Healthcare News & Insights

Doc to Obama voters: Get lost

Physicians and other clinicians have a right to political opinions on the health reform bill just like everyone else.  But is it appropriate to bring them into the exam room?

Meet Dr. Jack Cassell. He’s a Florida urologist who posted this notice on his practice’s front door: “If you voted for Obama…seek urologic care elsewhere. Changes to your healthcare begin right now, not in four years.”

In the office’s waiting area, patients are further presented with health reform timelines distributed by Republican officials. Above the handouts, another sign reads: “This is what the morons in Washington have done to your health care. Take one, read it and vote out anyone who voted for it.”

Unsurprisingly, some patients complained, and now Rep. Alan Grayson, in whose district the practice resides, has denounced the sign as “sore losers [coming] out in force.”

Cassell has already received a significant amount of press coverage over the incident — with more sure to follow.

For his part, Cassell has said in numerous interviews that he isn’t refusing to treat anyone — no matter what the sign on the door says. At the same time, he said if patients see the sign and decide to go to another doctor, he’s fine with that. He also said that the care he gives to his patients wouldn’t change based on their political views, but that he would prefer not to treat those who were in favor of the health care bill.

Cassell’s practice is located in heavily Republican Lake County, so the effect of the notice on his practice’s bottom line will probably be minimal. And Cassell’s wife is a Republican candidate for county commissioner — presumably, the notice could help bolster her campaign.

Free speech v. Ethics

For health care providers, the situation raises a few questions.

Is it legal?

Probably. Cassell has a right to free speech, and has no legal obligation to treat someone with opposing political views. It would only be illegal discrimination if Cassell’s sign discouraged members of protected classes — race, gender, religion, sexual orientation, etc. — from entering.

However, Rep. Grayson pointed out in one interview that targeting Obama supporters would effect a disproportionate number of members of protected classes, such as African-Americans.

Is it ethical?

We say: probably not. Although Cassell says he’s not turning patients away, the sign on the door literally says, “Go elsewhere.” It’s hard to see how patients with differing political views could feel confident they’d get top-notch care from a doctor who has stated he would rather not treat them.

And certainly, even some patients who agree with Cassell (or are simply apolitical) may not relish having his political views shoved in their faces every time they go for an appointment.

Visiting a doctor isn’t like getting a car tune-up. The nature of the relationship between a doctor and patient requires openness and candor — traits not easily established when the first thing a new patient sees is partisan notices to “go elsewhere.”

What’s your take? Should Cassell leave the sign up to protect his first amendment rights? Or is he exercising his free speech at the price of his patients’ care? Share your thoughts in the comments.

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  1. I have always thought of a doctor as a man/woman who is a cut above the rest -some one whose title and reputation commands respect and whom I could trust enough to put my life or the life of a loved one in his/her hands. But, I don’t feel that way any more and I no longer feel safe or cared about in most medical situations, but feel that I am just a number and if I do not have $s I may not even be seen.

    Personally, I am shocked to think that any doctor would allow their politics, etc. to enter into their practice and it is not something that I would want to know. I think the sign could possibly have a negative affect upon the practice. Whether or not I voted for Obama, if I saw this type of sign on an office it would make me feel uncomfortable. I don’t think that this will help the wife get more votes. It may have the opposite affect.

    However, I think the good doctor (so long as it is legal) should do what ever he feels is for the highest good of the patients, and that he is comfortable doing as a doctor –He is the person who has to live with his decisions. And, having said all this–I do think that most of us are probably misreading his intentions. I have to say that I admire him for speaking up for what he believes, just think their may have been a better way.

  2. David N. says:

    Thank goodness for the right to free speech in this country. It was an incredibly gutsy move to put a sign like that on his medical practice door. In a society who’s desire to ‘get rich quick’ has led to unscrupulous and insane numbers of lawsuits for anything that a quality attorney can squeeze through the system, I can’t help but wonder how long it will take before someone decides to sue this physician for some reason.

    In the spirit of what Bobbi mentioned above, the trust shared between a doctor and patient must be 100% open and honest. However, physicians are humans too. They must pay to put themselves through school which is only getting more expensive and now they have to fight in the business world with tighter insurance regulations, reduced compensations from Medicare/Medicaid and now all the new healthcare issues just passed by our current government. The doctors who lived in the mansions of the past are now living next door to you and I in the typical suburb home.

