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12/13/2016

Imminent Threats To Healthcare and Medical Professionalism: We Must Remain Vigilant

In a previous blog
I expressed concerns about the possible direction of politics in our country
and the risks it poses to the larger procedural, democratic framework, which I
take to be essential to the work of contemporary bioethics. Now that the
election is over and a new administration is taking shape, I have many grave concerns
about the fundamentally new policy directions our nation will be taking. None
concern me more than how the planned changes in our healthcare system in the
United States and, if they happen, how our most vulnerable patients will be
affected. This is because a top agenda for them on day one will be to repeal
the Affordable
Care Act
(ACA), which has provided healthcare coverage for about 21 million
more people since its inception in 2009.

The ACA was an imperfect healthcare plan from the start. But
after decades of false starts to reform a system that does not have a close second
in terms of excessive costs and inefficiencies among industrialized nations, especially
in relation to outcomes, in 2009 it was the best option our country had at that
time. In spite of some problems in its implementation, due largely to lack of
cooperation and critics setting up obstacles, the ACA has become entrenched
into our healthcare system. If it is repealed, there will be widespread
suffering and chaos. Just recently
the nations’ hospital industry “…warned President-elect Donald Trump and
congressional leaders on Tuesday that repealing the Affordable Care Act could
cost hospitals $165 billion by the middle of the next decade and trigger “an
unprecedented public health crisis.”

 The eagerness of the new administration to gut the ACA was
affirmed by the appointment of Tom Price, Representative from Georgia who has
been a ferocious and over the top critic of this law from its inception. A
prominent orthopedic surgeon prior to running for Congress, Dr. Price seems to
advocate for a system that is extricated from government as much as possible
and placed in the hands of the private insurance companies. His plan,
which provides for individual fixed tax credits and health savings accounts and
allows insurance companies to cross state lines, may be helpful for many
Americans who are relatively well off and have healthcare to start with. But
for most of the sickest patient in lower income brackets, these market-based
ideas will do nothing to help them and in fact make them worse off. But real
world, harmful consequences are the concerns of an ideologue: All
that matters is having in place a policy that accords with an ideal vision of
how the world should work.

There is no practical way that a purely market based
approached to providing access to healthcare to Americans will accomplish the
goals of healthcare that the majority
of Americans have, which is to provide some type of basic, quality healthcare
to all citizens, at an affordable cost. Price’s approach will leave millions of
American citizens, many already with serious health problems without access to
health except via the emergency rooms. The predictable consequences will be
astronomically increasing costs because healthcare will retreat to its pre-ACA
days of inefficiency by focusing more on rescuing patients from acute
conditions than preventing them from occurring in the first place; and
physicians caring for patients with insurance will be doing more and more
procedures for which they will be handsomely paid, without improving quality for
patients. Which makes it all the sadder to see the American Medical Association
(AMA), as it has done at prior critical historical junctures as it did in
standing against the passage of Medicare and Medicaid in 1965, endorsing
Price’s nomination.

Though Price’s nomination may be bad for patients, it likely
represents good
news for physicians
in terms of their incomes from reimbursement rates.
Which is the reason why the AMA supports him and why, in my judgment, it is an
abdication of professional, ethical good judgment and responsibility. Their
support violates the basic tenant of professionalism as stated in the American
College of Physicians (ACP) Ethics
Manual
that require its members “…to
teach and expand, by a code of ethics and a duty of service that put patient
care above self-interest, and by the privilege of self-regulation granted by
society. Physicians must individually and collectively fulfill the duties of
the profession.”

I am heartened by practicing physicians and
physicians-in-training who speak out and refuse to be a part of the AMA and its
support of Price’s appointment to be Secretary of HHS.  Most notably a petition has gained over 5,000
physicians’ signatures that make it clear “The
AMA Does Not Speak For Us
”.  As they
state in the petition:

 

“We are practicing physicians who
deliver healthcare in hospitals and clinics, in cities and rural towns; we are
specialists and generalists, and we care for the poor and the rich, the young
and the elderly. We see firsthand the difficulties that Americans face daily in
accessing affordable, quality healthcare. We believe that in issuing this
statement of support for Dr. Price, the AMA has reneged on a fundamental pledge
that we as physicians have taken?—?to protect and advance care for our
patients.”

 

Medical professionalism always exists in relationship to the
prevailing economic and political order in society. Because economic and
political winds can shift, so can medical professionalism that at times can put
it at risk of losing its moral compass. We do not know yet just how strong the
head winds will be. But medical professionals and all citizens who care about
the future of just and quality healthcare should be especially vigilant in the
coming days and remain prepared to show resistance when necessary.

The Alden March Bioethics Institute offers a Master of Science in Bioethics, a Doctorate of Professional Studies in Bioethics, and Graduate Certificates in Clinical Ethics and Clinical Ethics Consultation. For more information on AMBI’s online graduate programs, please visit our website.

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