I blog about free markets in medical care and transparent pricing.
Joseph Stalin and Adolph Hitler weren’t exactly friends, but ideologically they were on the same page about many issues, the right to health care and the right to due process, amongst them. They were proponents of the former and obviously, not so much the latter. Sound familiar?
What they were actually in favor of was control of the healthcare their citizens received. Hitler and his National Socialist Democratic Party actually used this issue of the “right” to healthcare to politically destroy Otto von Bismarck, whose power was already tenuous given the economic devastation intentionally inflicted on the Germans after the First World War, a “crisis” economy that begged for a tyrant like Hitler.
Control over healthcare gave the statists control over the very lives of their citizens, arming the state with the authority to decide who got healthcare and who did not, for many, who lived and who did not. As all totalitarian regimes value individual citizens strictly as a function of their value to the state, and as the citizens began to believe the “we’re all in this together” sort of nationalistic chant, this grant of power over healthcare given to the state therefore had credibility and even seemed to be a necessity to many of the affected citizens.
While the Allied nations worked hard to publicly paint Hitler as the monster he was, these same nations quietly and privately embraced his economic fascism. Frederick Hayek’s “Road to Serfdom,” an unintentional best-selling blockbuster in the United States, was written as a warning for the British people, a warning that the fascist corporate state so decried by the British government, had in fact, been embraced by the British government! The proud British paid no attention and quickly adopted what we now know as the National Health Service, a system that is actively and admittedly euthanizing patients in these modern times to make bed space for those in the waiting room.
This could never happen in the United States could it? Only the most naive wouldn’t recognize that we are on the same path as these failed and murderous states. One very sinister activity that is escaping most people’s attention is the move by the federal government designed to promote the hospital employment of physicians. This arrangement erodes the patient-doctor relationship and therefore disenfranchises the patient, as the doctor’s boss is the hospital, not his patient. Physician employees are much easier for tyrants to control. Hospital administrators controlling large groups of doctors and the government controlling a small group of hospital administrators-that is the goal. Private practitioners, those with their patients’ best interest at heart, never mind what the state has to say, must be marginalized if not eliminated completely, for the complete takeover of medicine by the state to succeed. This effort is well on its way.
This article in the Wall Street Journal provides a glimpse into how the productivity of hospital-employed physicians falls, but doesn’t go far enough to show the true devastating effects of this employment arrangement, I think. While patients can appeal to their personal physician for help, their appeals to their employed doctors are more likely to fall on deaf ears, as these employed doctors must follow the old proverb, “whose bread I eat, his song I sing.” These doctors must ultimately advocate for their boss, not their patient in the event their interests are not aligned.
Here are some examples of how the current system is rigged in favor of the physician-as-employee arrangement. Medicare pays hospital-employed doctors 40% more for the same service as non-employees. Physicians must buy prohibitively expensive electronic medical record systems (promoted in the name of “safety”) or face even lower payments from Medicare. Physicians who do not demonstrate “meaningful use” of their electronic medical record systems (if they can afford them at all) will face further cuts from Medicare. “Meaningful use” includes transmission of confidential patient information to Uncle Sam, by the way, without the patient’s consent. One part of Obamacare calls for bundled Medicare payments to hospitals, which then divvy up the money to the doctors, as they see fit. One part of Obamacare prohibits the construction or expansion of physician-owned hospitals, institutions demonstrating better outcomes and lower prices consistently. Recently, the federal government issued regulations providing for profitable administration of chemotherapy only to hospital-based oncology units, not the non-hospital private practitioners, who can only charge a price less than their cost for these drugs. I could go on.
If your doctor isn’t working for you, he or she is working for someone else. It is only a matter of time before this represents a conflict, your interests as a patient suffering as a result. This is a necessary part of the national health care plan, where rationing from the central planners will be used to balance health care budgets.
The response to shortages (invariably the result of state intervention) by the free market and its entrepreneurs, is to look for new and more efficient ways of providing the service, activities that lower prices and improve access for everyone. Entrepreneurs see shortages as opportunities, while central planners, not only cause these shortages, but respond with the usual rationing and price controls. The Independent Payment Advisory Board (IPAB), an integral part of Obamacare will be the price control mechanism, the mission for which will be to price services below their actual market price, ensuring that little supply of these services is available and therefore balancing health budgets with this subtle, behind-the-veil rationing.
