Monday, August 3, 2009

A Medical "1984"

Marc K. Siegel, a practicing internist and associate professor of medicine at NYU Langone Medical Center, has painted a scarey picture of what American medicine will be like under Obamacare. In an August 3, 2009 New York Post Op-Ed entitled DESTROYING THE DOCTOR-PATIENT BOND, professor Siegel writes:

"The most frightening thing about Washington's idea of 'health- care reform' is how it will interfere with the doctor-patient relationship."

Comparing the legislation to George Orwell's world of 1984, he describes the "new committees and commissioners with undefined but far-reaching powers -- a Health Choices Commissioner, a Health Benefits Advisory Committee, a Comparative Effectiveness Committee . . . ."

He writes:

A prime example comes in the section starting on page 425 of the House bill. This dictates that an Advanced Care Planning Consultation must take place every five years from the age of 65 -- with the intervention of so-called counselors, trained and appointed by the government.

The clear goal of the consultation is to decrease unnecessary care to the elderly. But, while a lot of resources are too often wasted in the last days of life, there are many vigorous and engaged senior citizens who shouldn't be shortchanged or pushed prematurely to euthanasia.

Whose decision should it be to phase out such people? The government's?

Another worry is created by Section 123 (page 30) of the House bill. This establishes a Health Benefits Advisory Committee, chaired by the Surgeon General, which makes recommendations to the HHS Secretary on what should be covered and what shouldn't.

These rulings from on high are problematic, since useful treatments or tests for one patient are not appropriate for another. Appeals are bound to be time-consuming and largely ineffective. This is the government interfering directly with the practice of medicine.

Then there is the Task Force on Clinical Preventative Services (page 937), whose stated purpose is to "review the scientific evidence related to the benefits, effectiveness, appropriateness and costs of clinical preventive services . . . for the purpose of . . . disseminating evidence-based recommendations on the use of such services."

The most disturbing word, of course, is "appropriateness." Where is the government and its board of political appointees going to get the insight needed to advise me on what's appropriate to prevent disease in a given patient?

While we should all worry about the government's intrusion into our rightful medical decisions, perhaps the scariest statement is this:

"Many of my patients use me as a guide to direct them to the best possible care. I'm not alone in this -- it's part of what makes medicine worthwhile to practice.

"But if the president has his way -- cutting costs through regulatory rationing and decreased reimbursements -- doctors will soon be so busy filling out government forms and seeing more and more patients for less and less pay that none of us will have the time to do a preventive curbside."
(Emphasis added.)

What will happen to the quality of medical care under this type of heavy-handed government control? It's not hard to fathom. The best, most independent, most innovative doctors and medical professionals will begin leaving the field in frustration. They will be replaced by what philosopher Leonard Peikoff calls "the new bureaucratic doctors...who want to escape the responsibility of thought and judgement... These doctors don't mind the forfeit of their professional autonomy to the HMO [or government] administrator...or object to practicing cut-rate medicine with faceless patients on an assembly-line basis, so long as they themselves can escape blame for any bad results and cover their own tracks." (From "The Death of a Profession" in The Voice of Reason, page 299. Dr. Peikoff comes from a medical family. His father was a surgeon.)

There are already signs of a coming abandonment of the field of medicine by the most competent, independent doctors to the "new bureaucratic doctors" who don't mind working under government orders. This veteran psychiatrist declares that if Obamacare passes, "I'm done". In an LTE, New Jersey doctor Leo Battenhausen writes:

"As a psychotherapist, I do not accept Medicare or Medicaid. Why? Because they pay a pittance compared to private health insurance...

"If President Obama's health care reform passes, any provider worth his weight will not take insurance at all and take only cash, freeing themselves from the organized crime of insurance all together. This will leave only the worst providers as 'In network.' Quality care will be left only to the rich, while those trying to save a buck will save little."

And Los Angeles Dr. Shira Miller already "doesn’t accept Medicare or health insurance so there can be no third-party interference with her individual rights or those of her patients", according to an article in the New York Times.

What will happen to independent doctors like Miller and Battenhausen once government gains a stranglehold on all of health care? Perhaps we get a hint of what is to come from a minor charactor in Atlas Shrugged, Dr. Hendricks, who retires in protest of socialized medicine:

“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… Let them discover the kind 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 even less safe, if he is the sort who doesn’t.”

Mr. Siegel offers a warning, and concludes with a plea:

"If the president has his way . . . the art of medicine will be lost.

"If only the feds were bound by the same Hippocratic vow that I follow: 'First, do no harm.' "