Any attempt to amend that law today so that resources could be used for more appropriate medical benefits would face heavy opposition from hospitals specializing in maternity care. Members of Congress must realize that mandating a sensible practice today means locking in what could become a costly, outmoded practice tomorrow. Thus, mandated benefits can impede progress, innovation, and improvements in the delivery of health care. Dr. Janet Roberto, a family physician, explained the problem at a recent congressional briefing. Benefit mandates imposed ostensibly to help doctors and patients, noted Dr. Roberto, can impede the doctor patient relationship by creating a situation in which the patient, whose insurance offers something different or more comprehensive, begins to question the physician's judgment regarding what treatment is best.
Mandates can, in effect, take away the physician judgment as to what is best for the patient.
Although mandated benefit laws do not prohibit advances in medicine directly, they can diminish the incentive to find new and better ways to deliver care. Nurse Lillie Shockney of Johns Hopkins University Hospital in Baltimore, Maryland, recently testified before the Maryland state legislature on the politically charged issue of outpatient mastectomies. Shockney is both an oncology nurse caring for cancer patients and a double mastectomy breast cancer survivor. She spoke of the Johns Hopkins outpatient mastectomy program's success in discovering improved treatment modalities for breast cancer patients, testifying that the program's emphasis on outpatient mastectomies was due to effectiveness and patient satisfaction, not to pressure from managed care. Advances in anesthesia, as well as a recognition of the primary role that family support plays in the healing process for breast cancer victims, have allowed Johns Hopkins to convert the majority of its mastectomy cases to the outpatient setting.