For thousands of years physicians took oaths to always act in the patient’s best interest when providing care. At the heart of medical ethics, this moral code was passed down through the centuries and reaffirmed by The World Medical Association (WMA) in 1949 and again in 2006. Additionally they specified:”A physician shall not allow his/her judgment to be influenced by personal profit or unfair discrimination,” and “shall not receive any financial benefits or other incentives solely for referring patients or prescribing specific products”.
Medical ethics ran head long into The HMO (Health Maintenance Organization) Act of 1973. The passage of this act set the stage for the undermining of long established medical ethics. The HMO Act was designed specifically to reduce costs, by charging patients a monthly fee for a set package of health care. The Act was passed with the knowledge that there had been no systematic analysis done to show that it would not negatively impact health care. None the less, the Government gave million of dollars in direct financial assistance to develop the HMO which was designed to be a profit making business.
This HMO economic arrangement put the physicians and other health care providers’ financial interest into conflict with the needs of their patients. The monthly pot of money must provide for profit, salaries, wages and health care. If too much is spent on the patients, there is less available for profit and wages. So began the Health Insurance, Corporate Medicine assault on medical ethics.
Did the Medical Profession fight to hold on to its ethics so as to always “act in the patient’s best interest when providing medical care”? No. Tragically the Medical Profession succumbed to the rise of Corporate Health Care by betraying their core medical ethic and became complicit “stewards” of an economic system that puts profits before people—The AMA’s (American Medical Association) Principles of Medical Ethics:V11, gives the following ethical guidelines for physicians: “Mitigatepossible conflicts between physicians financial interests and patient interests by minimizing the financial impact of patient care decisions and the overall financial risk for individual physicians.”
We have experienced four decades of HMO’s negative effect on health care while they became the darlings of Wall Street earning billions of dollars for investors as health care was rationed by: denial of service, restricted benefits, cost cutting, patients dumping, overworked and underpaid staff, and plunging physician’s incomes.
The author D.H. Lawrence (1880-1930) appears to have anticipated these horrors, when he wrote: “The mosquito knows full well, small as he is he’s beast of prey. But after all he only takes his bellyful, he doesn’t put my blood in the bank.”
Fast Forward to the ACA (Affordable Care Act) of 2010- One of its chief goals was to “reduce the cost of health care” by giving “financial incentives” to providers for the “Value” they provide in health care. A value-based payment incentive was to be established by bundling payment for certain types of care. Forbes Magazine, advertised as ‘The Capitalist Tool’ stated, “Bundled payments are just price controls by another name—and as such will yield subpar care by encouraging insurers and providers to put their own financial interests above the medical needs of patients.”  The ACA was passed with very little known about its effectiveness or risks to Patient Care. Once again it is all about cost cutting. But now with the so called “Value Based Purchasing”, it is no longer about making profits for corporations, but spending less government money — it is about getting more for the Governments shrinking dollars going to health care spending for Medicare, Medicaid and Social Security Disability. The politicians want to “save” money, which in reality means to redistribute money, but the economics is similar. With some ten trillion dollars in tax cuts for the rich over the last seventeen years, the US treasury has less available for social services as politicians continue to redirect a trillion dollars per year to the military–war industry without concerns that it is “costing the government too much”. The latest Republican Tax Reform Bill of 12/17 will suck out of Medicare an estimated thirty billion dollars. Bundled payments will shrink and the giant vice of shrinking payments, combined with rising costs (hospital profits, rising prices for supplies, drugs, medical equipment, etc.,) will inevitably squeeze the life blood out of both the patients and the health care providers.
The exsanguination of medical ethics has helped to bring us to this dangerous moment in history. We have witnessed a craven transformation of medical ethics when physicians, nurses and other health providers are clamoring to sign up for “Value-Based Bundled Care”. The AMA has betrayed their ancient oath as healers, in service to an economic system that puts profits before people. While deadly epidemics of cancer, heart disease, obesity, diabetes, violence and addiction haunt the nation, we have been led into a partnership with Dracula.
Dr. Nayvin Gordon is a Family Physician who has written many articles on Health and Politics. He can be reached at [email protected]
The Nation, 5/25/98 ,”Nurses Stand Tall” page 6-7