Canadian doctors have been placed in a similar ethical bind due to government control of scarce hospital beds and operating-room time through its infamous system of “waiting lists.”
One Canadian doctor told documentary filmmaker Stuart Browning that if a surgeon was too persistent in requesting operating-room time for his patients, he could be disciplined as a “disruptive doctor” and have his already limited operating-room time reduced even further. In other words, the surgeon would be forced to choose between upholding his Hippocratic Oath to his patient and maintaining his capacity to practice medicine.
Similar problems are threatening to develop in the United States as well.
Ever since Massachusetts adopted its “universal coverage” plan in 2006, state health spending has skyrocketed. In response, a special state commission has proposed controlling costs by eliminating the standard fee-for-service system of medical reimbursement and instead requiring the government or private insurers to pay doctors and hospitals an annual fixed fee for the medical care of each patient. Proponents claim this would give providers an incentive to improve efficiency and eliminate unnecessary tests and treatments.
But in practice, this would create an incentive for physicians and hospitals to provide as little care as possible. Under the Massachusetts proposal, if your care costs less than your annual allotment, then the providers would keep the unused portion. If your care costs more, then the difference would come out of their pockets. Such a system thus pits your doctor’s interests against your own.
Suppose the state had already paid out 90 percent of your annual allotment. You then see your doctor for a severe headache. He examines you, peeks at the balance on your allotment, and says, “No need for an expensive MRI scan of your brain. Just take two Tylenol and call me in the morning.” Can you be sure that he is giving you his best medical advice?
Even if a doctor conscientiously attempts to practice in his patients’ best interests, his decisions will inevitably be questioned by hospital administrators:
Does Mrs. Jones really need another ultrasound test? Can’t you use a cheaper antibiotic for her infection? Isn’t she stable enough to go home today, rather than spend another expensive night in the hospital? We’ve already burned through the money allotted to take care of her this year. Anything else we do for her puts us in the red.
Your doctor will thus be forced to constantly balance your interests against the demands of a government-beholden bureaucrat who might be deciding whether or not to renew his practice privileges.
Because the ObamaCare plan is closely modeled after the Massachusetts plan, the problems unfolding now in Massachusetts are a preview of what the rest of the country could soon expect under ObamaCare.
The great evil of “universal health care” is not that it allows a few bad doctors to cut a few medical corners. Instead, the evil is that it routinely punishes good doctors for their medical virtues and rewards them for their vices. Under ObamaCare, conscientious physicians will have to waste untold hours avoiding detection, arguing with bureaucrats, and defending their actions while their less conscientious colleagues will just follow orders, punch a clock, and go home.
Do we want a government-run medical system which forces doctors to choose between treating their patients in accordance with their best judgment or sacrificing their patients to keep their jobs?
Or do we want free-market reforms that will allow doctors to do what doctors are supposed to do — namely, uphold their Hippocratic Oath to take care of their patients to the best of their judgment and ability?
Our elected officials are deciding that question right now. If you value your life, let them know what you think.
[This essay is adapted from a forthcoming article in the Spring 2010 issue of The Objective Standard entitled, "Government-Run Health Care Vs. The Hippocratic Oath."]