By  Richard  Amerling, MD

Barack Obama’s recess appointment of Dr. Donald Berwick as head of the Center for Medicare and Medicaid Services (CMS) marks a new low in his destructive presidency, and that is saying something!

After forcing the Orwellian Patient Protection and Affordable Care Act (PPACA) onto an unwilling populace and through a reluctant Congress, he installs an elitist who admits to being “in love” with Britain’s National Health Service into a position of incredible power without so much as a hearing.

This is an affront to the American people, and to Constitutional government.  It also completely confirms our predictions regarding the true nature of ObamaCare.  It will be modeled after the NHS with rigid budgets, income redistribution, command-and-control structure, “death panels” (The National Institute for Clinical Excellence, or NICE), and a weighty bureaucracy.  Ironically, this comes at a time when the British are struggling with the bureaucratic morass of the NHS authority.  

How does Dr. Berwick hope to control the billions of decisions made by practicing physicians every day?  Daniel Henninger, in his Wonder Land column, has some revealing, and frightening, quotations:

"The unaided human mind, and the acts of the individual, cannot assure excellence. Health care is a system, and its performance is a systemic property."

"I would place a commitment to excellence—standardization to the best-known method—above clinician autonomy as a rule for care."

"Young doctors and nurses should emerge from training understanding the values of standardization and the risks of too great an emphasis on individual autonomy."

The mechanisms for this are already in place.  A central board, our version of the NICE, was already legislated into existence by the stimulus bill.  Payment-for-performance (P4P) is already being used in certain areas to enforce compliance with clinical practice guidelines.  Language in PPACA gives the secretary of Health and Human Services (which oversees CMS) authority to bar from participation doctors who do not comply with certain quality standards, i.e. conform to guidelines. 

Physicians are currently being bribed by CMS to purchase electronic health records, which will be used to insert algorithms to “guide” the physician to the “correct” plan of care.  Where do practice guidelines come from?

Practice guidelines are a recent fad and have proliferated to cover virtually all areas of medicine.   They are funded either by government, insurance and pharmaceutical cartels, or medical organizations such as the American Medical Association.  While billed as “evidence-based,” for the most part they are consensus opinions of a panel of “experts.”  These experts invariably have extensive financial ties to industry.   This may explain why practice guidelines are almost always biased towards greater levels of drug treatment targeting ever-wider patient populations.

Guidelines are sluggishly produced and often superseded by new information when finally published.  As an example, tight control of blood sugar has been pushed by guidelines for Type II diabetes for years.  Four studies published in 2008 showed either no benefit or increased death rates with this approach.  Guidelines discourage innovative thinking and encourage the “one-size-fits-all” approach so loved by Dr. Berwick.  If practice guidelines were in existence in the 18th century, bloodletting might still be the standard of care!

The problem with trying to implement guidelines as public policy is that we are all unique individuals and individual differences really do matter.  Only a personal physician has the local knowledge of the patient that permits tailoring of treatment for maximum benefit at lowest risk.  

Central control of medical care, which is the predictable endpoint of centralized payment for care, will wreak havoc on the medical profession and harm thousands, if not millions, of patients.  Since PPACA effectively nationalizes the private health insurance industry, the Berwick appointment affects everyone.

Patients need to seize control of their medical destinies by setting up Health Savings Accounts and paying for their medical care themselves.  Seniors should strongly consider opting out of Medicare Part B. For doctors, it has never been more urgent to sign the Physicians’ Declaration of Independence and sever third party relationships.  The future of an independent medical profession is at stake.

 Richard Amerling, MD, is a nephrologist practicing in New York City.  He is an Associate Professor of at Albert Einstein College of Medicine in New York, and the Director of Outpatient Dialysis at the Beth Israel Medical Center.  Dr. Amerling studied medicine at the Catholic University of Louvain in Belgium, graduating cum laude in 1981.  He completed a medical residency at the New York Hospital Queens and a nephrology fellowship at the Hospital of the University of Pennsylvania.  He has written and lectured extensively on health care issues and is a Director of the Association of American Physicians and Surgeons. Dr. Amerling is the author of the Physicians’ Declaration of Independence (http://www.aapsonline.org/medicare/doi.htm).