Examples are as close as your nearest clinic or doctor’s office, where medical experts with decades of training are now routinely required to obtain insurance approval for even the most basic tests, procedures, and medications. A cardiologist tries to prescribe a refill of digoxin for a patient with an irregular heartbeat. Despite the drug’s generic status and the fact that it’s been in use in some form since 1785, the patient’s insurance company insisted that he fill out a three-page form justifying his request. His written reply: “ARE YOU KIDDING ME?” An endocrinologist colleague of mine, an expert on the diagnosis and treatment of hormone-related disorders, reports that she can no longer prescribe testosterone for anyone without completing stacks of “Mother may I” paperwork and sending them off to insurance company functionaries – none of whom are doctors – for approval. Primary care providers looking to refer patients to specialists must now obtain pre-authorization in order to do so; apparently the provider himself is too ignorant to know when a case is beyond his level of clinical expertise. Patients trying to remain “in-network” for their surgeries often find that the networks of doctors and hospitals that they must use simply don’t overlap.
Such tactical red-lining and second-guessing would be familiar to anyone on the front lines in Vietnam, where President Lyndon Johnson once bragged that U.S. pilots “can’t bomb an outhouse without my approval.” The rules obstructing the actions of soldiers on the ground and in the air in that war were endless and frequently nonsensical. Enemy fighter planes could not be attacked unless they showed “hostile intent.” They created arbitrary “no fire zones” in which U.S troops could not fire at an enemy first, or sometimes at all. Surface-to-air missile sites could not be attacked while under construction – only after they were active. Once declassified by Sen. Barry Goldwater in 1985, these “rules of engagement” filled 26 pages of the Congressional Record.
Mind-numbing complexity is now the hallmark of medicine under ObamaCare – not the natural complexity of making diagnoses and fighting natural pathology, but new man-made complexity that destroys clinical productivity and creates long lines of patients waiting for care. In 2009, the Obama administration and a Democrat-majority Congress essentially mandated that U.S. doctors install and “meaningfully use” expensive, unintuitive, and complex electronic medical record systems. Repeated studies, including a 2013 report from the RAND Corporation, have found that technology interferes with face-to-face discussions with patients, requires physicians to spend untold hours performing clerical work, and degrades the accuracy of medical records by creating legions of lookalike template-generated notes. Reporting requirements for everything from pay-for-performance programs to having lunch with drug reps have skyrocketed.