On July 22, 2009, President Barack Obama held a nationally televised press conference that focused on his health care reform proposal. When asked by Steve Koff, a correspondent for the Cleveland Plain Dealer , if his proposed public insurance option would “guarantee that the government will never deny any services,” the president said, “Right now, doctors, a lot of times, are forced to make decisions based on the fee payment schedule that’s out there. So if they’re looking … and … and you come in and you’ve got a bad sore throat … or your child has a bad sore throat … or has repeated sore throats … the doctor may look at the reimbursement system and say to himself, ‘You know what? I make a lot more money if I take this kid’s tonsils out.’”

This shameful accusation received little media attention, because it was overshadowed by the president’s equally intemperate suggestion of racial profiling in a police incident involving a Harvard professor. The president later said that he could have “calibrated” his charges against the police differently, but as yet, he has offered no apology for his characterization of practicing physicians as greedy miscreants.

We have no doubt that the current fee-for-service system provides less than sufficient incentives for the optimization of health care, but we disavow completely the president’s disdainful charge that physicians are thereby being “forced” to engage in criminal misconduct, a perverse extension of his “Yes, we can” campaign rhetoric.

Such governmental demonization was presaged half a century ago in Ayn Rand’s dystopian novel, Atlas Shrugged : “’I quit when medicine was placed under State control, some years ago,’ said Dr. Hendricks. … ‘Do you know the kind of skill it demands, and the years of passionate, merciless, excruciating devotion that go to acquire that skill? That was what I would not place at the disposal of men whose sole qualification to rule me was their capacity to spout the fraudulent generalities that got them elected to the privilege of enforcing their wishes at the point of a gun. I would not let them dictate the purpose for which my years of study had been spent, or the conditions of my work, or my choice of patients, or the amount of my reward. I observed that in all the discussions that preceded the enslavement of medicine, men discussed everything—except the desires of the doctors. Men considered only the “welfare” of the patients, with no thought for those who were to provide it. That a doctor should have any right, desire or choice in the matter, was regarded as irrelevant selfishness; his is not to choose, they said, only “to serve.” That a man who’s willing to work under compulsion is too dangerous a brute to entrust with a job in the stockyards—never occurred to those who proposed to help the sick by making life impossible for the healthy. I have often wondered at the smugness with which people assert their right to enslave me, to control my work, to force my will, to violate my conscience, to stifle my mind—yet what is it that they expect to depend on, when they lie on an operating table under my hands? Their moral code has taught them to believe that it is safe to rely on the virtue of their victims. Well, that is the virtue I have withdrawn. Let them discover the kind of doctors that their system will now produce. Let them discover, in their operating rooms and hospital wards, that it is not safe to place their lives in the hands of a man whose life they have throttled. It is not safe, if he is the sort of man who resents it—and still less safe, if he is the sort who doesn’t.’”

Only judiciously regulated, free-market, evidence-based reimbursement incentives and meaningful tort reform can guarantee the safety and efficacy of the American health care system. Campaign rhetoric aside, the guiding principle of political and medical reform is not so much what we can do but what we should do.