Mandating mediocre medicine.

• Author: Emord, Jonathan W.
• Position: Medicine & Health

THE CURRENTLY beleaguered system for the provision of medical care in the U.S. is going to get much worse. Within a decade, we will witness the destruction of quality in every area of medical practice. ObamaCare will provide everyone with a one-size-fits-all set of options, leaving many to wait long periods or be denied access to needed care.

Medical practice depends on innovation, at the physician level and above. Disease has a funny way of morphing and new diseases have a peculiar way of cropping up year after year. To perform well in this changing landscape requires instantaneous adaptation and the tailoring of care. To the extent that care becomes more routine--void of exceptionalism and innovation by physicians--disease prevails and the quality of care diminishes.

For decades before the passage of the Patient Protection and Affordable Care Act--with many of its major provisions kicking in next year--Americans across the nation complained bitterly about the fact that health insurance plans denied them coverage for what they and their doctors deemed necessary treatments. The essential problem arose from insurance industry control over the practice of medicine, a system of distant second-guessing of the attending physician's judgment.

To be reimbursed for care of the insured, physicians have had to toe the line with insurance agents and avoid providing any level, degree, or quality of care that the insurer deems exceptional or unnecessary. Insurers rely on profiling of patients and medical practices to come up with routine standards of care. When a physician deviates from a standard, he or she risks being audited and required to reimburse the insurance company for all monies paid by the company to the physician. That sometimes lethal threat to a medical practice keeps physicians in check and risk managers employed at an enormous cost.

With ObamaCare, that already bad, even horrific system becomes far worse. The present system of government sponsored medical care is Medicare, in which participating physicians must live within bureaucratically defined limits to the provision of care. A physician must make sure that he or she chooses the right code to define the care given a patient and, if a code does not exist for what he or she wants to do, the doctor is best put at avoiding the provision of that care. Private insurance companies selected by the Center for Medicare and Medicaid Services are regional Medicare providers under contract with...