Headlines highlight the ongoing debate over the future of American health care. But much of today’s discussion involves philosophical differences that reach back to ancient Greece. That’s the idea Dr. C.L. Gray, founder of the group Physicians for Reform, expressed during a presentation to the John Locke Foundation’s Shaftesbury Society titled “The Coming Age of Post-Hippocratic Medicine: What History Teaches Us About the Future of American Health Care.” Gray discussed themes from that presentation with Mitch Kokai for Carolina Journal Radio. (Click here to find a station near you or to learn about the weekly CJ Radio podcast.)
Kokai: Before we get into the meat of this interview, we probably ought to tell people, first of all, “post-Hippocratic” — I assume you’re talking about Hippocrates. Remind us who Hippocrates was and what he had to do with medicine.
Gray: Hippocrates is known as the father of medicine. He was born in ancient Greece, 460 B.C., and he really framed the way we think about medicine. His thoughts have shaped medicine — medical care — over the last 2,500 years, so to a large degree, Western culture owes its view on medicine much to Hippocrates.
Kokai: Even people outside of medicine may have heard — many of them — about the Hippocratic Oath and its role in medicine. Remind us what that is.
Gray: The Hippocratic Oath is an oath that used to be taken by most physicians, though largely now, most medical schools no longer use the oath. I think there was a survey done in the mid-’90s — out of 127 medical schools interviewed, only three used the original Hippocratic Oath. But the Hippocratic Oath was a commitment of the physician to serve his patient above all else.
Kokai: In your discussion with the John Locke Foundation’s Shaftesbury Society, you mentioned that there really is dichotomy; there’s the Hippocratic way of thinking about the role of the physician, and the Platonic way, the way that Plato did. Very different. How were they different?
Gray: Yeah, Plato actually was born slightly after Hippocrates. Plato was born about 427 B.C. As I said earlier, Hippocrates was born about 460, but Plato’s thinking was much more in keeping with ancient Greece. The general perspective, if you read his Republic, was a physician was actually a tool of the state. The role of the physician, according to Plato’s thinking in his ideal state, was to assess patients on the basis of what they could contribute to culture. Patients that still had a lot left to give back to society were treated. Patients that were a burden on society were either killed or let die. This was dramatically opposed to the philosophy that Hippocrates introduced, where the physician was committed to the welfare of the patient.
Kokai: And you mentioned that the idea that Plato had — the Platonic idea — put the physician in sort of a role as a tool of the state, rather than as serving the patient.
Gray: Yeah, when you go back and read ancient literature, you find that, in fact, Plato very much thought that the physician was really a tool of the state to further the welfare of the state, rather than the well-being of the individual citizen.
Kokai: You mentioned during this presentation that these two different views — very different views — of medicine have predominated at different times, and I guess by the title of “post-Hippocratic medicine,” you’re saying that Plato’s view seems to be in the ascendancy now.
Gray: Yes. As you look back through history, after the rise of Hippocratic medicine, we follow — or see — that medicine followed Hippocrates’ footsteps for almost two millennia. And at the end of the late 1800s, beginning of the 1900s, you see a brief resurgence of Plato’s thinking, following Nietzsche, and then the rise of Nazi Germany. Then with the Geneva Convention, they specifically reinstitute Hippocratic principles, and now over the last 30, 40 years, once again, we see the rise of Plato’s thinking. Is a physician really a tool of the state, rather than serving the patient?
Kokai: Given those two different views, what happens next? What do we do — if we’re interested in the Hippocratic view, what do we do to get that back in place?
Gray: One of the recent stories that I became aware of illustrates this so nicely. There is a lady in Oregon, Barbara Wagner, who had recurrent lung cancer. She didn’t qualify for Medicare or Medicaid, and didn’t have private insurance, so she was part of what was called the Oregon Health Plan, which is a state-run health care plan. The state denied her chemotherapy twice, instead offering to pay for palliative care, or physician-assisted suicide. So that one example really sets off alarms in my thinking, that once again, the state is gaining control of medicine. And when the state controls medicine, and controls health care dollars, the physician is obligated to serve the state, rather than serving the patient.
Kokai: So we need to change that system if we’d like the physician to serve the patient.
Gray: Certainly, if we the people can get together to regain control of medicine, I think that is, by far, the better path for us to follow.
Kokai: You mentioned three different types of reform during your presentation. What are those?
Gray: Essentially, my nonprofit is advocating three basic reforms: insurance reforms, tax reform, and tort reform. The basic idea behind this is to give patients control over their health care dollars, rather than the state control over health care dollars. Whoever controls the health care dollar controls health care decision making. In brief, insurance reform would level the playing field and let every citizen buy a form of insurance, advocating some individual policies. We can also encourage low-cost, high-deductible policies, combined with a health savings account. That health savings account would fund the initial health care expenses of that unmet deductible.
Second is tax reform, and what we need to do there is implement — for the several million Americans who simply cannot afford their own private policy — use tax credits to help them buy private insurance, and fund health savings accounts, so once again, they’re in control of their own health care dollar.
The last piece is tort reform. We spend somewhere between $100 billion and $150 billion a year in defensive medicine. With federal-level tort reform, we can free physicians to use common sense. If we put patients back in charge of their health care dollar, they will ask for the medical care that’s needed, but pass on the unnecessary medical care that sometimes is asked for, under a third-party system.
Kokai: Some people will hear this and say, “OK, Plato, Hippocrates, Why should I care?” Why is it important that we shift the debate back toward the Hippocratic model?
Gray: Well, I’ve been in private practice for about 10 years, and my dedication, and what I’ve worked for, is to serve the patient. What I fear now, with the rise of government-run health care — it depends on — or really doesn’t matter what name you put on it — when the government is controlling the health care dollar, I end up serving the state. And physicians working with patients, working with businesses, can once again get a handle on the cost of health care, and once again put the patient back at the center of American health care.
Kokai: If people want to learn more about Physicians for Reform, is there a Web site they can go to?
Gray: Yeah, they can go to www.physiciansforreform.org and get more information there.