Independence from Medicare and Obamacare: The Stubborn Facts
are stubborn things; and whatever may be our wishes, our inclinations, or the
dictates of our passions, they cannot alter the state of facts and evidence.
Adams (1735-1826), Argument in Defense
of British Soldiers in the Boston Massacre Trials (1770)
9, 2012 - I
am for as much independence from government top-down control for physicians as
anyone, as it pertains to Obamacare and Medicare, but we cannot ignore these
Medicare has existed since 1965 and is
wildly popular. It will not go away, and
changing it – even in such commonsensical ways as advancing the age of entry to
67 or saving it from bankruptcy or bankrupting the nation, through premium
support or vouchers – will not be politically difficult.
Obamacare has been the law of the land
since March 2010, and many of its provisions will be implemented because of the
positive Supreme Court decision on its constitutionality and President Obama’s
Some of Obamacare’s provisions – such as
state-run health exchanges, the Independent Payment Advisory Board, federal-run Medicaid programs, and the 2.3% tax on profits of
medical devices – are vulnerable but the bulk of the law will remain intact.
As the biggest payer of health care, Medicare will continue to set the pace for
change in the private sector, and,
indeed, private insurers will still follow the Medicare lead in establishing physician, hospital codes, and compliance standards.
Obamacare will not cause states to secede from the
Union, but the Supreme Court decision gives states the leeway to withdraw from Washington and
set up their own health exchanges.
Physicians still have options to
minimize the impact of Obamacare, such as not seeing Medicare or Medicaid
patients or participating in other federal programs – and opting for cash-only or concierge practices or not accepting 3rd
party federal payments.
been thinking about these stubborn facts as I read David McCullough’s John Adams (Simon &Schuster, 2001).
Adams played a crucial role in the
committee that edited Thomas Jefferson drafts when he wrote the Declaration of
trust this preamble put the following parody
of the Declaration of Independence, which I wrote on July 4, 2012, in context.
Declaration of Professional Independence
“When in the Course of
human events it becomes necessary for One Profession to dissolve political
bands which have connected it with its government to assume among the powers of
the earth, the separate and equal station to which the Laws of Nature and of
Nature's God entitle them, a decent respect to the opinions of mankind requires
that they should declare the causes which impel them to the separation.
We hold these truths
to be self-evident, that all men are created equal, that they are endowed by
their Creator with certain unalienable Rights, that among these are Life,
Liberty and the pursuit of Professional Independence and Happiness — That to
secure these rights, Governments are instituted among Men, deriving their just
powers from the consent of the governed, — That whenever any Form of Government
becomes destructive of these ends, it is the Right of the Profession, to alter
its relationship, and to institute a new relationship, laying its foundation on
such principles and organizing its powers in such form, as to them shall seem
most likely to effect their Safety and Happiness.
Prudence, indeed, will
dictate that Relationships long established should not be changed for light and
transient causes; and accordingly all experience hath shewn that mankind are
more disposed to suffer, while evils are sufferable than to right themselves by
altering the forms to which they are accustomed. But when a long train of
abuses and usurpations, pursuing invariably the same Object evinces a design to
reduce them under absolute Regulations , it is their right, it is their duty,
to step aside from such Government, and to provide new Guards for their future
security. — Such has been the patient sufferance of this Profession; and such
is now the necessity which constrains them to alter their former Relationships.
The history of the
present President of the United States is a history of repeated regulations,
usurpations, taxations, and penalties, all having in direct object the
establishment of an Absolute Control over this Profession. To prove this, let
Facts be submitted to a candid world.
He has refused his
Assent to Autonomy of the Profession the most wholesome and necessary for the
He has encouraged his
Political Party to pass Laws of immediate and pressing importance, unless
suspended in their operation till his Assent should be obtained; and when so
suspended, he has utterly neglected to attend to them.
He has refused to pass
other Laws for the accommodation of large districts of people, unless those
people would relinquish the right of Representation in the Legislature, a right
inestimable to them and formidable to Government only.
He has called together
legislative bodies at places unusual, uncomfortable, and distant from the
depository of their Public Records, for the sole purpose of fatiguing them into
compliance with his measures.
He has ignored
Representatives of the other political Party repeatedly, for opposing with
manly firmness his invasions on the rights of the people, thus Poisoning the
He has refused for a
long time, after ignoring their desires for consultation, to cause others to be
elected, whereby the Legislative Powers, incapable of Annihilation, have
returned to the People at large for their exercise; the State remaining in the
mean time exposed to all the dangers of invasion from without, and convulsions
He has endeavoured to
prevent the population of these States; for that purpose obstructing the Laws
for Natural Opposition; refusing to pass others to encourage their migrations
of Power and Choice to Private Parties and raising the conditions of new
Appropriations of Funds
He has made Judges
dependent on his Will alone for the tenure of their offices, and the amount and
payment of their salaries.
He has erected a
multitude of New Bureaucrats, and sent hither swarms of Bureaucrats to harass
our people and eat out their substance.
He has combined with
others to subject us to a jurisdiction foreign to our constitution, and
unacknowledged by our laws; giving his Assent to their Acts of pretended
For imposing Taxes on
us without our Consent:
In every stage of these
Oppressions We have Petitioned for Redress in the most humble terms: Our
repeated Petitions have been answered only by repeated injury. Nor have We been
wanting in attentions to our British brethren. We have warned them from time to
time of attempts by their legislature to extend an unwarrantable jurisdiction
over us. We have reminded them of the circumstances of our emigration and
settlement here. We have appealed to their native justice and magnanimity, and
we have conjured them by the ties of our common kindred to disavow these
usurpations, which would inevitably interrupt our connections and
correspondence. They too have been deaf to the voice of justice and of
We, therefore, the
Medical Profession of the United States of America, do, in the Name, and by
Authority of the good People of these Colonies, solemnly publish and declare,
That this Profession, ought to be Free and Independent, that Absolved from all
Allegiance to an unjust Law, and that most political connections between Government
and the Profession, is and ought to be dissolved; and that as as Free and
Independent Profession, we ought have full Power over our Professional
Destinies and to do all other Acts and Things which Ian ndependent Profession
may of right do. — And for the support of this Declaration, with a firm
reliance on the protection of Divine Providence, we mutually pledge to each
other our Lives, our Fortunes, and our sacred Honor.”
I am not suggesting physicians abandon care for recipients of federal programs,
who number over 110 million, but that physicians insist upon autonomy and
relief from burdensome regulations that distract from patient care.
Tweet: Before declaring independence from Obamacare and Medicare, physicians
should consider certain stubborn facts b\that bind them to government.
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