When the Government Is in the Exam Room, It's Bad for Doctor and Patient
While listening to a clip of doctor representatives of the American Association of Physicians and Surgeons, I wasn't surprised to hear that internal polling of their members revealed that 65 percent of doctors would prefer to treat Medicare and Medicaid patients for free than deal with the government. That's certainly my perspective.
In fact, in my own office, Medicare and Medicaid are not accepted, but we do affiliate with the free clinics around the county, as do many, many other doctors. Helping people heal is why most doctors go into the business. That the business is also intellectually stimulating and personally rewarding is often secondary.
Why would the majority of doctors prefer not to deal with the government's health care system?
1. The ever-changing bureaucratic rules make for compliance challenges. Codes change. Coverage changes. And doctors have to keep up with this arcana in order to comply with the federal government. Imagine having to deal with the IRS about every investment you make, every purchase for your business. That's what it's like when deciding the best course of health care for a Medicare patient.
2. A doctor gets paid dirt for his trouble. Not only do doctors have to juggle like an acrobat at the circus when dealing with the government, they get paid cut rates to do so. At a certain point, the administrative costs outweigh the benefits of the hassle. Doctors just won't do the procedure or just won't work with the government-run health care system.
3. Patients covered by Medicare have a different attitude towards their health care. The further removed a patient is from paying for his service, the more entitled he feels and the less motivated he is to change his behavior. When a patient is unmotivated to take ownership of his health care choices, it can make doctoring extraordinarily frustrating.
Doctoring can be a soul-satisfying blend of human connection, scientific inquiry, and technical mastery. The doctor is motivated by solving the mystery, delivering excellence, and helping the patient feel better.
A dentist friend of mine specializes in root canals. He is the best at it anywhere, he bragged. You will feel no pain whatsoever and can get back to work today, he assured. He was right. He loves doing root canals and he's very good at it. It is very satisfying, challenging work. Another friend is an orthopedic surgeon and he got dreamy-eyed talking about how much he loves doing knee surgeries. Not only does this man get to do complex procedures, he gets to help people live better, longer, and more productive lives. A plastic surgeon friend admitted that he loved doing breast reconstructions, especially for women who've had breast cancer. He likes helping them look beautiful and feel good about themselves. All of them do pro bono work for people who can't afford it.
Doctors go into the business of helping people. When the business of helping people becomes purely business, the joy is sucked out of the art and science of medicine. The government necessarily contains costs (when they attempt it) a couple ways: eliminating procedures covered, rationing care that is covered, and cutting fees. These three steps make doctoring effectively joyless and in some cases, impossible.
Patients get angry that certain procedures are not covered under the government-run programs, but it's the government itself that is to blame. Or rather, people seem to have a disconnect between what the government is meant to provide and what an individual citizen must take care of himself. When the government gets involved in a person's health care, the relationship shifts. The government sits in the treatment room and dictates the terms. Imagine having parents in the bedroom with a married couple directing what goes on in the relationship. How much fun is that? The spouse not related to the parents (the doctor) often wants a divorce. As Lorie Byrd says regarding health care, "It's personal."
As it is, patients with insurance have dual relationships and often forget that. They have a relationship with their doctor, but they also have a relationship with their insurance company. Sometimes they have to haggle to get the rights to do what they want in the relationship. Likewise, the doctor spends time negotiating with the insurance company, too. Still, there's a difference between negotiating and being dictated to and that's the difference between private insurance and dealing with Medicare.
Many doctors would rather take smaller amounts of money from the patient, cutting fees dramatically, and have a relationship with the patient than have their doctor-patient interaction interfered with by a disinterested third party. The fact is, a government bureaucrat does not care about the life or death of one random American citizen. They care about containing costs for the vague "greater good." The motivation is all different.
The American people need to recognize that by giving the government the power in the health care equation, they give the government the nameless, faceless bureaucrat power over their lives from cradle to grave. Doctors already know the implication of this because of the parts of health care the government already controls. And some actually believe this to be a good thing. As reported in the New York Post, Ezekial Emmanuel -- brother of Rahm Emmanuel -- has a very different perception of the doctor-patient relationship:
Savings, he writes, will require changing how doctors think about their patients: Doctors take the Hippocratic Oath too seriously, "as an imperative to do everything for the patient regardless of the cost or effects on others" (Journal of the American Medical Association, June 18, 2008).
Yes, that's what patients want their doctors to do. But Emanuel wants doctors to look beyond the needs of their patients and consider social justice, such as whether the money could be better spent on somebody else.
Many doctors are horrified by this notion; they'll tell you that a doctor's job is to achieve social justice one patient at a time.
With government-run health care, there will no longer be a doctor-patient relationship. There will be a patient-government relationship. And the irony will be this: patients will still hunger for that unfettered relationship, so they'll pay cash out of their own pocket to get it while being beholden to the government through oppressive taxation to fund this new, vast entitlement. Patients could, and do, pay cash now for care without the tax burden.
Not only is bartering, taking cash, or otherwise meeting a patient's needs charitably more satisfying for doctors and patients, it costs everyone far less. Doctors want a relationship with their patients. They don't want more government invasion. Should the government control health care, the doctor-patient relationship will be altered forever and not for the better.