This is the compassion of the state, where central planners decide who gets what from a shrinking supply, whereas market players deliver more supply at lower prices. Employed doctors will be much more easily controlled than independent ones when this system is fully operational. Hitler and Stalin understood this. The current regime in the United States does, as well.
G. Keith Smith, M.D.
Black Flag, a company that makes roach traps, known as roach motels started an effective advertising campaign years ago: ”Roaches check in, but they don’t check out.” As a big fan of the free market, it had never occurred to me that a hospital would embrace the roach motel model for patients. Welcome to Great Britain’s Staffordshire Hospital, where unlike death row where prisoners are fed, even given a last meal, patients are neglected to death, many dying of dehydration or starvation, only to be found by family members lying dead in their own excrement.
After reading this article, you Pharaohbamacare supporters have two philosophical options, I think: admit that this whole idea of socialized, government-controlled medicine is a bad idea, or argue that this hospital mass-murder is acceptable collateral damage….you know…for the greater good. It turns out that hundreds (they seriously don’t know how many, though they admit the number may be as high as 1200) of patients have died unnecessarily in this British hospital over a four year period. These deaths are in excess of what they expected and include as causes starvation, dehydration, infection from lying in soiled sheets, to just pure neglect from a calloused staff.
I am assuming that the number of deaths, in excess of “what they expected,” don’t include those patients who were murdered by the staff utilizing the Liverpool Care Pathway in an attempt to free up more hospital beds for more…victims. I think it is interesting,too, that the prime minister insinuated that these neglectful murders were not confined to this one hospital. I think it is clear from what he said in his remarks in the article that this style of “care” is widespread. Interesting too, is that these murders occurred between 2005-2009. That was four years ago! I wonder who politically benefitted from the timing of this report? I wonder how many murders might have been prevented had this report been released earlier?
I can already hear the apologists: ”It’s the price you must pay for everyone to have access.” A friend of mine who lived in England for awhile told me of an old saying there: ”The first thing you do if you get sick is buy a plane ticket.” I suppose this is one way a government can keep their health costs down….scare folks into becoming medical tourists to the greatest extent possible. Maybe the U.K. should change the name hospital to “Hostel,” so patients will know they are about to enter a horror film not unlike a Black Flag poisonous box.
G. Keith Smith, M.D.
The National Health Service in Great Britain has made no secret about their use of the “Liverpool Care Pathway” as their favorite method to kill sick people. They have even admitted to using this method, which consists of denying food and water to patients while simultaneously sedating them, to free up hospital beds for those waiting. About 133,000 patients per year. In Great Britain. Euthanasia is standard in countries that have socialized the resources necessary to deliver health care, as having adopted the “we’re all in this together,” Marxist philosophy, puts the “good” of society ahead of individual rights. After all, you just can’t have all of these sick folks draining the “public,” “community” resources when they could be put to “better” uses, according to the central planners. Wow. These folks must be really smart to know who should live and who should die. I can’t imagine the “gunvernment” abusing this sort of power, can you?
Whether it’s rationing through death panels or shortage-causing price controls, the socialistic Unaffordable Care Act will bring murder to medicine just like all the rest of the countries that have gone down this road. I think that we need to be thinking of a name for this. The Brits have their Liverpool Care Pathway, Orwellian doublespeak on steroids. I like the “Kenya-Care Pathway,” named for the home country of this law’s main proponent and the current head of state. Any other suggestions are welcome. I think we should name this murder before those in favor of it get a chance.
By the way, here is a link to an article from the United Kingdom (courtesy of Brandon Dutcher at the Oklahoma Council of Public Affairs), describing how the Brits are now murdering children and babies with the Liverpool Care Pathway. Seriously.
