As a physician living and working in a community with too many under and uninsured patients, I sympathize with the impulse underlying the Democratic Party’s utopian "Medicare for all" Act. Like many doctors, I also dream of a sweeping legislative fix to provide high-quality, carte blanche medicine for all Americans, especially those facing serious medical challenges.
But this bill seeks utopia by giving government centralized power and control over every aspect of medicine via a single-payer model, and comes with an astronomical price tag. The cost in dollars is in the trillions, but there is also another, hidden cost: the elimination of the conscience rights of nurses and doctors.
The devil, as usual, is in the proposal’s fine print, and it comes couched in the bland language of inclusion and non-discrimination. The bill specifies that a doctor is not permitted to discriminate against any of his or her patients. What could be more reasonable and proper?
In medical school, the noble, Hippocratic ideal of treating every single patient with the same respect and dignity is taught alongside biochemistry and physiology. And long nights in the emergency room are spent learning not only how to diagnose ailments and start IV’s, but also how to enter the foul-smelling room of the poor psychotic sidewalk dweller with the same compassionate smile worn while entering the cubicle of the respectably-dressed and rational patient next door.
"Medicare for all," however, takes the honorable ideal of non-discrimination in medicine and twists it to enforce a liberal social agenda. The bill states that patients will not be discriminated against on the basis of race, but then extends the definition of discrimination to include categories of sexual orientation, gender identity, sex stereotyping, as well as pregnancy and its termination.
What does all this mean in practice? A physician who declines to perform an abortion would be guilty of discrimination under "Medicare for all." This flies in the face of most doctors and nurses’ basic understanding of their vocation — their vocation to preserve and protect human life in whatever condition or social category they find it. This common understanding of medical care, one that has dominated Western medicine for hundreds of years, views abortion as the worst kind of discrimination. It destroys one vulnerable life at the bequest of someone more powerful.
Under "Medicare for all," gynecologists or nurses who refused to perform an abortion — to end a human life — would have their employment agreements revoked. In other words, they would no longer be able to work for the only medical employer in the whole country: the government.
"Medicare for all" also strikes at medical conscience in the case of controversial treatments for gender dysphoria. Most liberals have decided that the only possible therapy for children who feel uncomfortable with their biological sex is puberty blocking, followed by life-long injections of opposite sex hormones and, eventually, mutilating surgeries.
Many physicians and therapists believe, however, that these are unethical experimental treatments. Unethical because children can’t consent to life-altering therapies whose extraordinary effects they cannot begin to understand. Experimental because no long-term studies have been done to prove that these “therapies” will cure their dysphoria. Again, a therapist or endocrinologist who preferred to take a safer “wait and see” approach, hoping the child will outgrow his or her psychological discomfort with appropriate support, would be accused of discrimination, and lose their livelihood.
Lest Americans reading about "Medicare for all" imagine that there will be room in the private sector for doctors and nurses with moral and ethical compunctions, it’s important to note that this proposal is meant to eliminate the private sector. This is government-run, socialized medicine, remember, and all payments to virtually all doctors would come from the government.
Doctors wanting to opt out of working for the government — say, OB/GYNs who could not bring themselves to perform abortions — would have to have an all-cash practice, because "Medicare for all" abolishes medical insurance. This is a practical impossibility.
America’s health care and workers consumers should read the text of the "Medicare for all" Act with great care. The utopia of high-end care for everyone is in the title, but the bill’s text presents a whole other dystopian picture. As Albert Camus once famously said, “Utopia is that which is in contradiction with reality.” If he read this bill, I think the French philosopher would be tempted to add, “Utopia is also that which is in contradiction with the freedom of conscience.”
Grazie Pozo Christie M.D. is a policy advisor for The Catholic Association.