In her latest op-ed, serial health care misinformer Betsy McCaughey quoted Dr. David McKalip -- infamous for forwarding to fellow members of a Google listserv a picture of President Obama dressed as a witch doctor -- to support her claim that the Senate Finance Committee health reform bill would institute the "most extreme change to Medicare ever." McCaughey also mischaracterized a statement by Obama appointee Dr. David Blumenthal to claim that one of her prior falsehoods -- that a Health Information Technology (HIT) provision in the stimulus act would lead to government "interfering in doctors' treatment decisions" -- was accurate.
McCaughey cited McKalip, who forwarded Obama witch doctor image
The law establishing Medicare in 1965 barred the federal government from interfering in doctors' treatment decisions. Slowly, Medicare regulations have begun unraveling that protection. Now the Cantwell amendment finishes the job.
This is the most extreme change to Medicare ever. Dr. David McKalip, a Florida neurosurgeon and a board member of the Florida Medical Association, predicts: "The only doctors left in Medicare will be those willing to ration care and practice cookbook medicine."
McKalip previously forwarded image of Obama as a witch doctor. In a July 23 post, TPM Media's Zachary Roth reported:
On Sunday night, Dr. David McKalip forwarded to fellow members of a Google listserv affiliated with the Tea Party movement the image below. Above it, he wrote: "Funny stuff."
In a July 23 statement, McKalip said: "I genuinely regret the decision I made in passing this e-mail message along. Directly to President Obama, I sincerely apologize for offending him."
McKalip affiliated with organization that has radical health care views. McKalip is affiliated with the Association of American Physicians and Surgeons (AAPS). AAPS is a conservative-leaning group that has promoted and endorsed controversial views on medicine and health, including urging doctors not to serve as Medicare providers and supporting a "moratorium on vaccine mandates." In a June 25 "open letter to America's physicians" posted on the AAPS website, McKalip stated: "Congress and Obama are proposing to turn doctors into servants of the state, insurance companies, hospitals, and everyone except who matters most: the patient. We will be turned into bean counters, computer entry clerks, dutiful 'providers' and will not resemble anything like a 'professional.' "
McCaughey: Obama appointee "settled that debate" over stimulus provision in her favor
McCaughey: Blumenthal confirmed her claims that HIT would lead to government "interfering in doctors' treatment decisions," "predicted that some doctors might rebel against tight controls." In her October 5 Post op-ed, McCaughey wrote:
To curb doctors' spending, the stimulus legislation launched a process of sending doctors protocols via computer on what the government deems "appropriate" and "cost-effective" care. Doctors who are not "meaningful users" will be punished financially.
When I warned that this meant the government would be interfering in doctors' treatment decisions, CNN and FactCheck.org said that was untrue. But Dr. David Blumenthal, appointed in March to head the new system of computer-guided medicine, settled that debate. In the New England Journal of Medicine (April 9), he confirmed that "embedded clinical-decision support" (his term for computers telling doctors what to do) would be used to reduce costs, and he predicted that some doctors might rebel against tight controls.
The Baucus bill completes the framework for tying doctors' hands when treating the elderly.
McCaughey's earlier claims about HIT provision in stimulus were false. In a February 9 Bloomberg "commentary," McCaughey distorted a section of H.R. 1 to claim that under the stimulus bill, "[o]ne new bureaucracy, the National Coordinator of Health Information Technology, will monitor treatments to make sure your doctor is doing what the federal government deems appropriate and cost effective. The goal is to reduce costs and 'guide' your doctor's decisions." In fact, the language in the House bill that McCaughey referenced did not establish authority to "monitor treatments" or restrict what "your doctor is doing" with regard to patient care but, rather, addressed establishing an electronic records system such that doctors would have complete, accurate information about their patients "to help guide medical decisions at the time and place of care."
CNN's Cohen debunked McCaughey's claims. As McCaughey noted in her Post op-ed, on February 11, CNN health care reporter Elizabeth Cohen debunked McCaughey's claim about the HIT provision. Cohen reported of McCaughey's claims: "I had a PDF of the bill up on my computer. I said, 'Show me where in the bill it says that this bill is going to have the government telling your doctor what to do.' And [McCaughey] directed me to language -- it didn't actually say that." Cohen added, "Now when we asked the folks who wrote this bill, 'Hey, is this bill going to allow the government to tell doctors what to do?' they used words like, 'preposterous' and 'completely and wildly untrue.' "
McCaughey mischaracterized Blumenthal's statement
Blumenthal actually said doctors "may rebel" if "requirements are set too high" to access incentives. Contrary to McCaughey's claim that National Coordinator for Health Information Technology David Blumenthal "predicted that some doctors might rebel against" the stimulus bill's provision because "computers" would be "telling" them "what to do," in his March 25 New England Journal of Medicine article, Blumenthal actually wrote that "many physicians and hospitals may rebel" if "the requirements" for receiving the stimulus bill's incentives for adopting electronic health records (EHRs) are "set too high":
All this constitutes a substantial down payment on the financial and human resources needed to wire the U.S. health care system. Still, major hurdles remain. First, the DHHS [Department of Health and Human Services] and ONCHIT [National Coordinator of Health Information Technology] are operating on a very tight schedule. The infrastructure to support HIT adoption should be in place well before 2011 if physicians and hospitals are to be prepared to benefit from the most generous Medicare and Medicaid bonuses. Meeting this deadline will be challenging. It takes time to develop and implement innovative federal programs, and it will take even more time to create the local institutions needed to support HIT implementation.
