When less is more…more or less

Last summer, I introduced you to Dr. Bernard Lown’s concept of “Avoidable Care.” Dr. Lown said that using every drug and technology ever developed, at every opportunity, harms patients. It also creates excessive and avoidable costs. And it defies patient preferences.

The American Board of Internal Medicine’s new “Choosing Wisely” program takes Dr. Lown’s concept one step further. The program tells you about medical tests and procedures that you should skip. This will help you avoid unnecessary costs. And also help you avoid medical complications.

The Choosing Wisely program says that care should be “supported by evidence, not duplicative of other tests or procedures already received, free from harm to patient, and truly necessary.”

Thankfully, some experts are finally learning that more is not always better.

And patients are catching on too. As patients, we can and we must make choices about our health. Ideally, we make choices for ourselves. Unfortunately, that’s all about to change, as I’ll explain in a moment.

But in the meantime, you still have choices when it comes to your health.

Take your colon health, for example.

Let’s say you are 50 years old. Your doctor recommends that you get your first colonoscopy. Thankfully, the test doesn’t turn up any polyps and everything looks normal. But the gastroenterologist says you need to come back in five years, just to be safe.

Feel free to ignore his advice!

The Choosing Wisely program says after a normal screening, you don’t need to repeat a colonoscopy for another 10 years. This avoids the unnecessary risk of perforated intestines and other complications.

Now, what should you do if you’re 65 years old and that test comes back normal? Do you need another one when you’re 75? The answers aren’t always as clear as they first seem, as I discussed a few weeks ago.

Now, let’s talk about tests for osteoporosis. The Choosing Wisely program recommends you don’t get DEXA (dual-energy x-ray absorptiometry) if you’re a woman younger than 65 years. Or if you’re a man younger than 70, with no risk factors.

Again, this avoids unnecessary costs that don’t return benefits. Now, if they find you have osteoporosis, you will face a greater dilemma. Should you follow Sally Fields’ advice and take a disastrous osteoporosis drug? Or are there other options?

The Choosing Wisely program says we must consider the harm as well as the benefits when considering a medical procedure. The immediate cost versus the long-term savings. And the patient preferences versus the doctors’ orders.

This is sound and well-intentioned advice.

But the looming behemoth of the Affordable Care Act will likely put a stop to it all. It will set aside patient preferences. It will set aside physician judgments. And it will set aside a lot of truly beneficial care.

Instead, beginning in January 2014, we will face health care rationing.

As the government gets more and more involved in healthcare, decisions won’t be made by doctors and patients trying to “choose wisely.”

Instead, government bureaucrats will make our healthcare decisions, based on what is “affordable.”

Oh, you say mammograms are cheap. Okay, let’s give them to women starting at age 30. (Despite the fact that they will turn up more false positives. With very few benefits. And cause a lot of unnecessary stress and worry.)

But oh, you say colonoscopies are expensive. Okay, men and women don’t get one until they’re 65. (By which point, they won’t be useful anymore.)

I call this “one-size-fits-all” medicine. It will reduce payments to providers. And withhold care from patients.

Yet amazingly, everyone will be required to pay for insurance to cover “routine” care, whether they want it or not. And now, whether they actually get it or not. In fact, insurance companies will routinely withhold more and more of that “routine” care. And/or coverage for it will be greatly reduced.

This kind of situation has been referred to as “Kafkaesque,” after the eastern European author of a century ago, Franz Kafka. He wrote about surreal bureaucratic circumstances that don’t make sense. In Kafka stories, it’s as if you keep trying to wake up from a bad dream–except you never wake up.

When America wakes up to the nightmare of Obamacare, they will learn that the government bureaucrats now make their health care decisions. Gone are the days when we could “choose wisely” for ourselves. Or with our doctors.

Instead, new legions of bureaucrats will regulate what is provided to whom. And what is covered or not covered.

All the while, more government thugs will impose ever more penalties and fines on Americans who choose not to play by the government’s rules and refuse to carry health care insurance.

Obamacare advocates like to say it’s our “basic right” to have health care. Yet they ignore our real right to freedom of choice.

Leave it to the government to turn “More is Less” into simply…less.

“Paging Dr. Kafka. Dr. Franz Kafka…please pick up. Or on second thought, don’t.”


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