    I believe that since it is his right to free speech, that he does NOT appear to be turning anyone away due to their political beliefs and that he would be crazy to risk his medical license and future for giving any kind of substandard care he should be allowed to post the sign on his door without fear of retribution. As he mentioned on the sign, if you don’t like it you’re free to take your business elsewhere. He’s not in a hospital setting where patients don’t have much choice.

  3. I wholeheartedly support the physicians stance and actions. As a member of the healthcare community, I have see first hand the deterioration of the system overloaded with beaurocracy. So more beaurocracy is only going to worsen the situation for caregivers as well as patients. I believe the bnext time I am driving through Florida, I may go out of my way to meet Dr Cassell in person and shake his hand. He is not refusing to treat anyone based on their views, only strongly encouraging them to consider alternative options. I seriously doubt he is asking political party affiliation on the h&p. (Which would be unethical).

  4. Recently at work someone mentioned going to one of our physicians offices. He shared that the doctor’s waiting room had the worst “junk furniture.” Everyone laughed at the doctor’s expense, but I didn’t. It costs a huge amount of money to go through medical school. And then they come out with an incredible debt. Medicare/Medicaid and insurance companies haven’t been fair to physicians for some time.
    The new Health Care Reform is going to help send droves of young people into this profession.
    I totally agree with Dave N. and I think Bobbi H. gave a cheap shot saying she thought doctors were supposed to be a cut above the rest. They need to eat and feed their families also. Lets respect them with the compensation they deserve. Yes, the day of doctors living in mansions is long gone!

  5. TexasGirl1960 says:

    I support this doctor. Unfortunately this new healthcare bill is going to result in private doctors who don’t accept insurance at all. Many facilities and/or doctors no longer take Medicaid due to reimbursements being so low. Medicare is soon to follow. Everyone is going to pay for this healthcare bill – whether they understand it or not. While Obama/Congress may have promised if you make less than $250k you won’t get any new taxes – what they mean is that your fed income tax won’t go up. They failed to let people know that hidden fees and taxes on businesses and insurance plans will in fact raise your premiums, cause prices to rise on the shelf and services to rise in cost. The states will also have to raise property and/or state income taxes to cover the new entitlements in Medicaid. Which will in turn be passed on to consumers.

  6. I say “Way to go Doc!” At least he’s not a hypocrite. He states freely and openly his views. Whether you agree with his stance or not, you have to admit that standing up for your own values, morals and ethics AND openly stating them is an uncommon trait these days. More power to him.

  7. I correct myself – I intended to say – this new Health Reform isn’t going to send young people into this profession.

  8. Sawtooth says:

    I think you’re going to see more of this kind of reaction. Doctors are professionals but they’re business people too. They sink 12 to 16 years in education and residency, come out with incredible debt unless they were born in to wealthy families to begin with and then are faced with reimbursement for their fees that are utterly ridiculous for some things. Doctors are criticized for driving nice cars and living in nice homes but don’t make as much as people think. Compare that to how professional athletes are showered with millions and most can’t complete a structured sentence if their life depended on it. People, our society has fractured its value system. Those of you who posted above that work in healthcare know that the system needs some reform. But we can’t continue to be on the end of every cost reduction strategy by simply cutting reimbursement more. They say there is “billions” in fraud and abuse in Medicare so why don’t they start with that? I think this will spawn more of a two tiered system of “regular” hospitals and physicians us common folk and then Private facilities and physicians for the rich which exist in Europe. Of course, you know where the politicians will be getting their health care from……

  9. Michael Montgomery says:

    The article suggests that the doctor’s politics shouldn’t affect his patients – but, their politics has affected his practice and the practice of medicine and delivery of healthcare in general for about 45 years and not for the better. Get government out of medicine and healthcare delivery except for the basics of enforcing contracts and prosecuting fraud and other criminal actions and the patient doctor relationship will be substantially improved. Those of you who can remember back to the fifties and early sixties, did you not have a better relationship with your family physician then and wasn’t there a lot of pro bono work done by doctors for the poor or down on their luck?

  10. Travis A says:

    I’d start off with saying I don’t know all the rules that apply to a private practice versus an ER or hospital, but my thoughts go more toward (adhering to all legal requirements) capitalism. If this is his own business shouldn’t he have the option to choose his customers? No shoes, no shirt, no service? All choices. Isn’t it his own businesses and shouldn’t he have the option to decide the fate of it? Doesn’t he pay taxes for the opportunity to have a business? We are talking about a sign referencing people’s choices not if they were born a certain race or gender. If you keep crashing your car because of poor choices, the insurance agency will eventually drop you. So, if people made the choice to vote for and/or support an administration and ultimately a bill that will adversely affect his private practice, I think the least he could do is put up a sign.
    And on the ethical point, it seem beauty is in the eye of the beholder, because I see very little ethical about how the bill got where it is to begin with… and where there is smoke, there is usually fire.

