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OPINION: Should patients have the right to decide when, where and how much health care to receive? Not according to Hillary Clinton, warns California physician Dr. Linda Halderman.

Are American patients, with the guidance of their doctors, capable of making their own healthcare decisions?

This insulting question has no place in the national healthcare reform debate. But Senator Hillary Clinton’s newly released healthcare plan suggests that she considers this question relevant…and believes the answer to be “NO.”

Senator Clinton’s perspective is clear in the declaration she made at George Washington University on May 24, 2007:

“There is a moral imperative to extend coverage to all Americans….There are three parts to my approach. First, lowering costs for everyone. Second, improving quality for everyone. Third, insuring everyone.”

The way Senator Clinton seeks to achieve these goals, outlined in her 14 page, “7-step strategy,” reveals her belief that patients and their doctors are less qualified to make healthcare decisions for themselves and their families than the U.S. government.

Under her plan, you will be required to pay for screening and vaccinations whether you like it or not. Under Senator Clinton’s plan, all insurers participating in Medicare, Medicaid or the Federal Employee’s Health Benefit Plan would be forced to cover “high-priority preventive services.” On its face, this seems like a good idea. Senator Clinton argues that cost is the reason why people choose not to seek preventive services.

Removing cost as a barrier to disease detection and prevention, she asserts, solves the problem. Enact a government mandate that insurance companies pay 100% for cancer screenings and childhood immunizations, and Americans will get healthier.

But there are unintended consequences for every action.

In this case, the consequences will be government mandates and higher premiums. According to the National Center for Policy Analysis, just 12 of the most common insurance mandates currently in place raise premium rates by 30%.

The State of California forces over 50 such mandates on the employer-provided (group) insurance market but not on individual plans. Consequently, it costs three times more for California employers to offer insurance than if a plan is privately purchased.

These mandates are largely promoted by well-funded special interests - the same special interests that would undoubtedly pressure Senator Clinton’s administration as she tries to enact healthcare reform.

Instead of giving patients the option of buying low-cost, basic health insurance plans to cover major illness and “pay as they go” for $10 pneumococcus vaccines and $90 mammograms, the only plans sold would contain such mandatory provisions as infertility treatments, inpatient drug rehabilitation and acupuncture, regardless of the patient’s need or desire for these services.

When Hummers and Ferraris are the only vehicles sold, people on Toyota budgets can’t afford transportation.

Patients, according to Senator Clinton, are not qualified to determine for which benefits and treatments they are willing to pay.

Still more disturbing is Senator Clinton’s May 24, 2007 statement that “doctors and patients don’t know which medical interventions are most effective - and which have little benefit.”

Rather than trusting the decision of recommending a medication or course of treatment to a surgeon or the parent of a sick child, Senator Clinton proposes instead to establish a “Best Practices Institute” so that “doctors, nurses and other health professionals…would know what drugs, devices, surgeries and treatments work best.”

Senator Clinton then explains how well this worked for the postal services company, Pitney Bowes. The corporation succeeded in cutting $3.5 million in prescription drug benefits to their employees by using data generated without benefit of knowing individual patient reactions to different medications or having the input of the doctors actually caring for them.

Yes, indeed, treatments chosen by a research think-tank far from the exam room, it seems, do save money. According to Senator Clinton, that is where healthcare decisions ought to be made - safely out of the hands of patients and their doctors.

And then there is the issue of location. Choosing where and from whom to seek medical care is critical to those facing that decision. This choice, according to Senator Clinton’s 7-step strategy, ought not to be left to those receiving treatment.

Rather, she proposes “federal spending to help redeploy high-priority preventive services…in schools, workplaces, supermarkets, churches, communities….”

Instead of using healthcare tax dollars in hospitals, rural clinics and urban health centers where patients now choose to receive care, government dollars should “fund and train new health prevention outreach workers, who understood the language, understood the culture of various constituencies around our country.”

Patients who prefer to receive care from doctors and nurses have not made the right choice, apparently - and Senator Clinton aims to correct their mistake.

She then justifies her proposal to limit even those with chronic illness to decide where they may seek medical treatment, even those she admits now “receive care from qualified, capable doctors and nurses.”

The problem, Senator Clinton explains, is a deficiency of government-funded “trained care managers.

“My proposal would require that Americans with costly, hard to manage illnesses have…care coordination models under federally-funded plans, like Medicare.”

Organizations hoping to cash in on this new government program would bid on the care management contracts, which include subsidized “management bonus payments” to physicians agreeing to participate in this form of cost-controlled, government-mandated managed care.

As the national healthcare reform debate continues in the presidential campaign, those with the highest stakes in the outcome - patients and their families - may wish to weigh in. Their ability to make their own healthcare choices with the guidance of their doctors has been challenged. It’s time to speak up regarding the right to make one’s own life-and-death decisions.

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Dr. Halderman is a Board-Certified General Surgeon practicing in rural central California.

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