Amicus Brief filed to FL v HHS

Docs 4 Patient Care, Benjamin Rush Society, and Pacific Research Institute,

File Amicus Brief Against Obama Care

May 12, 2011 – Docs 4 PatientCare, the Benjamin Rush Society, and the Pacific Research Institute issued the following statements after filing an amicus brief in the U.S. Court of Appeals for the 11^thCircuit supporting the district court’s decision that Obama Care is unconstitutional.

Hal Sherz, MD, FACS, FAAP, President and Founder of Docs 4 Patient Care said: “We believe that it is vitally important for a physician group to stand up and speak out on behalf of all of the doctors in this country who oppose this law, but feel disenfranchised and disheartened. As opposed to other medical organizations that have failed to stand up for its constituents and have instead urged them to accept the onerous changes being forced upon them by a statist administration, we are conveying hope by challenging the legality of this law and the brazen attempt of the government to control healthcare.”

Sally C. Pipes, founder of the Benjamin Rush Society and President and CEO of the Pacific Research Institute said: “We believe that the district court was correct that the mandates imposed by the federal government in the PPACA are not a constitutional exercise of governmental power. Forcing Americans to purchase expensive health insurance or face a penalty is not the responsibility of government. Doctors and patients – not the government -- should be in charge. Only then will America achieve affordable, accessible, quality care for all.”

Google docs web link of amicus brief

(Addendum: better link)  Amicus Brief

That's the official press release.

In my new role as Senior Health Policy Analyst for Docs 4 Patient Care, I was able to contribute behind the scenes by providing a comprehensive bibliography of peer-reviewed articles on cost-shifting in health care, as well as participate in strategy discussions while the brief was being written. Very exciting--and educational--process.

Although the D4PC leadership initially wanted to argue from fundamental principles, we were advised that such arguments, especially at the appellate level, would be dismissed almost out-of-hand because of the past 70 years of Supreme Court rulings on Commerce Clause interpretation. The more effective place for those more fundamental arguments is in the media and the political arena--places we are doing our best to speak out frequently and consistently.

If we are to rid ourselves of the PPACA and its disastrous effects on personal health care freedom, popular discontent must be loud and clear. Chances for complete repeal )after a successful 2012 election), as well as Supreme Court comfort with over-turning legislative action, both depend on public opinion of the law.

I am convinced that the more people know about the details, the more they will oppose the law.

Continue to write letters to the editor.

Speak up and speak out.

Invite conversations by wearing the Black Ribbon.

The battle for the sanctity of the private doctor-patient relationship is still going strong.

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Doctors Speak to Congress on behalf of Patient Care

Dr. Jane Orient, executive director of AAPS, congressmen Dr. Burgess (TX-R)  and Dr. Amerling testified last week before the House in support of freedom of choice for doctors and patients.

This clip is just shy of an hour long but is well worth the time to watch. The PPACA is tragically misnamed: it neither protects patients, nor will it bring down costs. Entitlements are driving federal and state budgets over the cliff, and the PPACA adds significantly to the momentum.These three doctors provide explanations for why this is true.

The new law is specifically designed to disrupt the direct doctor-patient relationship which is the foundation of private practice medicine. This fact is illustrated by what Dr. Berwick, the current head of Medicare, wrote in his book New Rules:

Today, this isolated [doctor-patient] relationship is no longer tenable or possible. Health care has become an industry, with numerous loci of authority well beyond the doctor’s office. In many ways, the relationship of the patient to the doctor is less important. Traditional medical ethics, based on the doctor-patient dyad must be reformulated to fit the new mold of the delivery of health care.

In place of a direct doctor-patient relationship, Berwick advocates (and the PPACA strengthens) our current dysfunctional third party payment system which places a bureaucrat into the middle of our medical decisions. More and more, doctors are being required to make treatment decisions based on population-based clinical guidelines rather than the customized needs of individual patients.

Regulatory requirements  are making it more difficult for physicians to survive as small businesses, driving physicians to either retire early or work as employees. It is possible that the physician-as-employee model is less expensive (which is not the same as more efficient or cost-effective,) but shifting to that model should occur voluntarily through a free market, not by the government stacking the deck against the option of private medicine.