  11. Peter Oudheusden says:

    This is reality starting to set in. Ask around – I have yet to find a local Doc who is not vehemently opposed to Obama’s reform. Similarly, EVERY insurance and healthcare mega corp is fully behind it. And oh yeah, the unions are in favor of it too, foolishly thinking it will mean better care = more healthcare workers. Maybe you think this reform will help you – think again, carefully, if the free lunch you expect is really worth it – or even real. You will pay for it, as will your children. It will create government jobs (that’s always a plus, right?). It will make insurance companies more prosperous. The poor will continue to get no better healthcare than they get now. Insurance rates will skyrocket, going up 15% annually instead of the already crazy rate now. This reform is modelled after European quasi-socialized medicine, and guess what? Anyone there with money, comes here to be treated. And everyone there with money buys supplemental insurance because the care provided without it is abysmal. Welcome to the new reality, the reality YOU created.

  12. Julie O. says:

    Freedom of speech applies to all, even doctors. The only factor that is unethical is the idea of socialized medicine to begin with. It’s always interesting that the population that is for socialized medicine won’t be directly affected by it. The president and all of the congress that voted for socialized health care exempted themselves. I think it is unethical that an insurance adjuster with a high school diploma sitting in some cubicle in Omaha is going to tell an MD. who spent 10 years beyond high school training for their specialty, what he/she can or cannot do for their patient. The common phrase is “according to our guidelines, not enough conservative care has been documented” (meaning do nothing for awhile and hopefully it will go away). In the end it isn’t about health care anyway, it’s about control, and the general public and their physicians are losing control to insurance and the government.
    So hats off to Dr. Cassell for taking control of his practice.

  13. A.Cornell says:

    I agree with all here. He has a right to say what he feels and, in this world of “political correctness”, it’s refreshing to hear someone just state his feelings for what they are. I disagree with the comment by Rep. Alan Grayson saying, “that targeting Obama supporters would effect a disproportionate number of members of protected classes, such as African-Americans.” Sounds like he’s the one doing the racial profiling here! As stated, he’s not refusing care to any protected class, just stating his own political views of healthcare… which, in his position, he may be more in touch with than many of our elected so-called “representatives”.

  14. I would be disappointed to go to my physician’s office and be asked to go somewhere else because of how I voted. But at least I would know that my physician cares more about politics than his patients.

  15. D. Garrett says:

    Not only do I wholeheartedly agree with the doctor in his stance, I personally will not go to a doctor for treatment if I find that he/she supported Obama!

  16. While it may be free speech, his actions say as much as his words. Don’t come here if you disagree with me. I do not care to give health care to everyone. Just to those who can pay and who don’t want the rif-raf to associate with rest of us. He is morally defecient. I woudl go elsewhere no matter what. I have insurance and I don’t want him to get it with that attitude. He is involving his views in my care.

  17. Z. Teeter says:

    Perhaps doctors should add the question when they are taking a medical history:
    1. Have you been treated for High Blood Pressure?
    2. Do you have a history of Diabetes in your Family?
    3. How did you vote in the last election?

  18. I would not go to a doctor who gets political, on either side, with his patients from the moment they get to the front door. It’s grossly inapproporiate. There is a time and a place for everything, and I would be immediately turned off by seeing my doctor care more about politics than patient care. I’m very disturbed by this doctor, and by those above rooting him on. It seems quite against the oath of a doctor. I think this doctor is SICK. Rally and write all you want, write your representatives, believe what you want, and discuss with your colleagues, strangers in the supermarket, intrested patients, friends, etc – debate away! but confront ALL your patients? Who are entering your office due to illness or concern of illness? That is truly awful. Again, this doctor is a sicko.

  19. I think the sign is pretty gutsy and absolutely GREAT!!! Wish the physicians I work for would consider doing the same! Won’t matter though after this travesty is implemented, a lot of physicians will not be able to afford to stay in business.

  20. Ok…I have to disagree…

    Just because I have the right to say something, doesn’t mean I should. Where are the societal norms of what is accepted behavior?

