President Obama’s health care “reform” plan has been criticized for being economically unsustainable, politically unpopular, and constitutionally suspect. But for many practicing physicians like myself, his plan contains an even greater but seldom-discussed flaw that overshadows those others. ObamaCare would fatally compromise doctors’ ability to uphold their Hippocratic Oath to treat their patients according to their best judgment and ability.
Whenever the government attempts to guarantee “universal health care,” it must also control that service, if only to control costs. Hence, it will inevitably seek to control how doctors practice. Accordingly, the White House Council of Economic Advisors has recommended controlling costs through “performance measures that all providers would adopt.” Physicians who strayed too far from government “comparative effectiveness” practice guidelines would be punished as “high end outliers.”
This will place your doctor’s medical conscience directly on a collision course with government bureaucrats.
If you developed severe abdominal pain due to gallstones, who should decide whether medication or surgery would be the best treatment for you? The doctor who felt your abdomen, saw your ultrasound, and knows your drug allergies? Or a bureaucrat who has never met you, never went to medical school, and is quoting “comparative effectiveness” guidelines from a book?
Yet if that bureaucrat decides that your doctor is performing more surgeries than government guidelines allowed, then your doctor could face punishment — even if surgery would be the best choice for you as an individual patient. Your doctor would be forced to choose between following his conscience and treating you to the best of his ability — or following a bureaucrat’s decree. In essence, he would be punished for upholding his Hippocratic Oath and rewarded for violating it.
Such ethical dilemmas have already arisen for doctors practicing in other countries with government-run “universal health care,” such as Great Britain and Canada.
In 2008, a scandal erupted in Great Britain when the public learned that the government-run National Health Service had paid bonuses to family physicians who reduced the number of patients they referred to specialists. According to the Telegraph, “A leading surgeon said that patients’ cancers had already gone undiagnosed after they were denied specialist care under two such ‘referral management’ schemes.”
If you physician feels a suspicious lump in your abdomen during a routine physical exam, do you want him to hesitate — or even worse, ignore it — for fear of losing his bonus because he referred too many patients to an oncologist?
Similarly, nearly one in four British oncologists admitted to deliberately withholding information from their patients about treatments widely available in other European countries, but not allowed under the NHS system due to cost. These oncologists argued that “there was ‘no point’ in discussing treatments their patients could not have” and that such a discussions might “distress, upset or confuse” their patients.
But patients rely on their physicians for information about treatment options — including an honest appraisal of all the risks, benefits, and alternatives — so they can make fully-informed decisions about their lives. Failure to disclose such information is a serious breach of a doctor’s Hippocratic Oath.
Government-run medicine thus pitted doctors against their patients in an ethically perverse situation. Physicians, prohibited by the government from doing what they actually thought was best for their patients, had to decide whether they should conceal medically important information from their patients. Patients were placed in a position of not knowing if their doctors were being fully truthful with them. The result was rationing not only of medical care, but of medical information.