Sometimes it is easy to forgot how senseless government bureaucracy is when you deal with it every day. Today I was reminded of one of those, frustrating, hard to fathom effects of government involvement in health care. In this case, I am talking about Medicare as it relates to cataract surgery.
I am an Optometrist by profession. When I first started practice, I worked with a couple of Ophthalmologists who did a lot of cataract surgery. Cataract surgery is an amazing procedure. It has the ability to change a persons whole outlook on the world, literally. Within half an hour a person can go from very poor vision to incredible vision.
In the early years of my career, a patient could elect to have cataract surgery if the cataract was a bother to them. The decision about when the cataract was removed was left up to the surgeon and the patient. Sometime in the mid 1980’s the rules change. Medicare changed the rules so that vision had to be worse than 20/40 before cataracts could be removed. That decision, by a bureaucratic board of some kind, took the medical decision away from the doctor and the patient.
Why the change? I believe the change was initiated on the government side as a way to decrease the amount of money they were devoting to cataract surgery. About the same time, the reimbursement by Medicare for cataract surgery started and continued to drop, not because the procedure was becoming less complex or less expensive, but because the government didn’t want to pay a fair market price for the procedure. I am not a surgeon, but I do refer many patients for surgery and it certainly didn’t seem right for either the patient or the doctor to be manipulated by the Medicare bureaucracy.
One of the effects of the Medicare decision to change the rules for cataract surgery is that patients had to experience years more of blurred vision. Cataracts tend to change very slowly, so it is not uncommon for patients to be frustrated with their poor vision for years. Patients with cataracts often find it hard to read, to watch television or to see well to drive, especially at night. How would you like it if there was a solution to those problems that the government wouldn’t let you take advantage of?
Another side effect of that decision is that the medical/legal standard changed not just for Medicare patients, but for every patient. Why? Because Medicare dictated that the standard of care for cataract surgery was vision worse than 20/40, surgeons were concerned about being sued if they performed surgery sooner than that. That arbitrary standard set by Medicare affected both Medicare patients and private pay patients.
Think about it, suppose a surgeon performs surgery on a person whose vision had only dropped to 20/30 and there is a complication not because the surgeon is at fault, but because of an act of God of some kind. The patient is unhappy, so they find a lawyer who will charge the surgeon with failing to meet the standard of care. As a result the surgeon is faced with a expensive settlement. That takes all the joy out of the practice of medicine. Soon,all over the nation, surgeons stop performing cataract surgery for any patient unless their vision falls below 20/40. They don’t dare do otherwise, not because of medicine, but because of the fear of medical/legal ramifications, all because a federal bureaucracy decided to take the place of the doctor.
I just saw a patient yesterday who was extremely frustrated with how he was seeing. He wanted the cataract to be removed and was willing to go outside of the Medicare system to get the cataract removed. Unfortunately there was no option for him to have the cataract surgery performed even if he was willing to opt out of Medicare. He was really angry. It didn’t seem right. It isn’t right.
Whenever government does anything for us that we can do for ourselves, we always lose freedom. Don’t forget it.