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Free Liberal: Coordinating towards higher values

Free Liberal

Coordinating towards higher values

There is No “Partisan” in Medicine

by Jane Orient, MD

Senators Bob Bennett (R-UT) and Ron Wyden (D-OR) might be calling for “bipartisan” health care in a May 22 letter to the Wall Street Journal, along with lots of others in many forums. As if doubling a bad idea could somehow make it right!

Since well before the massive 1993 Clinton effort to “re-design” American “health care,” we have had many Democratic, Republican, and bipartisan schemes—including the piecemeal enactment of an enormous chunk of the Clinton Plan: the criminalization of medicine; the State Children’s Health Insurance Program (SCHIP), and “administrative simplification.”

Nobody dares to suggest that things have gotten any better.

The reformers are all supposed to have good intentions of “fixing” or “transforming” our “broken health-care system.” What they are actually doing is trying to break up the working institutions and relationships that we have and force them into a monolithic, centrally engineered system. “Systemness” is the new primary virtue—not competence or compassion, and certainly not ingenuity or inventiveness.

What will the new system look like? I saw a photograph of it recently.

There were no faces in the picture, and no suffering, sick patients. Instead, there were the backs of six uniformed “health care workers,” possibly once called “nurses,” lined up along a wall, faces buried in a row of portable computer monitors.

They were presumably interacting with the interactive electronic medical record (EMR) or computerized physician order entry system (CPOE). Who, if anyone, was attending to patients? Answering call buttons, puzzling over symptoms, holding hands, observing response to treatment—all that is mere reality. It is being replaced by the virtual reality of documentation. If it wasn’t documented, it didn’t happen, and if it is in the record, it stays forever.

The computer is the key piece in all those bipartisan or unipartisan proposals. It is the net that ties everything into one giant interoperable virtual system.

The mere human beings who make diagnoses, prescribe or administer treatment, or make the thousands of split-second clinical decisions that occur every day are the ones who have “broken the system.” They make errors. They do too little, or else too much. They treat some patients differently than others (that’s called “disparity”). They spend too much of “our precious resources” on the seriously sick and the injured—relieving pain, binding wounds, removing tumors, curing infections, staunching hemorrhage, dissolving clots. That’s called practicing medicine, and it’s what is (or was) taught in medical school.

What all this medicine is breaking is the bank. Neither party is willing to admit that the federal government has made promises that cannot possibly be kept, and incurred debts that cannot possibly be paid. That’s not the fault of either party, both of which promised to just pay the bills and not interfere. It must therefore be the fault of those sending the bills. Accordingly, it is they who must be “fixed.” The system must “contain” costs, and that means it must control everything. And that means it must know everything; hence, those ubiquitous computers.

The bipartisan fix is to impose a centrally determined order on all that chaos of trying to fix broken human beings. An elite committee will determine “best practices” for each and every situation, “suggest” the proper action to the workers, and monitor compliance. The desired outcome is the optimal health of the system, or population. That’s why it’s called “health care.” And why it gives a higher priority to the healthy taxpayer over the sick or disabled, and to “health maintenance” as opposed to healing.

The bipartisan systems engineers don’t lay hands on patients—that would be a distraction. Anything with “partisan” in it is about money and control. Its “fix” for medicine is a wrecking ball. Patients (and noncompliant or “disruptive” doctors and nurses) just get in their way.

The next question is always: So you’re complaining about the sorcerer’s apprentice, but what’s your plan for fixing medicine? The question itself is a symptom—socialist central planning is so ingrained in our consciousness that we aren’t even aware of it. The American answer—try freedom!—doesn’t seem to ring any more.

In medicine, if you have a desperately sick patient, doing nothing is better than radical surgery that you know will fail. Better still—try stopping some of the poisonous drugs he has been taking. Let’s make a list of some toxic laws, and repeal them. If surgery is indicated, let’s identify the tumor (big government) and work on that instead of cutting off the patient’s healthy legs (doctors and nurses attending patients).

Jane Orient is the Executive Director of Association of American Physicians and Surgeons.

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Thank God there are still doctors like you! I retired as an RN years before I really needed to, simply because I spent most of my time with paperwork and counterproductive "rules" instead of fulfilling the real needs of patients.

14 of those years was in hospice work. I'd go back to it in a second if I was allowed to be a real nurse again.

# posted at by Susan

God Bless you, Susan.I have always appreciated working with nurses like you. And Dr Orient, as a physician, I am looking for the day when I can check out of this impersonal, inhumane system, where the people who do take care of real people are harassed daily.

# posted at by Tamzin Rosenwasser

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