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.
- “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.