Should Healthcare Be Above Democracy?

WASHINGTON, Oct. 18 - The Selective Service has been updating its contingency plans for a draft of doctors, nurses and other health care workers in case of a national emergency that overwhelms the military's medical corps.

In a confidential report this summer, a contractor hired by the agency described how such a draft might work, how to secure compliance and how to mold public opinion and communicate with health care professionals, whose lives could be disrupted.

On the one hand, the report said, the Selective Service System should establish contacts in advance with medical societies, hospitals, schools of medicine and nursing, managed care organizations, rural health care providers and the editors of medical journals and trade publications.

On the other hand, it said, such contacts must be limited, low key and discreet because "overtures from Selective Service to the medical community will be seen as precursors to a draft," and that could alarm the public.

In this election year, the report said, "very few ideas or activities are viewed without some degree of cynicism."

President Bush has flatly declared that there will be no draft, but Senator John Kerry has suggested that this is a possibility if Mr. Bush is re-elected.

Richard S. Flahavan, a spokesman for the Selective Service System, said Monday: "We have been routinely updating the entire plan for a health care draft. The plan is on the shelf and will remain there unless Congress and the president decide that it's needed and direct us to carry it out."

The Selective Service does not decide whether a draft will occur. It would carry out the mechanics only if the president and Congress authorized a draft.

The chief Pentagon spokesman, Lawrence T. Di Rita, said Monday: "It is the policy of this administration to oppose a military draft for any purpose whatsoever. A return to the draft is unthinkable. There will be no draft."

Mr. Di Rita said the armed forces could offer bonus pay and other incentives to attract and retain medical specialists.

In 1987, Congress enacted a law requiring the Selective Service to develop a plan for "registration and classification" of health care professionals essential to the armed forces.

Under the plan, Mr. Flahavan said, about 3.4 million male and female health care workers ages 18 to 44 would be expected to register with the Selective Service. From this pool, he said, the agency could select tens of thousands of health care professionals practicing in 62 health care specialties.

"The Selective Service System plans on delivering about 36,000 health care specialists to the Defense Department if and when a special skills draft were activated," Mr. Flahavan said.

The contractor hired by Selective Service, Widmeyer Communications, said that local government operations would be affected by a call-up of emergency medical technicians, so it advised the Selective Service to contact groups like the United States Conference of Mayors and the National Association of Counties.

Doctors and nurses would be eligible for deferments if they could show that they were providing essential health care services to civilians in their communities.

But the contractor said: "There is no getting around the fact that a medical draft would disrupt lives. Many familial, business and community responsibilities will be impacted."

Moreover, Widmeyer said, "if medical professionals are singled out and other professionals are not called, many will find the process unfair," and health care workers will ask, "Why us?"

In a recent article in The Wisconsin Medical Journal, published by the state medical society, Col. Roger A. Lalich, a senior physician in the Army National Guard, said: "It appears that a general draft is not likely to occur. A physician draft is the most likely conscription into the military in the near future."

Since 2003, the Selective Service has said it is shifting its preparations for a draft in a national crisis toward narrow sectors of specialists, including medical personnel.

Colonel Lalich, citing Selective Service memorandums on the subject, said the Defense Department had indicated that "a conventional draft of untrained manpower is not necessary for the war on terrorism." But, he said, "the Department of Defense has stated that what most likely will be needed is a 'special skills draft,"' including care workers in particular.

That view was echoed in a newsletter circulated recently by the Selective Service System, which said the all-volunteer force had "critical shortages of individuals with special skills" that might be needed in a crisis.

The Selective Service and Widmeyer held focus groups this summer to sample public opinion toward registration and a possible draft including medical personnel. People from a variety of professions, including doctors and nurses, were questioned.

The report summarized the findings this way:

$(6$)"There was substantial resistance to the notion of a call-up of civilian professionals that would send draftees to foreign soil."

$(6$)A draft of civilian professionals was seen as unworkable because "training would be inadequate to transform groups of people who had never worked together into cohesive units."

$(6$)People are apprehensive about the length of service that might be required. The "occupation of Iraq has proved more costly, in terms of dollars and lives, than most Americans expected." Members of the National Guard are "serving tours of duty far longer than many ever anticipated."

$(6$)People believe the government has the ability to "find whomever it needs" in a crisis, by using a "master database" if necessary.

President Bush and Mr. Kerry have said they oppose a draft. "Forget all this talk about a draft," Mr. Bush said at the second presidential debate, on Oct. 8 in St. Louis. "We're not going to have a draft so long as I'm the president."

But Mr. Kerry said, "You've got a backdoor draft right now" because "our military is overextended" as a result of policies adopted by Mr. Bush.

Bryan G. Whitman, a spokesman for the Defense Department, said: "The all-volunteer force has been working very well for 30 years. There is absolutely no reason to go back to a draft."

A "Draft" for health care workers is merely a euphemism for their compulsory labor, managed by government. What about the constitutional guaranteed freedoms of these health care workers?

Will the resulting health care system incorporate all the client service quality, technical expertise, and efficiency for which Army Boot Camp is so well noted?

Do you propose to use government power to force people to do any of these things? If so you don't understand either our Constitution or the importance of individual freedom.

You are confusing the established democratic process with constitutionally protected individual freedoms. The government can't compel a graduate of medical school to work for the government or a government controlled agency. That would indeed be a form of slavery. This principal was however violated when the constitution was enacted while southern states continued the practice of slavery. Southern states even regulated some aspects of slavery through the constitutionally enacted democratic process. However that all ended with the Civil war and amendments to the constitution forbidding the practice of slavery and restating the applicability of all the freedoms in the Bill of Rights to everyone.

I suppose you could raise the issue of military conscription and the draft, arguing that the two are analogous, but I don't believe the USSC would agree.

What about something like offering to pay for Med School in exchange for service as a Doctor in needy areas? So, like all tuition, room & board plus s stipend for 10 years work as a health professional in a remote part of America?

But imagine that Doctor getting paid a salary for 10 years, but his care was free to the people seeing him? Gets like a govt issued nurse, an x-ray machine etc and his/her Rx was mail ordered from the Govt?

Maybe, the Doctor, because he is a doctor, gives excellent care to his patients.

What about something like offering to pay for Med School in exchange for service as a Doctor in needy areas? So, like all tuition, room & board plus s stipend for 10 years work as a health professional in a remote part of America?

That would involve a contract by a free individual with the government , and no constitutional issue would arise.

It's still a bad idea in my view. The track record for government managed healthcare in this country and others is not very encouraging: bureaucracies are not noted for their creativity, innovation and focus on client satisfaction. Indeed any entity, whether government or private, that operates without client choice and competition generally yields poor quality service and indifferent management. In this country the government operated systems for both veterans and native American populations have yielded consistently poor quality services ad sometimes nearly criminal negligence by government providers.

I would think the student would still need to be accepted into the program and maintain an acceptable GPA. If all they are doing is providing incentive but otherwise not involved I see no issue - I think though the route similar to teaching should be to forgive the loans - that way you know they have successfully completed their academic career and will be on the hook for the loans if they do not completely commit to their side of the bargain.

Such legislation would likely be quickly thrown out by the Supreme Court as a thinly disguised form of compulsory employment. Moreover the usually unanticipated side effects of such legislation would be very harmful.

Then how come they are able to do just this in the teaching profession?