By Mona Charen
Tuesday, January 15, 2013
Now the other shoe begins to drop. Voters knew in
November that many of the promises Obama made in 2008 had been broken. The
economy had not revived, as he had promised it would (“or we’ll be talking
about a one-term proposition”). He has not “changed the tone in Washington” —
except for the worse. He didn’t prevent lobbyists from holding positions in his
administration. He didn’t cut the deficit in half; he increased it radically.
But voters apparently decided that the president deserved credit for good intentions.
How long will that indulgence last? The next four years,
whatever else they may bring, will tally the results of Obama’s first-term
policies. Some of those will not be felt until 2014, when Obamacare comes fully
online. Others will be subtle, like the depressing effect of Dodd-Frank on
lending. Still others will be obvious — Obama’s “chickens coming home to
roost.”
One of these deserves close attention because it so
perfectly captures what’s wrong with the president’s (and the Democratic
party’s) approach to government.
Remember Mr. Obama’s pet project to improve American
medical care by moving to digital medical records? Candidate Obama talked it up
in 2008, and the newly elected president inserted it into the stimulus bill in
2009. Switching from paper to digital medical records, Obama said, would reduce
the cost and improve the quality of care. It would “cut waste, eliminate red
tape, and reduce the need to repeat expensive medical tests.” Digital records
would also reduce “deadly but preventable medical errors that pervade our
health care system.”
Because Obama thought it would be a good idea, because it
seemed like common sense to him, U.S. taxpayers spent $19 billion to transition
doctors’ offices and hospitals to electronic systems. Doctors and hospitals who
adopt digital systems are eligible for payments from Uncle Sam. Those who fail
to comply will be punished with declining Medicare reimbursements starting in
2015. It’s a coercive, top-down, big-government “solution” in search of a problem.
It might be a good idea to adopt digital medical records.
But the “common sense” way to do it would be through an organic, grassroots
system in which doctors and other health professionals tested systems and
selected those that worked best for the money expended. Only doctors themselves
are in a position to judge whether switching to an electronic system makes them
more or less efficient. Doctors would not spend the money unless they were
confident that such technology would be worth the price.
If the government is paying for it, such calculations fly
out the window. In fact, with the government coercing adoption, bad decisions
are inevitable.
A number of studies and reports are filtering in showing
that government-sponsored digital medical records have not reduced medical
costs. A study in the journal Health Affairs found that offices with digital
medical records were 40 to 70 percent more likely to order diagnostic tests —
thus increasing medical spending. Doctors have also raised privacy concerns.
Patient confidentiality is strictly regulated by the 1996 HIPAA law.
Unauthorized releases could leave physicians vulnerable to lawsuits. But many
of the existing software systems fail to protect confidentiality.
As with so much of government cash, we have no idea
whether the money given to doctors for adopting digital health records will
really be spent on the intended end. HHS has issued a report suggesting that
Medicare officials have failed to verify whether the health professionals who
got the government cash to adopt digital systems have actually used them. None
of the payments has been audited.
The RAND Corporation, which had issued a cheerleading
report in 2005 arguing that the U.S. could save $81 billion a year by adopting
digital records, has issued a new report suggesting that its original estimates
were, ahem, optimistic. “Evidence of significant savings is scant,” reports the
New York Times, “and there is increasing concern that electronic records have
actually added to costs by making it easier to bill more for some services.”
The latest RAND study notes that many of the
electronic-records systems are hard to use and lack interoperability. Anecdotal
evidence suggests that doctors hate them. Like all computer-based systems, they
are vulnerable to crashes. Dr. David Brailer, the health-information czar under
George W. Bush, summed it up well for the Times: “The vast sum of stimulus
money flowing into health information technology created a ‘race to adopt’
mentality — buy the systems today to get government handouts, but figure out
how to make them work tomorrow.”
If then, but taxpayers will never see that $19 billion
again. That’s Democratic leadership — less efficiency at higher prices.
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