however, is that this overage is a result of physicians attempting to "game the system" to make more money, or because previous medical guidelines have been too lax. Rather, it is "defensive medicine" -- a direct result of serious concerns over medical liability, escalating malpractice awards, and an abject refusal by American trial lawyers to allow critical tort reform. In 2700 pages of new healthcare legislation, any mention of tort reform is glaringly absent.
So what explains the somewhat conspicuous timing of these new recommendations? The "American Board of Internal Medicine Foundation", despite its very official sounding title, is a self-appointed group whose charter is aimed at "advancing medical professionalism".
Just a cursory review of the resumes of the board of the ABIM Foundation reveals some interesting backgrounds. Dr. Christine K. Cassel, president and chief executive officer of the Foundation, is one of 20 scientists chosen by President Obama to serve on the President's Council of Advisors on Science and Technology (PCAST). She is also co-Chair and Physician Leader of a PCAST working group that makes recommendations to the President on issues relating to health information technology.
ABIM Foundation Chairman, Glenn Hackbarth, is a lawyer with no medical training whatsoever. He is also the current Chairman of the Medicare Payment Advisory Commission in the Obama administration.
Coincidence? Not likely.
Speaking of an "unelected group of people", this group has made some rather radical recommendations for rationing healthcare and has slyly tucked them in under the banner of something called "medical professionalism". While it is true that the American Board of Internal Medicine Foundation has no legal authority to set policy, their recommendations certainly hold sway over Medicare, Medicaid and private insurance companies. When panels of medical "experts" make broad sweeping recommendations that physician should eliminate certain tests, treatments and procedures, it becomes more and more likely that payers of all types will refuse to cover those same items. These newly published guidelines are therefore likely to alter treatment standards in hospitals and doctors' offices nationwide. Furthermore, they will remain in place, even if the healthcare reform bill is repealed.
It is this last fact of which Americans need to be most cognizant: the Obama administration has launched an all-out assault to dismantle U.S. healthcare as we know it. The massive Patient Protection and Affordable Care Act is the body of Obama's machine -- But there are tentacles and independent offshoots that can and will proliferate like malignant cancer cells left behind even if the larger tumor is removed.
Should the Supreme Court justices makes the correct decision to over-turn the healthcare reform bill as unconstitutional, we will still need to deal with all of the new IRS agents already hired through the HHS "implementation fund", as well as with these insidious panels of experts who have been working over-time to craft new guidelines clearly aimed at saving money at the cost of human lives. This is truly sinister government; if Obama remains in office, repealing the healthcare reform bill will never be enough.