He who controls the medical profession, controls life

As hard as some are trying to make healthcare reform to be about political sides, it is really about human lives. Sadly, because the general public largely doesn’t understand what healthcare reform is really about, the very people who are most likely to be harmed by it — older, fat, disabled, poor and the most vulnerable — are the ones being most led to believe that it’s about taking care of them. Even sadder, experienced medical professionals have seen where we’re being led for well over a decade, but the information hasn’t reached patients and people.

The debate, especially the one in the media, is centered on emotional, intuitively-correct arguments and anecdotes, rather than careful examinations deeper than the headlines to understand the facts, economics, history, medical evidence and, most of all, the ethics of the issue. It’s uncomfortable and hard to think about things that are unpopular to question, including our own beliefs.

As difficult as it is to contemplate, the emotional perspectives on healthcare reform are largely driven by whether one thinks individuals are basically good, caring people who try to do the right thing and will help those in need, or if one thinks everyone is looking out for themselves and what’s in it for them. The ethical questions come in when those looking at what’s in it for themselves try to convince themselves and others that they are acting more ethically.

“Evil acts can be given an aura of moral legitimacy by noble-sounding… expressions,” wrote Walter E. Williams last November when he explained the difference between laudable charitable acts done by caring people to help their neighbors versus forcible use of one person to serve the purposes of another.

The second perspective in this debate comes from whether one thinks individuals are too dumb and irresponsible to decide what’s best for themselves, to choose their own doctors and make their own lifestyle choices, and that doctors are incapable of making sound clinical judgments or do their jobs — or if you believe that you have the right to decide what’s best for someone else; to make others pay for and comply with treatments, diets and lifestyles you believe are best for the common good; to prevent other people from seeing the doctors or seeking the care they want; and to mandate the care doctors must provide. The ethical questions come in when those looking to take away the choices and control the actions of other people, including doctors, try to convince themselves and us that what they want is not only right, but a right.

“There can be no such thing as a ‘right’ to products or services created by the effort of others, and this most definitely includes medical products and services,” explained Yaron Brook, managing director of BH Equity Research, in a recent Forbes article. “Rights, as our founding fathers conceived them, are not claims to economic goods, but freedoms of action…The rights of some cannot require the coercion and sacrifice of others.” This entitlement idea, he said, has been the key driver of the expansion of government medicine in America and led to the growing unaffordability of healthcare. Prior to the government’s entrance into medicine, basic health care was affordable for virtually all Americans, “while those few who could not were able to rely on abundant private charity.” Had this system been allowed to continue, he wrote, “Americans’ rising productivity would have allowed them to buy better and better health care, just as, today, we buy better and more varied food and clothing than people did a century ago.” The history was described in more detail by one reader, who noted the immorality of government mandates that have caused everyone’s medical costs to skyrocket to among the highest in the world and created more problems with healthcare access. “No amount of ‘need’ on the part of one man entitles him to initiate the use of force to take another man’s property.”

Taking our information from mainstream media and social marketing venues can lead us to believe that those voices we most hear also represent what most people think, including most doctors and medical professionals. Over the past fifteen years, increasingly what we hear from media and spokespersons leads us to believe there’s a new medical ethics that is displacing our doctors' Hippocratic Oath to do what’s best for patients and replaced it with a duty to act foremost for the common good and based on costs to society. But are most of the doctors and nurses — the ones caring for you and me — really embracing the new medical ethics?

What do our doctors and medical professionals think?

When we are sick and entrust a doctor with our lives, most of us want to feel we can trust that the care we are receiving is based on our doctor’s years of experience and clinical judgment, that medical ethics and the personal and private relationship we have with our doctor are guiding our doctor to do what he/she believes will be best for us, and that our care is in accordance with our own choices. It’s a terribly frightening thought for most people that, instead, the medical marketplace and its bottom line is calling the shots and that our doctor could be being forced to answer to a growing hoard of government regulators; politicians; lawyers; policy makers; pharmaceutical, healthcare industry and insurance companies; and oversight agencies.

