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Physicians’ Declaration of Independence

The idea that men are created free and equal is true and misleading; they lose their social freedom and their individual autonomy in seeking to become like each other.

David Riesman (1909-2002), The Lonely Crowd (1950)

The American Association of Physicians and Surgeons is holding their annual meeting in Charleston, South Carolina, this week. On the agenda will be talk of direct pay independent practice, a national movement towards direct pay independent practice.

Physicians are seeking autonomy, the freedom and independence to practice to do what they were trained to do, take care of patients without outside interference. Independent physicians , however, are becoming an increasingly lonely crowd with less than one third now practicing independently of large organizations. The health law calls for physicians to practice a homogenized brand of medicine, under one-size-fits-all health plans, with a standardized set of benefits.

Physicians are resisting these reform trend. They do not think one-size-fits-all, nor should it.

The new president of the American Association of Physicians and Surgeons, Richard Amerling, MD, a nephrologist from New York City, last year issued this clarion call for Physician Independence.

A Physician’s Declaration of Independence

When in the Course of Human Events, it becomes necessary for the members of a Profession to dissolve the Financial Arrangements which have connected them with Medicare, Medicaid, assorted Health Maintenance Organizations, and diverse Third Party Payers and to assume among the other Professions 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 the Physician’s primary responsibility is toward the Patient; that to assure the sanctity of this relationship, payment for service should be decided between Physician and Patient, and that, as in all transactions in a free society, this payment be mutually agreeable. Only such a Financial Arrangement will guarantee the highest level of Commitment and Service of the Physician to the Patient, restrain Outside Influence on Decision-Making, and assure that personal information be kept confidential.

The Financial Arrangements between Physicians and the Third Parties have become so destructive to the Patient-Physician relationship, and to the Medical Profession as a whole, that it is the Right, and Obligation, of the Members of the Profession to abolish them.
Prudence will dictate that arrangements long established should not be changed for light and transient causes; and accordingly all experience has shown, that Physicians are more disposed to suffer, while evils are sufferable, than to right themselves by abolishing the forms to which they are accustomed.

But when a long train of abuses and usurpations evinces a design to reduce them under Absolute Despotism, it is their Right; it is their Duty, to throw off such arrangements, and to provide new Guards for their future security.

Such has been the patient sufferance of the members of this Profession; and such is now the necessity that constrains them to alter their former Financial Arrangements. The history of the present system is a history of repeated injuries and usurpations, all having in direct effect the establishment of an absolute Tyranny over the Medical Profession. To prove this, let Facts be submitted to a candid world.

• The Tyranny began during the Second World War, when the Government gave tax subsidies to Employers who offered Health Insurance Benefits, thus penalizing and disenfranchising individuals.

• The Government created and subsidized the Health Maintenance Organizations---Entities designed to ration Health Care by Capitation; These incentives set Patient against Physician, thus destroying the Sacred Trust between patient and physician.

• The Government, in 1965, going far beyond its Powers as set out in the Constitution, decreed that the Poor and The Elderly should receive Health Care Benefits funded by the Taxpayer. Thus came into existence Medicaid and Medicare, massive Entitlements that are bankrupting the Federal and many State Governments.

• Alarmed by the rising Health Care prices that it had engendered, the Government set out to restrain fees to Physicians. These Price Controls increased Health Care Spending, as Volume of Services increased, and Quality decreased. No other Profession in the United States is denied the ability to raise fees to cover increasing costs of doing Business.

• The Government enacted the fraudulently named 'Health Insurance Portability and Accountability Act' (HIPAA), forcing physicians, medical offices and hospitals to spend billions to comply with its provisions, with no positive effect on either Portability or Accountability, and many negative ones, especially on privacy.

• The Government passed the Sustainable Growth Rate formula which lowers Medicare Physician Payment when total spending and volume increase, assuring a downward spiral in Payments.

• The Government and HMOs now limit fees to Physicians by "Payment for Performance," based on "Practice Guidelines." Beyond insulting our Ethic, this destroys our Professional Autonomy.

• Our Leaders compel ongoing Maintenance of Certification that costs us time and money and does not improve patient care in the Least.

• A Temporary Democrat Congress and President have conspired to completely take over all aspects of the Health Care System, with all patient encounters feeding into a National Database. The so-called Affordable Care Act forces citizens to buy expensive “insurance,” subsidizes some, massively expands the Bureaucracy, and Empowers the corrupt Internal Revenue Service to oversee Private Health Care.

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. A System whose character is thus marked by every act which may define a Tyrant, is unfit to be the ruler of a Free Profession.

We, therefore, the undersigned Physicians of the United States of America, appealing to the Supreme Judge of the world for the rectitude of our intentions, do, in the Name of our Patients solemnly publish and declare, that we will withdraw our participation in all above-described Third Party Payment Systems. Henceforth and Forever, we shall agree to provide our services directly to our Patients, and be compensated directly by them, in accordance with the ancient customs of our Profession. The Patients’ medical interactions with us will remain confidential. We pledge the highest level of Service and Dedication to their Well-Being.
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.

Richard Amerling, MD, New York, NY
July, 2013

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