Human Exceptionalism

AMA Wants Doctors to Ration Care

The medical establishment is all on board for cost cutting in health care. That’s a good goal, of course. But how that is done really matters ethically.

Here’s the danger: Imposing a dual mandate upon doctors–cost cutting and patient care–could easily place physicians in a hopeless conflict of interest situation. Spend too much and the bureaucrats will throw brickbats. Save money at the expense of patient welfare and be sued for malpractice, while losing the trust of patients. 

Alas, the powers that be refuse to see that. For example, health care rationing is a definite agenda item under Obamacare–as many of these same advocates cry “alarmism” when people warn of that real potential. And now, a Journal of the American Medical Association editorial laments physicians’ ambivalence at accepting the dual mandate of rationing care to their patients. From, “Will Physicians Lead on Controlling Health Care Costs?”

If there was ever an “all-hands-on-deck” moment in the history of health care, now is the time. And yet, physicians must lead. They are the captains of the health care ship. Physicians’ decisions determine which patients are seen in the office, how frequently, and by which practitioners; which patients are hospitalized; which laboratory tests, diagnostic procedures, and surgical operations are administered; which medications are prescribed; and which patients will be visited at home for care. Implementing these transformations cannot occur without physicians’ active participation and engagement. If physicians oppose these changes, reform will fail.

Well, there’s reform and then, there’s reform. For example, prescribing generics as a cost saving is great–so long as the medicine is equally efficacious. But not prescribing a medication that works less well because it is cheaper. Like I said, the ethical question is in the details.

How does JAMA think doctors should control costs? Apparently by denying expensive care to certain patients:

More importantly, physicians did seem open to at least 3 specific reforms that could help transform the system into being more cost conscious. First, they seemed supportive of using cost-effectiveness data to determine availability of the services.

That smells like rationing to me:

Second, consistent with this position, 79% of physicians supported limiting access to expensive treatments with little net benefit.

But that is often defined as a “meaningful recovery,” e.g. Futile Care Theory and no-consent Do Not Resuscitate orders:.

Third, 70% supported the idea of having decision support tools in their electronic records that show possible costs of tests and treatments. 

Okay, if efficacy isn’t sacrificed on the altar of cost containment.

Doctors owe fiduciary duties to each individual patient, not society. Changing that focus will undermine medical professionalism and sow distrust in the health care system generally. Too bad the Medical Establishment is so caught up in helping build the technocracy that they seem blind to these pronounced threats to their own constituency. 

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