Bush Official: Doctor’s Right to Withold Information Greater Than Patient’s Right to Receive It

Surprise, surprise: the Bush Administration thinks that Ob/Gyns should not only have the right to deny women basic medical care like abortion, emergency contraception or regular old birth control, but they should also be able to refuse to provide a referral to another doctor for these services.

Last Friday, U.S. Health and Human Services Secretary Mike Leavitt sent a letter to the American Board of Obstetrics and Gynecology, with a copy to the American College of Obstetricians and Gynecologists.

Leavitt said he was concerned about an ethics committee statement from ACOG in November stating that doctors should either be prepared to perform “standard reproductive services” or else refer those patients to someone who will.

Leavitt’s letter said he was even more concerned that the Ob/Gyn board had made adherence to that policy a requirement for certification.

Pro-life Ob/Gyns complained that that would require them to make abortion referrals, something they morally opposed. And in his letter, Leavitt said that could violate federal laws protecting health workers’ conscience rights.

But here’s the thing. Also shockingly, Leavitt is an idiot. Not only because he sent such an outrageous letter in response to such a practical guideline — essentially stating that a person actually does have a right to medical care regardless of who their doctor prays to on Sunday — but because the board in no way makes adherence to this commonsense guideline a requirement for certification. It should be a requirement, of course; I don’t really know how the hell you could certify a doctor who refuses to provide his or her patients with basic information about services he or she doesn’t like and expect an acceptable result. But the fact remains that it’s not a requirement. And so Leavitt is not only an asshole who thinks doctors should be able to withhold information, he’s also an asshole who doesn’t bother to verify information before widely disseminating it.

But Norman Gant, executive director of the certifying board, says HHS got it all wrong.

“They took two and two and came up with five,” he said.

Gant, who didn’t respond sooner because he was out of the office, backed up what ACOG spokesman Gregory Phillips said Tuesday, which is that the ethics committee opinion regarding referrals is not a binding portion of the college’s ethics code, and therefore not a factor in the decision about board certification.

“We do not restrict access to our exams for anyone applying for initial certification, or maintenance of certification, based on whether they do or do not perform an abortion,” Gant said. “We do not base this upon whether they do or do not refer patients to an abortion provider if they do not choose to do abortions.”

Now, you’d think that a department which makes such a large and embarrassing blunder might show a bit of humility. But that’d be only if you don’t know the Bush Administration. They actually think that even though the world’s most basic and sensible ethical guideline is not a requirement for the certification of health care professionals, it should still be removed from their ethics statement. Not only do they not want the board to fail to enforce ethics, they also don’t want the board to hurt the delicate sensibilities of the wingnut doctor club by even mentioning ethical practice at all.

On the other hand, Gant, himself an Ob/Gyn, said he personally had no problem with the November ethics statement, particularly the idea that Ob/Gyns should be ethically bound to provide contraception.

Apparently the Bush administration doesn’t agree.

In an interview Tuesday, Principal Deputy Assistant Secretary for Health Don Wright said HHS would be relieved to find that the certifying board isn’t using the ethics statement for certification decisions. As for the college, “We would still hope that they would revisit their position,” Wright said.

Though a lot of this might sound like debate over hypothetical situations to the uninformed, we are dealing with a real problem, particularly when it comes to reproductive health care. Terrifyingly, a 2007 study showed that 63 percent of physicians believe that it is acceptable deny patients care and information based on their moral beliefs — based on self-reporting, which means it’s likely that the real numbers are even higher. In addition to doctors refusing to refer patients seeking abortions to an abortion provider, we’re also dealing with EC refusal at the ER for rape victims, Catholic hospitals waiting to perform necessary abortions until the woman’s life is actually in danger, pharmacists refusing to fill or transfer prescriptions for birth control pills, and maybe even doctors refusing to perform pap smears.

I have recently and repeatedly made my feelings clear on conscience clauses and the ways in which they are often used. I’m always amazed when anyone feels compelled to argue with me that it’s perfectly okay for doctors and pharmacists to refuse to do their necessary and vital jobs for the public that depends on them — and I blame our lack of universal health care for the common perception that medical care is somehow not a public service to which every individual has an innate human right. But the only thing worse than costing a patient extra money by sending them elsewhere, potentially making it impossible to get care due to travel concerns, denying a service that may be time-sensitive, and all around discriminating against women, is to refuse to even tell that woman where she can go to find a person who is not and asshole and willing to do their goddamn job. I’d like to think that even those who support the right of refusal to dispense EC, and the right of Catholic hospitals to exist at all when they’re not going to provide equal and basic care, would agree with me there.

