In a recent issue of the New England Journal of Medicine (09/26/12), the current candidates for president enunciated their approaches to treating the ailing U.S. healthcare system.  Are these would-be "doctors" for what ails the medical system  practicing good medicine on patient Healthcare, or are they guilty of malpractice?

Good doctors follow four principles of good medical practice.

1. Treat causes, not symptoms
2. Evidence-based decision-making
3. Quantify long-term costs (and risks) as well as benefits
4. Partnership with patient

Patient Healthcare's major symptoms are well-known: over-spending, bloating (an ever-expanding, costly regulatory bureaucracy), immobility (limitations in access to care), and concerns about quality (errors and adverse outcomes).

The root causes of these symptoms are listed below.

a) Disconnection of consumer (patient) from supplier (provider) and of consumer from control of his/her money.  The latter is called the moral hazard.

b) Rewarding outcomes we do not want.  This is called perverse incentives.

c) Failure to have hard evidence before making decisions.

d) A parasite called bureaucracy.

e) A medical malpractice system based on criminal law.

Doctor Obama's treatment plan for patient Healthcare includes the following features.

§ Mandatory insurance for all Americans and a tax to pay for the expenses.  (Muslims and illegal residents are exempt from this tax.)  

§ All insurance plans will contain a package of eight "essential benefits."

§ States will create health exchanges along guidelines required by federal government

§ States are expected to expand their Medicaid programs by age, income level, and type of illness.  

§ Exclusion for pre-existing condition and competition across state lines are illegal.

§ A new federal agency -- IPAB (Independent Payment Advisory Board) -- will determine what medical treatments are approved and which ones are not.  The government (IPAB) will control health care costs by limiting what treatments it will pay for.

§ No significant change in the current medical malpractice system.

Does the Obama Rx, called the ACA, address the root causes listed above?  In fact, the ACA increases "disconnection" by putting bureaucrats between consumer and provider while simultaneously taking away decision-making power from both.

What about incentives?  Are they aligned -- promoting outcomes we want, like health -- or are they perverse -- i.e., rewarding outcomes we don't want, like sickness and wasting money?  Answer: perverse.  Doctor Obama's IPAB rewards saving money at the expense of patient welfare and wastes hundreds of billions on new bureaucracies.

Advocates of the Obama Rx claim that it will save money.  All evidence shows that it will exacerbate the over-spending symptom, expending over $1 trillion.  This is money the U.S. does not have, and it must therefore be added to the deficit.

The parasite called bureaucracy is the big winner in the Obama scheme.  Before the ACA, the regulatory bureaucracy consumed 40% of all Healthcare dollars.  With six whole new agencies, thousands of new regulators, and 2,700+ pages of incomprehensible, often contradictory rules, tapeworm "B" will likely consume half of all the money the U.S. spends on patient Healthcare, leaving fewer dollars for health care (the service).

Doctor Obama presented no evidence of either proof of concept or proof of effect (engineering terms).  Clearly, he ignored principle #2.

House Speaker Nancy Pelosi's famous quote was clearly malpractice.  She said, "We will have to pass the bill to find out what is in it."  That is like your doctor saying, "Take this pill.  I have no idea what's in it.  We will see what it does to you, and then we'll know."  (If I said that, I would lose my license, and rightly so.)

The ACA fails to measure anything long-term: either positive fiscal metrics such as avoided costs or productivity gains, or benefits that We The Patients want, like good health and long life. 

Clearly, the most flagrant act of malpractice by Doctor Obama was inverting principle #4.  Instead of asking us what We The Patients want, he told us what we must have.  At least 57% of Americans do not want his medicine (the ACA).  Doctor Obama imposed his will on a resistant patient.  The good doctor absolutely never does that.

What about Doctor Romney?  Will he practice good medicine?

Romney's first act would be to repeal the ACA.  It is always good medicine to stop a treatment that is making the patient sicker.  Some of the treatments he recommends to heal patient Healthcare are the following.

§  Make all health insurance tax-deductible, not just employer-provided.

§  Facilitate purchasing pools; allow interstate competition; competitive bidding.

§  Reform of medical malpractice system, also known as tort reform.

§  Interoperable information technology systems, instead the current Tower of Babel.

§  Streamline the regulatory process and eliminate onerous mandates.

§  Younger (under age 65) Americans use same system as members of Congress.

§  Return control of Medicaid to States, with block grants.

Does Romney's plan utilize the four principles of good medical practice -- treat causes, use evidence, cost/benefit, partnership -- or is he, too, guilty of malpractice?

Romney does apply principle #1.  He treats causes by re-connecting consumer with supplier as well as consumer with his/her money.  He supports tort reform.  That is good medicine.

Does Romney have evidence -- viz., from both U.S. and British experience -- to support his recommendations?  Yes, he does.  Given a limited number of dollars or euros, there is always a seesaw effect: as the degree of government control goes up, care services for patients go down.  In the U.S. as well as Europe and Canada, as regulation increases and bureaucracy expands, medical services offered to citizens are curtailed.

Regarding principle #3 -- long-term cost/benefit data -- doctor Romney presents the same volume of such evidence as doctor Obama: none.  Both doctors fail to measure benefits that accrue to us or to the nation.  Without such metrics, the system cannot link the outcomes we want -- good health, productivity, and long life -- with incentives to encourage their achievement.

Doctors Romney and Obama both fail to apply the fourth principle: partnership with patient.  Neither physician asked what we want from healthcare.  They presume, infer, reason, cajole, and pontificate, but neither listens to We The Patients.

Based on the evidence presented, on the charge of medical malpractice on patient Healthcare, the court finds both doctors guilty.

• Doctor Obama is guilty on all four counts.  His license should be revoked.
• Doctor Romney is guilty on two counts and innocent on two.  He should attend remedial classes and be placed on probation.  If he subsequently uses all four principles, his license should then be restored.