G. Keith Smith, M.D.
A few years ago, I was invited to participate in a symposium on the disaster of Canadian health care by John Caldara of the Independence Institute. This event took place in Vancouver and featured the first-hand stories of Canadian patients that were denied or neglected or worse. You can watch Reason Magazine’s story of one of the patients here. After listening to these heart-wrenching stories all morning, my wife and I went along to the luncheon, seated at a table with Canadians, primarily. After making what seemed like a fairly obvious comment about the abysmal Canadian health care system, we discovered what I have since liked to call “Canadian healthcare pride.” Our new Canadian friends were appalled that we would bash the system they had just picked apart moments before! I’ve discovered that his nationalistic health care pride insanity is not unique to the Canadians. On the contrary, it is widespread as I will attempt to show in this blog.
You see, it is one thing for a Canadian to tell the story about being denied brain surgery in spite of the presence of a life threatening and growing brain tumor. It is one thing for a Canadian to tell the story about their child denied ear tube placement only to have their life miraculously saved by an American pediatric neurosurgeon in Washington state after they developed meningitis.
It is another thing entirely for an American to say anything derogatory to a Canadian about their system of health care. They will almost invariably defend it.
The Canadian health care nationalism pales in comparison to the Brits, though. The hate mail I’ve received from the Canadians for criticizing their system pales in comparison to that I’ve gotten from the Brits. Talk about pride. All the while the hospital medical staff murders their sick relatives under the guise of the Liverpool Care Pathway, a harmless-sounding euphemism for their brand of euthanasia.
I can’t leave out American Medicare beneficiaries and their nationalistic “insurance” pride. The reaction of patients to me years ago when I was happy to provide their anesthetic free of charge, but refused to deal with “their Medicare” was enlightening. ”What do you mean you won’t take ‘my Medicare?’” ”Do you think I’m charity?” The rage I witnessed made no sense to me then. It does now. This pride that can only be understood as a type of nationalism much like the Canadians’, explains this emotional and irrational reaction I witnessed.
The insurance of active duty military, Tricare, is a great example of Jane Orient’s saying that “coverage doesn’t mean care.” Tricare pays our surgery center almost exactly 1/3 of the cost of the surgeries we do. That’s right. Even with our efficiency, they would need to pay us 3 times what they do for us to break even. Needless to say, no doctors are waiting in line to accept Tricare patients. Yet in a townhall meeting, I witnessed an active duty military man go toe to toe with Senator Tom Coburn about his proposal to modify Tricare, a proposal that would increase this man’s payment slightly but would actually grant him access to care, care which is currently unavailable to him due to the price controls within this awful “insurance” product.
Tricare pride. Medicare pride. Canadian care pride. British care pride. Victimized by their “insurance” the pride remains, nonetheless.
Contrast that with patients that have come to our facility that are proud of the fact that they have never been insured. They pay their bills. They have saved for a rainy day. They have saved enough money for an open heart surgery ($26,000 here in Oklahoma City). They have saved enough (it doesn’t take that long when you are not paying $1800/month in insurance premiums) to pay for their hip replacement ($18,000 here in Oklahoma City). Many of these patients would buy cancer policies or other catastrophic policies if they were available but sadly, thanks to Uncle Sam, these types of policies have been legislated out of existence.
I guess that if you wrap filth in a country’s flag, the citizens perceive greatness no matter what is inside. The subordination of the rights of the individual to the whims of the state is a necessary step in any socialist or fascist system of government. I think that is the common thread in what I have described. As an individual’s health care becomes the responsibility of the state, its evils tend to be discounted by virtue of their association with the state. This irony shields government-run health care systems from much of the scrutiny and criticism they deserve. Once the “healthcare provided by government” step is taken, it tends to be self-fueled, as any criticism of such a system can be painted as unpatriotic, almost treasonous.
Samuel Johnson said that “Patriotism was the last refuge of a scoundrel.” He meant by this that to impugn someone’s patriotism was the lowest blow one could strike, a despicable tactic by the accuser. Let’s keep our guard up for the government healthcare boot lickers that would defend the rationing and euthanizing of the sick for the good of the many.
G. Keith Smith, M.D.
Here’s another example of government-run health care. Think anyone made money on this deal? Think the man in the white house believes that the plan that bears his name will be any different? Maybe the idea is to treat patients such that they beg for the Liverpool Care Pathway. Some journalists are comparing this to Auschwitz.