But our beloved government certainly doesn’t.  To them, the rights of each individual doctor to refuse medical care is more worthy of protection than right of their hundreds of patients to receive medical care.  Once again, I’m disappointed and yet wholly unsurprised.

0 thoughts on “Bush Official: Doctor’s Right to Withold Information Greater Than Patient’s Right to Receive It

  1. Rachel

    Reading your blog every day often shows me how much I still have to learn about pretty much every damn thing. I had no idea docs were refusing to do Paps on grounds of faith – it promotes sexual activity? Sweet Jesus, that is fucking stupid.

    Reply
  2. Cara Post author

    Thankfully, it’s believed to be exceedingly uncommon — of course, that it has happened at all and that the doctors have not been disciplined is cause enough for alarm.

    Reply
  3. kelly g.

    As I was reading through your post, I started ranting about it to my husband. “What’s next, gynecologists refusing to look at my vagina because the Bible says that lady bits are dirty and should not be seen!?”

    And then I clicked over to the rhrealitycheck post re: Canadian doctors refusing to perform pap smears.

    Holy. Shit.

    I can only hope that dick pills are next, because then the menz might actually give a flying fuck about what’s happening.

    Reply
  4. Kate

    What I don’t understand is why people become OB GYN’s when they’re opposed to women’s sexual health! My midwife and doctors all throughout my pregnancy and birth were clearly there because they wanted what’s best for women. They were more than enthusiastic to give me as much information that they could, and really helped me with my decisions about forms of birth control after my son was born. I can’t imagine becoming specialized in women’s bodies for the purpose of denying them care!

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  5. Cara Post author

    It doesn’t seem to make any sense at first, but I’ve long decided that the hatred that some people (*coughronpaulcough*) feel for women knows no bounds — it seems that some truly make female oppression a hobby, if not a career. I’ve also had the impression for a long time that a depressing number of ob/gyns don’t get into the practice for the women at all, but for the babies.

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  6. Thealogian

    “I can’t imagine becoming specialized in women’s bodies for the purpose of denying them care!”

    One of Bush’s appointees on Women’s Health at the NIH used to annually rape his wife when she passed out due to a sleep-disorder. They get off on controlling women’s bodies and abusing women. That’s why these “pro-life” OBGYN’s become OBGYN’s–more access and more power over women’s bodies. Before more women got into the field (were allowed into medical schools), some of the standards of OBGYN care were appalling–like administering pelvic exams on unconscious women without their knowledge for Docs in training. Don’t get me wrong, there are many many men in the field in the field for women’s health, but they ones that are loud and proud about hating the sluts and saving the baybeezz are really just sick fucks trying to get off.

    peace

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  7. ouyangdan

    word.

    Cara, you never fail to write something that i wish i could articulate myself. you have such a way w/ words…

    i totally also agree that some people become OB/GYNs simply to have more control over women’s bodies…i think it is the same w/ the ass hat pharmacists who refuse to fill BC prescriptions. i can’t imagine any other reason someone would go into a field of health care that deals primarily w/ women’s health knowing that part of the job you may be asked to do is something you object to

    conscience clauses are a load of crap. period. people can argue w/ me all they want, but seriously, i am not forcing you to have sex, take birth control or get an abortion…i guess it is too much to ask to get the same respect…

    and it’s part of why it took me so damned long to find a doctor that would actually give me an IUD…conscience clauses. even though all my other general doctors said it was the best for me since it had no hormones i struggled for over a year to find a doctor who would give me one…or even refer me to another doctor to insert it when i offered to buy the device out of pocket ($200!). they refused either b/c they believed it caused abortions, or b/c i was unmarried and it was unacceptable to allow me to have one, since ya know, i couldn’t be trusted to be monogamous or careful if i wasn’t married.

    thanks for another awesome post on a pissy subject.

    Reply
  8. Ran

    That is so horrifying.

    Since I started reading this blog, I’ve learned about all the horrifying things in the world that are apparently quite common but that I’d managed to remain blind to. I don’t know whether to thank you or be angry at you. 😛

    Reply
  9. Lesbilicious

    Once again, I thank my lucky stars I don’t live in the States, and feel great sadness for the women who do and have to put up with this kind of shit.