Before we let the media scare us into believing that most doctors are following this new medical ethic and no longer care most what’s best for us. Before we let the media scare us into believing that most doctors are so incompetent and corrupt they need governmental oversight and mandated clinical guidelines in order to provide safe, ‘quality’ care. Before we let the media convince us that only a few uncaring, uninformed people with political motives are opposing healthcare reform… We should listen.

The voices rarely heard in mainstream media are those of the medical professionals who are providing the hands-on care we receive. The general public doesn’t realize that what experienced doctors and nurses have been discussing for years is far different from what we hear from doctors on TV and in academia. It turns out that most doctors do care, very much, for their patients and they have not abandoned the medical ethics that brought them to medicine. Their opposition to third-party managed care is because it violates the most fundamental medical ethics.

“What the public does not know,” wrote Dr. Sean Khozin, M.D., MPH, in a post on Sermo, “is the pervasive hypocrisy of the [healthcare] system and how it has diminished the authority of the only true advocates of patients: physicians.”

Sermo is the world’s largest online medical community with more than 100,000 registered licensed physicians in 68 specialties and in all 50 states who collaborate on difficult cases, share clinical research and work towards better patient outcomes. It has been active since 2006. This past week, it released the results of a survey of a nearly 10,000 doctors representative of the U.S. physician population in regional distribution, urban and rural locations, age and nearly all specialties. These doctors were all verified to have valid, active licenses to practice medicine in the United States, with a median 25 years of practice experience.

It reported that 94% of the physicians do not endorse the healthcare reform bill in the House [which is soon to be melded with the Senate’s similar version] or government managed care. Not one of the healthcare issues cited by practicing doctors as being most important were addressed in the legislation. In fact, practicing physicians believe it reinforces and will worsen what they described as the “insurance industry’s undue authority and oppressive control over healthcare,” the “excessive and misguided government administrative costs” and regulations that require doctors to spend more time on documentation than with their patients, while giving non-medical professionals oversight and decision-making authority over the care they can provide.

Nor do most practicing physicians support the American Medical Association’s recent endorsement of such healthcare reform. For years, opposition to the American Medical Association (which has been steadily moving towards promotion of those new medical ethics) has grown among doctors and the AMA’s membership is now estimated at only 15-20% of doctors. As the CEO of Sermo said of the healthcare reform legislation, it perpetuates the AMA’s core revenue streams and puts its own financial interests ahead of doctors and patients.

What isn’t grasped by laypeople who support healthcare reform, is that most doctors and medical professionals do believe healthcare reform is needed, but what medical professionals know is necessary to deliver the best care to their patients and in the most cost-effective manner bears no resemblance to the current system and to any managed care healthcare reform legislation, in the House or Senate, in this Administration or any previous. “We do not believe, ”said Dr. Todd Williamson, M.D., president of the Georgia Medial Association, “that increasing the federal government’s control over the practice of medicine is the best way to heal our ailing system.”

The concerns of doctors and medical professionals and what they’ve been seeing happening to medicine and healthcare for years has been well-documented in thousands of discussions in medical forums and journals that the public, sadly, never sees. Last year, in an effort to get information to the public, doctors wrote an open letter from America’s Physicians, which has been signed by more than 13,000 doctors so far. It shows that most doctors do hold dear their Hippocratic Oath and the traditions of medical ethics. As it stated:

[O]ur healthcare system has lost focus to the point where patient well-being is placed after politics, profits and special interests. Healthcare costs are on the rise and patients have lost their freedom of choice. These trends are hurting our economy and compromising the doctor-patient relationship. As a result, it has become difficult for physicians to deliver the best possible care... You are paying a lot for healthcare and not receiving enough in return. Your insurance premiums continue to increase while your healthcare options are dwindling. Gatekeepers, insurance networks and restrictive regulations limit your choice of doctors and your access to care. You have been made dependent on complicated and expensive health insurance plans. Employers are forced to take money out of your paycheck to purchase health coverage. If you lose your job, you are left with no safety net and the money you have paid for health coverage vanishes. The time you spend with your physician has become remarkably brief due to regulatory hurdles requiring doctors to spend more time on documentation than with you.

