Friday, July 03, 2015

Doctor/patient confidentiality

Obamacare is just a means to an end, not an end in itself. The real goal is a gov't-run healthcare system. Barney Frank, an architect of Obamacare, admitted that in a 2009 interview:

Because we don’t have the votes for it. I wish we did. I think if we get a good public option that could lead to single-payer and that’s the best way to reach single-payer.

He didn't quite explain how Obamacare is transitional to a single-payer system. One possibility is that it's a softening-up exercise. It prepares the public for a single-payer system.

There is, however, a more cynical theory. That Obamacare was designed to destroy private healthcare by producing a death spiral in the private insurance market. Here's a description:

Obamacare’s community rating results in insurance prices that are higher for younger people than they would be in a free market, and its guaranteed issue allows people to sign up for insurance even if they get sick, so young and healthy people have ample incentive to forgo insurance. This leaves the insurance “risk pool” older and sicker and, hence, more costly to insure. Premiums will have to rise to cover those costs, leading some of the younger and healthier people who did initially sign up to then drop out. The risk pool then becomes even older and sicker, premiums rise again, and the process repeats.

Now, why do I bring this up? There's a tradition of doctor/patient confidentiality, as well as doctor/patient privilege. But a single-payer system will erase the doctor/patient confidentiality/privilege? To begin with, if physicians are actually gov't employees, then your medical records are gov't records. Even if technically, only a subset of gov't employees has access to the records, there is no real doctor/patient confidentiality. Also, it's trivially easy for "confidential" records to be accessed by unauthorized personnel. 

And even if the physicians don't work directly for the gov't, if many of the treatments require authorization by some gov't bureaucrat, then once again, there will be a gov't record of the patient's condition and treatment. 

Perhaps a parallel objection might be raised with respect to physicians who must request authorization from a private health insurance company. That's a problem, but that's still different from the gov't knowing all about your sensitive medical conditions.

Also, Americans didn't always have health insurance. That's not a given. 


  1. 1. I'd add in many fields there's already considerable gov't oversight (to say the least). For example, I may not have all the details, but at least to my current knowledge oncologists don't seem to have as much wiggle room as in the past to work together with their patients to develop a treatment plan individually tailored and best suited for their patients. Instead, oncologists seem to be gradually having to work with chemotherapies and other treatment options strictly regulated by the gov't. For oncologists, this means a loss of autonomy to work together with patients, while for patients it means there's increasing likelihood they'll get treatment plans suited to the statistical mean of the population with this or that cancer but not necessarily suited to them as individuals.

    2. Also, Obamacare includes the EMR mandate:

    "Dr. Hayward K. Zwerling, an internal-medicine physician in Massachusetts who is also president of ComChart Medical Software, blasted the Obamacare EMR mandate in a recent open letter: 'As the developer of an EMR, I sincerely believe that a well-designed EMR is a useful tool for many practices. However, the federal and state government’s misguided obsession to stipulate which features must be in the EMRs, and how the physician should use the EMRs in the exam room, places the politicians in the middle of the exam room between the patient and the physician, and seriously disrupts the physician-patient relationship.'" (Source)

    3. Obamacare is a war against physicians (among others). For starters, it attacks doctors' pocketbooks (e.g. bundled payments). I suspect the end-game is for doctors to become increasingly reliant on the gov't.

    4. Related, my impression is it's only increasingly difficult for private practices to survive under Obamacare. If current trends continue, I wouldn't be surprised if in say 20 years most doctors end up employees. Either of the gov't, mega groups (essentially corporations or big companies), hospitals, or universities. Private practices will likely be few and far between.

    Next, if doctors are employees, then the gov't can more easily regulate how doctors practice by regulating companies, hospitals, and universities.

    5. The current tremendous rise of "midlevels" to take over key aspects of what doctors do. In theory, there's nothing wrong with midlevels at all, and in fact much good about midlevels. But the problem is our society wants to push midlevels to replace doctors as much as possible. This isn't due to Obamacare, but it has arguably been accelerated by Obamacare. (Let alone if a single-payer system ever comes into place.)

    For example, when someone has surgery, it used to be there were always at least two physicians in the room: the surgeon and the anesthesiologist. The surgeon does the operation, while the anesthesiologist's basic role is to ensure the patient makes it through the surgery as well as possible, as pain free as possible, that when the patient falls asleep, the patient also wakes up, etc. That's changed.

    Anesthesia is gradually being taken over by nurses i.e. nurse anesthestists. Nothing wrong with nurses. But to be frank they don't have the same knowledge and experience that a physician does. Yet in a huge number of surgeries, maybe the majority of surgeries today, anesthesia is done by a nurse rather than a physician. The nurse anesthestist is often overseen by an anesthesiologist, but sometimes the nurse anesthestist does the entire case by themselves.

    I suppose this saves hospitals, organizations, and the gov't a lot of money since it's much cheaper to employ a nurse than a physician. But at the cost of reduced patient care and increased risks to patients undergoing surgery.

  2. "Marxist Healthcare - when just-so care is enough!"

    Welcome, comrades...