    Thanks for drawing attention to another ridiculous situation Cara…

    Reply
  10. Astraea

    I think it needs to be pointed out, repeatedly, that many health insurance programs (for those lucky enough to have it in the first place) require people to go to specific doctors, or to have a referral from their main doctor. Without those referrals, the individual won’t be covered by insurance. That puts a lot of women at risk if their doctor won’t refer, or if she’s forced to go out of network.

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  11. Cara Post author

    Excellent point, Astraea, and one that I totally missed. Thanks for bringing it up. As I’m sure that this won’t be the last time I end up having to post on this subject, I’ll definitely be keeping in mind for the future.

    Reply
  12. sara

    I think this is a thread that deserves to be split into differnet topics.

    Doctors should not be forced to provide services, but should be ethically bound to provide referrals.

    For abortions, you dont need a referral. Planned Parenthood clinics dont require any referrals whatsoever to get an abortion. Insurance issues are largely irrelevant, because they wont pay for abortions regardless of whether there is a referral or not. Its considered to be an elective procedure, and for 99% of women seeking abortions thats a valid description.

    I agree that its ludicrous for a doctor to refuse a pap smear. However the proper punishment for that doctor is for hte marketplace to work and force him out of business. How many women would continue to see that doctor once it became known that he refused pap smears? That clinic wouldnt be open very long. Even if the doc does refuse to do a pap, its very easy to find another doc who will do it.

    In an emergency situation, the onus to provide service falls on the hospital, not the individual doctor. If a doc refuses to provide emergency service, then of course he should (and usually will) be removed from the hospital staff.

    I think the pap stuff is being blown out of proportion. I’d surmise that the percent of OB/GYNS refusing to provide paps is less than 5% of all OB/GYNs.

    Reply
  13. sara

    As for the larger issue, I dont believe healthcare is a right. A right requires it to be provided free of charge. Poll taxes were declared unconstitutional not only because they discriminated against blacks, but also because a “right” cant be something that is charged for.

    Same thing with criminal defense lawyers. They are a “right” when you are accused of a crime and they have to be provided free of charge.

    Healthcare is a valuable service, but its not a right.

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  14. sara

    Let me also say somethign about the changing workforce of OB/GYN. While the overall number of male ob/gyns is still larger than the females, its changing rapidly.

    Females now comprise over 90% of all ob/gyn residents, or doctors-in-training. Interestingly, the percentage of ob/gyns who provide abortion services has remained unchanged, regardless of whether its a male-dominated or female-dominated profession.

    Abortion training is optional, but not required for ob/gyns. All residency training programs are required to offer it, but they dont require that their residents undertake it if they dont wish to.

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  15. Cara Post author

    For abortions, you dont need a referral. Planned Parenthood clinics dont require any referrals whatsoever to get an abortion. Insurance issues are largely irrelevant, because they wont pay for abortions regardless of whether there is a referral or not. Its considered to be an elective procedure, and for 99% of women seeking abortions thats a valid description.

    Not true, on several counts:

    1. Though Planned Parenthood is great, there is not a Planned Parenthood everywhere. Many women have abortion clinics closer to where they live than Planned Parenthood.

    2. But women may not know that, as many other abortion providers do not openly advertise their services in the phone book. Therefore women need a referral.

    3. Actually, some insurance does cover abortion. How do I know? Because mine does. I’ll state up front that I think this is unusual, I’m highly impressed with it and was rather surprised when I learned. They also don’t come close to covering the whole procedure — they pay for 20%. But the fact remains that for some women, abortion is covered or partially covered by insurance.

    4. This is a small quibble, because I know that most insurance does consider abortion to be an elective procedure. But in all actuality, it is only as elective as birth. And I’d love to see you or anyone else find insurance that does not cover prenatal care or child birth because they consider it an “elective procedure.”

    I think the pap stuff is being blown out of proportion. I’d surmise that the percent of OB/GYNS refusing to provide paps is less than 5% of all OB/GYNs.

    I don’t know who you think is blowing it out of proportion. I already said that the instance is likely exceedingly rare, and I would indeed believe that it’s actually closer to 1%. That doesn’t mean that they don’t exist and that it’s any less ludicrous.

    However the proper punishment for that doctor is for hte marketplace to work and force him out of business. How many women would continue to see that doctor once it became known that he refused pap smears?

