Tuesday, August 31, 2010

A Letter to all who are Patients

Thousands of physicians will be distributing the following letter to their patients in the next few months and weeks. Speaking up about the detrimental effects of the new healthcare control law is becoming an important part of attending to the health and welfare of patients.

To My Patients,

Section 1311 of the new health care legislation gives the US Secretary of Health and Human Services and her appointees the power to establish care guidelines that your doctor must abide by or face penalties and fines. In making doctors answerable in the federal bureaucracy this bill effectively makes them government employees and means that you and your doctor are no longer in charge of your health care decisions. This new law politicizes medicine and in my opinion destroys the sanctity of the doctor-patient relationship that makes the American health care system the best in the world.

In addition to also badly exacerbating the current doctor short age, the law will bring major cost increases, rising insur ance premiums, higher taxes, a decline in new medical techniques, a fall-off in the development of miracle drugs as well as rationing by government panels and bureaucrats like passionate rationing advocate Donald Berwick forcing delays of months or sometimes years for hospitalization or surgery. Finally, studies show the legislation will adversely affect the elderly, the poor and rural residents.

Despite countless protests by doctors and overwhelming public opposition -- up to 60% of Americans opposed this bill -- the current party in control of Congress pushed this bill through with legal bribes and Chicago-style threats and is determined now to resist any “repeal and replace” efforts. This doctor’s office is non-partisan -- always has been, always will be.

But the fact is that every Republican voted against this bad bill while the Democratic Party leadership and the White House completely dismissed the will of the people in ruthlessly pushing through this legislation. In the face of voter anger some Democratic candidates are now trying to make a cosmetic retreat, calling for minor modifications or pret ending they are opposed to government-run medicine. Once the election is over, however, they will vote with their party bosses against repealing this bill. Please remember when you vote this November that unless the Democratic party receives a strong negative message about this power grab our health care system will never be fixed and the doctor patient relationship will be ruined forever.
I will be glad to discuss this with you at the end of our consultation.

Your Doctor

A message in consultation with Docs4PatientCare - a 501(c)6 national organization of of concerned physicians committed to the establishment of a health care system that preserves the sanctity of the doctor-patient relationship, promotes quality of care, supports affordable access to all Americans, and protects patients’ personal health care decisions. Learn more online at www.Docs4PatientCare.org

Wednesday, August 18, 2010

Good Medicine Requires Freedom

Autonomy--one of the pillars of individual rights--is also a central principle of biomedical ethics and an essential ingredient of the doctor-patient relationship. Doctor and patient form a partnership of autonomous individuals--united in the goal of promoting the patient's health.

Autonomy includes the freedom to choose who your doctor is, and how you will pay for the doctor's services. The new health care control law (PPACA) severely reduces our autonomy by restricting the choice of payment methods to those pre-approved by government.

Efforts are on-going in multiple states to preserve freedom of choice in health care by resisting the federal mandate to purchase health insurance. In addition to a number of Health Care Freedom Initiatives (both legislative and ballot initiative,) many state attorneys general have filed lawsuits questioning the mandate's constitutionality.

Colorado has an interesting approach, which you can learn about through the links provided by Dr. Paul Hsieh at Freedom and Individual Rights in Medicine. Although federal law trumps state laws, states are not without power against the federal government. Read more here, and here, and here.

Good medicine is not simply a set of pre-defined protocols. Decisions must ultimately be made according to each individual's unique circumstances and values. Doctors must be free to advise patients of the full range of options--and patients must be free to choose.

UPDATE 8-21-10: as of May, 2010, 20 states had filed suit.

Tuesday, August 10, 2010

Social Justice and Medical Ethics

The AMA is actively working in conjunction with Association of American Medical Colleges to inculcate young physicians with the ethics of "social justice."

Since 2005, the "Initiative to Transform Medical Education" has been working to correct what it views as deficiencies in the current training of physicians. These include an over-emphasis on the ability to acquire knowledge and problem solve-- to the detriment of "caring." Traditionally, physicians have expected to be autonomous decision-makers--but according to the Initiative this clashes with "increasing requirements...to be more accountable to various constituencies, including...the public, payers and government." Although physicians are recognized as "prepared to do what they believe is best for individual patients... [t]hey are not...prepared to participate in ethical and political discussions about the allocation of health care resources, which are not limitless." The solution proposed for allocating finite resources is John Rawls' principle of social or "distributive" justice.

"Social justice" is a euphemism for economic egalitarianism--and since people do not naturally come by equal wealth, "social justice" requires taking from some to give to others. "Social justice" is thus in direct conflict with the principles of equality before the law and the individual right to private property. "Social justice" also requires that a physician NOT advise his patients solely based on what is in the patients own best interest. He must instead somehow "balance" the patient's interests with those of the rest of society.

The concept of "social justice" has now been incorporated into several official statements of medical ethics. The Physician's Charter of the American College of Physicians now states:
[C]onsiderations of justice must inform the physician's role as citizen and clinical decisions about resource allocation. The principle of distributive justice requires that we seek to equitably distribute the life-enhancing opportunities afforded by health care. How to accomplish this distribution is the focus of intense debate. More than ever, concerns about justice challenge the traditional role of physician as patient advocate.

The Council of Medical Specialty Societies ethics statement includes the following:
The ethic of medicine must seek to balance the physicians' responsibility to each patient and the professional, collective obligation to all who need medical care.

