Obama's Care vs. ObamaCare

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(Photo: Reuters/Jonathan Alcorn)A man fills out an information card during an Affordable Care Act outreach event hosted by Planned Parenthood for the Latino community in Los Angeles, Calif., Sept. 28, 2013.

The whole country has heard the saga of the President's sore throat. Many people who have a similar problem—or a true emergency—might compare his treatment with theirs.

For a complaint of an apparently mild sore throat lasting a couple weeks, the President reportedly got an ENT consult, a fiberoptic ENT examination, and a CT scan of the neck because some "swelling" was noticed. The scan was done on a Saturday afternoon to suit the President's convenience. According to an article in the Arizona Daily Star, an opening occurred in the Presidential schedule when rain caused the cancellation of his golf game. Then a diagnosis of acid reflux was announced, and unspecified "appropriate" treatment was prescribed.

Now suppose you, as a beneficiary of ObamaCare, developed this symptom. There would be no motorcade to an iconic medical center. Instead, you would need to seek an appointment with your PCP (primary care provider). Several weeks later, you might see the first available "provider"—probably a nurse practitioner or physician assistant.

To become a patient in the "medical home," you would need an electronic health record (EHR). It would document your complete "health" history, including an extensive sexual, drug, alcohol, and smoking history. Many practices now ask about gun ownership, and even about how any guns are stored.

Although EHRs are not very good at "interoperability" (sharing with other medical facilities), they are available to very large number of "authorized" users (such as law enforcement, government planners, insurers, and researchers) and quite vulnerable to hackers. Most patients have no opportunity to opt out of a health information exchange. Once in the record, an item may be impossible to remove, even if it is a serious error. Physicians are required by law to retain records and make them available to licensure boards, attorneys, courts, and law enforcement. They cannot "lose" records, as regularly happens in government agencies, with impunity. And don't even think about lying, or asking your doctor to lie. Making a misstatement in a health record is a federal felony.

This President, in contrast, has managed to keep much of his past a secret.

Once you are an established patient, a provider will regularly see to "prevention" measures: scolding you about your weight or smoking, checking your hemoglobin A1c for diabetes, and nagging you to get a flu shot. Then there might be a few minutes for your problem.

Sore throat? There will be a protocol for that. When I was a staff physician at the Veterans Administration hospital, we did an expensive study on the use of algorithms for common conditions by nurse practitioners. We had one for sore throat. To culture or not to culture? To give antibiotics or not? To test for mononucleosis or not?

We didn't have CT scans back then, but I am certain they would not have been on the sore throat algorithm. Anything that is sore might be swollen, and simple swelling is not an indication for a CT scan. That would be overuse of scarce resources.

The provider will probably shine a flashlight on your throat, possibly feel for lymph nodes, and maybe do a rapid Strep screen. Then you'll get something for symptomatic relief, and perchance an antibiotic. If someone thinks of acid reflux (not diagnosable by CT), you too will be on the purple pill, and get another smoking lecture.

If the provider thinks you might need a consultant or a CT scan, she will hesitate. She has to worry about penalties for "overutilization," in addition to deciding whether to endure the preauthorization hassle, which likely means hours on the phone. If approved, say after multiple courses of treatment fail, you will get the scan only at the convenience of the provider, no matter what you have to cancel.

Your provider might miss something, but she'll be doing what is best on average, and most cost-effective, as determined by government-approved experts.

When ObamaCare talks about eliminating "disparities," it does not mean the special treatment for the political elite.

Remember that on George Orwell's socialist Animal Farm, all animals are equal, but some animals are more equal than others.

ane M. Orient, M.D., executive director of Association of American Physicians and Surgeons, has been in solo practice of general internal medicine since 1981 and is a clinical lecturer in medicine at the University Of Arizona College Of Medicine.