Trendspotter: Doctors Debate the Right to Healthcare

October 27, 2010

The battle over healthcare reform, which has been sharpened by the impending election, seems as fierce among doctors as it is in the general public. I’m not referring to the state medical societies that have protested the AMA’s support for reform; I’m talking about how individual physicians feel. Doctors’ attitudes toward improving access to care - the main goal of the Affordable Care Act - seem to depend on whether or not they see healthcare as a right.

The battle over healthcare reform, which has been sharpened by the impending election, seems as fierce among doctors as it is in the general public. I’m not referring to the state medical societies that have protested the AMA’s support for reform; I’m talking about how individual physicians feel. Doctors’ attitudes toward improving access to care - the main goal of the Affordable Care Act - seem to depend on whether or not they see healthcare as a right.

A recent discussion on the KevinMD blog brought this issue into sharp focus. Patrick W. Hisel, a family physician, wrote about Texas Congressman and former Presidential candidate Ron Paul’s libertarian approach to healthcare. Paul told Chris Mathews on the “Hardball” show that nobody should be forced to pay for anyone else’s care, noted Hisel. The family doctor agreed: He should not be forced to care for Medicare patients, for example, if the government cuts his reimbursement. And, just as grocery stores don’t have to provide food to the hungry, Hisel said, he should not be compelled to care for anybody who cannot afford to pay him.

This forthright statement elicited 143 comments, showing that Hisel had hit a hot button among doctors. Most of the comments that I read, both pro and con, revolved around the question of whether healthcare is a right. One responder asked, “Do we really want a society where people are told to go home and die if they cannot afford care?” He also wondered why Rand Paul (Ron’s son, a Republican Senate candidate in Kentucky, and an ophthalmologist) accepts Medicare if he’s such a libertarian. Another doctor pointed out that without Medicare many of Rand Paul’s elderly patients with cataracts couldn’t afford to have them removed.

On the other side of the coin, a physician argued that people should take personal responsibility for their health and their healthcare. Even though they may suffer from congenital birth defects or have accidents, it’s not anybody else’s responsibility to make sure they get good healthcare, in his view. And if the government intervenes to ensure that they do, this doctor said, it destroys the whole notion of personal responsibility.

Another doctor took what she regarded as a more nuanced view, to wit: “Healthcare is a right for all Americans and legal citizens…However, I do not feel that illegal citizens should be able to access medical care, especially when it comes to long term, chronic treatments, such as oncology and renal dialysis.”

Other respondants viewed universal healthcare as a societal responsibility. Because of modern medicine’s ability to extend life and reduce mortality (45,000 people a year are said to die for lack of insurance), it’s no longer possible to argue that healthcare is not a right. One physician wrote: “It is…a matter of how we provide the right access to medical care for all at a reasonable cost.”

That also seems to be the view of practicing physicians in Massachusetts who were recently surveyed about their attitudes toward healthcare reform. Most respondents - 86 percent - did not approve of modeling national reform legislation after the reform law in their own state.

But that isn’t because the Massachusetts doctors oppose universal healthcare. In fact, 34 percent of responding physicians favor a single-payer, government-run system, and 32 percent would keep the public/private system but with a “public option.” (The public option, which was a focal point of the national reform debate, would have had the government sponsor a health plan in the state insurance exchanges.) Only 17 percent wanted to allow insurers to continue selling plans with limited benefits and high deductibles.

What this all of this suggests is that most physicians do care about their patients and are willing to support reasonable ideas to increase access to healthcare. But, although they are willing to provide some charity care, they don’t want to be responsible for ensuring that everybody gets treated. While Massachusetts has significantly expanded coverage as a result of its 2006 reform law, physicians there seem to prefer a system that provides more public insurance, perhaps because the Bay State legislation has not gotten private insurers off their backs.

So is healthcare a right? The debate goes on. But a lot of physicians think that it is.