    That’s assuming an awful fucking lot, and I don’t think that there’s any evidence that you would be correct in every case.

    Healthcare is a valuable service, but its not a right.

    I don’t even know how to begin to respond to that. If health care is not a right, then people do not have the right to not die in the streets when there is medical care that could help them. I have to say that I rather do believe that people have a right to not die in the streets.

    Unless you’re suggesting that health care is not currently a right in America, which is outrageous because it absolutely is a human right, and though America failing to respect human right is hardly anything new, it is still astoundingly immoral. If this is what you’re suggesting, I agree 100%.

    Females now comprise over 90% of all ob/gyn residents, or doctors-in-training. Interestingly, the percentage of ob/gyns who provide abortion services has remained unchanged, regardless of whether its a male-dominated or female-dominated profession.

    Reference? The first could potentially be true, but the only way that the percentage of OB/GYNs who provide abortions could remain unchanged is if the number of OB/GYNs has rapidly dropped, since the number of abortion providers has been dropping for decades, and 87% of U.S. counties do not have an abortion provider, and 97% of non-metropolitan U.S. counties do not have an abortion provider.

    Reply
  16. sara

    I think you need to make a distinction between “emergency” healthcare and healthcare as a whole. In most nations, emergency medicine is considered a right and therefore payment is not required.

    Even in the socialized medicine nations, routine healthcare is not defined as a “right.” Although its paid for by taxes, socialized med nations require small copays for service.

    Reply
  17. lauredhel

    For abortions, you dont need a referral.

    Depends where you live. State law here _requires_ that a woman be referred for abortion (and given an explanation, and offered counselling) by a doctor independent from the doctor providing the abortion. This is under 20 weeks, and no medical indication is required. Over 20 weeks, there is state Ministerial oversight of a panel of doctors who declare whether the woman should be ‘allowed’ the abortion. Girls under 16 who wish to have an abortion without parental notification have to apply to the Children’s Court for an order. (Thankfully, there are some youth workers around who help them negotiate this process.)

    Reply
  18. Cara Post author

    Even in the socialized medicine nations, routine healthcare is not defined as a “right.” Although its paid for by taxes, socialized med nations require small copays for service.

    I have an Australian husband sitting right next to me who just said that no, he did not have copays (and would not if he were to move back to his country of citizenship). He also said that you would only have copays if you chose to opt out of medicare and have private insurance. Like the kind of private insurance that we have in the U.S.

    Reply
  19. lauredhel

    As for the larger issue, I dont believe healthcare is a right. A right requires it to be provided free of charge.

    A right requires it to be accessible to all who need it. Are you saying that it shouldn’t be? That the US healthcare provision system is perfectly reasonable and above board from a human rights point of view?

    Reply
  20. Cara Post author

    Also, I’m not sure that I see how only emergency care would prevent people from dying in the streets. Cancer is not an “emergency”; it requires routine care. Same with HIV, heart disease, diabetes, and dozens if not hundreds of other medical conditions. Right now, homeless people die in the streets from all of these conditions. Right now, people also lose their homes because they lack health insurance and have to try to pay out of their own pocket for treatment for these kinds of conditions.

    Reply
  21. sara

    I’m not claiming the US has a great or equitable healthcare system, I’m simply claiming that healthcare is not a “right” regardless of what country you live in.

    Defining it as a “right” requires 2 things:

    1) Guaranteed access
    2) Free of charge

    I’m all for socialized medicine, and I think the US should switch to a single payer model. But even if that happens tomorrow, healthcare would STILL not be classified as a “right.”

    Even in socialized med nations, there’s no guaranteed access. For example in Canada there is no law requiring that doctors accept patients in their region. You can try to get an appointment, and 100% of your bill will be covered by Canada’s Medicare system, but that still doesnt mean you are actually going to be seen by a doctor.

    Reply
  22. sara

    A right requires it to be accessible to all who need it. Are you saying that it shouldn’t be? That the US healthcare provision system is perfectly reasonable and above board from a human rights point of view?

    No you got me all wrong. I’m saying that no country (socialized medicine or not) treats healthcare as an actual right. They offer coverage, but they dont GUARANTEE access.

    Reply
  23. Al

    Sorry Sara, in Canada, where I live, we do GUARANTEE access.
    Though I suppose it may be contingent on how you are defining either term.

