Is Hippocratic Oath Still Relevant under Medicare Business Model?

Ancient philosophers could afford the luxury of suggesting ethical models for good professional behavior.  But the corrupting influence of money tempers such concerns today.  Medicare and Obamacare remind us that big medicine follows big government.  An army of accountants and support staff is needed today in medical practices.  Freedom and independence are a thing of the past.

      During the late 1950s, American general practitioners could still earn a comfortable living making house calls and charging very little for office visits, as the example of one Vermont doctor illustrates:

      Routine office visits and typical procedures cost between $1-2.  There was no big chunk of the bill set aside for government compliance and mandates, nor was there an army of personal injury lawyers out to sue for malpractice whenever they could get away with it.  Bookkeeping was about like what we find today for neighborhood garages, electricians, and plumbers.  Cost was kept down this way.

      Quality, of course, was guaranteed by the Hippocratic Oath, and the personal values of the doctor, not “forced” by government regulation.  There was more personal time for “continuing education,” accomplished by reading medical journals rather than by taking expensive trips to resort settings to learn the latest government management techniques.

     Beyond social respect, healthcare professionals today also expect their incomes to be lucrative.  What good is it to knock yourself out studying medicine if only a meager income can be expected?  Then consider all the debt from paying off student loans and medical school?  Becoming part of a local medical center means that overhead can be shared.  Then teaming up with specialty “centers” in distant urban areas can outsource accounting and billing services.

      Government-managed healthcare, like Medicare and Obamacare, inevitably means that mass production and automation will favor more and more patients and less doctor-patient interaction.  Well, we live in the Online Age, don’t we?   Patients can do their own medical research to cover typical “office visit” questions.  No need for extensive “Marcus Welby, MD” attention anymore.

     National news outlets such as The New Yorker and Wikipedia are full of reports about doctors overcharging the government and ordering unnecessary tests and procedures.  Deliberate fraud is sometimes justified with phrases like “I’m not the only one doing it.” Often the patient is left out of the knowledge loop, almost entirely.

     Medicare billing is often inscrutable and intended for accounting purposes only.  There’s little attempt to help patients understand what’s recently been a fearful medical experience.  Basic lab tests hardly communicate to the patient.  What do the numbers mean? and what are the implications and options I should be considering? patients might ask.  What do all of these billing codes mean?  Why do I have so many days to appeal something on a bill that I can barely interpret.

      Besides, people don’t actually pay for medical help, except for a slight copay, do they?  It’s even worse than for the low-income consumer who asks “how much per month in terms of minimum payment” rather than the total purchase amount.  Entitlements seem “free” in a sense, so what is my incentive to challenge a fake or exaggerated charge by a physician?

     Unnecessary surgeries are best if they’re invisible.  Skin cancers, for example—several friends have had them repeatedly—might seem nothing more that a slight blemish when you go to your “free” screening.  But biopsies cost the government plenty.  Should you trust the doctor who then says you need extensive “Mohs” surgeries, again costing taxpayers thousands and thousands and disfiguring the patient, at least for weeks, until the next inevitable discovery of possible cancers?     

        What if the doctor refuses to give you a copy of the biopsy lab report, the one that patients or other physicians could check for themselves?  Shouldn’t the patient have access to all medical laboratory “reports” on which major surgeries are planned?  Chances are that a nurse or receptionist will relay the results these days, as they set up a surgery appointment.  Shouldn’t both politicians and doctors make a signed form of Hippocratic Oath available to those they serve?