Tuesday, June 1, 2010

The Coming Collision Between the Doctors and the State

The ink of the President’s signature is hardly dry, and already the horrifying ramifications of ObamaCare are surfacing. Two recent episodes, one in Florida and one in Massachusetts, highlight the dangerous path that must logically follow when government decrees a “right” to healthcare, and begins to enforce it.

The Florida case involves a single doctor launching a lone dissent against ObamaCare. Dr. Jack Cassell has an independent practice in Mount Dora. In “A Prescription Against Tyranny”, Ralph R. Reiland describes this individual American’s method of protest:

“He's the Florida doctor who told his patients to go elsewhere for treatment if they voted for President Obama. The message posted on his office door: ‘If you voted for Obama ... seek urological care elsewhere. Changes to your health begin right now, not in four years.’

“It didn't take long for Cassell's congressman, Rep. Alan Grayson, a Democrat, to say that he smelled racism [because] ‘many of the Democrats who live in Mount Dora happen to be African-Americans [which implies that] he's saying that he's not going to treat a large number of African-Americans in this country.’

“Cassell told Fox News that the real purpose of his door posting was educational, not racist, and that he wasn't literally turning down patients” although, as Investor’s Business Daily quoted him as saying ‘If they read the sign and turn the other way, so be it.’ ”

“Meanwhile, Rep. Grayson,” continues Mr. Reiland, “ trying to dig up a victim in order to challenge Dr. Cassell's medical license and/or empty the doctor's bank account, reportedly is looking for an Obama voter who encountered Dr. Cassell's notice on the door and then took flight, thereby being deprived of medical care.”
(Emphasis added.)

Under the doctrine of a “right to healthcare”, someone must be forced to provide it. Dr. Cassell is merely exercising his basic unalienable human right to contract freely and voluntarily with patients of his choice, in this case coupled with his right to dissent against what he considers governmental tyranny. He is not depriving, and in fact has no power to deprive, anyone of medical care, any more than someone choosing another doctor is depriving Dr. Cassell of patients. If he chooses not to treat someone, for whatever reason, that person is free to seek treatment elsewhere. But because anyone seeking treatment from him has a right to his services under this doctrine, the doctor’s refusal means that someone “thereby [is] being deprived of medical care.” Dr. Cassell’s actual, political rights are obliterated. Such is the nature of all alleged economic rights … the violation of actual political rights, and the imposition of involuntary servitude upon the provider.

The second case involves the continuing evolution/deterioration of the healthcare industry in the land of ObamaCare’s model, the RomneyCare universal healthcare scheme of Massachusetts. Among many problems, that state is apparently having some trouble attracting doctors voluntarily into the state plan’s network. So, the politicians have come up with a solution – force them into it. In a Voices for Reason post entitled Massachusetts law would turn doctors into serfs, Don Watkins quotes a proposed law:

“ 'Every health care provider licensed in the commonwealth which provides covered services to a person covered under ‘Affordable Health Plans’ must provide such service to any such person, as a condition of their licensure, and must accept payment at the lowest of the statutory reimbursement rate…' ”(Emphasis added.)

One doctor he quotes termed the law “unbelievable”.

“But it isn’t unbelievable–not if you view need as an entitlement [i.e., a right]” continues Mr. Watkins. “If a Medicare patient’s need of health care entitles him to it, then why should a doctor have the right to refuse service just because the doctor won’t make money? Wouldn’t that be selfish and greedy?

“There is nothing noble or benevolent about political thugs forcing doctors–the men and women without whom all of our health care needs would go unfulfilled–to sacrifice their time, their energy, and their wealth to anyone’s need.

“Remember: the morality of need means serfdom for doctors.”

Indeed it does, as these two instances prove. And as IBD observes in the Cassell case:

“Washington will eventually treat him and other doctors as vassals of the state.

“They will no longer be the owners of their minds and their labor, their years of study and the development of their skills. All those instead will be owned by their masters on the Potomac.”

Notice the common denominator tying the Massachusetts and Florida cases together – government licensure. As I pointed out in my post of 6/24/08, government licensure in America is reaching epidemic proportions and is “being led … by private citizens looking to protect their occupational turf through governmental coercion”, leading to the emergence of the modern-day version of Medieval guilds. This extracts a tremendous cost on the economy. Medical licensing, in particular, has had a very deleterious effect on healthcare. In an article entitled Medical Licensing Impedes Quality, Affordability of Care, Jillian Melchior writes:

"Medical licensing is ineffective and inefficient, and patients would be better served by relying on brand recognition when choosing their doctors, writes [Cato Institute fellow] Shirley Svorny in a new report for the Cato Institute.

“In health care, we haven’t used brand names because people have been trusting licensure,” Svorny told Health Care News, “but it’s a weak apparatus, and it’s not trustworthy. People put a lot of faith in this license, and it doesn’t tell you very much.

“In essence, you’re putting your life at risk,”
Svorny continued. (Emphasis added.)

Government occupational licensure is destructive, immoral, and a violation of individual rights, to be sure. But, as the two cases cited above reveal, the worst evil is that it is a tool of coercion and control.

Doctors are being threatened with the choice of either submitting to a modern-day version of slavery, or loss of their careers and livelihoods. This, because many are exercising their basic human right to follow their own convictions, consciences, and professional and economic self-interest. This brazen, legalized thuggery is the logical end result of a society that accepts the principle that, to quote Francisco d'Anconia, “in order to produce, you need to obtain permission from men who produce nothing” (p. 413).

