De-skilling America’s Doctors

A surgeon declared war against health care’s central planners recently in The Wall Street Journal.

"So when do we say damn the mandates and requirements from bureaucrats who are not in the healing profession?" asked Dr. Daniel F. Craviotto Jr., an orthopedic surgeon, in "A Doctor’s Declaration of Independence."

"I acknowledge that there is a problem with the rising cost of health care, but there is also a problem when the individual physician in the trenches does not have a voice in the debate and is being told what to do and how to do it."

My doctor said the same thing two decades ago when Hillary Clinton was behind closed doors at the White House developing a Rube Goldberg contraption that was supposed to restructure a seventh of the nation’s economy by transferring the decision-making in medicine to thousands of bureaucrats in hundreds of interconnecting committees — a bloated Leviathan in which a patient had a good shot at expiring before his paperwork made it through all the hoops.

"It’ll just get worse," I remember him warning about HillaryCare. He said he already had to fax people who had no medical knowledge just to get approval for even the most routine treatments. He saw that he was being ground down into a semi-skilled operative.

In her novel "Atlas Shrugged," published in 1957, Ayn Rand focused on the personal, medical and economic wreckage caused by big government through the character of Dr. Thomas Hendricks, a surgeon.

In declaring his autonomy and noncompliance, Dr. Hendricks stated: "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 — yet what is it they expect to depend on when they lie on an operating table under my hands? Their moral code has taught them to believe that it is safe to rely on the virtue of the victims. Well, that is the virtue I have withdrawn. Let them discover the kind of doctors their system will now produce. Let them discover, in their operating rooms and hospital wards, that it is not safe to place their lives in the hands of a man whose life they have throttled. It is not safe, if he is the sort of man who resents it — and still less safe, if he is the sort who doesn’t."

Craviotto said he spends two hours a day jumping through regulatory hoops just so he can get paid and/or not be penalized with lower reimbursements. Still, even with clearing all the hoops, "Medicare reimbursement for a total knee replacement decreased by about 68 percent between 1992 and 2010," adjusted for inflation.

In her essay "What is capitalism?," Ayn Rand asks a fundamental question regarding individual freedom and economic liberty: "Is man a sovereign individual who owns his own person, his mind, his life, his work and its product — or is he the property of the tribe, the state, the society, the collective that may dispose of him in any way it pleases, that may dictate his convictions, prescribe the course of his life, control his work and expropriate his products?"

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Ralph R. Reiland is an associate professor of economics and the B. Kenneth Simon professor of free enterprise at Robert Morris University in Pittsburgh.
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