Pivotal. Monumental. Constitutive. So much is at stake in the 2012 presidential election that many have put its significance on par with the country's first election, as well as the 1860 contest that spawned the American Civil War. It is also a study in stark contrasts.
Perhaps nothing elucidates more sharply the axiological difference between the candidates than their approach to healthcare reform.
Without doubt, the Affordable Care Act will have a devastating impact on the economy and the sustainability of the U.S. healthcare industry. As a physician, I also have grave concerns about the very fundamental changes that ObamaCare, if not repealed, will inflict upon the American way of life. Rather than entrusting physicians to make informed clinical decisions and tailor care to individual patients, ObamaCare represents thousands of pages of new regulations that control office visits, operating rooms, consultations and treatment options. It ultimately prohibits the ability of doctors to provide the best possible care.
Few things are as sacrosanct as the relationship between patients and their doctors. We have laws that recognize the confidential nature of the alliance between people and their lawyers, and protect the "attorney-client privilege." We safeguard interactions between people and their pastors. We hold dear the "spousal privilege" that protects the sanctity of conversation within a marriage. And, historically, we have held the essence of the relationship between patients and their doctors in the same inviolable regard.
As a country, we have always recognized that patients and their doctors are in the best position to make decisions about what is right for them and their families. We have valued the very personal and private bond that occurs within the confines of the exam room.
For the first time in history, the Affordable Care Act threatens the very fiber of the patient-doctor relationship by inserting a host of government mandates and regulations that legislate what doctors can and cannot do. ObamaCare represents an egregious intrusion of the federal government into what was formerly hallowed ground.
Although the Affordable Care Act was passed in 2010 and is just now in the process of full implementation, the seeds of its philosophical transformation were sown from the beginning of the Obama administration. Medical education itself has changed, as medical students and young physicians have been taught to rely on government issued "guidelines" and standards set by bureaucrats not trained in science. They have been inculcated with the concept that cost-of-care trumps quality, and that the government is better able to make decisions about treatment options than doctors and patients. As a result, we are training an entire generation of doctors who are little more than reasonably competent "healthcare technicians." They have no understanding of how to assess and care for the whole patient, weigh treatment options, and make well-reasoned clinical decisions.
In what can be best described as linguistic subterfuge, ObamaCare's architects and supporters have co-opted conservative terminology such as "personal responsibility" and "market competition." They have hijacked these phrases in hopes of surreptitiously passing off their centrally planned and statist concepts. Forcing people to purchase a government-defined product – and threatening them with a hefty tax penalty for failure to comply – is not "individual responsibility." It's extortion. These requirements serve only to drive costs up and severely limit choice. The healthcare law and the new "insurance exchanges" that it mandates are designed for overwhelming government control and income redistribution rather than for individual choice and free-market competition. As with every other sector of the economy, liberals simply refuse to believe that the free-market can work in healthcare, and therefore, the government must intercede.
Despite President Obama's claim that the insurance mandate will guarantee that everyone will now have access to care, "insurance" is not "assurance" of anything. Plummeting reimbursement and ObamaCare's overwhelming intrusion into the treatment room will cause tens of thousands of highly-trained doctors to leave the practice of medicine, worsening an already critical physician shortage. The multitude of new taxes and entitlements included in the Affordable Care Act will devastate our economy and impoverish future generations. Mandates and regulation will cripple medical innovation and technological advancement. In short order, ObamaCare will lower the overall standard of living for Americans.
When the focus of healthcare delivery becomes standardization and cost-containment, there is no option but for quality to suffer and rationing to ensue. How can physicians possibly render personalized treatment when they are restricted by mandates dictated by appointed bureaucrats like the Independent Payment Advisory Board? How can they provide the best care when they are being pressured by an auditor at an Accountable Care Organization to keep costs down? Patients need a doctor who can be an advocate as well as an expert to provide professional medical expertise. A physician should never be put in a position to choose between doing what is best for a patient and what has been mandated by the government. I took an oath to, first and foremost, "do no harm;" ObamaCare will force me and others in my profession to violate that crucial first principle of medicine.
In speaking to medical students in 1908, famed poet Rudyard Kipling noted, "There are only two classes of mankind in the world – doctors and patients." Americans no longer have the luxury of remaining apathetic or uninformed about the potential impact of this election. It is incumbent upon all of us to vote and to encourage others to do so. If President Obama is re-elected, future historians will reflect on the period from 2008-2016 and conclude that he successfully forced the government take-over of American healthcare and, in so doing, sounded the death knell both for democracy and for the greatest healthcare system on the planet.