    If, for example, I slice my finger off making dinner, and then proceed to walk into the ER, disregard triage and toss myself onto the suture table and say “sew me up’, my access would be halted, yes. But not denied.

    When resources, equipment, and the triage needs of others more acute than myself have been managed, I will be given access to assessment and a variety of treatment appropriate to my presenting condition. That is something that is *guaranteed*.

    Reply
  24. sara

    I’m not talking about emergency treatment, I’m talking about “routine” care.

    Suppose you develop diabetes and try to get an appointment at your local doctor’s office.

    Does Canadian law REQUIRE that doctor to accept you as a patient? No, it doesnt. Therefore you have guaranteed coverage, but NOT guaranteed access. Defining something as a “right” requires guaranteed access. If you get accused of murder, and the govt comes to you and says “we dont have enough public defenders to cover you, therefore you are on your own” is that allowable under the law? No, because defense counsel is considered an absolute RIGHT under law and therefore it has to be free as well as guaranteed access. There are no similar guarantees to access for medicine, therefore healthcare is not a right.

    You could say EMERGENCY healthcare is a right, but not healthcare as a whole. In the US emergency healthcare is a right as well.

    Reply
  25. Al

    “Does Canadian law REQUIRE that doctor to accept you as a patient? No, it doesnt. Therefore you have guaranteed coverage, but NOT guaranteed access.”

    Not true. You may not neccissarily have a wide range of provider choices, but you will always have access to health care. Primary, routine, and emergent.

    How? In the ER’s of most major cities in Canada, a majority of cases and conditions which are assessed and treated are not be defined as an emergency. Often they are routine, or primary care issues that concern people who lack a primary care practitioner, for a variety of reasons. The mandate of the department is that these people are seen. It may be a lengthy wait, and it may be a tedious wait, but they are always seen.

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  26. sara

    How? In the ER’s of most major cities in Canada, a majority of cases and conditions which are assessed and treated are not be defined as an emergency. Often they are routine, or primary care issues that concern people who lack a primary care practitioner, for a variety of reasons. The mandate of the department is that these people are seen. It may be a lengthy wait, and it may be a tedious wait, but they are always seen.

    So what? Thats not the same thing as primary care. In the USA (just like Canada), everybody who goes to an ER is required by law to be triaged and seen by somebody (could be an RN, NP, PA, or doctor). Under your example, the USA already provides “guaranteed access” to all primary care services. President Bush recently made a stupid comment like this, stating that it was OK if nobody had health insurance because everybody could just go to the ER instead.

    The idea that ER care is somehow a substitute for primary care is a ridiculous joke.

    Reply
  27. Al

    I wasn’t making the distinction that the care is of equal value at a hospital ER vs. the continuity and insight gained from a regular practitioner.

    “Thats not the same thing as primary care”

    Yes it is. It may not be the best setting or way of managing personal health, but the practice setting alone does not somehow magically alter how we define primary health delivery.

    My point, was in response to you saying that there is no guarantee to health care access. As I state, there is a guarantee of access. I share your opinion that it may be sub optimal as ones only route to health access, but given the option of no access, I would re frame it from being nothing more than a “ridiculous joke”.

    Lastly, I’m not sure if it was your intention, but are you equating NP or PA care with being sub standard? NP’s and PA’s are trained and competent to provide roughly 70% of physician services in the primary care practice setting. Whether that be an office or an ER.

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  28. sara

    I wasn’t making the distinction that the care is of equal value at a hospital ER vs. the continuity and insight gained from a regular practitioner.

    Not only are they not equal, they are not even in the same ballpark. Its a total apples and oranges comparison, and the fact that you equate the two means you know as much about healthcare as George Bush does (after all you basically mirrored his quote in your post above).

    And yes, claiming that going to the ER is the same thing as access to a primary care clinic is absolutely a ridiculous joke.

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  29. Cara Post author

    Here’s a distinction: in the U.S., you don’t get the ER for free. They have to treat you, insurance or not. But they’re going to bill you, and it’s going to be ugly. Being seen at the ER in Canada for primary care is going to fucking suck, no doubt — but it’s not going to put someone at risk of debt collectors calling their homes or garnishing their wages, or if it was actually a true emergency that required serious intervention, even bankruptcy.

