It is presently fair to ask the question, do doctors participate in our society as individuals being free? If this is no longer the case, why and what are the consequences? If a doctor is employed, he answers to an employer. If there is participation with Medicaid and Medicare, the rules must be followed. These are rules, mandates, and regulations created by the administrative state, politicians, and faceless bureaucrats. If there is participation with an insurance company, compliance with the contractual relationship is mandatory. Why would physicians allow themselves these masters in what are easily described as tyrannical relationships?
Doctors have allowed themselves to be characterized as untrustworthy, even devoid of virtue, by those who covet power over them. The title of doctor has even been replaced by provider. Such an immoral group of individuals needs the iron hand of government, its egocentric politicians, and power-hungry bureaucrats to control their inherent duplicity by allowing them only the appropriate freedoms to practice their profession. Of course, allowed freedom is not freedom. It is just the opposite. Certificate of Need laws, non-compete clauses, mandated use of the electronic medical record, and Stark Laws are clear examples of laws specifically designed to restrict doctors’ freedoms. The created perception that physicians are motivated by their own self-interests and not the interests and needs of patients, so the argument goes, allows such restrictions on freedom to be defended.
Why have doctors allowed this to happen? It is difficult to conclude but unavoidable. Doctors are so risk-averse that they would choose to surrender freedom and be taken care of by their paymasters rather than engage in the unique freedom opportunities that our society still offers, albeit to ever lesser degrees. Unfortunately, when physician finances are controlled by others, these others also control the physicians. There seems to be more comfort in this progressive loss of freedom and an actual affinity for what was once described as slavery.
Edmund Burke stated “There is no liberty without morality.” What is tragic is that it is actually the immorality of government that has allowed physicians to be falsely characterized as immoral, or at least not deserving of trust, and hence in need of being controlled. So, freedom has been taken away by the creation of a duplicitous narrative and engaged by a profession that would rather be taken care of as opposed to maintaining independence and freedom.
There is an interesting historical story that might be studied. The Bolshevik Russian Revolution took place in 1917. Of course, the equality of circumstances would now prevent “people from dying in the streets,” a familiar refrain from the political left. It was the utopian dream that the government could supply medical care more fairly and cheaper than a “greedy” market-oriented system. In a consumer-oriented medical business, the former cottage industry, doctors’ success was dependent upon their professionalism, which included the provision of care to the poor and their reputation. Doctors were able to earn a comfortable living and could provide charity care to the needy poor. Patients choose their doctors. Implying that physicians’ professionalism was a fantasy and relegating all physicians to the same reputational status needed to be and was accomplished. The great Russian author Solzhenitsyn, in his novel Cancer Ward, imagines a vision of health care, the essence of which is the consensual relationship between the patient and physician. In Mr. Solzhenitsyn’s words, “Among all these persecutions [of the old doctor], the most persistent and stringent had been directed against the fact that Doctor Oreschenkov clung stubbornly to his right to conduct a private medical practice, although this was forbidden.” “In general, the family doctor is the most comforting figure in our lives. But he has been cut down and foreshortened. . . . Sometimes it’s easier to find a wife than to find a doctor nowadays who is prepared to give you as much time as you need and understands you completely, all of you.” It was accepted that the profit motive, compensation, and the professional spirit of charity could deliver comprehensive and quality medical care.
Medical education was traditionally sought by the best students, and the most qualified became their teachers. Appropriate future income and professional status also created competition for medical school admission based on merit, not class, gender, ethnicity, or race. For a talented individual with a brilliant mind, working hard, only to be rejected because of lacking some immutable characteristic, is not only immoral punishment but certainly paves the way to physicians’ mediocrity.
Quite analogous in this country has been the welfare and entitlement states becoming more a part of the culture’s leftward movement. It became apparent that the previous system of health care delivery and the physician basis for that care needed to be destroyed and replaced increasingly by the centrality of government. Of course, independent medical practices, the previous cottage industry of physician businesses, would be replaced by the corporatization of health care megaliths, by the insurance industry, and through entitlements that were increasingly regulated both directly for entitlements and indirectly for hospital systems and insurance companies.
Of course, now the private expenditures for health care in a competitive free market were increasingly replaced by governmental budgeting requirements. The intensity of such budgeting considerations has always magnified as deficits and debts swell for all countries adopting “Medicare for All” collectivist philosophy. Physician reimbursements were continuously lowered, salaries replaced revenue, and inventions such as the RVU system of compensation were created together with other schemes of managed care. In the end, the cost-prohibitive utopia of free health care for all depicted as a right rather than a privilege could only be managed via pricing. Pricing is simply code for the multitude and variety of rationing strategies. If health care was a right, physicians, by caveat, had none. Freedom for doctors could actually be depicted as an oxymoron.
If this historical lesson applies to the evolution of health care in this country, a race toward the increasing socialization of medicine seems undeniable. Socialism never adds freedoms or protects what was “endowed by our creator” and memorialized in the Bill of Rights. It centralizes authority and grows government size and control at the expense of “inalienable” human freedom. It appears now quite non-debatable that doctors have become among the most freedom-deprived in our entire country. This did not happen by chance. It was intended by “elite” political classes needing this outcome for a more managed leftward society. Perhaps more tragically, it was allowed to happen by a profession that, if nothing else, should have been and should be characterized as free, independent, and possessive of always retaining the characteristics of critical thinkers.
This cannot end well. History repeatedly shows the folly of such thinking for the preservation of an exceptional profession of medicine with the provision of the best health care as its motivating objective for all of us who will someday need it. I am finally convinced that the words of Dr. Hendricks in Ayn Rand’s Atlas Shrugged were prophetic: “I have often wondered at the smugness with which people assert their right to enslave me, to control my work, to force my will, to violate my conscience, to stifle my mind.”
Allan Dobzyniak is an internal medicine physician.