Is this the tip of the iceberg? We are at the beginning of a slow-motion medical catastrophe in this country the like of which the world has never seen. As the trend of socialized medicine spread around the world during the 20th century, there were various instances of doctor resistance. One of the most infamous cases was in 1964 Belgium, where Doctors staged a limited nationwide strike in defiance of the enslavement of their profession – a peaceful rebellion that was crushed when the government instituted a military-style draft…yes, a draft…of doctors into the civilian national health service. But overall, despite varying levels of resistance, doctors ultimately submitted, resulting in the gradual deterioration of heathcare in those nations that government-run medicine is infamous for.

But this is America, the last bastion of semi-freedom in healthcare. There are growing signs that the doctors here won’t take this lying down. Dr. Joseph M. Scherzer, M.D., reports that:

Just "two years after a survey found nearly half of Texas doctors weren't taking some new Medicare patients, new data shows 100 to 200 a year are now ending all involvement with the program."

And Daniel Palestrant reports about ObamaCare at Forbes.com:

“…the medical establishment is not celebrating. In fact, the mood in those exams rooms is downright morose.

“In tens of thousands of exam rooms all over the country physicians are struggling to make sense of the 2,000-plus pages of the reform bill. A recently released poll of more than 2,000 physicians, conducted by Athenahealth and Sermo, is alarming. The poll, part of a broader Physician Sentiment Index, indicates that 79% of physicians are less optimistic about medicine since the passage of health care reform. Fifty-three percent indicate they will consider opting out of insurance plans with passage of the bill. Worst of all, 66% indicate that they will consider opting out of all government-run programs. The same reform bill that will provide "care for all" may drive away more physician caregivers than attract previously uninsured patients. What a predicament that would be.”

What a predicament, indeed! Consider the Massachusetts and Florida medical licensure cases cited above as you digest that 66% figure. If that percentage is even close to becoming a reality, we are heading on a collision course between the government and the medical profession, which will have very broad and serious implications for American liberty. Will the statists in Washington resort to terroristic practices when its universal healthcare fantasy begins to disintegrate? Will they move to literally enslave the doctors? Or will they relent, and move toward medical freedom? The Florida and Massachusetts actions by our government officials, not to mention Belgium’s doctor draft, gives us a glimpse into a chilling future.

The doctors are the front line in this battle. A principled doctors’ rebellion of some sort against the coiling snake of government control of medicine is, in the end, our best hope of avoiding not just an American, but a world-wide, medical catastrophe. America’s island of relative freedom in a world of socialized medicine has been the safety valve for the stressed systems of other countries. Both directly and indirectly, the American market has been the catalyst for medical progress. It has absorbed many of the victims who couldn’t get the care they needed in their native countries. When America goes, so will go the rest.

How recalcitrant individual doctors respond to the ObamaCare assault will undoubtedly depend upon their personal circumstances. An older doctor who is financially set is obviously in a very different position from his younger colleague who still has a mountain of debt to pay off. But one thing that may unite a large segment of the medical profession is the kind of outraged sentiment expressed by Dr. Hendricks in Atlas Shrugged:

“I quit when medicine was placed under State control, some years ago,” said Dr. Hendricks. “…I observed that in all the discussions that preceded the enslavement of medicine, men discussed everything — except the desires of the doctors. Men considered only the ‘welfare’ of the patients, with no thought for those who were to provide it. That a doctor should have any right, desire or choice in the matter was regarded as irrelevant selfishness; his is not to choose, they said, only ‘to serve.’ That a man who’s willing to work under compulsion is too dangerous a brute to entrust with a job in the stockyards never occurred to those who proposed to help the sick by making life impossible for the healthy. I have often wondered at the smugness with which people assert their right to enslave me, to control my work, to force my will, to violate my conscience, to stifle my mind — yet what is it that they expect to depend on, when they lie on an operating table under my hands? Let them discover the kinds of doctors their system will now produce. Let them discover … that it is not safe to place their lives in the hands of a man whose life they have throttled. It is not safe, if he is the sort of man who resents it – and still less safe, if he is the sort who doesn’t.” (P. 744)

If the Florida and Massachusetts assaults on their rights become the preferred method of force behind the government’s drive to guarantee everyone healthcare, then the doctors have an unbeatable trump card. Medical licensure gives doctors a secret weapon of their own that can be thrown back in the politicians’ faces, if they discover it and choose to use it, much the way Hank Reardon challenged the judges at his trial:

“The penalty which this court has the power to impose on you is extremely severe.”

“Go ahead,” said Reardon.

“I beg your pardon?”

“Impose it.”
(P. 478)

One of the lessons of Atlas Shrugged is that evil can only triumph with the sanction of the good. Otherwise, it is thoroughly impotent. The doctors’ have more than the choice of to quit or submit. The statist political establishment apparently believes it has a trump card – government licensure. Some such snake like Rep. Alan Grayson is counting on the doctor’s love and need for his profession in order to force his will, what Ayn Rand called “White Blackmail” – the practice of extracting involuntary concessions by using not some victim’s villainous secret but his virtues as the weapon against him. But what if some doctor such as Dr. Cassell were simply to call the government’s bluff? That is the power the doctors hold.

I know it’s easy for me to say. I’m not a doctor. I acknowledge that. It’s not my livelihood that’s at stake here.

On the other hand, the future of not just my healthcare but the healthcare of my children and grandchildren is at stake. So, let us imagine what might be if enough doctors are willing to take a Hank Reardon stand:

“Go ahead, take my license!”

Who, then, will be depriving whom of medical care?

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