Second, much will depend on the federal government's skill in defining two critical terms: "certified EHR" and "meaningful use." ONCHIT currently contracts with a private organization, the Certification Commission for Health Information Technology, to certify EHRs as having the basic capabilities the federal government believes they need. But many certified EHRs are neither user-friendly nor designed to meet HITECH's ambitious goal of improving quality and efficiency in the health care system. Tightening the certification process is a critical early challenge for ONCHIT. Similarly, if EHRs are to catalyze quality improvement and cost control, physicians and hospitals will have to use them effectively. That means taking advantage of embedded clinical decision supports that help physicians take better care of their patients. By tying Medicare and Medicaid financial incentives to "meaningful use," Congress has given the administration an important tool for motivating providers to take full advantage of EHRs, but if the requirements are set too high, many physicians and hospitals may rebel -- petitioning Congress to change the law or just resigning themselves to forgoing incentives and accepting penalties. Finally, realizing the full potential of HIT depends in no small measure on changing the health care system's overall payment incentives so that providers benefit from improving the quality and efficiency of the services they provide. Only then will they be motivated to take full advantage of the power of EHRs.
McCaughey again mischaracterized Ezekiel Emanuel's statement about the Hippocratic Oath
McCaughey: Emanuel "argues that the Hippocratic Oath is largely to blame for the 'overuse' of medical care." In her op-ed, McCaughey wrote: "President Obama and his advisers vilify doctors for over-treating patients. Dr. Ezekiel Emanuel, brother of White House Chief of Staff Rahm Emanuel and a key Obama health-care adviser, argues that the Hippocratic Oath is largely to blame for the 'overuse' of medical care." This follows her claim in an August 27 Wall Street Journal op-ed that "Dr. Emanuel blames the Hippocratic Oath for the 'overuse' of medical care."
Emanuel did not "blame" the oath for the "overuse" of medical care. Rather, Emanuel argued in his June 18, 2008, Journal of the American Medical Association piece, co-authored by Victor R. Fuchs, that the "physician culture" in which "meticulousness, not effectiveness, is rewarded" has led physicians to interpret the Hippocratic Oath "as an imperative to do everything for the patient regardless of cost or effect on others."
McCaughey's distortion is a backtrack from false claim that Emanuel wanted to "eliminate" the oath. On the May 11 edition of Fox Business' Cavuto, McCaughey claimed that Emanuel "said if you want to save money in health care, we're going to have to push doctors to eliminate the Hippocratic Oath and give more attention to costs when they're treating a patient." McCaughey has repeatedly been caught making an outright false claim about health care reform and backtracking, but nonetheless continued to attack and distort progressives' policies without acknowledging her backtrack from her prior falsehood.
New York Times: McCaughey has "largely quot[ed]" Emanuel's "past writings out of context this summer." In an August 24 article, the Times' Jim Rutenberg wrote:
Few people hold a more uncomfortable place at the health care debate's intersection between nuanced policy and cable-ready political rhetoric than President Obama's special health care adviser, Dr. Ezekiel J. Emanuel.
Largely quoting his past writings out of context this summer, Betsy McCaughey, a former lieutenant governor of New York, labeled Dr. Emanuel a "deadly doctor" who believes health care should be "reserved for the nondisabled" -- a false assertion that Representative Michele Bachmann, Republican of Minnesota, repeated on the House floor.
Former Gov. Sarah Palin of Alaska has asserted that Dr. Emanuel's "Orwellian" approach to health care would "refuse to allocate medical resources to the elderly, the infirm and the disabled who have less economic potential," accusations similarly made by the political provocateur Lyndon H. LaRouche Jr.
In fact, Dr. Emanuel has written more than a million words on health care, some of which form the philosophical underpinnings of the Obama administration plan and some of which have enough free-market elements to win grudging respect from some conservative opponents.
The debate over Dr. Emanuel shows how subtle philosophical arguments that have long bedeviled bioethicists are being condensed, oversimplified and distorted in the griddle-hot health care debate. His writings grapple with some of the most complex issues of medical ethics, like who should get the kidney transplant, the younger patient or the one who is older and sicker?