Thursday, April 19, 2012

Physicians As Freedom Fighters
You should never wear your best trousers when you go out to fight for freedom and truth.

Henrik Ibsen (1828-1906), An Enemy of the People (1882)
April 19, 2012 -   In  past surveys I have cited in these posts  - by The Physicians Foundation,  Reuters,  athenahealth,, and the Doctors Company,  60%-70% of physicians say the health reform law will decrease quality of care.
Why is this?  As nearly as I can tell, the underlying reason is loss of clinical freedom to choose what they want for  their patients and freedom to go outside the boundaries of 3rd party restrictions  if patients desire  to pay for further  recommended treatments or tests. 

I speak here of restrictive and time-consuming  public and private bureaucracies limiting clinical freedoms.

On the Fourth of July,  my late brother-in-law, who fought for Patton in World War II,  who, when sufficiently pixilated,  would shout ,”It’s about freedom!”  And in case you didn’t hear,  he would repeat, louder, with emphasis, “ It’ s all about freedom, and don't you forget it!”

And indeed it is.   That’s why immigrants from around the world,  past and present,  flock to America – for freedom and opportunity  to live, behave, and  rise as they please.  

I was thinking of this the other day,  when I asked  a Tibetan immigrant,”Why did you come to America?”  She replied,  “For freedom. Everybody knows America is the land of freedom.”
Not everyone. It depends on what one means by “freedom.”   Bureaucrats, in their zeal to protect people,  exercise expertise,  and cement power,  think  they can best achieve their goals through centralized government control.   But as Friedrich Hayek (1899-1992)  explained in his 1945 classic,  The Road to Serfdom, the road to bureaucratic  bondage is paved with good intentions.

I conclude in my 2005 book, The Voices of Health Reform,

“Democracy is a messy business. That’s the way Americans like it.  It explains why Americans prefer local health solutions, why they reject federal government mandated universal coverage with rationing, why they feel capable of making their own health care decisions, why they seek equal  opportunity access to high technologies, why they prefer pluralistic payment systems, why they allow market-based and government–based institutions  to co-exist and compete, and why they permit doctors to behave democratically, seeking their own locales to  practice, often acting independently of hospitals, health plans, and government, making their own decisions, free of fetters from outsiders.”

The German General and the Italian General
Democracy is  messy.  I’m reminded of the story of  a German General and an Italian General at the front.   The Italian General says to the German General, “Why do you wear that red jacket? ”  “Because,” replies the German,” “when I get hit, I don’t want my men to see me bleed!”  The Italian turns to his aide-de camp and says, “Get my brown  pants!”

Don't you ever forget it.  America is an exeptional  country  - home of the free.

Tweet: Many physicians object to bureaucratic constraints of the health reform law because it restricts freedom for doctors and patients.

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