Will 'Health Care' Kill American Medicine?

My mother, a doctor's daughter who became a doctor herself, sometimes accompanied her father when he made house calls in the Livermore Valley of California during the Great Depression.

In those tenuous times, as she later recalled, her father occasionally provided his services without a fee or in return for whatever unsolicited payment-in-kind the rancher or farmer produced.

Medicare and Medicaid did not exist in those days. Nor were there massive for-profit insurance companies or hospital chains. But America had good doctors and good local hospitals.

My grandfather spent his life serving his neighbors. Medicine was not just his job, but his vocation. He did not live by one set of values in his professional life and another in his personal life. He had one life and one set of values. They were indivisible.

My mother met my father at medical school. She ended up having 11 children, and decided not to practice medicine but to be a stay-at-home mom -- with an M.D. That was her vocation. She, too, had one life and one set of values.

My father, like my mother and my grandfather, lived by an indivisible code. The same moral vision that guided his family life, guided his life as a doctor and a neighbor.

In the latter part of my father's career, two ominous trends began to emerge in American medicine: nationalization of control and normalization of intrinsically evil practices. The neighborly relationships that prevailed between Americans and the local doctors and health care facilities they turned to in times of need were gradually being replaced by ever-more remote corporate and government entities.

(In his new book, "Falling in Love With America Again," Heritage Foundation President Jim DeMint calls such institutions the "Bigs" -- whose "continued existence ... is no longer contingent upon its quality of service.")

In 1965, Congress enacted Medicaid and Medicare, putting government in control of health care for Americans below a certain income level and over a certain age. In 2010, Congress enacted the Affordable Care Act, compelling all Americans who do not qualify for Medicaid or Medicare to purchase health insurance -- while promising significant subsidies for the purchase of insurance to anyone earning less than 400 percent of the poverty level (currently $95,400 for a family of four).

There were 72.7 million Americans enrolled in Medicaid at some time during fiscal 2013 and 8.4 million enrolled in Children's Health Insurance Program. In 2012, 51.8 million were enrolled in Medicare (although some of these were dual-enrolled in Medicaid).

Before Obamacare is fully entrenched, the federal government has already become the paymaster for the health care of a large share of the nation's 318 million people.

Meanwhile, the number of hospitals has been shrinking -- and in a definite pattern. In 1975, according to the Centers for Disease Control, there were 7,156 hospitals in the United States, including 3,339 non-profit hospitals (which would include those runs by religious organizations), 1,761 local- and state-government run hospitals and 775 for-profit hospitals.

Non-profit hospitals decreased by 435; local and state government hospitals decreased by 693 -- but for-profit hospitals increased by 238.

As government increased control of health care through Medicare and Medicaid, non-profit hospitals decreased and for-profit hospitals increased.

According to World Health Organization data, America may have passed a peak in per capita doctors. In 1990, there were 1.8 doctors per 1,000 people in the United States. In 2000, there were 2.6. In 2004, there were 2.7. But in 2010, there were 2.4.

In the Hobby Lobby case, the Obama administration argued in the Supreme Court that the Green family, which owns Hobby Lobby, has no right to run their business according to their Christian values. So far as providing health care to their employees is concerned, the administration argued, the Greens must live according to the administration's values.

The administration is not claiming -- yet -- that it can force a doctor to perform a surgical abortion. But it is claiming that American doctors, like everybody else, must buy insurance that covers abortion-inducing drugs. Doctors must follow this rule for themselves, their families, and -- if they buy insurance for their employees -- in their medical practices.

The administration is also telling all health insurance companies that they must provide coverage for abortion-inducing drugs. An American who has one indivisible set of values that governs all his life -- and who conscientiously opposes cooperating in the taking of an innocent life -- is now effectively barred from the health insurance business.

When Obamacare is fully in place, a federal government that believes it can force people to act against their consciences in the taking of innocent life will have near-monopoly control over the medical industry.

Will a government that is telling the Green family -- and all others like the Greens -- that they must act against their consciences in the conduct of their business, tell doctors they must act against their consciences in the conduct of theirs?

Why would it not? What would stop it? Love? Compassion? Charity? Respect for the law of God?

“I quit when medicine was placed under State control, some years ago,” said Dr. Hendricks. “Do you know what it takes to perform a brain operation? Do you know the kind of skill it demands, and the years of passionate, merciless, excruciating devotion that go to acquire that skill? That was what I would not place at the disposal of men whose sole qualification to rule me was their capacity to spout the fraudulent generalities that got them elected to the privilege of enforcing their wishes at the point of a gun. I would not let them dictate the purpose for which my years of study had been spent, or the conditions of my work, or my choice of patients, or the amount of my reward. I observed that in all the discussions that preceded the enslavement of medicine, men discussed everything — except the desires of the doctors. Men considered only the ‘welfare’ of the patients, with no thought for those who were to provide it. That a doctor should have any right, desire or choice in the matter was regarded as irrelevant selfishness; his is not to choose, they said, only ‘to serve.’ That a man who’s willing to work under compulsion is too dangerous a brute to entrust with a job in the stockyards never occurred to those who proposed to help the sick by making life impossible for the healthy. I have often wondered at the smugness with which people assert their right to enslave me, to control my work, to force my will, to violate my conscience, to stifle my mind — yet what is it that they expect to depend on, when they lie on an operating table under my hands?”

Atlas Shrugged-Ayn Rand

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