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Is the Healthcare Reform Bill Unethical?


The American Medical Association's conditional support of the healthcare reform bill was good for physicians' wallets, says Dr. Howard Brody, but bad for the overall health and wealth of the nation.

I ask that question not from in a political, anti-reform frame of mind, but do so considering a recent piece by Sharon Begley in Newsweek in which she discusses Dr. Howard Brody’s proposal in the New England Journal of Medicine “that every medical specialty identify five procedures—diagnostic or therapeutic—that are done a lot and cost a lot but provide no benefits to some or all of the patients who receive them,” and get doctors to pledge to avoid them.

Brody, who is the Director of the Institute of Medical Humanities, University of Texas Medical Branch’s, believes that the American Medical Association’s conditional support of healthcare reform was both “ethically questionable” and damaging to the bill’s efforts to control healthcare costs.

Further, Brody believes that by not including an overhaul of healthcare’s reimbursement pay structure, which rewards volume over quality, as part of the reform bill, the medical community continues to foster an environment in which "doctors rip off the system with inappropriate care” (eg, 351,000 spinal fusions were performed in 2007, at a cost of $26.2 billion, yet medical literature supports their use only when “the pain is caused by fracture or tumor”).

In his latest blog, Jeff Brown, MD, also chastised the healthcare community for not taking a larger, more substantive role in the healthcare reform debate, and urges doctors to be instrumental in shaping the industry in response to the changes which reform will inevitably cause. How doctors are paid is certainly one of these areas.

Can and/or should it be done, and how would this be accomplished?

Hope to hear from you soon.

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Victor J. Dzau, MD, gives expert advice
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