Tuesday, December 22, 2009

Persecuted Doctors and Government Regulation of Health Care.

This cartoon image accompanies a post at Monty Pelerin's World of a 2000 article by a doctor about the "poor doctors" who are being unjustly subjected to government regulation. Of course the article is written by a doctor, a member of a profession which has for decades used its wealth, clout, authority, and professional associations to deny patients' rights and an overhaul of the medical industry. Doctor's gains of greater autonomy have been patients' loss, as is clear when the current state of care is assessed. Using doctors' authority to determine how the government should proceed in regulating delivery of medicine is like relying on the banking industry to look out for the public's financial needs. It doesn't work.

There's a lot of talk lately, spurred by the failed attempt by the Obama administration to reform the medical - and particularly the insurance - industry and regulate quality, affordable, accessible medicine for all, that doctors will be damaged by any regulation of "their" industry and practices. What has resulted from this tussle between patients' rights advocates, the medical industry, the church and the state is a failed bill that rewards the insurance industry with mandated payments for care. We're going the wrong way, progressive rightly claim. Yet another industry has been given a pass to discriminate, control, and financially thrive on the restrictions it exerts to the detriment of patients, particularly women, the poor, the elderly and the gay community.

What doctors claim is an entirely different thing. Despite the AMA's belated support for the plan - and why shouldn't they support a reform plan that essentially makes no reforms and brings more patients into their closed system - the association has historically worked to prevent any regulation of medicine delivery. As can be expected, their role is to advocate for doctors' rights, not patients'. Unfortunately, theirs is a position respected by the state and often the church.

A recent ad campaign by conservative doctors claims that health care reform will create a shortage of doctors, yet the AMA has long determined how doctors are trained - and how many. Any shortage of doctors will be in the general practitioner category because the association has protected and encouraged medical specialization. That's where the money is, where the prestige is. These new claims that reform or "socialization" in the form of government regulation will create a shortage is disingenuous from an industry that has worked to limit general practitioners. If you're a supplier, you want to keep your costs up by limiting access to your service. Since the advent of Medicare, the industry has kicked and screamed against further extending their reach in favor of specialization.

So these are the two prongs that the AMA has successfully worked in their fight against greater access for all citizens: prevent government regulation; and control the number of doctors available and in what discipline. It's a power play, pure and simple, which leaves patients' rights out of the equation.

Two weeks ago, I had the opportunity to communicate with the former chair of the AMA's Council on Ethical and Judicial Affairs. According to this doctor, patients had no rights because mandating such would infringe on doctor's rights. In other words, the doctor was the individual who should be left to decide what a patients receives. He actually likened a woman's need for a tubal ligation, unmet by providers in her area, to the challenges a consumer may have in finding collard greens for Thanksgiving or a new coat only sold at a department store the next city over.

This position, that care is not a right but a commodity, is abetted by religious cries for strict conscience clauses in health care reform. While I of course believe that individuals should be left to determine their own conscientious guidelines for their work, I do not think that such a decision should be allowed to institutions which receive government funding and are responsible to the entirety of society. You staff a doctor who won't inform, perform or refer a woman for abortions? You are discriminating against that woman's rights unless you provide a manner in which she can get the care she needs. Anything short of giving a woman a full range of options should never be allowed or funded by the government, to hell with institutional conscience, association ethics, government funding, church demands. If we are to develop a medical system that serves patients, we must do so without reserve or discrimination.

Our failed attempt to reform health care this year is yet another sad chapter in the demonstration of monopoly of medicine by the industry itself, left alone to regulate it's own responsibilities without the interference of government on behalf of the needs of patients.

Screaming that doctors will be forced out of medicine, that the AMA and doctors are being discriminated against, that government regulation of delivery of what should be considered a human right, is all unjustified claim of persecution. The "poor doctors" have been doing just fine for themselves. It's time to address the needs of the poor patients, as doctors' oath to the profession demands.

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Anonymous tubal reversal said...

Of course, its not only our personal issue government should notice about health care problems seriously.

May 13, 2010 at 1:43 AM  

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