We believe the following factors have made our current healthcare system unsustainable:

The insurance industry's undue authority and oppressive control over healthcare processes

Excessive and misguided government regulation

The practice of defensive medicine in response to a harmful and costly legal environment

We, the physicians of the United States, will no longer remain silent. We will not tolerate a healthcare system where those without medical expertise or genuine interest in our patients' health have absolute control...

The medical ethics of managed care

This isn’t about politics. This is about the ethics of forcing medical professionals to do what third party payers— government Medicare, Medicaid and private insurers — order. With the medical home model that’s been under planning for years, electronic medical records and pay-for-performance measures will give the government, insurance, pharmaceutical and medical industry unprecedented surveillance, control and oversight over patient care, leaving doctors unable to provide the care they feel best and patients unable to have a choice. Most medical professionals recognize that many of the clinical guidelines, regulations and performance measures they will be compelled to follow are, as covered at JFS for years, not based on sound science, have not been shown to improve health outcomes for patients, and will harm large numbers of patients — most especially those who are aging, fat and socioeconomically disadvantaged.

Under nationalized managed care, those with bad numbers (health indices that the evidence shows are not measures of health or risks of chronic disease or premature death, but of age, size, heredity and social-economic status) or special needs will be targeted as costing society too much. We've already seen the "costs" of obesity and chronic disease of aging used to support all manner of public policies, interventions and surveillance. Those not seen as complying with prescribed diets, lifestyles, exercise regimens, screening tests, weight loss, counseling and taking medications will be blamed for failing to take responsibility to stay healthy and, therefore, undeserving of care when they get sick. We've already seen these beliefs in preventive wellness widely circulated, too. This has become serious really fast. We can no longer afford to just worry about trivial things like if someone thinks we look too fat.

We’ve already examined the concerns of medical professionals with managed care, as well as the proposed rationing of care based on comparative effectiveness that target those who are older, fat, disabled and the most vulnerable in need of care. The unthinkable consequences are closer than we might want to even think about. You’d have to live under a rock, too, to not know that Obama’s Science Czar has proposed some of the most unconscionable acts of eugenics, based on radically unsound beliefs, and his appointment sent shock waves through the scientific community that understands the science surrounding population control. But never before in the history of our country, have we been this close to making federal law that formalizes withholding of care to certain groups of people.

“Never before have we been this close to adopting a system that will tell certain citizens to forego treatment for the good of their country,” John Griffing poignantly wrote this morning in American Thinker while explaining Section 1233 of the health reform legislation. “Today’s Medicare recipients could be the first to experience our government’s new solution to America's ‘useless eaters’,” he wrote. “When all is said and done, the ultimate result of the proposed bill is to transfer to government the unprecedented power of determining who lives and who dies.”

Healthcare reform may prove to be the most expensive and deadliest consequence of the public’s scientific illiteracy, prejudices and inability to understand sound science. Healthcare reform may prove to be the most costly and deadly consequence of people failing to learn history and realize what is being reenacted and the unconceivable place it’s taking us. [Yet few people have read the more than a thousand pages of the legislation, let alone read Ominous Parallels, The Nazi Doctors and War Against the Weak.]

Sure, there are some bad doctors out there who are incompetent or follow greed rather than creed, and others who are guilty of looking the other way. But it’s reassuring that medical ethics is not dead and so many doctors have been trying to speak out, even at risk to their careers. Most doctors and nurses made medicine their vocation because they care about people and love helping people, and still do. What ethical oath have government appointees, politicians and corporate executives pledged?

What’s really behind healthcare reform

Most practicing doctors believe medicine can return to caring for patients and address the problems with the healthcare system without losing the things that make it among the best care in the world. But, as cardiologist Dr. Westby G. Fisher, M.D., said, “we can’t do that and continue to fund the gravy train. And that gravy train is the multi-billion dollar health insurance industry with executives who made over $24M annually in 2007, the $800B pharmaceutical industry with executive compensations of over 25 million dollars the same year, the over $24 billion spent in one year in our country on new hospital construction, the nearly half a billion dollars in political campaign contributions from health care special interests a single year (2008), and the 55-80% increase in malpractice insurance premiums that your doctors have paid over the past 5 years.”

