G. Keith Smith, M.D.

Alan Zarembo reports in the Los Angeles Times that “Heart attack patients in states that require health care providers to report the outcomes of procedures to open blocked arteries are less likely to receive those live-saving treatments than patients in states without reporting mandates, according to a new study. “  Dr. Hitinder Gurm at Michigan University said the study reported in JAMA raised concerns that doctors, under pressure to keep their success rates high were avoiding or denying care to the sickest patients.  Dr. Karen Joynt of Boston who led the study said the “buzz” among cardiologists “was that some doctors were not operating on patients with the lowest chance of survival.”

Is this a sliver of truth leaking out, a view into how the easily defended “quality reporting mandates” have already morphed into rationing of care to the sickest patients?  If so, this is purely unintentional on the part of the AMA’s flagship journal, as this is essentially a government-funded organization.  If, however, this is a rare view behind the curtain, I predict that we will see nothing further from Dr. Karen Joynt!  Hopefully she will not suffer the fate Dr. Eric Topol did at the hands of the Cleveland Clinic.  Hats off to her for doing this study. 

At the risk of saying “I told you so,” I’ll say it.  Readers of this blog are familiar with this “unintended consequence” of mandatory quality reporting, it’s implementation resulting in rationing to the sickest patients, as physicians, “paid for performance,” alter their actions to……maximize their performance!  Watch, in addition, for droves of patients not needing coronary artery stents at all to get them as these patients tend to do the best.  

Once again, any time the government gets involved in anything, the resulting disturbance in the free and unfettered market is predictable.  In the health arena, this initially means prolonged suffering and agony from denial of care.  Later, these patients will become, like sick British patients, targets for euthanasia, the “greater good,” rather than the interests of the individual patient guiding the “policy makers.” Many suffering patients will beg for their deaths and societies bankrupted by government health care will oblige them.  The time to turn around and change direction is prior to arrival at the destination.  Like it or not, we are well on our way. 

G. Keith Smith, M.D.

Allow me to introduce you to Anya Rader Wallack.  Her career and background read like a most wanted list for fans of the free market in health care.  Let’s just say that she is to free markets in health care what Ron Paul is to the federal reserve system.

Ms. Wallack is president of Arrowhead Health Analytics.  Their website is here.  This outfit has been created to help private and public sector businesses deal with the health regulations and reforms that Anya, their president, has advocated for many years.  Can you say cottage industry?  Remember my blog about the lady I met on the plane who ran a consultant company to help others deal with the rules and regs from the consumer product safety commission…..which she wrote as their chairman?!

She is considered an expert on health reform.  Her experience includes a term as interim president of Blue Cross Blue Shield of Mass. Foundation.  She worked on Hillary Clinton’s Health Task Force.  Her testimony has been sought by our friends in Washington.  She tried unsuccessfully to implement a single payor plan in Vermont under Howard Dean’s government.  She has a Ph.D in social policy from Brandeis (don’t think she’ll be voting for Dr. Ron Paul).  She is a former employee of the ultra-leftist lobbying firm, Kimbell, Sherman and Ellis.  She developed a cost-containment plan for the state of Massachusetts (gee…I wonder why they needed that??). Now she is special assistant to the governor of Vermont and also the chair of the Green Mountain Care Board, a five member panel that will create a universal care system for the state of Vermont.  This board is busy “holding education meetings twice a week to get up to speed on health care data and evaluation systems,” according to Alan Panebaker who recently interviewed her.  She has recently written in the New England Journal of Medicine: 

“we must align incentives for payers, providers and consumers so that the risks and rewards embedded in provider payment systems, benefit designs and cost sharing all promote a higher value health system and better health.  Continuing, “..the project will expand to include ‘anchor’ specialists attached to advanced primary care medical homes, with bonus payments linked to both quality and total cost of care.”  The New England Journal is demonstrating the same socialist editorial skill as the Journal of the American Medical Association, it seems.  I am unable to find articles about the provision of high quality and reasonably priced health care brought about by the adherence to the principles of the free market in either one of those rags.