    When I first heard this story, I googled him and checked out his practice. Of the 250+ people who rated him and his practice, he only recieved 1.5 out 5 stars. THAT says more to me than any thing…how he treats people day in and day out. This appears that he wasn’t doing such a hot job before this.

    I would be disappointed to have wade through any type of literature that has no place in a professional office. He could hang nude photographs of Nazi tattoed women and call it art…but that wouldn’t make me want to return…Same for religious or other social issues. It has no place in a professional setting. Period. And that transcends all professional offices…I wouldn’t want to hire an attorney who not dressed professionally or his office was full of ambulance chaser posters… Does he have a right to do it…absolutely from a capitalistic sense but ethically or socially? Another story…

    He can voice his opinion on healthcare in other ways…bumper stickers, OP-Ed pieces, blogs…he didn’t have to do a frontal assault. Guerrilla marketing at it’s best. I think it is very telling of his character. I’m with Doug…he appears way too concerned about what he has to say rather than any thing I might want to say……self promoter comes to mind.

    He even wrote a book…on his webite (it appears he wrote his own “about the author”)…there is some interesting reading… he developed a new surgical tool in 2003 and he has yet to get a manufacturer for. And as a business member of the Set Decorators Society of America, he has been to Hollywood to to represent/promote his other business…his prop house, “Demented Drek”. And I am not even going to take a cheap shot at that one!

    The comments about insurance companies dictating care has been a healthcare issue since the healthcare reform act of 1995…This is not new, people… Where do you think “care paths” came from or “treatment plans” or “standards of care”?!! Ask the family practice physicians about insurance reform…not the specialty practices. Those are the guys in the trenches-those who make less than $ 200K. We have had a steady decline of physicians accepting Medicare patients since around 2004 or 2005 in my area.

    WELCOME TO THE PARTY, BUBS! Where have YOU been? Did you need to have someone tell you to be outraged this last year or exactly when did you first have symptoms?

  21. E.S. Ron says:

    From the Hippocratic Oath: ..”I will apply dietic measures for the benefit of the sick according to my ability and judgment; I will keep them from harm and injustice…” Politicizing the medical treatment starts a dangerous slippery slope. I condemn Dr. Jack Cassell for taking the country this way

  22. Stephanie says:

    Bravo Dr. Cassell! This signage is not only legal, but is absolutely ethical! As a healthcare professional, I believe it’s his obligation to inform his patients about the damage this healthcare reform is going to cause. I’d like to see more physicians post this type of messaging. Unfortunately we’re all going to suffer the effects of poor healthcare and sky-high prices due to this reform. Those who support it should be made to suffer the consequences of their stupidity.

  23. The Dixie Chicks got fired for criticizing our last moron President. Who were they to exploit their own popularity to speak out? Theirs was a world stage and they took a misguided risk. Dr. Cassell is taking NO RISKS if his client base is as saturated with Republicans as the article states. He’s either building customer loyalty, or doing what I hear Republicans doing everywhere — commiserating bitterly and throwing group tantrums like ninja toddlers. He’s not stupid, but he’s not brave either.

  24. H. Taylor says:

    Perhaps, it would be prudent for the good doctor to refresh his memory of the Hippocratic Oath he took…and perhaps if this does not address his mischief, it would be worthy to remind the good doctor of the golden rule !

    The Hippocratic Oath
    (Modern Version)

    I SWEAR in the presence of the Almighty and before my family, my teachers and my peers that according to my ability and judgment I will keep this Oath and Stipulation.

    TO RECKON all who have taught me this art equally dear to me as my parents and in the same spirit and dedication to impart a knowledge of the art of medicine to others. I will continue with diligence to keep abreast of advances in medicine. I will treat without exception all who seek my ministrations, so long as the treatment of others is not compromised thereby, and I will seek the counsel of particularly skilled physicians where indicated for the benefit of my patient.

    I WILL FOLLOW that method of treatment which according to my ability and judgment, I consider for the benefit of my patient and abstain from whatever is harmful or mischievous. I will neither prescribe nor administer a lethal dose of medicine to any patient even if asked nor counsel any such thing nor perform the utmost respect for every human life from fertilization to natural death and reject abortion that deliberately takes a unique human life.

    WITH PURITY, HOLINESS AND BENEFICENCE I will pass my life and practice my art. Except for the prudent correction of an imminent danger, I will neither treat any patient nor carry out any research on any human being without the valid informed consent of the subject or the appropriate legal protector thereof, understanding that research must have as its purpose the furtherance of the health of that individual. Into whatever patient setting I enter, I will go for the benefit of the sick and will abstain from every voluntary act of mischief or corruption and further from the seduction of any patient.

