Tuesday, September 17, 2013

Obamacare-"Law of the Land"except those parts that the administration Postpones or exempts the favored from

As opposition to Obamacare grows even as deadlines loom for its implementation,the dwindling numbers of defenders issue increasingly strident and lame defenses.

Members of the administration as well as Paul Krugman  blatantly proclaim Obamacare is the "law of the Land" and is no longer a political matter. The administration that has done much damage to the rule of law in the way it has selectively enforced, or postponed  or issued exemptions to the law has the audacity now to claim it is the law. As least those parts they it deems to be politically expedient."No longer a political matter"- really, the way it has been arbitrarily administered has been nothing but politics.

The ACP Advocate blog has recently  questioned the ethics of physicians who would refuse to help their patients to sign up for the plan and of those physicians who bring their anti-Obamacare views into the examination room. No, the blog did not say it was unethical but just raised the issue and used the term "borderline unethical".(I wonder if saying they were unethical would be libel per se.Further, the blog writer, Bob Doherty ,ACP's  Executive VP and governmental affairs man in Washington, challenged the claim that Obamacare will damage the physician-patient relationship  with the astonishing counter claim that  Obamacare might actually strengthen the physician-patient relationship.See here for that blog entry and a series of  related commentaries.

 I argue that this relationship is not a function of insurance or its lack  but rather it is based on the patient's belief that the doctor is acting in the best interests of the patient, treating him with respect, respecting his autonomy  and maintaining confidentiality. To the degree that Obamacare encourages physicians to join ACOs there may well be a tendency for the patient's trust to diminish as has been the case in some HMOs if and when the patients sense that the organization's interests  clash with his own and that his physician's income depends of adhering to the policies of the HMO-ACO-vertically integrated health care entity. Does anyone believe that HMOs have strengthened the physician-patient relationship?

I find it interesting that a ACP sponsored blog raises the issue of physician-patient relationship in  in regard to Obamacare.IMO it has been the efforts of ACP,along with  the ABIM foundation, to promulgate the new medical ethics and the "professionalism for the new millennium" that has damaged the physician-patient relationship by sneaking into medical ethics the concept of the physician having a co-duty to the patient and to society to the determent of the traditional physician's fiduciary duty.

ACP proposed ( and now seems to assume it is accomplished) a major change in medical ethics ( adding social justice and physician obligation to conserve "society's resources" ) and then with an apparent straight  face claimed there was really nothing new there at all. See here for a detailed discussion of this disingenuous tactic.

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