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  30. Al

    “means you know as much about healthcare as George Bush does”

    Slow down there Sara. I’ve seen nothing in your opinions that would that would warrant that type of snark, so before you decide my aptitude for health care, maybe you can offer something beyond a petulant comparison to a ridiculous joke.

    “And yes, claiming that going to the ER is the same thing as access to a primary care clinic is absolutely a ridiculous joke.”

    Interesting, since I said nothing of the sort. My point, I will say again, is that the practice setting does not dictate the level or quality of care, in and of itself. I have provided quality primary health care at both clinics in the western world, and in a third world Sudanese refugee camp. I do know something about the topic, even if it does not conform to the point you are trying to make.

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  31. Feminist Avatar

    Sorry I left a comment and got spammed and I have been having this problem all day so I’d thought I’d test first.

    I would say that in the UK medical care is considered as a human right. We have free access to doctors, treatment and care, and only pay £7 for prescriptions. Prescriptions are only paid for by people with non-life-threatening and most non-chronic conditions (asthma is an exception). Children and people on low incomes don’t pay. Contraception is free.

    Only procedures with no medical justification, such as cosmetic surgery, need to be paid for and, even then, if it is required for your psychological health then it is free.

    We don’t guarantee the most expensive treatments or new experimental treatments, but if you feel you need them you can ask. Your case then goes before a panel of doctors who make a cost-benefit analysis. If you lose you can sue the NHS for an infringement of your human rights. And whether you win is usally determined by whether it can actually help you and not about cost.

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  32. sara

    I would say that in the UK medical care is considered as a human right. We have free access to doctors

    Well I’m sure that they claim its a right, but its not actually treated as such. You claim that you have free access to doctors, but I dont think thats accurate.

    What you meant to say is that you going to the doctor costs nothing. Thats different than access. Do the laws in the UK guarantee you that if you call up a doctor’s clinic in your region, that they must accept you as a patient?

    Everybody seems to think thats not part of calling something a “right” but it absolutely is, because it comes down to access, which must be provided along with free cost to consider something a right.

    Lets take up the example of voting again. Everybody agrees that voting is a right. You dont have to pay for it. You go to your precinct and provided that you have registered appropriately, they MUST let you in the door to vote. They cant come out and say “sorry we’re not letting you in today, come back next year”

    A doctor’s office on the other hand, can do EXACTLY that. You may have fistfulls of cash to give him, or you may be covered under a public health system which has zero cost to you, but the fact remains that there is no law to FORCE him to accept you as a patient.

    I know its a subtle distinction, but its critical. Calling something a “right” implies a high burden of both free cost and relatively unhindered access.

    Food, shelter, and healthcare all fall under the “esssential commodity” umbrella, but they arent treated as fundamental human rights under the law.

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  33. sara

    If you lose you can sue the NHS for an infringement of your human rights. And whether you win is usally determined by whether it can actually help you and not about cost.

    Well if thats true then I think its a boneheaded policy. Public health dollars should be rationed out on a cost/benefit analysis, not a purely benefit perspective.

    Lets take Herceptin for example. I know there was a famous case in the UK recently of a woman who petitioned the NHS for Herceptin for breast cancer treatment. I think she was initially denied, but won on appeal or something. Her particular outcome is not my point, but lets take a closer look at Herceptin and use it as an exmaple of how rationing should/should not be done.

    Herceptin has shown some promise for advanced stage breast cancers when there’s really no other therapy available. However, teh actual benefit is so ridiculously miniscule that it fails to justify the cost (upwards of $100,000 for a single treatment). The mortality statistics show that Herceptin delays mortality by only about 6 weeks. Thats compared to an average lifespan of 2 years after diagnosis.

    I submit to you that paying $100,000 for an extra 6 weeks (tacked onto a 2 year baseline) of very poor quality of life is an absolutely STUPID decision to make.

    Overall I like single payor systems compared to to the US system, but they should not operate in that fashion.

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  34. Al

    “I submit to you that paying $100,000 for an extra 6 weeks (tacked onto a 2 year baseline) of very poor quality of life is an absolutely STUPID decision to make.”

    Clearly, you have never had to make that decision for yourself. but I suppose that doesn’t factor into your neat little cost / benefit paradigm does it? Quality of life decisions are really only relevant when they are made by those with a personal stake in the matter.