For more details on how the new health care control law will take away freedom of choice without solving problem of rising costs, watch the video clip below.
If you prefer to read their statements instead of watch, you can find them here: Dr. Orient's, Dr. Amerling's. I don't have a link to Br. Burgess' statement, but he comes first in the video after a brief introduction by Dr. Orient.

Why the ACA is wrong and must be repealed.

The Black Ribbon Project is participating in the Independent Women's Voice ObamaCare Video Contest. The deadline of midnight March 19th is approaching fast, but it's not too late to add your own original contribution. First prize is $5000---but the competition is pretty stiff. All entries will be posted on their website, however, so it's a great way to spread your personal message.

The Black Ribbon Project supports repeal of the ACA because of the way it tramples on the doctor-patient relationship--but more than that, it endangers the roots of civil society.

What a great challenge to get to meat of the matter in under one minute!

Be sure to check out the website and vote for your favorite. Some are really quite good!

IWV You Tube Channel

Shameless request: Vote for my video. From what I can tell, the winner is whoever gets the most viewer votes. Any winnings I receive will go to The Black Ribbon Project.

How to Defend Health Care Freedom

Last fall, I was invited to speak about the Black Ribbon Project at the annual meeting of the American Association of Physicians and Surgeons. I took the opportunity to share a few of my thoughts on the principles we need to promote to effectively defend health care freedom and the doctor-patient relationship. I am pleased with how much I was able to cover in just 25 minutes. Let me know what you think!

For Patient Autonomy: Repeal ObamaCare

Dr. Alieta Eck of AAPS, and Drs. Pegg, Hansen and Lovett of Docs4PstientCare assisted the Independant Womens Forum in making this commercial prompting voters to ask their candidates to pledge to repeal ObamaCare if elected.

Listen carefully to their message, because it gets right to the heart of the matter: ObamaCare takes control away from patients and doctors and gives it to government bureaucrats. The PPACA may be primarily insurance reform, but whoever controls insurance, controls the payment for medical care and will eventually have to control what gets paid for. That means deciding what your treatment options will be.

The solution?

Repeal ObamaCare.

Restore choice and accountability--for patients, doctors, hospitals and insurance companies.

In a free country, we all have our part to play.

Then, to make sure we don't simply go back to the problems which prompted health care reform, the next steps include:

1. End government policies which give preferential tax treatment to employer-based insurance with first-dollar coverage. Instead, all medical expenditures must have the same tax advantage or disadvantage. This will increase the availability of insurance for individuals, and insurance portability for everyone.

2. Allow insurance companies to complete across state lines. Insurance companies from states with the least intrusive regulations are already less expensive than those in heavily regulated states, so prices for insurance will rapidly drop. (For an Oct. 2010 report on health insurance mandates by state, see here.)

3. Remove legal limits and hindrances to purchasing catastrophic health care combined with a Heathcare Savings Accounts so people can more easily take advantage of this form of insurance which has repeatedly demonstrated its superiority in lowering health care spending and maintaining patient satisfaction. A significant part of the cost problem in health care relates to the perverse incentives which occur in a third-party payer system.

4. Allow balance billing for Medicare to end the massive amount of cost-shifting doctors and hospitals have to do in order to make up for the inadequate payments they receive from the government. When doctors are able see Medicare patients without losing money, the doctor shortage for Medicare patients will disappear.

5. Encourage states to enact real tort reform. Defensive medicine increases testing and procedures and drives up costs.

But first, we have to repeal ObamaCare.

Take the Pledge.

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ACOs Threaten Quality Medical Care

The PPACA is "nudging" doctors out of independent practice and into working as employees of large practice groups or hospitals. This move is occurring because of the bundled payment structure of Accountable Care Organizations (ACOs) which favors "vertical integration" of doctors, hospitals and health plans.

The only problem is that bundled payments are simply capitation rewritten, and employee physicians face divided loyalties between the needs of their employers and the desires/needs of their patients.

