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AFCM Reports: The Sanctity of the Doctor-Patient Relationship
March 18, 2000
The Chicago Tribune of March 12 reported that more doctors
are refusing to see Medicare patients. Fewer doctors than ever are generally available to treat
patients, and those who remain in the profession are rejecting the increased pressure to see more
patients for less reward.
Reports of these trends are not new. The likely reason for the
article's timing is the prominence that health care policy will take in this year's elections. If
so, this is entirely appropriate: it is the government's involvement in health care that caused
these problems.
There is a brain drain in medicine. Career physicians are quitting—as
they have in Britain, Canada, and every Western country which has socialized its health care
system—in frustration with the health care bureaucracy and the impossible financial conditions
to which they are subjected. As one physician said, “When Medicare pays you 45% of your charges
and your overhead comes to 65% what are you going to do?”
The sizable role of government in health care (there are 39 million
elderly and disabled individuals on Medicare programs) is further lowering the quality and quantity
of new physicians. Incoming medical students are reportedly lazier, with lower work expectations
and less ambition. These youngsters—who are expected to maintain the physicians' ranks—are
increasingly schooled in bureaucratic procedures rather than medical ones.
Additionally, the government sponsors shortages. To reduce costs, the
government pays medical schools not to take students in order to reduce the number of
physicians who will “drain” the government's coffers in the future.
For the courageous physicians who remain in practice, treating
Medicare patients results in lower fees that are often up to four months late in being paid. The
paperwork required for dealing with Medicare and Medicaid is a massive burden compounded by
bureaucratic suspicion and the criminalization of doctors. The Health Care Financing Administration
(HCFA) is increasingly aggressive in pursuing fraud and abuse of Medicare. Recent government
figures refer ominously to “improper Medicare payments” that rose in 1999 to $13.5
billion, about 8% of the Medicare budget. (Over the past 4 years, these “improper payments”
amount to about 10% of the Medicare budget.) Most of these are likely attributable to the honest
errors that come from dealing with the burdensome paperwork. Undoubtedly, as with any welfare
scheme, there are physicians who attempt to defraud the system, but the HCFA treats every physician
and hospital with suspicion. The honest inevitably suffer doubly from the bureaucratic mindset. Not
only are honest physicians tainted by the frauds, but they probably commit errors because their minds are where they
should be: on their patients, not the paperwork. Additionally, HMOs—“free-market”
organizations who actually gain their economic power through government fiat and favors”place
doctors under their own brand of bureaucratic pressures.
Is it any wonder that physicians refuse to see those patients who
bring the lowest reward, the greatest hassles and the highest risks—all of them non-medical?
The tragic consequence is that the elderly and disabled patients—who
Medicare is supposed to protect—are suffering. The doctors with whom they have long relationships
drop these patients because they cannot afford to treat them. It then becomes even harder for these
patients to find new physicians, let alone ones who will build the long-term relationships they
need. The Chicago Tribune reported one instance of a husband and wife—who were not even
old enough for Medicare and were simply trying to prepare for their future—who were refused by
25 doctors.
The doctor-patient relationship is not merely eroding, it is dying.
The article is a timely reminder of the problems government causes in
the health care system. Unfortunately, the presidential candidates want either to “save”
Medicare (Bush), or expand it (Gore). Saving it is impossible; expanding it would be disastrous.
Both courses serve only to perpetuate the system which caused the problems. The future will be worse.
The only solution is to dismantle the government's health care
apparatus and return control of health care decisions to individual patients and doctors. Leave
doctors free to concentrate on their work and make the living they deserve, and allow patients of
all ages and health to seek out those doctors. If our politicians were serious about reforming
health care, they would not try to resuscitate the current mechanism, but to kill it before it
kills health care altogether.
Copyright © 2000 Americans for Free Choice in Medicine. All rights reserved.
Send reprint requests to . Reprints must include above copyright statement.
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