G. Keith Smith, M.D.
Great Britain, just like the U.S., is going broke. Entitlement spending will be their doom. Their National Health Service costs 158 billion dollars a year to run. ”But health care is free there!!” These blokes have come up with an idea that might jolly well keep their system alive. We bloody well can’t let the staff run out of the supplies necessary to euthanize the sick inpatients now can we? Seriously. The NHS admits that 1/3 of all patients that die in their hospitals are euthanized.
So here’s their idea. Public hospitals in England should set up profit-making branches in other countries! Jill Lawless, writing for the Associated Press writes, “Officials said the country should capitalize on international respect for the British health care brand.” Later, “Health Minister Anne Milton said that plan would create jobs and revenue, which would be channeled back into the health service.”
Many of you are laughing right now. Aren’t central planners fun? Probably not when they deny you dialysis (remember it’s free) or murder a sick relative to free up a hospital bed. I think they should give some thought to flying a “Jolly Roger” flag at each of these branch hospitals. What a great logo for their “brand.”
Put yourself in the shoes of a patient walking in to one of these facilities. However much you are charged, it will be too much, as the mission of this hospital will be to charge enough to cover the cost of your care and that of the folks back home. Why would anyone patronize a facility with this mission? Why wouldn’t someone else set up a hospital and charge a fair rate, charging only for your care? How long would foreigners endure being overcharged to bail out the mother ship?
How will the NHS do a price calculation for their services? I suggest that if they really want to make a profit they should contract with one of the “not for profit” hospital chains here in the states for a lesson in aggressive billing, or just sublet the facility out to them. I suppose they will consider some “tax” like a VAT, added to the hospital bill but call it a TAB, for “thanks a bunch!”
Will the British doctors operate in a for profit manner, or be salaried like back home, while the hospital acts in a “for profit” manner? I’m thinking that if the doctors don’t care whether they are profitable, this hospital can call itself “for profit” all it wants….it will not make a dime! On the other hand, if the doctors are offered a chance to work in a “for profit” fee for service manner in Dubai, there may not be any doctors left in England!
What happens when a competitor hospital opens up, charging a fair rate, without the TAB? If any talented British doctors go to Dubai, won’t they go to work for this facility not owned or operated by the NHS? What sort of doctors would remain working in an NHS hospital when the competitor, charging probably half for better care, shows up, offering the doctors a fee for service setup?
Will they use the Liverpool Care Pathway to euthanize resource-intense patients who aren’t profitable in these new facilities? Will they bring staff trained to simultaneously starve and sedate the sick? Exporting these skills might actually be a good idea for the care of those remaining in England!
What does this arrangement say about the “free health care plan” back home in England? What better evidence of failure could there be, that “for profit” hospitals need to be built all over the planet to support the bankrupt and failed system back on the home front? Their socialism only works if allowed to piggyback onto a “for profit” system elsewhere. What a message!
Or will the old British accent portray a higher IQ than justified, making this a brilliant marketing move, an unbeatable strategy? Even so, what makes them think that the free market won’t create a better priced Harley Street in Dubai, as patients realize their scam?
G. Keith Smith, M.D.
There are many reasons to object to government-run health care. Some would argue that if the government runs it, it will run like everything else in the government: poorly and corruptly. Failure by a government program, an extremely poor performing school, for instance, simply results in more money chasing the failure. Whatever ails the delivery of health care in the U.S. (virtually all of which has been caused by government intervention), granting the administration of this service to the folks at the department of motor vehicles or the TSA doesn’t seem like progress.
Others would say that government-run health care is a bad idea because anything that requires first the theft of an individual for the benefit of another is wrong, no matter what good is claimed to have resulted from the robbery. The ends never justifies the means.
I think both of these positions are compelling and sufficient. Here’s another one, though. If you are the medical ward of the state, they want you dead and they will kill you. Think I’m too harsh? Read this. It turns out that 1/3 of patients who die in British hospitals are euthanized. This is done to save money and to make beds available for more assassinations. This British hospital path (Green Mile?) down death row is called the “Liverpool Care Pathway.” This consists of heavy doses of morphine and other sedatives combined with denial of food and water. Let me see…..I’m checking some of my reference texts….yep that will kill you every time. Either component alone is sufficient to kill you. It occurs to me that even condemned death row criminals having been granted a last meal are afforded more courtesy than these poor British patients.
