When the doctor leaves no order we feel helpless

We assume a boundary exists between our health decisions and those of our doctors, at the doctor's waiting room or the hospital admission table. What insurers, employers and government all want to do is move that border, or erase it entirely

In his 1985 TV series The Day the Universe Changed, science historian James Burke gave over an entire episode to a key transformation in our attitude toward medicine that took place gradually over the last 200 years. (The whole episode is available at YouTube.)

When the nation was founded it was assumed that we would decide what to do. A doctor, if one was available, was an adviser.

But knowledge was gradually coming forward. This new attitude of respect for knowledge, Burke wrote, could be found in the person of Benjamin Franklin, whom he called the father of modern medicine.

Public health, if it existed at all, was a matter of noblesse oblige.

It was the spirit of Franklin that animated the Founders' attitude toward medicine. The best thing government could do was to let people alone.

As medical knowledge grew throughout the 19th century, and the center of medicine shifted about Europe, the relationship between doctor and patient gradually changed.

Once doctors could safely operate on us, and once the germ theory of disease allowed the creation of modern medicines, things turned around completely.

Today we assume, reflexively, that our doctors will decide what is wrong with us and how to proceed. When they offer us options, stark and difficult options, without pushing us one way or the other, we are apt to panic.

Thus we have the story of Peter Hyman, a Slate.Com writer who recently detailed his own battle with a brain tumor. What makes his story compelling is the vagueness of the diagnosis, and the fact doctors left it up to their patient to make the call -- cut out the tumor or see what happens?

Hyman eventually made the right call. But reading his story we are all forced to ask whether we would, and to take responsibility for choosing.

It's in the balance of power between doctor and patient where health reform lies. What reformers want, whether they are public or private, employers, insurers, or government, is for science to tell us how to live, in the person of a primary care physician, and for us to comply.

Opponents call this the nanny state. They feel their personal liberty is at stake.

But on the merits we know the scientific method is right. That 72-ounce steak tastes good, but a steady diet that is unbalanced will kill you over time. So will that cigarette. So will that afternoon in front of the TV, swilling beer but otherwise staying motionless.

We assume a boundary exists between our health decisions and those of our doctors. We assume the boundary lies at the doctor's waiting room, or the hospital admission table.

But what insurers, employers and government all want to do is move that border, or erase it entirely. If your lifestyle does not comply with what we know is good for you, business says, your insurance rates should rise and your condition might not be covered.

Ironically it's the supporters of public plans who are on the side of liberty in this case, since a public plan will care for you regardless of how you got sick. It's no fault insurance coverage that business alleges will break the nation's financial health.

So we're left with this dilemma. Conservatives, crying freedom, oppose health reform. Reformers, trying to push lifestyle changes, support a public plan. Insurers, seeking to cut costs, leave people uncovered.

We know what works. Covering everyone, and giving doctors control over lifestyle choices, cuts costs. That's science, not socialism. What freedom and private cost-cutting leave us with are lifespans closer to those of Cuba than people anywhere else in the Western world.

All reformers, whether or not they support public or private insurance, agree that the key to better public health lies in compliance with new lifestyles where we eat balanced meals, exercise, cut out tobacco, and drink only moderately. And if science changes its mind, as it does, they reserve the right to change their orders.

Fewer choices, in other words. Does that really make you more comfortable, or less?

This post was originally published on Smartplanet.com