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Autonomy

Docs Totally 'FED UP'

Tennessee doctors "would rather treat patients free of charge" than deal with TennCare, according to a new survey by the Tennessee Medical Association. About two-thirds of primary-care doctors said they would accept uninsured patients as charity cases.

Doctors cited other frustrations, including inadequate payment and paperwork hassles, and 27% said they had to either borrow money or use personal savings to cover the costs of providing care. Physicians also failed to rate any HMO in the "zone of excellence."

Doctors also complained of drug restrictions and treatment denials in all three TennCare plans.

"There are quite a few more hurdles to pass in a managed Medicaid program than there are in a commercial program, just in terms of the forms and rules that are required."
(See "Managed Care")

(Snyder, Nashville Tennessean, 11/4). (c) Copyright 1998 by National Journal Group Inc.

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CONCEPT OF AUTONOMY

Autonomy relies on equality. Within our present system, physicians and insurance companies are focused on maximizing profit, minimizing loss. All of this devalues medicine and fosters inequality.

Kant's principle was that everyone is equally significant. In medicine, this means that every individual deserves equal access to medical treatment.

We must strive for moral equality in order to realize true autonomy, in which each person controls his own life. Health care would be a means of keeping people equal. Without concern for money or advantage, people will consider the interests of others as equal to their own. Everyone will thus obtain equal services according to his needs, relative to the needs of others, and to the good of society as a whole.

Autonomy is a product of equality.
It is also a tool that, when used properly, enforces equality.

Kai Nielson feels that the health care system in the U.S. is detrimental to autonomy. In our system, health care is a business as much as a service. If it were state-controlled, the emphasis would no longer be on profit. Funding could be re-distributed so that it benefits everyone equally.

Nielson's theory is that two-tier and three-tier systems are a symptom of our lack of autonomy in health care. It shows that doctors are accepting patients based on their ability to pay, and patients themselves are focued on self-interests. The same applies to insurance agents, HMO's and hospitals.

In the articles above, you read about how doctors are constantly defending their judgment and integrity. Medicine has fallen secondary to finance and bureaucracy.

It is a Catch 22 for physicians in the U.S. Patients want them to do everything possible, and HMO's want them to do as little as possible. Both patients and HMO's want to keep costs down and quality high.

All of this lessens the autonomy of physicians. Doctors are prohibited from making certain treatment options available to the patient. This deprives the patient of her own right to decide which options to pursue. HMO's may simply say, "Fine, do whatever you want, but don't expect US to pay for it!"

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