This arrangement is especially insidious when coupled with the ethics of "social justice" which gives a physician the moral OK to sacrifice his patients to the "greater good" of society. What is good medicine for the masses is often at direct odds with what is good for the individual patient--and thus, quality medical care suffers.

Resources:

For more on the PPACA effects on private practices see "Killing Marcus Welby: How ObamaCare stifles private practices" by Scott Gottlieb, MD, NY Post 10/18/100

For more on problems with the underlying assumptions for ACO's see "On Being Politically Incorrect and Realistically Correct about ACOs" by Richard Reece, MD at Medinnovation, 10/7/10

For more on the destructive effects of the concept of "Social Justice" on the availability of quality medical care, see Dr. Rich Fogoros at The Covert Rationing Blog.(multiple posts)

See also:'"Deconstructing ACOs" by John Goodman at John Goodman's Health Policy Blog, 8/18/10

The ACA is destroying independent medicine

A few months ago, I had dinner with a couple from Pennsylvania. Knowing the husband was a physician, I asked what type of medicine he practiced.

He replied, "I am a dinosaur. Something that hardly exists anymore: a family practice doctor in solo practice."

In addition to being a primary care physician in a small town, he is a small business owner, doing his best to survive in an era of increasing government demands both on his business and on his practice of medicine. Solo and small group practice is becoming less and less financially viable within the third-party payer system.

For years, this doctor saw many Medicaid patients, willingly accepting payment less than his cost of providing care because of his loyalty to these individuals and his interest in offering charity care. Recently, he regretfully had to inform these patients he would no longer be able to be their doctor. Not because of the inadequate "reimbursement," but because of the onerous and expensive regulations Medicaid required. He provided the following example:

In order to provide immunizations for children on Medicaid, he could not simply have a special shelf in his office refrigerator. Medicaid required he purchase an entirely separate refrigerator in which to store the shots. This was in addition to reams of paperwork accounting for the purchase and use of the immunizations for Medicaid recipients.

Squeezed between falling payments and rising costs, the solo and small group practice of medicine is indeed endangered. More and more physicians are flocking to large group practices, frequently as employees. Maybe this is a good thing. But maybe not. However, patient demand is not the driver of this change, but rather the increasingly expensive government mandates placed upon the practice of medicine.

Dr. Richard Reece, physician, author, and health care policy commentator, has a recent blog post on the effect of the ACA on physician employment. He summarizes the findings of a recent survey, "Physician Alignment in an Era of Change."

• 74% [of hospital CEOs] plan to employ a greater percentage of physicians over the next 12 to 36 months.
• More than 70% say they have received increases in requests [from] physician groups for employment.

He concludes the post stating:

I spoke to John McDaniel, founder and CEO of Peak Performance Physicians, a practice management firm in New Orleans, and he pointed out to me that what’s driving hospital physician employment is not only anticipation of lower reimbursements under reform but the mounting costs and complexities of doing business.

Complexity per se is not the problem doctors are currently facing. Medicine and business are replete with complex problems which must be faced and dealt with on a daily basis. The problem is that far too much of the complexities doctors must deal with are the constantly shifting mandates and regulations which substitute the plans and values of the politically powerful for the plans and values of patients working privately in conjunction with their doctors.

Will the system of employee-physicians that is emerging be superior to the independent private practice of medicine? It depends on your criteria for judging.

If the goal is to meet the individual medical needs of patients according to their personal priorities, offered on a voluntary basis by physicians whose primary focus is the welfare of the patients he treats, then the ACA pushes us in exactly the wrong direction.

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In Defense of Physician Autonomy

Dr. Saul Greenfield, pediatric urologist and professor of medicine, wrote in the Sept. 7, 2010 WSJ:

In recent political debates, the autonomous physician has been portrayed as a problem to be solved, an out-of-control actor motivated by greed---and a major cause of rising health-care costs...