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  35. Feminist Avatar

    I would say that access to doctors in the UK is a right, because while you cannot demand that a particular doctor put you on their books, very few people are refused. Part of the NHS plan is to ensure that there are enough doctors for each region for the population and doctors can only refuse if they are full. When that does happen you can be put on a waiting list and seek routine medical care at your local hospital. When it is known that there is a waiting list in a particular region, most hospitals put on surgeries to deal with routine care to save you waiting in triage. There are also clinics, such as women’s health and sexual health clinics, that you can make an appointment with independent of your doctor and they will give you routine care if you don’t have a doctor. But, I actually don’t know anyone who hasn’t been able to register with a doctor immediately.

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  36. sara

    Clearly, you have never had to make that decision for yourself. but I suppose that doesn’t factor into your neat little cost / benefit paradigm does it? Quality of life decisions are really only relevant when they are made by those with a personal stake in the matter.

    Every healthcare system in the world is based on a rationing scheme, because clearly allowing unfettered access to every treatment out there would break the budget. In the US, healthcare is rationed based on cost via the insurance sector. In other nations, healthcare is rationed based on utility via government organizations.

    Budgets are a zero sum game. For every 100k you spend on a 90 year old stage IV metastastic breast cancer patient to get Herceptin, thats 100k you dont have for other interventions, that by any measure, produce a better cost/benefit analysis.

    The United States spends more money on “advanced” treatments and procedures than any other nation in the world, yet we have zero data to suggest that health outcomes are better.

    Somebody has to justify these cost decisions. Its either the insurance company or the government. IMO, govt is a better entity to wield this power, but make no mistake, SOMEBODY has to do it.

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  37. Astraea

    I’m very confused by your insistence, Sara, that to be considered a right, you must have access on demand from any physician you call or visit.
    Your comparison to voting doesn’t quite work because while they have to let you vote, they can put you in a line. Which is essentially the same as a physician asking a patient to wait until there is time available, or asking the patient to go to another physician. Exercising the right to vote requires having access to the polling place on one particular day. It’s time-sensitive. Preventative medical care is not as time-sensitive, and others have pointed out that when a patient visits an emergency room, treatment that is time-sensitive is MANDATORY.

    “I know its a subtle distinction, but its critical. Calling something a “right” implies a high burden of both free cost and relatively unhindered access.”

    Really? Is that why I can walk down the street and pickup my free rifle, as per my right to keep and bear arms? Is that why all criminal defense attorneys come free of charge regardless of need? oh, that’s not the case.

    I’m sorry that’s a little snarky, but the point is that the philosophy of rights does not mean that something we have a right to must be free or completely free of all obstacles.

    Reply
  38. Al

    While all of what you say above may be accurate in an application approach, as someone who works on the delivery end of health care, and thus have a role as a patient advocate, I begin to get really nervous when decisions around personal autonomy in so far as it regards treatment choice, are made with no serious consideration to the human end.

    Reply
  39. ouyangdan

    i know this point came up a long time ago, but it is worth mentioning (not to take away from the discussion, Cara, but still)…

    Even if the doc does refuse to do a pap, its very easy to find another doc who will do it.

    the problem here is that most insurance only covers one female check up visit per year. you get one covered day to get your breast exam, pap, and any other services you need (some will do six months for BC consults and refills). if your insurance approved doc won’t give you a pap, or the HPV vaccine, or BC, you can’t simply find another doctor w/o having to front the whole cost of the office visit out of pocket, plus the lab costs, and anything else that would have been covered in the insured visit. plus, most OB/GYNs (i don’t know the exact number, i know w/ BC/BS this is true) won’t just give you BC or a pap w/o first having a “get to know you” consult or some other such thing…something you don’t need at your regular, insurance covered doc. so there is another visit you would have to pay out of pocket. most women would not be willing or able to do this.

    you also have to figure in how easily one could find a doctor in her area. in my home town, there was only one OB/GYN office. i would have had to travel thirty minutes to the next town to see another one. and that was if i had a car of my own to make the trip. public transportation isn’t going to take you there.

    this is not a final end all rule, but every private insurance company by which i have been covered, and also TRICARE do things this way.

    Reply
  40. sara

    you also have to figure in how easily one could find a doctor in her area. in my home town, there was only one OB/GYN office. i would have had to travel thirty minutes to the next town to see another one. and that was if i had a car of my own to make the trip. public transportation isn’t going to take you there.

    Pap smears are not solely part of the ob/gyn domain. Internal medicine docs do them, family practitioners do them, NPs do them, PAs do them, RNs do them.