    WHATEVER IN CONNECTION with my professional practice or not in connection with it I may see or hear in the lives of my patients which ought not be spoken abroad, I will not divulge, reckoning that all such should be kept secret.

    WHILE I CONTINUE to keep this Oath unviolated may it be granted to me to enjoy life and the practice of the art and science of medicine with the blessing of the Almighty and respected by my peers and society, but should I trespass and violate this Oath, may the reverse by my lot

  25. Julian Cutler says:

    Just the beginning. First, if you voted A, no service. If you voted B, come on in. Next will be the Mark of the Beast and you will not be asked since it will be very visible.

    It is all coming together. Get ready or just sit and watch.

  26. How I voted is none of his or anyone else’s business. I would get my medical records, which I assume I could get free of charge since he no longer wanted to see me, and take me well paying insurance somewhere else.

  27. I find it apalling and would not want to be treated by a physician who would post such a hostile statement on his door. I work in healthcare too and leave my political views at home.

  28. Is Grayson implying that only African-Americans are responsible for the election of the President?
    Talk about reverse discrimination!
    I’m a Registered Rebublican, but as with all things, political or otherwise, I use my brain when participating in any selection process.
    As a Registered Nurse, I use my brain to select those Physicians that I think are going to provide me and my family with the the the best care possible.(Although my current insurance company makes it expensive to be seen by leading physicians in some specialties)
    With the new healthcare, your choices may be very limited.
    I salute Dr. Cassell for sharing how he sees the changing tide of health care and how this tide may become a tsunami and drown us all.

    • Carol Katarsky says:

      TR, Grayson wasn’t saying that at all…his point was that African-Americans (as well as other groups) were more likely to vote Democratic, and thus, refusing to treat people based on their voting history it could conceivably be used to also discriminate against protected classes.

      I apologize if in paraphrasing him I muddied the issue.

  29. I agree with Alex. If this physician does not support the option of everyone having access to healthcare, I most certainly do not want him to be a provider of my care. That is my opinion based on the fact I have lived without health insurance at one point at one point in my life. You never forget that feeling of fear when your child or spouse is sick. I voted for Obama and support the healthcare reform and I am a healthcare professional. Perhaps Dr. Cassell is only concerned with his bottom line,the chance his wife will be elected and getting his face on the news (c’mon he had to know this would be breaking news!) rather than the patient care he is supposed to be providing.

  30. Geez,

    Is this a republican rally or what. I’m pleased to know that all here are well taken care of and have health insurance that covers their needs. I, on the other hand am a college educated, close to six figure making, uninsured citizen of this country. Why am I uninsured you may ask. Well, in this country most of us depend on our employers to provide health insurance. My employer chose to drop my insurance without one comment to me or any other employee three months before I was hospitalized with a catastrophic illness. This after I paid my portion of the premiums faithfully for over a year while I was denied coverage for a pre-existing condition. Thank God I didn’t have to see this doctor or I probably would not have survived my illness. Sounds to me like he is only interested in the financial benefits of his profession not the care of suffering humanity. I now have over $100,000.00 in outstanding medical bills for which I am responsible. Our health care system favors the healthy and wealthy and doctors like this turn away patients who disagree with their political views. Yeah, Dr Cassell is just stating his views and telling the rest of us that we are unwelcome. Good for him. While I disagree with Dr Cassell’s politics, if he ever needs the care of a urologist I wish him a better doctor than he is being to those who disagree with him.

  31. J. Clifford says:

    The truth is that Doctors, like all people, are swayed by their positions on things. It doesn’t matter who you see, they have a bias and an opinion that influences their judgement and view of things. It’s Human nature despite what the political correct rule book says. I find it refreashing to see a doctor who is willing to state what his opinions and biases are openly. At least one knows where they stand with this guy. I think people who are offended by this are simply the type who don’t like to face facts when its uncomfortable. They can keep their heads in the sand. I say honesty is the best policy. I say this Dr. is to be comended for standing up rather than quietly practicing in secret for fear opf loosing an allmighty buck.

  32. Hmmm… That gives me an idea. I will now ask my doctors if THEY support the law or not. If not, I will ask them to refer me to a new doctor. How about that?