Not only is this new ethic altering the curricula of medical schools to emphasize "social justice," but admission requirements will also be changed--deemphasizing a background in the sciences and MCAT scores. It is hoped that the selection of more "altruistic" and less competitively driven applicants will result in a larger number of residents opting for a less prestigious and less remunerative career in primary care.

This shift away from academic excellence and autonomy in the doctor-patient relationship toward serving the needs of society follows directly from centuries of medical ethics disavowing the legitimacy of physician self-interest. This error is compounded by a claim of moral superiority because "medicine is a profession not a business."

The distancing of medicine from business has done both a disservice. In claiming to be primarily an altruistic service, physicians have essentially invited the government to enforce this ideal while simultaneously denigrating the honorable occupations of production and trade. In failing to understand and defend the morality of profits, and the harmony of self-interest which characterize voluntary economic transactions, doctors have aided the enemies of freedom and capitalism-- who are now designing medical school curricula and admission requirements.

Capitalism is nothing more than the individual rights of life, liberty and property as applied to trade. Profits, in medicine as in any economic transaction, are not gained by exploiting patients or customers. Profits are simply the proper reward for successfully offering a value to others which is worth more to them than it costs to produce. In a system of free trade, self-interests are not in conflict--not even between a physician and a patient. In a direct-pay, fee-for-service relationship, it is in the best long term interest of the physician to offer advice and treatment based on the patient's best interest. And, it is in the best long term interest of the patient to only deal with a physician who does!

We can not defend patients' freedom without also defending the freedom of physicians. We can not protect the doctor-patient relationship without protecting the autonomy of both. Freedom of association and freedom to contract are interrelated principles fundamental to a free republic, to capitalism and to the ethical practice of medicine. "Social justice" requires that the individual be sacrificed to the collective. Such an act is as immoral in medicine as it is anywhere else.

"Social justice" claims to be what it isn't-- because true justice will never involve the violation of individual rights. The only way to assure justice and an ethical doctor-patient relationship is through the consistent, proud, principled defense of individual rights. The only way to assure justice and an ethical doctor-patient relationship is through the consistent, proud, principled defense of individual rights. In economics, that means capitalism. In medicine, that means the freedom of choice, not government mandates, for both doctors and patients.

Update 5-21-10 Two other articles on the training of physician to advocate for "health care reform"--by which is meant greater government control.
"Train physicians to participate in health care reform" by Sachiin Jain, Jordan Bolman in Skin & Allergy News, July 2010
"A Plea to Medical Students" by Joseph M Scherzer

Wednesday, August 4, 2010

ObamaCare Visual Aids

How in the world are we to understand the explicit details of the new 2000+ page health control law, let alone make reasonable estimations of potential unintended consequences?

Although a picture is not an argument, sometimes it's worth 1000 words.
This chart is large and complex, but is reportedly still only about a third of the bill.
(Click on image to go to pdf to enlarge.)
More information here.

Here's a chart which focuses just on one small aspect of the "Affordable" Care Act.
Navigating the Small Business Tax Credit
(Click to enlarge)

A brief introduction to the chart is given by its creator, Committee on Ways and Means member Dave Camp here.
The IRS explanation is here.

And one last one that just attempts to diagram major deadlines:

Implementation Time Line for the ACA by Center for Health Transformation
(Click on the image to go to the PDF to enlarge for details.)

How much will each box cost to implement---both in money and in freedom?
How many new directives in this bill will replace the private decisions of patients and doctors with a bureaucratic decree?
How can a nation of independent, free citizens tolerate this massive invasion into private lives---no matter what the claimed justification?

No one know, but too much.
No one knows, but too many.
We can't--if we desire to remain independent and free.


Tuesday, August 3, 2010

White House Releases Misleading Ad

Today the White House released an ad campaign featuring actor Andy Griffith, hoping the friendly sheriff from Mayberrry will convince voters that ObamaCare is not the disaster we know it to be. Although technically correct, the ad falsely attempts to reassure Seniors that the new law won’t change Medicare benefits.

As FactCheck.org explains:
So how can the Obama administration claim that “guaranteed Medicare benefits will remain the same”? The answer is that the term “guaranteed” is a weasel word…It may sound to the casual listener as though this ad is saying that the benefits of all Medicare recipients are guaranteed to stay the same — and that may well be the way the ad’s sponsors wish listeners to hear it. But what the administration is really saying is that only those benefits that are guaranteed in law will remain the same…But here’s the catch: The extra benefits generally offered by Medicare Advantage plans aren’t guaranteed by law.

The White House is also counting on people forgetting that the original Medicare legislation made the following “guarantee”:
Sec. 1801: Nothing in this title shall be construed to authorize any federal officer or employee to exercise any supervision or control over the practice of medicine or the manner in which medical services are provided, or over the selection, tenure, or compensation of any officer or employee or any institution, agency or person providing health services; or to exercise any supervision or control over the administration or operation of any such institution, agency or person.

In 2002, Dr. Lawrence Huntoon, MD collected more Medicare Myths and Facts including the myths that Medicare has lower administration costs, and that we can count on the government to keep its promises.

For more on the subtle duplicity of the White House ad campaign, read the rest of Mayberry Misleads on Medicare.