Paul Hsieh

Suppose you move to Las Vegas, and you hire a real estate agent to help you buy a house. She returns with several inappropriate choices — all too expensive and too far from your work. She explains, “I know these aren’t what you wanted. But you’d really help the struggling Nevada housing market by purchasing one of these.”

Most people would fire her on the spot. Your real estate agent has a professional obligation to look out for your individual interests, not some nebulous “Nevada housing market.” Yet under ObamaCare, your doctor will be increasingly pressured into sacrificing your individual medical interests for a nebulous “social justice.”

In traditional Western medical ethics, a doctor’s fundamental responsibility is to practice to the best of his ability for his patient’s benefit. But lately, doctors are being taught a radical new collectivist medical ethics where the “social good” trumps the individual patient’s welfare.

A now-famous article in the 1998 Annals of Internal Medicine recommended that “devotion to the best medical interests of each individual patient be replaced with an ethic of devotion to the best medical interests of the group...” The American College of Physicians ethics charter now states that physicians should balance traditional principles of patient welfare and patient autonomy with “social justice” to achieve “a just distribution of finite resources.” A 2011 New England Journal of Medicine article urged abandoning “the primacy of patient welfare” in favor of “collectively caring for a defined population within a fixed annual budget.”

Translation: Physicians should sacrifice the interests of their individual patients to save money for the collective.

Fortunately, most physicians still place their patients’ welfare first. In 2009, the federal government proposed restricting screening mammography to women over 50 (and then only at 2 year intervals), despite the proven benefits of annual mammograms beginning at age 40. Most doctors ignored these new guidelines and continued practicing in their patients’ best interests according to the old guidelines.

However, starting in 2012 physicians will have a more difficult time defying such government guidelines. Through various financial carrots and sticks, ObamaCare legislation will pressure doctors into joining large “Accountable Care Organizations” (ACOs). ACO physicians would treat patients according to government-approved “cost-effectiveness” guidelines. ACOs would monitor doctors with electronic medical records, rewarding those who adhere to government guidelines and penalizing those who don’t. In theory, ACOs will encourage cost-effective, “integrated” care; in practice, ACOs will reward doctors for limiting medical care.

Suppose you see your ACO doctor for a severe headache. He performs a brief physical exam, then tells you that you don’t need an MRI scan of your brain — just take two Tylenol and call him in the morning. Could you be completely sure he was acting in your best medical interest? Or might he be unduly influenced by the bonus he receives for reducing the number of MRI scans performed by the ACO?

ACOs make doctors accountable — but to the government, not their patients. This is the inevitable result of government-funded medicine. Government now accounts for 45% of all US health care spending, and he who pays the piper calls the tune. Under ObamaCare, government will exert ever-increasing control over how doctors can treat patients, even those with private insurance. The solution is not more government regulations, but repealing ObamaCare and eliminating all government interference in health care.

If ObamaCare is not repealed, many doctors will quit medicine, frustrated by the constant pressure to restrict their patients’ care. Others will reluctantly submit to government pressure, telling themselves, “I have no choice. I’m just following orders.” Still others will embrace this new system, gladly limiting your care in the name of “social justice.” You won’t want these kinds of doctors caring of you.

In the meantime, you can still take steps to protect yourself. If your doctor is a part of an ACO, request that your medical records be excluded from his ACO practice statistics — thus reducing his pressure to follow ACO guidelines. Better yet, find a doctor who has not yet joined an ACO, or use a “direct pay” or “concierge” doctor committed to working only for you.

Just as your real estate agent should represent your individual home buying interests and your lawyer should represent your individual legal interests, your physician should represent your individual medical interests — not sacrifice you to some collectivist ideal of “social justice.” Do you want a medical system that allows your doctor to work for you? You should — it’s your life at stake.

Paul Hsieh, MD, is co-founder of Freedom and Individual Rights in Medicine (www.WeStandFIRM.org) and a member of the Colorado chapter of Docs4PatientCare (www.Docs4PatientCare.org).


Paul Hsieh

Dr. Paul Hsieh is a member of the Colorado chapter of Docs4PatientCare and co-founder of Freedom and Individual Rights in Medicine (FIRM).