Remember when Sen. Nancy Pelosi said they had to sign the healthcare bill to know what was in it? Well it has come to light, and some people are troubled by what it reveals.

Dr. Donalid Condit says it’s a big document loaded with sugar-coated rhetoric covering a bitter pill to swallow.

This ObamaCare prescription  threatens patients, the physicians who care for them, and the common good. The only clear winners are the consultants and lawyers busy trying to decipher this 429-page tome of acronyms and encrypted methodology that will compromise the doctor-patient relationship and is contrary to the principle of subsidiarity.

Very good point.

Medicare beneficiaries will be “assigned” to 5,000 patient-minimum organizations to coordinate their care. While HHS Secretary Kathleen Sebelius talks about improvement in care, the politically poisonous truth is that Medicare is going broke and ACOs are designed to save money. The words “rationing” or “treatment denial” or “withholding care” are not part of her press release, but reading the regulations reveals intentions to “share savings” with those who fulfill, or “penalize” others who fall short of, the administration’s objectives. The administration’s talking points include politically palatable words which emphasize quality improvement and care enhancement when the real objective is cost control by a utilitarian calculus.

Physicians and other health care providers will find themselves in conflict with the traditional ethos of duty to patient within ACOs.

Somebody has to point this out. The moral medicine we have taken for granted, that’s now under new threat.

Ever increasing numbers of doctors are leaving private practice and becoming employed by hospitals, due to a variety of challenges inherent in these uncertain times . The hospitals are the most likely recipient of bundled payments for caring for Medicare patients. Doctors will face agency conflicts between the time honored primary duty to patient, which may conflict with hospital administration, and ACO goals of fiscal savings. Medical care providers will receive incentives for controlling spending, and penalties if they do not. “No one can serve two masters” (Matthew 6:24). Not even physicians.

The physician’s ACO conundrum is illustrated in the language where these regulations proclaim that,  “Providers should be accountable for the cost of care, and be rewarded for reducing unnecessary expenditures and be responsible for excess expenditures.”

This is chilling.

Yet the very next sentence stipulates that, “In reducing excess expenditures, providers should continually improve the quality of care they deliver and must honor their commitment to do no harm to beneficiaries.” (page 14)

Doublespeak? Where is this leading?

The principle of subsidiarity guides policy makers to empower decision making and scarce health care resource allocation at the doctor-patient level. However, the Affordable Care Act moves in the opposite direction.

There is no question that significant – and scarce — health care resources are consumed in the Medicare population toward the end of life. ACOs intend to limit this spending — the government way. The Ethical and Religious Directives by the United States Conference of Catholic Bishops suggest a better path forward…