For a glimpse into what the future holds under Obamacare, one might not need to look any further than the nation of Hungary, where diabetics who don’t adhere to government decreed treatment plans will not have the more modern treatments offered them. According to the article:
“Diabetics undergo a blood test on average every three months and those who score high levels of glycemia more than twice a year could be turned away from treatments with analog insulin -- more efficient but also more expensive -- and left with the less efficient human insulin, under the new rules.”
This is enough to drive the Mad Hungarian even madder.
Why does this matter? A number of reasons come to mind. To wit, from the article:
“Currently, all diabetes treatments are subsidized by the state, which hopes to reduce health spending with the new rules.”
When the government pays the bills, they will make the rules. This appears to be the harbinger of things to come when the U.S. government recommends the use of clinical guidelines; guidelines that initially will be held out as suggestions or best practices, but will eventually held as strict mandates that will preclude the use of clinical judgment in the instance of recalcitrant cases. Guidelines may work for a certain percentage in the middle of the bell curve, but woe to the doctor and the patient on either end of that curve. I predict physicians will eventually find themselves sanctioned or financially penalized if they stray from these mandates. An interesting blog post here from the esteemed DrRich emphasizes this point. As the story from Hungary shows, the patients as well will be punished for non-compliance, at times for circumstances beyond their control.
At the end of the day, what I fear will happen is that patients will be herded into a style of medicine that is completely beholden to what is most cost-effective for society, and not necessarily what is best for them. Physicians will be more akin to robots on an assembly line and will provide a cookbook approach towards their clients (can’t really call them patients anymore). This approach will be so unappealing to the current cohort of physicians that they will opt out and leave the field of primary care to the nurse practitioner set that is being trained under the guideline-centric ethic of the medical care of the future.
With this as the underlying trend in healthcare, is the Hungary experience a realistic expectation of what is to come?
My Magic 8 Ball says: “As I see it, yes”.