Rationing Medicare: Update

My last article, Medicare is Already Rationing Care, focused on one small aspect of a much larger story, a story every American needs to know. The battle over the meaning of medicine began 2,500 years ago, not last spring.

In the late 1990’s I gave a lecture entitled “Post-Hippocratic Medicine in the Shadow of Nietzsche” in response to Peter Singer, the chair of bioethics at Princeton University. Singer had proposed we not consider humans “fully human” until they reached five weeks of age (after birth). During the first four weeks, he argued, we should allow the overt killing of infants with disabilities. This was “cost-effective.” It served the “greater good” by controlling the skyrocketing cost of healthcare.

For a decade I studied the question “How did America reach a place in her history where we could seriously consider resurrecting the ancient practice of infanticide?” What I discovered changed my life.

For the past 2,500 years physicians served only one of two roles in Western culture. They either followed Hippocrates and served the wellbeing of their patients, or they followed Plato and served the greater welfare of the State. The philosophy of Peter Singer is not new–it has been with us for millennia. We once again stand at these same fated crossroads of Plato and Hippocrates as we debate the future of American healthcare.

Based on my study of history, philosophy, and current events, I feared we were rapidly returning to the world of Plato; a world where physicians worked at the behest of government, not solely for the patient. To help Americans understand what was about to transpire, I launched Physicians for Reform in 2006.

The challenges facing American healthcare are real. The cost of healthcare is rising at twice the rate of inflation. Driven by the high cost of care, 28% of the patients visiting the emergency room where I work do not have coverage. Change will come; the only uncertainty is where that change will lead. Will the patient remain at the center of American healthcare? Or will the needs of the State reign supreme?

During the spring of 2008, the Barbara Wagner story confirmed my fears. After two years in remission, Barbara’s lung cancer returned. Her oncologist recommended treatment with Tarceva, a new chemotherapy. However, Barbara was a patient under the state-run Oregon Health Plan. Based of the “greater good” the State, Oregon denied her chemotherapy, instead offering to pay for physician-assisted suicide.

When asked about denying Barbara’s treatment, Dr. Walter Shaffer, a spokesman for Oregon’s Division of Medical Assistance Programs, explained the State’s policy this way, “We can’t cover everything for everyone. Taxpayer dollars are limited for publicly funded programs. We try to come up with policies that provide the most good for the most people.” (Learn details of the story here.)

In this context, Medicare is Already Rationing Care takes on an entirely new perspective. The fundamental issue is not physician reimbursement. The issue paramount for every American is access to care. Mayo just closed the doors of one of its clinics to new Medicare patients. Others will certainly follow if we continue down the road Washington is hell-bent to travel.

We must find fiscally responsible, patient-centered solutions to the challenges facing American healthcare. If we do not, financial pressures will drive us once again into the arms of Plato. Physicians for Reform is dedicated to finding these solutions so physicians can tread once again the ancient path of Hippocrates.

Visit Physicians For Reform to learn more about the history of Western medicine and the efforts of this grassroots movement. Only by working together will the patient remain at the center of American healthcare.