  33. His sign is intended to have a chilling effect on reform support. What’s else? Office stfaf sent out to the parking lot to look for Obama bumper stickers on cars?

    I agree with John Mack. Let’s refuse to give healthcare business to anti-reform doctors.

  34. MM R.N. says:

    We are losing sight of two very important things here:
    1. He isn’t turning anyone away, but he is putting a barrier between himself and some patients. Not exactly a good idea when communication between physician and patient is vital.
    2. Physicians are not in short supply in Europe where this type of system has been in place forever. The fact is that there many more physicians in Europe per capita than here for many reasons. Physicians in other parts of the world aren’t paid nearly what they are here, and people in Europe don’t go to medical school to enrich themselves financially. They go into medicine to help people, and do so with the understanding they will be paid a reasonable wage. Europeans get excellent healthcare, ask them.
    Bottom line, keep your political and religious views out of work, even if you’re the boss, and stop griping about something when you have no real idea how it will impact you.

  35. Cheryl Cannon says:

    I find his attitude appalling for a health care professional. Freedom of speech does not include assuming to tell me how to vote in order to be welcomed into his office.

  36. I am a physician and am embarrassed by Jack Cassell’s behavior. I am not pleased with the American health care system, but flinging politics directly into the face of patients is shameful. We have all taken an oath to care for our patients and we have an obligation to adhere to that oath.
    Physicians have never been wealthy until that past 70 years in America. Being a physician has nothing to do with wealth, but with the care of other human beings. Of course physicians have a right to make an income to support their family, but they do not have a right to be as wealthy as they were in the last part of last century.

  37. Bringing politics into life like this is really refreshing. Doctors should not have to treat those they fundamentally disagree with. Doctors should not be required to administer treatments they disagree with (abortion) or administer care they feel is unethical (end of life treatment that will only cost a family money that will not significantly extend life). What is unethical is when people expect doctors to behave differently than any other citizen. They have no special obligations, and society has shown them no special status. They are just like everyone else and should have the same rights and privileges. Selection into medical school and taking an oath does not mean they have any special obligations. Dr. Cassell is within his rights. People such as myself who have made their fortunes on wall street are going to support his right to make a living just as we do.

  38. Rich Johnston says:

    Remember the southerners with clubs that beat African-Americans who wanted equal rights and an opportunity to attend college in the 60’s? Those people were certain what they were doing was moral, patriotic, and right. In reality, what they were doing was an abomination. Today’s Republican is a reincarnation.

    This doctor, it is just one more example of the 2010 Republican– small minded, intolerant of any views that don’t match their own, close-minded, unable to see behind the empty rhetoric they gobble up every day from Rush Limbaugh and Fox news, and hoping to see the country fail so their candidates can get elected. What a disgrace. God help us overcome these people.

  39. Diane RN says:

    As a Registered Nurse for over 30 years, it is amazing to me how some professionals lose sight of what healthcare is really about. Putting the needs of others above self, doing no harm, extending compassion for others, that is what we should be focusing our attention. Yes, it is a livelihood for us and the cost of providing care has escalated. But don’t allow hatred of a view that is not your own blind you of what good can come from reforming what the AMA, Catholic Health and so many other non-partisan parties recognized as well overdue. When we as a country realize it is much cheaper to prevent illness, than to provide primary care in the Emergency Rooms of hospitals all across the country, we will truly be a healthier people and a country that others will want to emulate. That is if we don’t implode before it happens.

  40. Hari, what an arrogant statement. You ought to count your blessings. And yes, physicians are expected to live up to a higher standard than the average citizen. They indeed take an oath that no other citizen is required to take and that oath should be honored as best they possibly can. Sure if the guy wanted to post what he thought healthcare reform would do to our healthcare then right on. However, to say that patients should go elsewhere for care is going way too far. Should hospitals make a post like this as well in their emergency rooms, if you voted for _______ go to another hospital for treatment. I think not.

  41. I assume Dr. Cassell had a previous sign that said “If you voted for Bush, come on in…the healthcare system in this country is just fine.”

    As an independent, I have to say that Obama is doing more to correct problems than anyone in the past few decades. Of course the recent health legislation could be better, but, unfortunately, like all other legislation, it is a product of our dysfunctional, two-party political system, as corrupted by the media and special interests. The healthcare system has been a mess for decades but the 3-year-olds in Washington haven’t yet learned to play nicely with each other and fix it.

