Myth 20. Doctors, not bureaucrats, make decisions in national health systems.
Thursday, September 17, 2009 at 10:48AM Obama has promised that doctors, not bureaucrats, will be making the decisions under his “health care reform” plan.
If Obama’s promise is true, why do central planners need extensive data on every encounter with every patient?
Doctors, it appears, would indeed be making day-to-day decisions about what to do for individual patients. The centralized planning authority, however, would make the decisions on resource constraints and permitted options, within which physicians would have to function.
Physicians would be free—to comply or to accept the penalties for “deviations.”
Some American physicians, who have contracted with managed-care plans, long for what they believe is the simplicity and professional autonomy in nationalized systems.
Physicians who actually work in these systems generally do not share this sanguine view.
In Germany, doctors complain, on video with English subtitles, that they are inundated by the masses and cannot focus on the individual. They must work faster and faster, with less and less to show for it. A fundamental change in values has crept in, and the patient/physician relationship is deteriorating. Doctors say they are in a bureaucratic straitjacket. Politicians have them by a nose ring. Drugs and procedures are all constrained by a budget; some treatments simply cannot be offered. Thus, care is expedient, rather than optimal. There are so many forms that “you could paper the office with them.” Overall, the situation is “deplorable,” “critical,” the “worst in 31 years of practice.” Physicians conclude that “state medicine is rationed medicine.”
Elsewhere in Europe, headlines read: “Belgian Doctors Take to the Streets,” “Spanish Physicians Strike for More Time [10 Minutes] with Patients,” and “French Doctors Are Burned Out.”
According to a poll conducted by Pfizer of 1,741 physicians in 13 countries, 51% of European physicians are concerned about a negative direction for medicine, compared with 44% in the U.S. The majority report spending less time with patients (53% in Europe and 55% in the U.S.); bureaucratic demands were cited, unprompted, as a reason for that by 51% of Europeans and 21% of Americans. In both Europe and America, physicians have a negative view of the politicians’ panaceas for efficiency and quality: 83% of American and 61% of European physicians think that treatment guidelines have an adverse effect on patient health, while 70% of Americans and 64% of Europeans think that health technology assessment and evidence-based medicine have a negative impact on quality of care.
Gammon’s Law of Bureaucratic Displacement was developed in a London (National Health Service) hospital. Gammon defined bureaucracy as a rigid system “governed by fixed rules and tending to exclude human initiative.” He found that bureaucracy was destroying British medical services—not destroying the NHS, he emphasized, as “it is the [NHS] itself which is the destroyer.”
It’s not just that the number of administrators has increased in a close correlation with a decrease in the number of NHS hospital beds (correlation coefficient a remarkable – 0.99). It’s the displacement of productive by nonproductive activity throughout the organization.
“An example is the progressive transformation of nurses from patient-centred carers to administroids whose requirement to produce detailed patient care plans…leaves them little time to attend to patients’ basic dietary needs or prevent them from developing pressure ulcers” (Australian Doctors Fund teleconference, Jan 24/25, 2005).
The proposal before the House, H.R. 3200, establishes some 53 new bureaucratic agencies (Human Events 8/10/09).
Obama can keep his promise—by turning doctors into bureaucrats.
Additional information:
- “Medical Information and Bureaucracy: F.A. Hayek and the Use of Medical Knowledge,” by Hilton P. Terrell, M.D., Ph.D., and Timothy D. Terrell, Ph.D., J Am Phys Surg , Fall 2005.
- “Medicare: Incompetence-Based Bureaucracy,” by Lawrence R. Huntoon, M.D., Ph.D., J Am Phys Surg, Winter 2004.
- “ ‘Giving’ and Taking,” AAPS News, January 1992.
Reader Comments (10)
As a cash-only family doctor for 3 years with no third party, over 10 with no gov. dictates, I really enjoy my work. Income declined with volume to $90K/y , but very low overhead ($40K/y) enables an 82 year old, last passing Boards in 2001 to enjoy semi-retirement.
Many of my patients have already been to the ER, gov.clinic or HMO and found standard care did not fit, so intellectual challenge is interesting. Executives appreciate immediate knowledge of cholesterol, exercise ECG, etc. to modify exercise, nutrition and stress.
Who pays the piper calls the tune. Omnia pro aegroto. Just say "No!" to bureaucracy pay.
THE AMERICAN PUBLIC DOES NOT WANT SOCIALISED MEDICINE, I DON'T CARE HOW OBAMA LAYS IT OUT IT'S STILL SOCIALISED MEDICINE BOTTOM LINE. I WISH WE COULD VOTE ON THIS BILL, BUT THEN THE GOVERNMENT THINKS IT KNOWS WHAT'S IS BEST FOR THE TAX PAYERS.
I AM A 70 YR. OLD WOMAN, AND DO YOU THINK THAT I ALONE COULD DESTROY OBAMA OR HIS PRESIDENCY, I DOUBT IT. IF HE AND HIS CRONIES WOULD JUST TELL US THE TRUTH AND LET US MAKE UP PUR MINDS IT WOULD BE HELPFUL. HE SAYS THIS BILL WILL NOT COST TAX PAYERS ANY MONEY, THAT'S JUST A LIE, YOU HEARD ME RIGHT I CALLED OBAMA A LIER, I JUST HOPE I DON'T GET CENSORED.
I had much rather go to a doctor that had the FREEDOM to treat my illness or injury in the best possible way that the DOCTOR recommends, rather than some figure on a speadsheet. I still want to know how professional athletes and their medical teams will fit into all of this. Will they be exempt from all the requiring and mandating? We have always enjoyed the freedom of doctor/patient priviledge - what will happen to that? How is being "Required" to have health insurance giving me the freedom to choose? Letfreedomringnow.com
I believe Obama is trying to outdo every President to ever precede him. In attempting to do so, he is simply showing his genuine stupidity. His first order of business as President was to move all Terroists to a better prison. Is he sympathetic to these killers? I realize we must ban together as Americans to stop him. However, I am not convinced that we can. It seems to me that the President can get things passed right under our noses before we even know anything is being voted on. For instance, how and when was swearing under God to tell the truth in Courtrooms abolished? I never heard anything about it, until it was actually abolished. So, how can we be sure the healthcare plan he has up for vote will not get voted in without us?!!!
Washington needs to scrap all their hogwash about healthcare. The American people should insist we have the same coverage they do, they like it and II'm sure we will too! Why should we have less than them!!!!!!!!!!!!!!!!!!!!!!!!!!
I am 60 yrs old and a Realtor that is working two full time jobs in this economy. Obama should focus on putting people back to work at decent wages so that they can afford to buy homes instead of trying to screw up our medical care..
Beware of the Cult of Cochrane. It's ruined British medical care; don't let it ruin yours.
Ever since the advent of "managed care", someone other than the doctor has had a voice in what treatments will be reimbursed at what levels. The question is pretty simple: would you rather have this influence exercised by someone driven by a mandate to maximize profit (i.e., minimize expense on treatment) or by someone driven by the goal of optimizing care for the citizens of the U.S. The latter won't be perfect in his/her decisions, but the motives will be far more acceptable to me.
Politicians have been lying to their constituents and getting away with it for as long as there have been politicians. President Obama has honed lying to a degree of excellence. I was quite saddened to visit with a 93-year-old friend who with one breath firmly stated everything the government ran they ruined but with the next breath said how he had turned the very medical people giving him excellent care into Medicare because he thought he was being billed twice. I was working as a bookkeeper in a small hospital in 1965 when Medicare took hold and have watched the federal government takeover since. How do we stop this menace without a revolution?