Who Gets to Decide?

As the regulations and statutes that will define the nature and shape of our reformed healthcare system are fleshed out and take effect, new evidence continues to emerge that our legislators may have burdened patients and physicians with a raft of new laws and requirements that could do lasting damage to both parties. Far from promoting greater healthcare access and improved care, these changes may instead end up denying patients' freedom of choice, degrading physicians' clinical decision-making authority, and disrupting the trusted physician-patient relationship.

One of the most troubling developments has been the realization that the new laws may prevent us from transitioning to a consumer-driven healthcare model, one of the most effective means of controlling costs and increasing the use of preventive healthcare services -- two goals that were allegedly centerpieces of reform.

Kathryn Nix, in a recent post for the Heritage Foundation blog The Foundry, noted that "lack of transparency in pricing is only part of the problem driving soaring health care spending." The bigger problem, she said, "is that patients are completely disconnected from the cost of their medical bills because of the growing role of third-party payers." True, but while private insurers and third-party payers play a large role in the distortion of incentives when it comes to healthcare utilization in this country, it is the government -- in the form of Medicare and Medicaid -- that has the most to answer for.

Consumer-driven healthcare is the solution that is often proposed for this lack of price transparency, healthcare overutilization, and the third-party constraints placed on physicians' and patients' power to make healthcare decisions. A truly consumer-driven healthcare system would:

• Remove governmental and corporate bureaucratic interference;

• Replace market distortions, inefficiencies, and price controls with payment models (such as health savings accounts, or HSAs) that enable patients to make rational, informed treatment choices; and

• Restore physicians and patients to their rightful places as primary decision makers in the care process.

To me, that last point is the key to consumer-driven healthcare's appeal -- not only for patients, but physicians as well. Indeed, it can also properly be referred to as "physician-driven healthcare," for it seeks to empower physicians just as much as it does patients.

Will "Obamacare" and the expanded role in healthcare it seeks for government stifle the drive toward consumer-driven healthcare? The signs are not good. John Goodman, president and CEO of the National Center for Policy Analysis, has noted that although the new healthcare law does not excessively limit the use of HSAs and other consumer-driven approaches, it does "place new limits on how people can spend their HSA dollars and increase penalties for non-government approved purchases.” He adds that it also “opens the door to death by regulation" and gives the Secretary of Health and Human Services the authority to effectively outlaw the one form of consumer-driven care shown to lower healthcare costs and promote the use of preventive services.

As I mentioned before, this is isn't just about your patients and the ways that they pay for your services. This statutory curb on healthcare choices has implications that go far beyond dollars and "cost curves." It highlights the fundamental disagreement between those who think that well-intentioned elites should make these kinds of healthcare decisions, and those who trust that physicians and their patients are the best arbiters of their health, and should be given every opportunity to exercise that freedom to decide. I know which side I'm on.

Thank you for reading.