Health Care Reform: Accountability to Patients or Government Bureaucrats?

by Robert Maynard

Should health care reform leave doctors accountable to patients, or government bureaucrats?  That is the question posed at a town hall forum held by the Green Mountain Patriots tonight at the Grange Hall in Essex.  The forum featured a new film produced by the Tea Party Patriots, which is a network of local Tea Party groups from all around the country.  The film was entitled “The Determinators” and was based on a book entitled “The Battle for America’s Soul” by Dr. C. L. Gray MD.

Dr. C. L. Gray is a nationally known writer, speaker, and board certified physician practicing hospital-based medicine in western North Carolina. In 2006 he founded Physicians for Reform, a non-profit organization dedicated to preserving patient-centered healthcare. Gray’s current book, The Battle for America’s Soul, resulted from a decade spent in research and analysis of the history and philosophy of medical ethics. This book presents findings that link America’s present cultural divide with the practice of Post-Hippocratic medicine.

There is an old saying  that “he who pays the piper, calls the tune.”  Dr. Gray applied this well known concept to the issue of health care: “Government compassion sounds so noble. But in the end, whoever pays holds the power to choose… and the government cannot provide everything for everyone.” p. 13  Here is what he saw as a result of going down that road: “In the end, the State secured the power to ration healthcare in order to control its financial risk, even if that meant replacing a patient’s chance to live with the choice of how to die.” p. 12

The real matter at stake here is the fundamental relationship between a doctor and his/her patient.  Whose interest should the doctor be primarily concerned with serving?  The answer to that question would seem obvious.  Most people would argue that the doctor should be primarily concerned with serving the needs of his/her patient.  That is the fundamental principle of a system of medical ethics that goes all the way back to the Greek physician Hippocrates, after whom the Hippocratic Oath was named.  However a different system of thought, primarily associated with the ancient Greek philosopher Plato, has long been at odds with this assumption.  Plato had a view of a utopian society as an organic whole with the individuals as mere parts of that greater whole.  The “Guardian Class” represented the “intellect” of the society and had the exclusive right to rule.  Justice required that the needs and desires of mere individuals be subordinated to the will and design of the state.  Applied to the field of medicine, this meant that doctors are accountable primarily to the state, not the patient, and were expected to serve the enlightened will of the state’s guardians.  Dr. Gray uses the dichotomy of a Platonic approach to medical ethics, as opposed to a Hippocratic approach, as a guide for the direction we are headed in with regards to the practice of medicine.  Indeed, the question of medical ethics is at the center of his discussion of health care reform.

According to Dr. Gray, the practice of medicine in Western Civilization was more or less influenced by Hippocrates until the influence of Friedrich Nietzsche started to rise.  “The concept of a fixed point of reference insured that medicine would always serve the patient, and government would always serve the citizen. Neither the physician nor the government could strip individuals of their unalienable rights.” p. 39  With the rise of Nietzsche’s thought, the notion of moral absolutes were abandoned, along with a fixed set of principles guiding medical ethics.  Here is how Dr. Gray expressed this concern: “Once the heart of medicine has changed, how long will it be before compassion dries up? When that happens, how long before compassion is replaced by the contempt of Nietzsche?” p. 58  He does not think that returning to the Hippocratic approach will be easy: “Driven by unbridled expectation, America is rapidly approaching a time when treatment and litigation costs will exceed available resources. When this happens, the ability to maintain Hippocratic ideals becomes untenable.” p. 49

The debate over health care reform all too often focuses primarily on cost.  Perhaps we should pay more attention to the shift in medial ethics where the focus is moving from serving the needs of patients to following the dictates of government bureaucrats.