    Dont get me wrong, I think ob/gyns are the best service provider for paps, but its not exactly a hot commodity.

    Reply
  41. sara

    Your comparison to voting doesn’t quite work because while they have to let you vote, they can put you in a line. Which is essentially the same as a physician asking a patient to wait until there is time available, or asking the patient to go to another physician.

    Putting someone in a line is NOT the same thing as refusing service outright. I’m not talking about one doctor’s office, I’m talking about something that applies to all of them collectively.

    Suppose there are 50 doctors offices, all of them with openings. Suppose that you try to go to all of them, and they refuse to take you on as a patient. Thats totally 100% legal for them to do. On the other hand, if a voting center tells you outright that you cant vote there, thats illegal and its a critical difference.

    Reply
  42. Astraea

    Individual doctors can technically refuse to take you on as a patient, but as others have observed, that’s not really how the system works and patients are guaranteed some kind of access to health care in one form or other.

    It functions as an accepted right.

    Can you provide anything indicating that someone in Canada or England has no recourse if they can’t find a doctor?

    I think this whole disagreement stems from a difference in philosophy. The argument you make seems to come from a legal positivist view. The problem is you assume that this is not just one philosophy of rights, but the one that is largely accepted. That’s not really the case.

    Reply
  43. sara

    Can you provide anything indicating that someone in Canada or England has no recourse if they can’t find a doctor?

    Sure they have “recourse” if by recourse you mean access to an emergency room. ER access is guaranteed. But access to a primary care doctor is NOT.

    http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1472980

    More than 4 million Canadians cannot find family physicians to care for them1

    http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1949098

    A Decima Research poll commissioned by the College of Family Physicians of Canada in September 20061 revealed that 17% of Canadians do not have family physicians—about 5 million Canadians have no family doctor. Of these 5 million, nearly 2 million have looked for a doctor but cannot find one.

    In Canada, UK, France, Germany, and everywhere else access to primary care is not guaranteed. Of course I think their systems are a lot better than the US, but nevertheless there is no “right” to primary care access in any country.

    There is no legal recourse for primary care doctors who refuse to take on new patients. They are untouchable.

    The vast majority of people just keep shopping until they find a doc who is taking new patients, but there’s nothing in the law FORCING doctors to do so.

    Reply
  44. Cara Post author

    Sara, you seem to be fundamentally confused about the difference between “a right” and “a government succeeding in upholding a right.” The U.S. seems to be failing miserably in upholding the right to not endure cruel and unusual punishment. That doesn’t mean that people have any less of a human right to not be tortured. Heath care is a right. That various governments all over the world fair to treat it as a right doesn’t diminish the fact that it is.

    Reply
  45. konstanze

    Sixty-three percent? Sixty-three percent?
    I can’t get past that. Every day I get more and more amazed at how f’ed up our country is.

    Reply
  46. lauredhel

    I’m not getting your definition of “right” either, Sara. Perhaps you could define it more clearly to help progress the conversation.

    I think people have a right not to starve, but I don’t think they have a right to demand that a certain waiter at a certain restaurant bring them free caviar and a gin & tonic right NOW dammit. I think universal public education is a right, but I don’t think that you have the right to march up to a random professor and demand she sit down with you today and give you a tutorial on the topic of your choice.

    Reply
  47. Thealogian

    Sara, you’re just arguing for argument sake at this point.

    Now, to take the voting analogy a bit further– you have the right to vote (if you’re not a felon), but YOU CAN’T VOTE JUST ANYWHERE ANYTIME. You have to vote at your polling station which is assigned to you on the basis of your address. So, with the right to healthcare, you may not be able to demand that Dr. 90210 sews up your cut finger to prevent scarring, but you will get that medical service–the stitches–when you need them in a just medical system.

    Reply
  48. Heather

    Thanks for your article. Glad to see it on Alternet health and wellness post. BUT PLEASE don’t use “pro-life” for anti-choice crusaders. WE who value a woman’s right to make decisions about her body and her reproductive life are pro-life. And we care about babies (and their mothers) after they’re born, which the right wing apparently does not.

    Reply
  49. Cara Post author

    Hey Heather, I agree. If I use “pro-life,” it’s in quotation marks for effect (i.e. “the policies of the ‘pro-life’ administration are killing women all over the world). The only time the term appears in the post is in quoted text!

    Reply

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