Navigation Links Gets It Wrong on Stimulus Package

NEW YORK, Feb. 23 /PRNewswire-USNewswire/ -- The following is a statement from Betsy McCaughey, Ph.D., Chairman/Founder of Committee to Reduce Infection Deaths:

Americans need to know how the health provisions hidden in the recently enacted stimulus package will affect them. To inform the public about these provisions and the dangers, especially for seniors, I wrote an analysis for on February 10th. Lori Robertson, an employee of, challenged the accuracy of my analysis in her February 20 critique posted on Readers of Robertson's critique should consider these facts.

Robertson begins by portraying me as a Republican politician out to score partisan points. I am a Democrat and a patient advocate leading a national campaign to prevent hospital infections.

Robertson also states that I am not a journalist and therefore lack the qualifications to analyze the stimulus package. In fact, I am a widely published author who has won three prestigious journalism prizes, including a National Magazine Award, an H.L. Mencken Award, and the 2003 Media Award from the American Association of Anesthesiologists. In addition, I earned a Ph.D. in constitutional history from Columbia University, wrote two books on the U.S. Constitution, and served as Lt. Governor of a large state. What are Robertson's credentials to analyze this legislative document? She holds a B. A. in advertising.

Robertson interviewed me by telephone and writes that "throughout our conversation McCaughey spoke of an 'unprecedented' award of authority to the secretary (of Health and Human Services). That's a matter of opinion on which we won't weigh in."

But that is the most important issue. And it's a matter of fact, not opinion. How much power is given to the HHS Secretary over your health care, and what choices are left to you and your doctor?

The goals of the National Coordinator for Health Information Technology are to ensure that "all individuals in the United States" have their medical treatments entered into an electronic database and to guide physicians "at the time and place of care" so as to reduce costs and eliminate "inappropriate care".

Are these guidelines voluntary? Hardly. Physicians and hospitals that fail to meet the HHS Secretary's standard of "meaningful use" will be subject to financial penalties from Medicare. How much leeway will there be to use experimental treatments and off label drugs? Will doctors be able to meet the needs of the atypical patient or provide more care than the guidelines recommend? It's hard to say, because the HHS Secretary is empowered to determine what "meaningful use" means and to make the definition more "stringent" over time.

"Perhaps so," writes Robertson. "But the fact remains that the law does not impose any federal treatment guidelines or require the government to do so." Robertson concedes that "perhaps" such interference with the doctor-patient relationship "will indeed come to pass some time in the future. Who knows?" she says. "But the law doesn't require it."

Require it? No. Allow it to happen? Absolutely. The point of analyzing legislation is to understand what could happen once the law is passed. In this case, there is a transfer of power from patient to government. Robertson fails to address that.

In the early 1990s, HMOs used a financial penalty called a "withhold." HMOs would withhold as much as 10% of a physicians' reimbursement until the end of the year and give it back only to physicians who met stringent targets for limiting how many diagnostic tests, referrals to specialists, and days in the hospital their patients got. What a doctor ordered for a patient came out of the doctor's own pocket. Patient advocates like me acted quickly to demand that the withhold be outlawed. Now the HHS Secretary would be permitted to do virtually the same thing by withholding Medicare reimbursements.

Robertson also concludes that the creation of a Federal Council on Comparative Effectiveness Research should not alarm seniors. Comparative effectiveness is code for limiting care based on a patient's birth date. Treatments for the elderly, who have fewer years to benefit, are likely to be deemed too costly. This is already happening in England and several European countries. Numerous recent articles in Health Affairs, the inside-the beltway manual for health policy makers, describe comparative effectiveness research as the tool to reduce Medicare spending.

U.S. Senators were so concerned about the meaning of comparative effectiveness that the Senate version of the stimulus replaced that term with "clinical effectiveness". However, the change was overturned when House and Senate conferred on a final version. Representative Charles Boustany Jr. from Louisiana, a heart surgeon, told The New York Times he feared the research would be used to "deny life-saving treatment to seniors and disabled people."

Finally, Robertson fails to explain why these health provisions were slipped into a stimulus package with no expert testimony and no opportunity for input by patient advocates, seniors, or physicians' groups. If these provisions are so good for patients, why avoid public scrutiny and debate? Secretary of HHS nominee Tom Daschle advised the president to do just that, even if it meant "attaching a health plan to the federal budget."

Americans should demand that these health provisions be repealed and offered as separate legislation so their impact can be further assessed.

Betsy McCaughey, Ph.D., is Chairman/Founder of Committee to Reduce Infection Deaths and former Lt. Governor of New York State.

SOURCE Betsy McCaughey
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