    Obama is also pumping money into fixing the information infrastructure in healthcare which will lessen the considerable paperwork burden and he is restoring the importance of medical research (void of religious special interests)…among other things. Clinton’s attempt to help healthcare was defeated and Bush did nothing. So given the mess he inherited and “working conditions” in Washington, I give Obama credit for taking the initial steps to address the problem.

  42. Family M.D. says:

    This entire discussion is an interesting snapshot of the discord in our country today over the health insurance issue. However, I know this physician personally, and would not refer any of my patients to him, primarily because he does not act in a professional manner, either with his patients or with his medical colleagues. The sign on his door is just another example of his character.

    We physicians ARE held to a higher standard of behavior; we have taken an oath to serve our patients regardless of their social class or beliefs, and it is entirely unprofessional and unconscionable to inject our personal political beliefs into our relationships with our patients. Freedom of speech is not the issue here. The special calling of the physician forbids the injection of our personal beliefs into the care of our patients.

    Dr. Cassell is not a hero. He is an opinonated, self-interested publicity-seeking man whose ethics are an embarassment to the rest of us in this medical community.

    Incidentally, in response to Peter Oudheusden above, there are many primary care doctors who wholeheartedly support the healthcare reform which has passed, although it is not nearly comprehensive enough. As a physician I would rather deal with Medicare any day than any one of the commercial insurance carriers. If we could simply achieve tort reform and make Medicare available as an option for all ages, we would have a much better world in which to practice.

  43. Arthur J. says:

    Although I disagree with the method that this physician has chosen to speak his mind, I certainly believe that this is the majority of opinions that I recognize in many of my colleagues. I am a member of the AMA, but am hard-pressed to find other physicians who believe in the AMA’s support of the current health reform. I am a physician trained in the US, with all of my extended family and in-laws living in Europe, so I have had the benefit of seeing first-hand the differences of care.

    Nobody can correctly compare what European citizens receive in regards to health care, since the average European earns less money than the same American, and pays significantly more in income taxes (55% versus approx 35%), and still add some money personally or through employers for health care. That difference alone allows the government to provide significantly more services, although the Europeans do have significantly more rationing of the care and the current level of care cannot be maintained. Additionally, many European physicians try to come here to not only practice, but also to receive the best training available in US residencies and hospitals. How many US medical school graduates go to other countries for residency?

    Most physicians do not enter into the profession for the money, but after putting so much of their own money, time, and sweat into learning, practicing, and working, we do expect not to have to worry about being paid. With the continuous chipping away at reimbursements, we no longer can trust that we will be taken care of while we make critical decisions for our patients at all hours, spend 80-100 hours per week away from our families, and attempt to pay off our mounting financial obligations (education loans, malpractice premiums, practice costs). Physicians continue to make less money each year while the work load continues to increase. In fact, Congress has made no movement towards deferring the 21% cut in Medicare reimbursements this month. Imagine if you were suddenly receiving a 21% pay cut despite working more than before?

    I do not want to delve into who this physician is personally, as this has no bearing on the larger topic at hand. In regards to looking up this doctor’s rating, it is irrelevant. We are not talking about an eBay seller, in which all people leave feedback. There is no denominator to judge the true performance.

    This is a loaded issue that is full of half-truths from both sides of the political lines; preexisitng condition coverage and dropping of policies are not partisan issues. The fact of the matter is that the Republican recommendations/alternative plan also included removing pre-existing condition limitations, preventing insurers from canceling policies, pooling small businesses for health plans, allowing dependents to remain on parents’ insurance, etc. The problem is that the current health reform law is not debt neutral, and continues to limits reimbursements to many physicians.

  44. Interesting perspective that Arthur J brings.
    Just 2 things to add; Physicians in Europe have plenty of excellent and little to no cost schools and training facilities. There are many more physicians because there are many more medical schools, and people want to be physicians to help people. It is an honorable profession; unless you superimpose your views on your patients.
    Arthurs J wants the national healthcare plan to be “Budget Neutral” but also wants physicians to be paid more. I don’t know how your calculators works, but mine doesn’t have a function of manufacturing money. There’s no free lunch for anyone.

  45. It’s pretty much a fact that we need food more than we need healthcare. You WILL starve if you never eat anything, however, loads of people go through life without Health Ins or even health care. So maybe the grocery stores should start giving away food for free. Yes, yes, it should all be free… free food for all… universal food paid for by taxes. This is plain stupidy of course. So why should doctors have to abide by rules that nobody else, no other occupation has to? All of you people that make statements about how he is putting politics before patients should wake up. You are totally wrong, in fact his stance says that he believes that this bill will be bad for patients and he is saying that the goverment is forcing themselves between that doctor and his patients, which is never a good idea. So you need to quit smoking your funky mushrooms and get real.