Physician autonomy is a major defense against those who comfortably sit in remote offices and make calculations based ont concerns other than an individual patient's welfare. Uniformity of practice is a nonsensical goal that fails to allow for differing expression of disease states.

this is not to say that critical research, randomized controlled trials, literature meta-analysis an guidelines are not necessary and useful. They are all essential...But we must recognize that many physicians will often make decisions that deliberately do not conform to "community standards"---and that patients will be better for it.

Dr. Greenfield correctly points out that quality medical care consists of physicians applying their independent assessments to the unique circumstances of each individual patient. Without autonomy, this goal can not be achieved.

Read the rest of what he writes "In Defense of Physician Autonomy."

ACA intentionally undermines the Doctor-Patient relationship

The new healthcare law has multiple provisions which disrupt individualized decision-making between the physician and patient. This is no accident. It is by concerted design.

Dr. Donald Berwick, the new head of CMS, wrote the following on the doctor-patient relationship:

“Today, this isolated relationship is no longer tenable or possible… Traditional medical ethics, based on the doctor-patient dyad must be reformulated to fit the new mold of the delivery of health care...Regulation must evolve. Regulating for improved medical care involves designing appropriate rules with authority...Health care is being rationalized through critical pathways and guidelines. The primary function of regulation in health care, especially as it affects the quality of medical care, is to constrain decentralized, individualized decision making.” (emphasis added)

from New Rules, by Donald Berwick

Dr. Zeke Emmanuel and Nancy DeParle want and expect the new law eliminate solo and small group practices. Along with Dr. Robert Kocher, they wrote the following in an article in the August 23, 2010 issue of the Annals of Internal Medicine:

"To realize the full benefits of the Affordable Care Act, physicians will need to embrace rather than resist change. The economic forces put into motion by the Act are likely to lead to vertical organization of providers and accelerate physician employment by hospitals and aggregation into larger physician groups...

The health care system will evolve into 1 of 2 forms: organized around hospitals or organized around physician groups...Only hospitals or health plans can afford to make the necessary investments in technology and management skills."

Other revealing quotes from Dr. Berwick include:

"I can not believe that the individual health care consumer can enforce through choice the proper configurations of a system as massive and complex as health care. That is for the leaders to do."

and

"I would place commitment to excellence--standardization to the best-known method--above clinician autonomy as a rule for care."

These health care policy makers believe the source of our health care problems stem from the autonomous decisions made by the private doctor-patient team, working together in the best interest of the individual patient.

They are wrong.

They have forgotten that the best interest of the individual patient is the purpose and standard of medicine--both morally and practically. The health of the nation depends on the sum of the health care provided to individuals. Nothing more or less.

Medicine for the masses is meaningless if the lives and health of individuals are sacrificed to the "common good."

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UPDATE 9/28/2010:

Worthwhile related posts at Retired Doc's Thoughts:

Physician fiduciary duty-a thing of the past?

Crisis in medical professionalism

What is the fate of the doctor-patient relationship in a Donald Berwick designed health care system?

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

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.

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

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?

Answers:

No one know, but too much.

No one knows, but too many.

We can't--if we desire to remain independent and free.

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New Lows in Newspeak

When is price fixing not illegal price fixing? When it's done by the government.
When is price fixing illegal price fixing? When it's done by anybody else.

Justice Department has unambiguously stated that refusal to accept government price controls is a form of illegal “price fixing.”

--Christian Science Monitor 5/31/2010

In an landmark decision, the Justice Department has ruled that under the Sherman Antitrust Act, a group of Idaho orthopedists are guilty of conspiracy and price fixing. In this particular instance, the defendants were prosecuted under civil jurisdiction, but under antitrust law, it could just as easily been tried as a criminal case!

In an incredible act of economic ignorance and political hubris, the DOJ has announced that "Government prices are market prices." Additionally, refusal to accept government set prices has been equated with refusal to accept a private insurance company contract.

The degree of Newspeak is astounding.

The State is the Free Market.

Public is Private.

Government price-fixing is Competition.

The Sherman Antitrust Act long ago was demonstrated to be internally contradictory --which makes it impossible to understand, and arbitrary in its application, reducing business to the rule by men (as opposed to Rule by Law.)

