“Primum non Nocere” and the Affordable Care Act

A typical physician begins her career as a thirty-year-old with six figures of debt. While her peers have spent the last decade accumulating income and work experience, she’s been pulling all-nighters in the library – living on coffee, Ramen noodles, and student loans. She enjoys what she does, but the hours are brutal. After 8+ years of post-secondary education (plus another 3-6 years of residency) and tremendous personal and financial sacrifice, she has finally scaled the summit. She’s a doctor. In the meantime, changes in the U.S. healthcare system leave her feeling more like a glorified bureaucrat – trying to navigate the mountains of paperwork and ever-changing federal guidelines that stand between herself and her patients.

Most of the medical students and young physicians that I interact with are growing increasingly disillusioned with the future of our profession. The outlook is especially bleak for those considering primary care – the dwindling supply of “front line” doctors expected to accommodate an exploding demand for office visits. In their great wisdom, the architects of Obamacare sought to extend health insurance to 32 million new Americans without taking any steps to increase the number of practicing physicians.

I'm no economist, but this doesn't look like a recipe for "affordable healthcare".

I’m no economist, but this doesn’t look like a recipe for “affordable healthcare”.

Supporters of the Affordable Care Act are quick to point out that the law was endorsed by the American Medical Association. What they won’t tell you is that only 15% of America’s physicians are members of the AMA (compared with 85% of American’s dentists who belong to the ADA). In fact, individual physicians oppose the Affordable Care Act by a wide margin, and believe it will ultimately increase the cost of healthcare.

In a recent interview with MSNBC host Chris Matthews (may the thrill run ever up his leg), the president characteristically deflected blame for the Obamacare website debacle. Yet along with the usual finger-pointing at House Republicans, he actually suggested that the problem might lie with overly bloated government agencies, “some of which are outdated, some of which are not designed properly.”

"If you like your health care plan..."

“If you like your health care plan…”

This kind of schizophrenic assessment – blaming, in the same breath, both government bureaucracy and those who opposed the law’s reliance on government bureaucracy – seems strangely befitting. The Affordable Care Act is a stamp collection of such paradoxes.

Most of us in the medical field aren’t policy wonks. Our primary interest is fixing sick people – preferably with as little interference from third parties as possible. There are, however, a number of sensible and liberty-minded proposals that receive widespread head-bobbing in hospital break rooms. Physicians are generally receptive to the very solutions that were conspicuously absent from the ACA: tort reform, health savings accounts, conscience protections for healthcare providers, and market-based reforms to Medicare and Medicaid. John Mackey, CEO of Whole Foods, proposed some very workable (but largely ignored) reforms back in 2009.

Returning control of medical decisions to patients and their doctors would go a long way toward controlling costs and reversing the damage done by the ACA. The U.S. healthcare system has a fever, and the only prescription is less government.


5 thoughts on ““Primum non Nocere” and the Affordable Care Act

  1. This: ” I believe that a law addressing medical care should be held to the same standard as medical care itself: “first, do no harm”. Too many progressives are anxious to overlook the harm caused by the Affordable Care Act, saying things like, “we had to do something” or “it might be flawed, but it was a step in the right direction”. They want to judge the law by its motives, rather than by the impact it’s having on people.


  2. Great piece. For the obvious reasons (it’s doing more harm than good—as you say, this attempt at reform was literally worse than doing nothing, which in the context of current American health care is really saying something), I would have already agreed with you that Obamacare is terrible, but you still told me very useful things that I didn’t already know, such as that only “somewhere in the neighbourhood of 15% of practising US doctors now belong to the AMA.”

    In addition to the motives-vs.-results orientations you point out, I think part of the reason that liberals and conservatives talk past each other on Obamacare (as on so many things) is that a lot of liberals are more willing (able?) to listen to personal stories, as opposed to empirical data. So, for whatever it’s worth, here’s the story of my recent personal experience:


  3. Pingback: AMA Supports Obamacare, but Doctors Don’t Support AMA | Enjoyment and Contemplation

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