I have written before about Hayek’s “Fatal Conceit.”  This refutation of all forms of socialism relies on the fact that society has evolved, a process completely disregarded by socialists who want to plan society, by contrast.  Ms. Wallack demonstrates this logical error as well as the hubris of knowing, of course, what is best for everyone else.

I’d never heard of Ms. Wallack until today when I noticed a small news piece announcing her travel plans to New Hampshire.  She plans to cross the Connecticut River, leaving Vermont for New Hampshire, to discuss her views on universal health care for the state of Vermont, to a gathering on the Dartmouth (New Hampshire) medical campus.  This is interesting because many patients in Vermont, seek their medical care across this same river in New Hampshire.  Ms. Wallack’s problem is clear, isn’t it?  Vermonters with the health coverage she proposes will either have to stop travelling across the river to New Hampshire, or those in the medical business in New Hampshire will need to be on board with her plans.  This is typical of planning of the type she admires.  Wallack has to have the support of the facilities in New Hampshire or her plan goes down the toilet.  This is an example of how a “great idea!” expands, becoming more and more coercive to cover for the unintended consequences of socialist planning.  All of this would of course be solved if the entire country were required to subscribe to her plan!  Or the whole world!

If health care is “free” in Vermont, will folks from New Hampshire cross the river the other way?  Will the Connecticut River more resemble the Rio Grande with health illegals streaming across to Vermont to get their free health goodies?  Once the health care is “free” in Vermont, Vermont won’t need raiders from New Hampshire to bankrupt their system.  Their own state residents will be sufficient for that purpose.  Every state that has tried this has failed.  Tennessee, Washington, Massachusetts.  It seems that Vermonters like Ms. Wallack are determined to fail as well.  Ho hum.

G. Keith Smith, M.D.

I love the writings of Frederic Bastiat.  Get your hands on anything this Frenchman wrote and you’ll be changed by it.  In his struggle to promote the ideas of liberty, he found the utilization of reductio ad absurdum to fit his needs.  Simply, he would take the argument of his foe to extremes in order to magnify the true meaning behind a socialist’s proposal or statement.  Here are some abbreviated examples.

He wrote a short treatise about candlemakers’ petition on the unfair competition of the sun.  The idea was that everyone should have to close their blinds during the day so that more candles were needed, as the “free” light provided by the sun was the ruin of the candlemakers.  Since the candle industry was indispensable, as the only source of light at night, this protection of their industry was deemded justified.  This is how Bastiat made his point against any and all businesses that claimed some “right” to protection. 

A railroad was proposed, but every little tiny town wanted a depot.  Such was the furor and demand for the great number of depots that the train company could not profitably deliver goods or passengers.  Bastiat, in his usual way, proposed that the train operate in reverse! 

I attempted to emulate Bastiat recently in a blog where I made the case that those declaring health care a “right,” must extend this “right” beyond our borders.  I wrote, “this is serious human rights stuff here!”  If health care is a right, why does that right vaporize once U.S. borders are crossed?!

Bastiat had an advantage on me.  The world was not as crazy then so his arguments could more easily be magnified to the absurd to make his point.  I thought I had done just that.  Turns out that I was wrong.  Lawrence Gostin, a teacher at Georgetown University, in May 16th Journal of the American Medical Association (a government organization) seriously proposes, what I had proposed as absurd.  You can read the extremely long article here if you are so inclined.  I don’t recommend it.  Many thanks!? to my friend Dr. Lawrence Huntoon for passing this article along.  This is the kind of disgusting socialistic rubbish that government committees typically rely on.  If you are considering sending your child to Georgetown for their college experience,  you should read the article in its entirety.  You’ll then deserve the conversations you must endure when they come home for Christmas break.

Mr. Gostin proposes that the whole world should be taxed to provide health insurance to everyone on the planet.  For my failed attempt at reductio ad absurdum to have succeeded I would need to have included extraterrestrials.  Or all organisms with a notochord.  I’m not sure I’ll try this again.  You never know when some creep like Gostin is lurking around the corner advocating absurdities, the extremeness of which render my old friend, Basitat, obsolete.  

G. Keith Smith, M.D.