FT Hippocratic Oath

The Hippocratic Oath - it is our Nature

by Josh Yelon

What impressed me most about the entire experience is that the doctor took the time to sit down with me and relate her own story. She told me of how she too had been scared, how frustrating the recovery process had been, and what day-to-day hassles she had experienced. The conversation easily used up a half hour of her time, which served no curative purpose other than to calm me down – for which I was extremely grateful. I know that emergency rooms are legally required to treat the uninsured, but spending a half hour just sitting, talking, and relating on a personal level went far beyond what was legally required. Obviously, my doctor cared.<p> The Hippocratic Oath contains the words “I will treat without exceptions all who seek my ministrations.” Clearly, my doctor had taken these words to heart. I understand why. When I was young, maybe eight or nine, I heard the oath for the first time, and it immediately resonated with me. If I had to put my reaction into words, it would be “Yes, that oath sounds right to me – that oath represents a kind of greatness, it is a symbol of what is best in the medical profession. If I were a doctor, I would want to swear to that oath right away.” I have spoken to many, many Americans who feel the same way – and I was glad to see, when I visited the hospital, that most doctors feel that way too.<p> There’s a reason that the Hippocratic Oath resonates so powerfully with Americans: it fits us as a people. There are very few Americans who, standing in front of a suffering man, would be able to turn their backs and walk away. Simply put, we are not a callous nation. Our compassion is a part of our culture; because of this, the Hippocratic Oath is here to stay.<p> This has policy implications: We, as Americans, will never tolerate a medical system that doesn't cover everyone. Doctors, first and foremost, will work to undermine any system that turns away the downtrodden. It simply isn't in our nature to turn away the sick.<p> But what about our current medical system, you ask? We don’t have universal coverage now, do we? In that, you are half-right. It is true that universal coverage was not designed in to our current medical system. Yet, as my personal experience at the hospital shows, even the uninsured get treated – and of course, somebody's paying for it. In effect, universal coverage was grafted on to our existing system.<p> To find out who's paying for that universal coverage, follow the money: first, the uninsured person goes to the emergency room. When the bill comes due, the hospital takes the sick person to court to try to force them to pay, and the sick person declares bankruptcy. The hospital, unable to collect on the bill, raises its prices to compensate. Those high prices then pump up the cost of insurance.<p> The point is this: we do have universal coverage, the wealthy are paying for care for the poor. This was inevitable, given the Hippocratic Oath, and given who we are as a people. Our culture is such that it could not have turned out any other way. But our universal coverage system was not created by design, it was tacked on to a system that wasn't designed for it.<p> Using such a half-baked system imposes a long list of costs. Some of the costs are moral, such as the gratuitous vindictiveness of forcing a sick person into bankruptcy when they're bedridden, or the injustice of driving hospitals in struggling neighborhoods out of business and thereby denying good care to the people who live there. Some of the costs are measurable in dollars, such as the expense of sending all care through the emergency room, or the expense of all the collection agents, lawyers and judges needed to run the bankruptcy cases. All told, these pointless expenses are a big part of why health care in the US costs double what it does in Europe.<p> Everyone knows the system is broken. The question is this: why are we providing universal coverage in such an inefficient, backwards way, instead of providing it straightforwardly? The answer has to do with distorted self-perception, which is a form of mild insanity.<p> Once, I asked my wife Laura what kind of superpower she would like, and what she would do with it. She said that she would like to be invisible, so that she could rob banks. I was appalled! I waggled my finger at her and proclaimed “Bad Laura! We do not use our superpowers for evil!” But when I thought about it afterwards, I realized that her answer matches her self-perception: she likes to see herself as a hard-nosed, take-whatever-I-want sort of person. But her self-perception is plain wrong. Whenever she’s presented with an actual situation, she is giving to a fault. This is common: many, many people like to see themselves as “tough and ruthless,” when in fact, they are kind and giving.<p> America as a whole is suffering from distorted self-perception. We see ourselves as a greedy, materialistic people – and we’re not. Don’t misunderstand me: I like fast cars and big TVs as much as the next guy. But when push comes to shove, if there were a dying man in my living room and I could save him by smashing my car, I’d do it in a heartbeat. After he recovered, then I might start thinking about whether he can buy me a new car, but until then, his life would matter more. I suspect that every one of you feels the same way.<p> This distorted self-perception is screwing up our ability to reason about health care. We like to pretend we are unyielding free-market worshippers, and call people who admit that they care about their fellow men “bleeding-heart liberals.” But it's just a facade, and the facade is not healthy – it is schizophrenic, and it leads to deeply conflicted behavior. With a steely gaze, we declare “buy insurance or die.” But when push comes to shove, we always take care of the sick, as our nature dictates. We pay for it in the most under-the-table way possible so as to be able to maintain the pretense of ruthlessness. The result is expensive and illogical.<p> To remain in denial about our most basic values is to continue acting erratically and wastefully. We now have two choices. We can continue to pretend to be callous, and keep on designing health care policies that do not include universal coverage. If we choose to go this route, the outcome is predetermined: no matter what we design, a costly and distorted version of universal coverage will always be grafted on after the fact. Alternately, we can acknowledge our true nature in advance, that we are a people who are culturally unable to abandon the Hippocratic Oath. Once we accept that there will always be universal care, it becomes obvious that we should plan it out, design it well, and pay for it intelligently. </td></tr></table>