What most consumers don’t realize is that healthcare reform chiefly isn’t about helping people, covering the uninsured or addressing health disparities, but about increasing the private-public medical industry and making money for them. Doctors have been watching the evolution of medicine and healthcare depart from caring for patients to caring for its bottom line and expanding the system’s sphere of power and control. “One only has to look at the diagram of the recently-proposed health care system interconnections,” he wrote, “to realize that the health care providers and consumers are on opposite sides, separated by so much regulation and oversight, we wonder who stands to win.”

Do those who are leading seniors, fat people or minorities to support managed care, healthy lifestyles and medicalization — whose script is right out of the pages of Nazi healthism — realize that they are really working to advance the agendas of the pharmaceutical, medical supply and insurance industries and their government agency partners? Do they understand what they are supporting?

While all eyes have been focused on the weight of the latest Surgeon General nominee, for example, few know that she is a Robert Wood Johnson Foundation Trustee, having serviced on its national advisory committee of prescription drugs for health. As she told media on her election to the RWJF Board of Trustees, “I am proud to be a part of accomplishing significant and lasting social change.”

But the most important person in government overseeing healthcare reform, is Nancy-Ann Min DeParle, who President Obama appointed as director of the White House Office of Health Care Reform in March. Also known as the Healthcare Reform Czar, this position is above Cabinet-level and answers only to the President and has been given the authority to make or influence decisions for Cabinet-level agencies. The Healthcare Reform Czar position, as readers may remember, was originally slated to go to Tom Daschle in addition to serving as Secretary of Health and Human Services, until his vast conflicts of interests came out during the Senate confirmation hearings for Secretary of the HHS and put him out of the picture. In his place, Ms DeParle was quietly appointed the Healthcare Reform Czar, which is not subject to Senate confirmation.

It is doubtful that the general public knows much, if anything, about the person behind healthcare reform. Ms DeParle holds a law degree from Harvard Law School, not a medical degree, according to whitehouse.gov — which provides few details on the corporate boards she’s served on, saying only that she “brings a unique industry perspective from her work in the private sector.” Most of her positions have been administering and serving on the boards of major medical companies. Shortly after her Czar appointment, she stepped down from the corporate boards of Cerner, Medco Health Solutions (a pharmacy benefit manager), Boston Scientific (medical devices manufacturer), CareMore Health Plan and Legacy Hospital partners, as well as from CCMP Capital Advisors LLC, a private equity firm whose interests include a Medicare managed care plan. She is also a trustee of the Robert Wood Johnson Foundation, receiving earnings not only in that position, but $7,500 a speech for Johnson & Johnson.

According to an in-depth investigative report by the Investigative Reporting Workshop and msnbc.com, and SES filings, she has earned more than $6.6 million since early 2001 for her work for major medical companies. Details of her income from the medical industry were released on July 2^nd, here. “[T]he public wasn’t told that much of that corporate career was built at companies that have frequently had to defend themselves against federal investigations,” the report added. “After leaving government, DeParle accepted director positions at half a dozen companies suspected of violating the very laws and regulations she had enforced for Medicare. Those companies got into further trouble on her watch as a director.” Five of those corporations have paid a total of $566 million since 2003 to settle fraud or product liability cases, often involving tax dollars paid by Medicare.

Her Czar appointment will no doubt have significant impact for the corporations she formerly served, said the report. While promoting electronic records, for instance, no one mentions that she served on the Board of Cerner Corporation, a major manufacturer of electronic medical records software, from May 2001 until the day after her White House appointment, earning at least $680,000 in compensations. Cerner has boasted that it is well-positioned to take advantage of the stimulus bill, which provided $19 billion for electronic medical records.

Yet, many consumers still don’t understand what healthcare reform is mostly about, even though it was clear long ago just by examining the science and evidence. They want to believe that it’s about helping them.

What do experienced medical professionals advocate for healthcare reform? To return medicine to the ethical, caring practice it once was that puts patients and people first, not profits and politics.

Let’s put the patient in control, with the doctor as trusted adviser. Let’s not lose the liberty that is our right as Americans. — Dr. Donald Palmisano, M.D., July 22, 2009, National Press Club in Washington, D.C.

© 2009 Sandy Szwarc