Speaking on Fresh Air about his new book, The Hippocratic Myth: Why Doctors Have to Ration Care, Practice Politics, and Compromise their Promise to Heal, Bloche explains how rationed care undercuts the very core of the medical oath, which says, in essence: “In each house I go, I go only for the good of my patients.”
Bloche says that doctors are increasingly expected to decide which expensive tests and treatments they can and cannot provide for their patients. Their duel role as examiner and cost-cutter can then potentially compromise patients’ care, he says, particularly when insurers and hospital administrators urge physicians to only perform “medically necessary” treatment.
“The average person thinks that ‘medically necessary’ care means all care that might potentially be beneficial,” he says. “But the reality is that it’s a wide-open term.”
Care may be denied, says Bloche, for a variety of reasons, including whether patients have consented to cheaper treatment options through their health insurance plans. What that means, he says, is that doctors who ration care on behalf of insurance providers may simply be following their patients’ wishes — even if patients are not aware that they’re receiving subpar treatment.