By ALLAN DOBZYNIAK, MD
The practice of medicine was not a political exercise for centuries. Now it seems more political and proscribed than thoughtful, deliberative or even analytical. The educated experienced physician exercising judgment and guidance for a unique individual, his or her patient, has been increasingly replaced by rules, regulations, mandates, laws, schemes and perverse incentives. These have been mostly at the hands of non-professional administrators and bureaucrats. That medical professionals have been cajoled into participating in this evolution acknowledges physicians acceptance of such questionable transitions in rendering care.
Politics, laws, and the burgeoning onerous administrative state are not intrinsic to the medical profession. How this occurred, has been allowed to occur and continues to occur are questions one would think a profession populated by educated, talented individuals exercising critical insights and analysis might ponder.
At its very basis, it is hard to escape the evolution of a fundamental “misconception” that has become the accepted fallacy permitting government’s intrusion into the sanctity of the relationship between a physician and her patient: the political fallacy that medical care is a right. If medical care, which must include physicians’ services, is considered the “right” of the patient, the “right” should be properly protected by law. Here then is the entrée opportunity for government, and it has progressed with rapidity. With this circumstance now dominant, what is bedrock for an economically free society has been interrupted.
Physicians produce economic value via the services they render. It is what a doctor depends upon for his livelihood as a means of supporting his own life. The result for free men, whose natural right to private property has been intrinsic to Western civilization since 17th century England, should be the freedom to exchange with other men, also free, in trade or not. Government cannot enforce laws that protect the patients’ “right” to medical care other than by coercion, force. This is in contrast to medical care being a service that is provided by doctors and others to those who wish to purchase it. If the “right” to health care belongs to the patient, he in essence owns the services of a doctor without the need of either earning them or receiving them as a gift from the doctor.
Since this is the principle, government coercion is the vehicle. Coercion can take many forms. At the extreme was Bill 41 in Quebec, Canada. Doctors objecting to a Medicare law were forced to continue working under penalty of jail sentence and fines of up to $500 per day. Those speaking out publically against the bill were subject to one-year jail sentences and fines of up to $50,000. Here in America we have 4,000 pages of ACA rules and regulations for physicians, CMA mandates, payment schemes, EMTALA laws, Medicare and Medicaid rules of participation, EMR mandates, and MIPA demands just to name a few.
A single example (which I am sure every physician and elected legislator is familiar with) is a modification to a regulation resulting in a multitude of new regulations. These new regulations were produced carrying the authority of “administrative law” and crafted by a group of bureaucrats at the Department of Health and Human Services, Office of the Secretary. “2015 Edition Health Information Technology (Health IT) Certification Criteria, 2015 Edition Base Electronic Health Record (EHR) Definition, and ONC (The Office of the National Coordinator of Health Information Technology) Health IT Certification Program Modifications.” As an aside, the implementation cost for just this is estimated at $331.8 million.
So what we have are likely immoral and unconstitutional (my judgments), coercive laws based on a fallacy and the spewing out of mandates and regulations at an exponential rate. This regulatory onslaught is being created largely by unaccountable and certainly unelected bureaucrats. These regulations have the force of law (but without due process since it does not exist for so called “administrative law”) with fines and punishments that are nearly uncontestable. Almost as tragic, at least from my perspective, is many in the medical profession participating in this “Mad Hatters Tea Party.”
Moving forward a step or two, doctors are pandered to by politicians who seek money and laudatory sentiments from physicians as they seek election or reelection. Platitudes and sophistry somehow seem eagerly consumed by doctors participating in this charade. Hopefully and alternatively, perhaps all participants really know it is nothing but a façade, a silly game they choose to engage. For physicians the rate of coercion might be somewhat mitigated, doubtful. Really, can physicians in their wildest dreams expect politicians to bring an end to the barriers erected by the regulatory state? Are the barriers to innovation, to differentiated physician excellence, to physicians’ economic opportunities and to a competitive health care environment that have been created politically through statuettes and regulations up for real or even any debate? Or are the statutes and regulations now permanent stumbling blocks for a diverse physician community? But, for the politicians, the luxury of picking winners and losers based on influence, lobbying, money and cronyism can continue unimpeded.
Is this really the best way to evolve a dynamic, innovative, facile, enthusiastic group of medical professionals and to create access to medical care that is unquestionably the best in the world? I leave it to you to ponder this question.
Is there a way out? Absolutely, but doctors must have the fortitude to change the paradigm before it becomes too late. An entitlement mentality is an almost impossible habit to break even if the future promises to health care are a financial impossibility and therefor a cruel delusion. Accepting government provided financial compensation cannot persist if change is to occur. Coercion as a mechanism to force political change away from the traditional, historical and “equitable” doctor-patient relationship is not likely to succeed in the real sense of producing value through excellence. As David Hume has stated, “all plans of government, which suppose great reformation in the manners of mankind, are plainly imaginary.” Is this really the way a great republic should function. Is what is happening to the medical profession a harbinger, a warning signal to society as a whole?
The author’s opinions are his own, and not necessarily those of Healthcare Michigan.