When I became a doctor almost 40 years ago, I swore to uphold the Hippocratic Oath — “do no harm.” Never has this solemn promise been more difficult to keep. Today, Obamacare is the greatest threat to a doctor’s ability to help patients — and I see it impacting and diminishing the quality of American health care both now and into the distant future.
I recalled my oath when President Obama declared recently that Obamacare is working. He pointed to the law’s 8 million sign-ups as proof. Yet this number is deceptive — it says nothing about whether the law has achieved its goals.
Obamacare was advertised to the American people as a fix for two problems: Reining in the runaway cost of health care and extending health insurance to the uninsured. Long before the law was passed, physicians agreed that major reform of health care financing, taxation and insurance could help fix these issues, which were very real. The cost of health care had ballooned from coast to coast. These steady increases simultaneously made it harder for many to afford health care or health insurance for their families, thereby driving up the number of uninsured.
Intentions didn’t equal results with Obamacare. Neither of these two problems have been addressed by the law. Health care experts at Harvard University and Dartmouth College still estimate that health care costs will continue to grow faster than the economy for at least the next 20 years. Most troublesome, the federal government estimates that 31 million Americans will still be uninsured by 2024.
In other words, our health care system is still broken — and getting worse. Obamacare places unprecedented regulatory and financial burdens on doctors and hospitals. As a result, practitioners in all specialties are increasingly focused on paperwork and checking statute-driven boxes rather than on patient healing and well-being.
A major problem stems from Obamacare’s Accountable Care Organizations. The organizations collectivize hospitals and many physicians together into single units. These units are then paid by the federal government for the specific services and treatments that they provide following federal guidelines.
Although this currently applies only to Medicare patients, the model is already being adopted for all patients. One of Obamacare’s main architects, Ezekiel Emanuel, brags that this was ultimately the law’s main goal — it shifts health care from a focus on individual patients to society as a whole.
Accountable Care Organizations are not about the doctor-patient relationship because the government will ultimately dictate all treatments, procedures and payment schedules. The federally run Independent Payment Advisory Board, a 15-person panel appointed by the president, determines which medical services will and will not be reimbursed and for how much. This is a rationing board by another name. Doctors must stay within federal rules and regulations or violate the law and the Accountable Care Organizations that employ them.
This is a dagger aimed at the heart of medicine. Instead of caring for each individual patient and trying to achieve the best health outcomes, doctors become professional assembly-line workers who only follow federal guidelines. If they vary from those guidelines, Washington will refuse to reimburse them and they can face criminal liability.
Obamacare thus directly conflicts with the Hippocratic Oath. The federal bureaucracy increasingly sits in the middle of the examination room, dictating to doctors and patients what they can and can’t do.
In too many cases, doctors will have to choose between what is medically appropriate for their patient — the Hippocratic ethic — and what is mandated by the government. The two will frequently conflict. Each patient’s health needs are always unique.
When I ask pre-med and medical students why they want to be doctors, they invariably say they want to help people. I praise and encourage that sentiment but now explain that they can’t do this without the freedom of an unwavering commitment to each individual patient, which requires hard work and significant expertise. Right now, nothing threatens this more than Obamacare. Physicians increasingly face a moral crisis: uphold the Hippocratic Oath or follow Obamacare’s mandates.
Dr. John Ammon is an anesthesiologist practicing in Phoenix.