The new war on physicians
By Richard E. Ralston
The debate on health care reform is starting to turn ugly. Those who want to increase government power to rule American medicine are adding physicians to their list of "enemies of the people." We hear frequently that insurance companies and drug companies are inefficient and greedy businesses that must be replaced by efficient, enlightened and compassionate government bureaucracies. Now doctors are coming under attack for daring to resist government attempts to tell them how they must practice medicine.
In a recent editorial in The New York Times ("Doctors and the Cost of Care," June 14), readers were told, "Doctors have been complicit in driving up health-care costs." "Complicit" is an ominous term, most often used in a legal or criminal context. Such language is obviously intended to intimidate physicians into submission to the government masters of medicine.
How are doctors "complicit" in rising costs? The Times tells us they are to blame because "doctors largely decide what medical or surgical treatments are needed," which makes many of them "unabashed profiteers."
Such a statement provides two keys to understanding the whole debate on medical reform.
The first and most obvious is that reform advocates in government want the legal power to prevent doctors from deciding "what medical or surgical treatments are needed." They think that is a role that must be reserved for politicians and government officials. Physicians must not be allowed to prescribe a drug if the government decides it helps only some but not all patients, and is thus not "comparatively effective."
Physicians must conform not to their own judgment in providing treatment but to new government "protocols." If they do not, the government will make them more liable to malpractice suits for not doing it the government way. Physicians will be forced to shift from making their own judgments to obeying government instructions. They are now forced to computerize their patients' medical records and turn them over to the government—without the patients' permission—to better help the government supervise their practice of medicine.
The second key revealed by the Times statement is the attempt to disarm doctors morally and politically so they will do what they are told. Any attempt to protect their ability to practice medicine as they think best will just prove that they are greedy profiteers like businessmen. Anyone who makes a living or runs a profitable business that does not need to be bailed out by the government may be condemned. The only indulgence provided by this morality is for those who devote their entire lives to obtaining and holding on to political power. Greed for power is a saintly virtue for those who want to instruct physicians how to run their practices.
From other quarters we hear arguments that doctors should just do what they are told and accept what the government pays them, even if it does not recover their costs, because they owe us all for their medical education. Never mind the huge debts with which most MDs graduate from medical school. Never mind the long years and long hours of medical education and internship. If they went to a government school, never mind the taxes their parents paid to support it. If the government gives you an education, these politicians say that you owe that government your life. Are we now discovering the true purpose of government-controlled education?
Doctors are probably coming under attack now because even the American Medical Association—not known in recent years for its resistance to government incursion in medicine—is showing a bit of backbone in opposing proposals such as a new "public option" for medical insurance. They are to be encouraged. If physicians do not take a stand to defend their rights to their own lives, their careers, and their freedom to practice medicine, and, yes, to decide with their patients "what medical or surgical treatments are needed," who will? Physicians must do this first, then all Americans who want to retain their own rights to make personal choices about their medical care should support them.
We will not preserve our freedoms or our health if we as physicians and patients surrender our rights to politicians in return for their promises to take care of us.
Richard E. Ralston is Executive Director of Americans for Free Choice in Medicine, Newport Beach, California. Copyright © 2009 Americans for Free Choice in Medicine. All rights reserved.
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