One doctor's story: Government endangering patients' lives, right in the middle of surgery

I return to this principle often, and just as often I hear from people who find it to be the most outlandish thing they have ever heard. But it's true: When someone else is paying for the things you need, you are in trouble.

That is especially true in health care, where both patients and doctors find a decision-making process that is complicated enough in sheer medical terms becoming all the more convoluted as they try to deal with the government's insane tapestry of rules about what Medicaid will pay for, and under what circumstances. In today's Wall Street Journal, pediatrician Zane F. Pollard recounts his recent experiences with having to choose between the well-being of patients and the arcane rules of the government:

---

In my pediatric ophthalmology practice, I have experienced firsthand how government limits a doctor's options and threatens the traditional doctor-patient bond. I recently operated on a child with strabismus (crossed eyes). This child was covered by Medicaid. I was required to obtain surgical pre-authorization using a Current Procedural Terminology, or CPT, code for medical identification and billing purposes. The CPT code identified the particular procedure to be performed. Medicaid approved my surgical plan, and the surgery was scheduled. During the surgery, I discovered the need to change my plan to accommodate findings resulting from a previous surgery by another physician. Armed with new information, I chose to operate on different muscles from the ones noted on the pre-approved plan. The revised surgery was successful, and the patient obtained straight eyes. However, because I filed for payment using the different CPT code for the surgery I actually performed, Medicaid was not willing to adjust its protocol. The government denied all payment. Ironically, the code-listed payment for the procedure I ultimately performed was an amount 40% less than the amount approved for the initially authorized surgery. For over a year, I challenged Medicaid about its decision to deny payment. I wrote numerous letters and spoke to many Medicaid employees explaining the predicament. Eventually I gave up fighting what had obviously become a losing battle. Every surgeon must have the option to modify and change a surgical plan according to actual anatomical findings that only become apparent during surgery. For example, if a general surgeon operates on a patient with a suspected acute appendicitis and finds that the patient is actually suffering from an ovarian cyst, that doctor must be free to change the plan and do what is best for the patient. The physician should not be denied payment simply because of a rigid government requirement to follow only the pre-approved plan.

This is the perfect encapsulation of why government involvement in just about anything inevitably leads to poorer results. A physician performing surgery has to be able to think on his feet and react, sometimes at a moment's notice, to what he discovers. If you can't do that, the patient's very life may be in jeopardy. Government doesn't work that way. Government insists that you follow pre-fabricated parameters and structures, obtain prior approval, fill out Form B and submit your requisition to Office Z. Of course, a dedicated physician is not going to let a patient die because of concern over reimbursement. But if physicians are constantly having to make such choices, what do you think that's going to do to the cost of health care overall? They're going to have no choice but to raise their prices on everyone to cover their losses in the inevitable cases in which they have to choose between getting paid and saving a patient's life. And by the way, I would not assume that every physician is as committed as Dr. Pollard to doing right by the patient in every situation, even if it means operating for free and/or spending a year or more wrestling with paper-pushing government bureaucrats over reimbursement. When Sarah Palin talked about death panels, she was talking about situations in which the people who control the purse strings decide money simply is not going to be spent on certain things, and that leaves physicians little choice in the matter. This is a classic example. No, it's not some board of elders sitting high atop a dais pronouncing your death sentence. It was never going to work that way, and Palin never said it would. Rather, it's some rule-making bureaucrat complicating the decision-making process of a doctor, and forcing that doctor to choose between his own economic best interests and the life of a patient. And that's just Medicaid in its current form. The more the purveyors of ObamaCare try to manipulate the workings of the system, the more of this we will see. It's inevitable. And yes, people will die, if only because they can't find surgeons willing to take the risk. When economic relationships are primarily between patients and their doctors, with insurers as a fallback and the government out of the picture entirely, doctors can make the decisions they need to act in the best interests of their patients, without having to be conflicted in the way Dr. Pollard described here. But that is not the way things work under Medicaid or under ObamaCare, and it is only going to get worse.