Tuesday, August 25, 2009

My fellow physicians and I share one interesting thing in common with professionals in the federal government: We all take an oath relating to our jobs.

A physician pledges to “apply, for the benefit of the sick, all measures [that] are required, avoiding those twin traps of overtreatment and therapeutic nihilism.” We also pledge to “remember that [we] do not treat a fever chart, a cancerous growth, but a sick human being, whose illness may affect the person’s family and economic stability.”

A federal employee pledges to “support and defend the Constitution of the United States against all enemies, foreign and domestic … .”

Both pledges are solemn and profound. But they are very different. My question to the well-meaning authors of current health care legislation on Capitol Hill is this: Will the federal employees who implement a government-run health care option begin to take the Hippocratic Oath in addition to their traditional oath of office?

Will federal bureaucrats pledge to keep in mind the human consequences of their decisions? Will they pledge, as doctors do, to “remember that there is art to medicine as well as science, and that warmth, sympathy, and understanding may outweigh the surgeon’s knife or the chemist’s drug”?

I suspect they will not. After all, the employees of the Department of Health and Human Services who implement Medicare and Medicaid currently do not. They simply agree to defend the U.S. Constitution (as well they should, however that might relate to their jobs).

Perhaps this is why a nationwide, nonpartisan poll of physicians this month found that a full 70 percent oppose the health care reform proposals under consideration by Congress. Sixty-six percent feel that a government-run health insurance plan would restrict doctors’ ability to give the best advice and offer the best care possible to their patients. Perhaps most importantly, 60 percent said they would not accept new patients covered by a government insurance plan.

Nearly all the doctors polled have worked with Medicare. Most have likely been denied Medicare reimbursement, or given minimal reimbursement, for a course of treatment that they prescribed that best fits the needs of a patient and that patient’s family. They know that government coverage does not allow for flexibility, creativity, or, sometimes, even compassion.

As an immigrant to this country, I am grateful for the oath that government servants take to protect and defend a Constitution under which I chose to live. But, with all due respect, I will suggest that the government take care of following its oath and my colleagues and I in medicine will take care of following and implementing ours.

I share the view of the 60 percent in the August poll — those doctors who are planning to “just say no” if government-run health coverage is implemented. Many of us already do not accept patients who are on Medicare or Medicaid because of restrictions those programs put on our decisions as doctors. It pains us to turn away a patient in need, but the narrow rules of government reimbursement programs stymie our ability to follow our oath, so we simply opt out and work with patients who are also in need but have more flexible, private coverage.

If a government option gains the popularity that is expected — after all, who would not choose the most affordable option available, and how could any option compete with one that is subsidized by taxpayers — millions of Americans will face severely limited options in choosing a doctor. As physicians reject working with a system that does not honor our oath, patients will be left opening their own checkbooks, or going into credit card debt, to get the treatment they need and deserve.

President Obama has said over and over that if you like your doctor you’ll be able to keep your doctor. This is patently false. If a physician opts not to sign on to a government-run option, and the government-run plan is what you’re stuck with, you will lose your doctor. It’s as simple and as terrible as that.

The moral lines drawn by my oath are very clear to me. I know they cannot be honored when working with a government system. I will stand my ground and refuse to work with a plan run by people who do not share my oath. Research indicates I am not alone in this position — but am, in fact, in the majority.

Dr. Alfred Bonati is the head of the American Society of Medical Doctors and founder of the Bonati Institute. He is the creator of the patented Bonati Procedure for laser spinal surgery. The poll mentioned above was conducted Aug. 7 by WRS Opinion Research.

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