HIPPOCRATES ROLLS OVER IN HIS GRAVE   Robert L. Maggs, M.D.
 
More than 59 years ago l swore an oath. Upon graduating from The State of New York Downstate College of Medicine in Brooklyn, l promised to use my power and strength to help the sick to the best of my ability and judgment. All of the graduates, fledgling Medical Doctors that we were, understood that patients always must be considered first, regardless of cost, the effect upon others or any other factor.
 
We have witnessed unbelievable advances in medical care during these past 50 years. Everyone lives a healthier life. Life span has more than doubled in a very short time. But spectacular treatments,potent medications, space-age equipment and devices, and much more,.in every specialty and sub-specialty, have brought us to a precipice. It is a virtual brick wall. The available money needed to pay for Americans to enjoy this wonderful progress may be moving beyond our reach.  
 
Something very radical is likely to occur. We as a nation must address a significant moral and ethical problem. It goes well beyond reducing Physicians' fees, or squeezing hospitals' reimbursement for their services, or limiting care by the .HMO's, PPO's, insurance companies, and public health care companies. It even goes beyond our feeble attempts to alter the expensive tort rules that drain so much in mal-practice premiums from all providers (and their patients). The very root of our concepts concerning medical care will be exposed. It will produce a moral, ethical and religious re-evaluation of the value of each of us as human beings. Washingtonian winds are blowing ever stronger for a great 'change'.  
 
President Obama promised 'change'. Dr. Ezekiel Emanuel is his Chief Medical Advisor. Dr. Emanuel is very clear about the answers needed to combat the financial stress in American medicine. He firmly believes and verbalizes that the Hippocratic Oath is responsible for the overuse of medical care. It too strongly emphasizes thoroughness. A new interpretation of that oath is needed to allow for socially sustainable, cost effective care. He understands that hard choices are involved in allocating what we can afford in medical treatment, not solely what a patient needs. There would be rules that determine who should get care, who should be favored, who should be relegated to 'attenuated' medical services.
 
Should a 75 year old with Alzheimer's, advanced cancer, severe heart disease or obesity due to over-eating and no exercise be given access to expensive medical care, or should a 15-40 year old with medical needs that are curable. receive the expensive medical care. If you can pay for only one, which will you choose? An allocation of the costly medical resources to the younger person is viewed as keeping society going. It insures healthy future generations. It allows full and active participation in social and public matters The chief architect,favors saving one 20 year old rather than four at 70 years of age. Again if finances are stretched to the maximum, and you can<·do, only one and not the other, which would you choose? Adolescents are favored over a newborn infant. Refusal to approve spending drug treatment for metastatic cancer, when the anticipated best result of poor quality life, is acceptable.  
 
Health care reform will be very painful! It will involve examining our basic concepts of who we are and what we are. It will include changing our interpretation of my Hippocratic Oath to include considering the greater good of society on an equal footing with the needs of the individual. In a sense we will put a price on a life, and yes, it will be a form of rationing. President Obama promised 'change'. Our nation will get it sooner than we all had expected and in many ways we all had never, ever dreamed. However as they say, keep your eye upon the ball. Maybe the issue is not so much the money, as it is government power and control over people. RLM.