Ensnared by mountains of detail and overwhelmed by months of endless rhetoric, America never fully understood the profound historical context of the current health care debate. The untold story is that on Tuesday, with the stroke of a pen, President Obama ushered America into an age of post-Hippocratic medicine. Unless this legislation is repealed and replaced with fiscally responsible, patient-centered policy, the relationship between patients and their physicians will never be the same.
With disturbing consistency, the sweep of history reveals that physicians have served one of only two possible roles in society—there is no third alternative. Physicians either follow Hippocrates, remaining free to serve the well-being of the individual patient, or they follow Plato and become servants of the State, compelled to guard the “greater good” of society. This is the battle of our time.
Government compassion sounds so noble, but we cannot escape the fact that whoever pays holds the power to choose. It is here that Washington’s utopian plan falls short. When Washington gains control over the American health care dollar, physicians become employees of the State. When the “collective good” trumps the well-being of the individual patient, the physician’ loyalties become divided.
In 1978 Milton Friedman warned of the loss of liberty associated with the government takeover of health care. The process began when the medical community welcomed government money as an additional source of revenue—cash flowed freely as the federal dollars poured in.
But with the federal money came the need for oversight—a responsible government must follow the hundreds of billions of dollars they spend. With increased oversight came increased control over behavior. With control of behavior comes increased control over medical decision-making. The current legislation calls this process “Comparative Effectiveness Research” and grants the Secretary of Health and Human Services enormous power to enforce this efficiency.
Enter politicians seeking votes. According to Friedman, once the government gains control of a social program, politicians embark on new endeavors in search of yet more votes. This results in pulling money from the previous program to fund a second. We see this now as Washington cuts $500 billion from Medicare to pay for their new $1 trillion health care entitlement.
But starving Medicare of resources comes at a cost. This past January the Mayo Clinic closed its doors to some Medicare patients in Arizona because they lost $840 million caring for Medicare patients in 2008. This begs the question, how do you cut $500 billion dollars from a program that is already bankrupt?
The answer lies in creating a post-Hippocratic physician by instituting what is benignly called “Pay for Performance.” Current legislation grants the Secretary of Health and Human Services sweeping power—including the power to decide what physicians should spend on the average patient. Doctors who do not “perform” effectively will be paid less that those who do. So what does it mean to “perform”?
Section 3007 “Value-Based Payment Modifier” of HR 3590 states that appropriate costs are “expenditures per individual as determined appropriate by the Secretary” and “the Secretary may take into account the amount of growth in expenditures per individual for a physician compared to the amount of such growth for other physicians.” In short, if doctors spend more money on patient care than their peers, the Secretary of Health and Human Services will punish them financially.
How long will it be before physicians decide enough is enough and leave the practice of medicine? When they do, how long will it take the government to recruit physicians willing to practice under such abusive government control, even if it means providing substandard patient care?
Physicians who care for a large number of patients on Medicare already hover on the verge of bankruptcy. Any drop in reimbursement will push them over the edge. What more powerful mechanism could be employed to end Hippocratic medicine for our elderly than to threaten physician Medicare reimbursement—unless physicians are willing to look out for the financial interests of the State? Even more, such punishment cannot be challenged in court. “There shall be no administrative or judicial review.” (Section 3007, Page 686)
The patient or the State? This is the battle of our time. Today We the People mourn because Tuesday was the day Hippocrates died.
C. L. Gray, M.D. is the founder and President of Physicians for Reform. For more visit www.PhysiciansForReform.org.
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