So if you are one of those die-hard universal health care loonies, remember that the government, armed with the power to rob someone down the street to provide for your “free” medical care, also has (and will use) the power to kill you, if some bureaucrat believes treating your medical condition might cost too much or you are no longer useful to the state.
This is the essence of socialism and fascism, isn’t it? Everyone exists for the good of the state. But once the tapeworm of government reduces us to sickness, the machine is actually better off without us, discarding us into a mass grave. Hayek’s phenomenal book, “The Road to Serfdom” was a warning to the British that while fighting against and vilifying the fascist Germans, the British had embraced many of the ideas of their fascist society. Looks like the British love for medical fascism has been used to achieve the same “efficiencies” of their former German foes.
One of the most chilling parts of the article linked to above was the response by one of the government defenders of the use of this Liverpool Care Pathway. He said that in defense of its use, if once begun a patient shows signs of improvement, it (the Liverpool protocol) is stopped. So if you struggle while they are killing you, they let up. No wonder the British, just like Hitler disarmed the populace before they tried this.
G. Keith Smith, M.D.
More and more articles are surfacing about the bankruptcy of the British National Health Service. As a government organization, they will never go bankrupt, of course, they will just stop offering certain services. This is called rationing. Ah…the advantages of a monopoly. The NHS is looking for 20 billion in cuts. This is not something they want to phase in. They are looking for it now. This outfit is in trouble and the Brits, long accustomed to paying nothing, are very angry about the possibility that some services will be eliminated or privatized. One of the most popular tweets circulating now is that the Brits “earned our health care in a war.” This Ponzi scheme did, in fact, start in 1947 shortly after WWII. I’m not sure I understand the connection with free health care as some sort of reward for having endured a war, but the popularity of this quote gives you some idea of the entitlement mentality of the Brits.
The bankruptcy of the Canadian Health System has been looming for over a decade. Were it not for their monopoly and control of access, they would have disappeared long ago. There is little to no difference in not paying your bills and simply denying or delaying care to people. I have written at length on this blog about the Canadians that travel to our facility to avoid a wait of 2 years or more for the most routine surgical procedures. This rationing by delay would translate to bankruptcy in the private sector. Not surprisingly, more and more articles about partial to complete privatization of the Canadian system are surfacing from think tanks and journalists not known for their love of the free market.
That said, I think it is rational to think of Medicare as our National Health Service. I have thought this for some time. Medicare has no competitors and in the effort to create a “health care is free for anyone enrolled” has brought bankruptcy within sight. As P.J. O’Rourke has written, “if you think health care is expensive now, wait until it’s free.” Consistent with the national schemes in Britain and Canada, the Medicare bureaucrats are dealing out their brand of rationing here in the U.S. This has initially taken the form of payments to physicians so low that fewer and fewer doctors are willing to see patients enrolled in Medicare. This, of course, works beautifully for the rationers as it makes the physician look like the bad guy. This is the game of government, it seems. Engage in Draconian control and make sure someone else takes the fall for the consequences. Simultaneously, the consequences to physicians who run afoul of the incomprehensible Medicare codes and regulations are subject to fines and imprisonment. This coupled with the low payment makes the cost/benefit ratio even more problematic for the physician contemplating seeing Medicare patients.
Here’s a new one, though. A friend of mine told me recently that Medicare is conducting “audits” of payments to a facility where he does orthopedic surgery. This audit procedure is delaying payment for total joint replacements for up to two years. This is actually worse than the rationing activities in Canada. At least in Canada when they run out of money, the doctors stop working. With our national health service, the physicians and facilities are providing a line of credit to Medicare, who should be paying their bills. Once again, this would be declared bankruptcy in the private sector. Once again, the physicians will look like the rationers, the bad guys, and the Ponzi scheme will continue and those running it will get off scott-free.
What makes anyone think that Obamacare will be any different? Someone famously said years ago, “the only thing that’s new to you is the history you don’t know.”
G. Keith Smith, M.D.