MARK STEYN: THE DOCTOR WON’T SEE YOU NOW
A few years ago, my small local hospital asked a Senate staffer if she could assist them in obtaining federal money for a new building. So she did, expediting the process by which that particular corner of northern New Hampshire was deemed to be “under-served” and thus eligible for the fed gravy. At the ribbon-cutting, she was an honored guest, and they were abundant in their praise. Alas, in the fullness of time, the political pendulum swung, her senator departed the scene, and she was obliged to take a job out of state.
Last summer, she returned to the old neighborhood and thought she’d look for a doctor. The sweet old guy with the tweed jacket in the neatly painted cape on Main Street had taken down his shingle and retired. Most towns in the North Country now have fewer doctors than they did in the 19th century, and the smaller towns have none. The Yellow Pages lists more health insurers than physicians, which would not seem to be an obvious business model. So she wound up going to the health center she’d endowed so lavishly with your tax dollars just a few years earlier.
They gave her the usual form to fill in, full of perceptive inquiries on her medical condition: Do you wear a seat belt? Do you own a gun? How many bisexual men are you now having sex with? These would be interesting questions if one were signing up for eHarmony.com and looking to date gun-owning bisexuals who don’t wear seat belts, but they were not immediately relevant to her medical needs. Nevertheless, she complied with the diktats of the Bureau of Compliance, and had her medical records transferred, and waited . . . and waited. That was August. She has now been informed that she has an appointment with a nurse-practitioner at the end of January. My friend pays $15,000 a year for health insurance. In northern New Hampshire, that and meeting the minimum-entry requirement of bisexual sex partners will get you an appointment with a nurse-practitioner in six months’ time.
Why is it taking so long? Well, because everything in America now takes long, and longer still. But beyond that malign trend are more specific innovations, such as the “Office of the National Coordinator for Health Information Technology,” which slipped through all but unnoticed in Subtitle A Part One Section 3001 of the 2009 Obama stimulus bill. Under the Supreme National Coordinator, the United States government is setting up a national database for everybody’s medical records, so that if a Texan hiker falls off Mount Katahdin after walking the Appalachian Trail, Maine’s first responders will be able to know exactly how many bisexual gun-owners she’s slept with, and afford her the necessary care.
This great medical advance is supposed to be fully implemented by 2014, so the federal government is providing incentives for doctors to comply. Under the EHR Incentive Program, if a physician makes “meaningful use” of electronic health records, he’s eligible for “bonuses” from the feds — a mere $44,000 from Medicare, for example, but up to $63,750 from Medicaid. If you have a practice at 27 Elm Street and you’re treating the elderly widow from 22 Elm Street, she’s unlikely to meet the federally mandated bi-guy requirement, but you can still qualify for bonuses by filing her smoking status with Washington. For medical facilities in upscale suburbs, EHR is costly and time-consuming, and, along with a multitude of other Obamacare regulatory burdens, helping drive doctors to opt out entirely: My comrade Michelle Malkin noted the other day that her own general practitioner has now switched over to “concierge care,” under which all third parties (whether private insurers or government) are dumped and a patient contracts with his doctor solely through his checkbook. Some concierge docs will even make house calls: Everything old is new again! (For as long as the new federal commissars permit it.)
But in the broken-down rural hinterlands, EHR and other novelties make it more lucrative for surviving medical centers to prioritize federal paperwork over patient care. For example, there’s a lot of prescription-drug abuse in this country, and so the feds award “meaningful use” bonuses for providing records that will assist them in determining whether a guy with a prescription for painkillers in New Hampshire also has a prescription for painkillers with another doctor over the Connecticut River in Vermont. So in practice every new patient in this part of the world now undergoes a background check before getting anywhere near a doctor. It doesn’t do much for your health, but it does wonders for an ever more sclerotic bureaucracy.
Hence the decay of so many “medical” appointments into robot-voiced box-checking. At the doctor’s a couple of months back, the nurse was out to lunch, and so the receptionist-practitioner rattled through the form. In the waiting room. “Are you sexually active?” she asked. “You first,” I replied. I hope I didn’t cost her the federal bonus.
But don’t worry, it’s totally secure. Carl Smith Jr. was the first physician in Harlan County, Kentucky to introduce EHR. “Because of this technology,” Dr. Smith says, “we can send the patient’s prescription electronically by secure e-mail to pharmacies.” Wow! “Secure e-mail”: What a concept! It’s a good thing the e-mail is secure at American pharmacies because nothing else is. Last Christmas, while guest-hosting at Fox News in New York, I had a spot of ill health and went to pick up a prescription at Duane Reade on Sixth Avenue. The woman ahead of me was having some difficulties. She was a stylish lady d’un certain age, and she caught my wandering eye. After prolonged consultation with the computer, the “pharmacist” informed her (and the rest of us within earshot) that her insurer had approved her Ortho but denied her Valtrex. I was thinking of asking her for cocktails at the Plaza, when I noticed the other women in line tittering. It seems that Ortho is a birth-control pill, and Valtrex is a herpes medication.
So good luck retaining any meaningful doctor-patient confidentiality in a system in which more people — insurers, employers, government commissars, TSA Obergropinführers, federal incentive-program auditors — will be able to access your medical records than in any other nation on earth.
No foreigner can even understand the American “health care” debate, which seems to any tourist casually surfing the news channels to involve everything but health care. Since the Second World War, government medical systems have taken hold in almost every developed nation, but only in America does the introduction of governmentalized health care impact small-business hiring practices and religious liberty, and require 16,500 new IRS agents and federal bonuses for contributing to a national database of seat-belt wearers. Thus, Big Government American-style: Byzantine, legalistic, whimsical, coercive, heavy on the paperwork, and lacking the one consolation of statism — the great clarifying simplicity of universal mediocrity.
As I wrote a couple weeks ago, Obamacare governmentalizes one-sixth of the U.S. economy — or the equivalent of the entire French economy. No one has ever attempted that before, not even the French. In parts of rural America it will quickly achieve a Platonic perfection: There will be untold legions of regulators, administrators, and IRS collection agents, but not a doctor or nurse in sight.
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