  46. Here in lies the problem with our health system. As long as health care is made into a political issue, we will never fix the problems. Wouldn’t it be refreshing to take healthcare out of the political posturing we see every year at elections.

    I would say the good Doc has got his priorities all wrong. Yeah he should leave the sign up, but don’t make him a martyr for Freedom of Speech. His silence up to this point tells me he is OK with where US healthcare was going. We deliver sub par quality (life expectancy and infant mortality to name a few) at the highest price per capita in the world. If that is the direction we want to continue to go, then let’s follow this Dr. Cassell into the future.

    What Dr. Cassell, should have said to make a point, was I no longer will accept any government funded reimbursement, because I am against the current Health Bill and current president’s views. But I am sure his standard of living would change too much to make such a bold statement. Last time I checked the government already pays ~45% of all healthcare cost in this country. I don’t know how he would keep up with his personal bills without that.

  47. To BF: Unfortunately your analogy doesn’t work. A grocery store is a conventional business. The consumer pays for what they want, the stores that provide what the consumers want stay in business the ones that don’t go out of business. Pure capitalism. Healthcare is far from this. The consumers demand quality but don’t pay for it, providers are paid by insurance companies that are profit-driven, and employers pay the insurance companies. Far from a normal business relationship. Costs go up every year so employers cut back on health coverage. Together with unemployment, this leaves a lot of people uninsured who may face an enormous debt should they have an accident or get ill. Since this system is getting worse I think it is entirely reasonable for the government to step in.

    I believe the person smoking mushrooms is the person that believes the healthcare system is miraculously going to fix itself without any government intervention. I’m also tired of hearing complaints about government intervention without offering an alternate plan.

  48. I am happy to see B.F.’s comment because it does make one very point clear – that many opponents of the Healthcare Refom bill truly do not understand it at it’s most basic level and have little to no idea what they are fighting. Not only is the anaology a false one, it is assuming the health care bill is free universal healthcare for all (under a single payor system), which it is not. This reform does not offer free healthcare for all. It’s a very complicated piece of legislation that does not eliminate or drastically alter most people’s current health insurance, i.e. employer-based health insurance. And there are already accepted government programs through which those who cannot afford food in this country get assistance so that they and their families do not go hungry. There are still those in our wonderful country that do go hungry, and there are a small amount of people on benefits who abuse the system, but by in large it is an accepted and needed part of our country (and that is not “free food for all”). B.F.’s ridiculous posting illustrates how difficult it is to discuss healthcare on forums like this when silly and simplistic analogies or, even worse, those posting with blinding anger, are thrown into the mix.

  49. MM R.N. says:

    Let us not forget that if you “don’t eat” only you are harmed. If someone without health coverage shows up at an emergency department everyone else pays for it through higher costs and increased premiums.

    Also, people die sooner and present at emergency departments more often without preventative care.

  50. Nowhere in the Hippocratic Oath does it say that doctors are not entitled to their own opinions.

    As for the poster who said: “I will now ask my doctors if THEY support the law or not. If not, I will ask them to refer me to a new doctor. How about that?”. I don’t think too many would hesitate to let you leave. There are far more patients than doctors. You have a right to seek a physician who shares your views, and physicians have the right to seek patients who share their views as well.

    Do I think the sign was in good taste, or a wise busniess move? No on both counts, but he has the right to speak his mind, whether you agree with his opinion or not.

  51. al yearty says:

    There seems to be a couple of hot topic issues at play here, noone disagrees with the Dr. right to freedom of speech just what he had to say and the impact on potential patients, which I think he has the right to refuse service for various reasons-wrong kind of insurance, history of abuse of system, ect. The second issue is the apparent thought by Rep. Grayson the a large majority of voters for Obama were minorities which would seem like profiling, I am agianst profiling so to sum up Dr has right to refuse service but congressman no right to profile. In conclusion I hope that the new Heath reform is successful and helps provide a better helthcare delivery system, but I’m openminded enought to see the potential for multiple problems not the least of which is elderly care which is mostly ignored by proponents of helthcare reform or at least not factored in to cost

  52. On a different note… I heard on the radio the other day that Obama has kicked his smoking habit. I think that send a positive message to our country’s kids.