The practice of medicine required that both patients and physicians be able to freely contract for remuneration in exchange for services offered. When physicians are denied the right of refusing payment which they deem to been unacceptable-jointly or individually, we no longer have freedom. Physicians become the indentured servants of the State and deprived the freedom of association---either with patients and insurance companies of their own choosing, as well as with their professional colleagues.

With the government's gun to their doctor's head, can patients really trust the workings of their doctor's minds?

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Dr. Zwelling's Home Sweet Medical Home

I learned of Dr. Marcy Zwelling through her participation in a debate at Standford University yesterday in which she defended the free market as THE compassionate and efficient way of delivering medical care.

Here is her description of her concierge practice as a far superior alternative to the "medical home" that government bureaucrats have in mind for us.

The Patient Centered Medical Home

When I became a doctor...I understood that hethcare was about relationships, communication, and cooperation: the patient/doctor relationship, doctor/doctor communications, and doctor/nurse cooperation...

The passion that my colleagues and I have to preserve the medical home and the sanctity of the relationship(s) that we have with our patients is as real as our patients’ trust and love. The necessity to safeguard the professionalism that we have earned so that we can provide the discretionary judgment to assist our patients with decisions about life and death is indispensable to the conservation of the integrity of the science...

Home sweet home is not an institution to be judged by the federal government. It is a place we go to belong, to reinvigorate, to strategize and build our lives. Medical homes belong to our patients and must never become government fashioned institutions.

Read the whole post here.

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The Hippocratic Oath

Centuries old, the Hippocratic Oath is considered by most to be the fundamental ethical creed of medicine.

Central to the oath is the following promise of the physician to the patient:

"I will follow that system of regiment, which according to my ability and judgment, I consider for the benefit of my patients."

This promise is severely undermined by all third-party payment systems. When the third party is a private insurance company, at least patients voluntarily agree to the limitations placed on them and their physicians under the insurance contract --although the extent of contractual freedom varies widely from state to state.

When the third party is the government, and the restrictions and mandates hold the penalty of law, the voluntary nature of the agreement is changed to one based primarily upon coercion. The more the government mandates, the less the physician is able to legally offer advice and treatment based solely on his "ability and judgment." Instead, physicians are increasingly required to substitute their judgement and advice for the judgment of politicians and regulators.

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Paperwork vs. Patient Care

As the health care bureaucracy grows, so does the paperwork.

Paperwork, or documentation, takes up as much as a third of a physician’s workday; and for many practicing doctors, these administrative tasks have become increasingly intolerable, a source of deteriorating professional morale. Having become physicians in order to work with patients, doctors instead find themselves facing piles of charts and encounter and billing forms. –NYT 4/8/10

Paperwork is also taking more and more time away from patient contact and direct patient care during medical training-as much as 6 hours a day! This trend will only worsen with the recent massive increase in health care laws and regulation.

In 1965, when Congress created Medicare and Medicaid, the bill was 137 pages long… Thirty years later [the Mayo clinic] found 130,000 pages of rules they must comply with. –G-M Turner, 4/16/10

This time we are starting with a law over 2000 pages long which will create over 100 new federal agencies. Instead of spending time advancing medical expertise, how much time will physicians have to spend learning all the new regulations? (Especially now that coding errors are more likely to be interpreted as fraud and subject to felony changes. [2010HR 3590, Sec. 6402(f)(2)]

Medical training used to emphasize how to think in essentials and document only the information directly pertinent to the medical condition and care of the patient. This simplified future information retrieval–by oneself as well as medical colleagues. Now the essentials are buried in a morass of details required for payment and as protection against malpractice suits.

The switch to electronic records are no panacea as studies are showing they do not decrease administrative costs, only ”might modestly improve” quality of care provided, and may actually slow doctors down. In addition, electronic records combined with reporting requirements put patient privacy seriously at risk.

Doctors can spend time focusing on patients and their medical needs, or they can spend time being sure their paper trail is properly covered. More time on paper work means less time for patients.

Just one more way that the new laws are putting the government in between patients and their doctors.

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