With Hippocratic Oath, Doctors Pledge Allegiance to Patients, Not Profits

The Maine Medical Association recently updated a 2008 poll of their members that asked the question, �When considering the topic of health care reform, would you prefer to make improvements in the current public/private system (or) a single-payer system, such as a �Medicare-for-all� approach?� In 2008, 52.3 percent favored the Medicare-for-all approach. In the updated poll, released last week, that number had risen to 64.3 percent.

It�s pretty unusual for two-thirds of a group of doctors to agree on something as controversial as a single-payer health care system. Until recently, doctors formed the core resistance to �government-run� health insurance in the U.S.

A number of factors account for this impressive change, but the huge administrative burden on practicing physicians created by our plethora of private insurance schemes is certainly near the top of the list.

The other day, I spoke with a Maine physician nearing retirement and looking forward to it. She was recently returning home after a long day in her practice, carrying her �homework,� a pile of administrative paperwork several inches high. Her husband asked her how she got so far behind in her paperwork. �I wasn�t behind at all,� she replied. She did this much paperwork, mostly insurance forms, at least twice a week.

American physicians spend at least three times as much time, money and effort on administrative work related to payment and insurance coverage as our Canadian brethren, with their single-payer system. Administrative hassle is a major factor driving more and more American doctors to sell our practices to large corporations that take care of the back-office work. The Affordable Care Act has only added to that burden. Sixty percent of doctors now work for corporations, and that number is growing.

Working for a corporate provider of health care services is a mixed bag. He who pays the piper calls the tune. As both for-profit and nonprofit health care corporations have become increasingly focused on the bottom line, doctors working for them have come under increasingly subtle and not-so-subtle pressures to generate revenue for their employers.

Some tests and procedures are more profitable than others. Increasingly, doctors� �productivity� is measured by the amount of profitable revenue we produce rather than by the results we get for our patients. But in health care, profitability is a very unreliable measure of value because doctors� fees and other health care prices are often set arbitrarily.

When we graduate from medical school, most of us take the Hippocratic Oath, swearing our primary allegiance to our patients. Young doctors tend to take their oath very seriously. Most doctors truly want to do what�s best for patients, not their insurance company or our employers� bottom line.

But in today�s corporatized and increasingly monetized health care environment, the demands for generation of profit often directly conflict with our clinical judgment. The belief that doctors and other healers act as stewards for our patients� welfare has long earned us a special place in society and the trust of our patients. That position and that trust, so critical to healing, is now threatened.

This conflict has made many doctors very angry. Practicing a profession that has traditionally been a calling has become a business. Doctors today are caught in a system corrupted by an excessive focus on money that is forcing us to behave in ways that conflict with our professional ethics. We are growing very tired of being told how to practice medicine by insurance company bureaucrats and corporate MBAs.

This is another major cause of the burnout experienced by increasing numbers of doctors. Many older doctors are now simply looking for a way out. Others are calling for systemwide reforms that will allow them to return to focusing on the welfare of their patients. Hence the results of the recent MMA poll.

In an excellent new book called �What Matters In Medicine�, longtime Maine family doctor David Loxterkamp points out that medical care, while often using scientific jargon, methods and tools, is at its core a profession about relationships, not profits. That�s something the bean-counters and policy wonks who have become increasingly influential in determining the nature of our corporatized health care system seem unable to understand.

It�s time to remove corporate profit from the financing of health care, and perverse financial incentives from the direct provision of services. It�s time for improved Medicare-for-all.

Physician Philip Caper of Brooklin is a founding board member of Maine AllCare, a nonpartisan, nonprofit group committed to making health care in Maine universal, accessible and affordable for all. He can be reached at pcpcaper21@gmail.com.

Hillary Clinton Likes Obamacare, Opposes Single-Payer

From the Huffington Post –

Hillary Clinton has confirmed, to a paying audience of 20,000 sellers of electronic health records systems, that she supports Obamacare, and opposes single-payer health insurance.

Speaking to a closed-to-the-press meeting of the “HIMSS14″ (Healthcare Information and Management Systems Conference 2014) in Orlando Florida on February 26th, she condemned the Canadian and other nations’ single-payer healthcare systems by saying, “We don’t have one size fits all; our country is quite diverse. What works in New York City won’t work in Albuquerque.” The presumption is that what works in Canada cannot work here, that local control must trump everything in order to fix what’s wrong with American health care.

The data prove her statement to be false, if not irrelevant. America’s healthcare problems are deeper than that. The latest OECD data on healthcare costs show that the U.S. spends by far the world’s highest percentage of GDP on healthcare, 17.7 percent; and also show that the average U.S. life expectancy is 78.7 years; by contrast, Canada spends 11.2 percent, and their life expectancy is 81.0 years. The OECD average expenditure is 9.3 percent , and life expectancy is 80.0 years. So: the U.S. spends twice as high a percentage of GDP as every other OECD nation, and gets markedly inferior results. This makes the U.S. far less economically competitive than it otherwise would be; but, the healthcare industries finance conservative politicians such as Hillary Clinton, Barack Obama, and all Republicans; so, those politicians don’t like single-payer — it would take much of the excess profits out of exploiting the sick, and those excess profits help to fund their campaigns.

The American people’s financial losses produce exceptional financial gains for the investors in healthcare-related stocks, and also inflate the pay for executives in those firms. This helps to fund lots of what conservatives such as Antonin Scalia lovingly call “free speech” — campaign commercials.

A physician in Canada headlined in the Los Angeles Times on 3 August 2009, “A Canadian doctor diagnoses U.S. healthcare,” and he wrote: “Until 50 years ago, we had similar health systems, healthcare costs and vital statistics.” But this situation ended with Canada’s single-payer system, where, “all Canadians have insurance for hospital and physician services. There are no deductibles or co-pays. Most provinces also provide coverage for programs for home care, long-term care, pharmaceuticals and durable medical equipment, although there are co-pays. On the U.S. side, 46 million people have no insurance, millions are underinsured and healthcare bills bankrupt more than 1 million Americans every year.” Nobody goes bankrupt in Canada to pay for needed care. Their system is shared sacrifice, not all of the downsides dumped onto the poorest and the sickest, who can’t pay their bills and end up in emergency rooms until they die of needless ailments.

The Canadian doctor explained that, in that year: “Canada spends 10% of its economy on healthcare; the U.S. spends 16%. The extra 6% of GDP amounts to more than $800 billion per year. The spending gap between the two nations is almost entirely because of higher overhead. Canadians don’t need thousands of actuaries to set premiums or thousands of lawyers to deny care. Even the U.S. Medicare program has 80% to 90% lower administrative costs than private Medicare Advantage policies. And providers and suppliers can’t charge as much when they have to deal with a single payer.”

So, Hillary received many bursts of applause from her audience of people who profit from other Americans’ being vastly overcharged for inferior healthcare. In fact, the transcriber of her speech headlined “Hillary Clinton wows the HIMSS14 crowd.”

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