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 only thing that’s new to you is the history you don’t know,” goes the quote.  Actually, in this age of information, things are only new to you if your eyes are closed.  The articles here and here give you some idea of what is happening right now in countries with government-controlled, socialized medicine, and are a glimpse of what is coming here, courtesy of the Unaffordable Care Act.  Death panels represent the height of Hayek’s fatal conceit, bureaucrats deciding who lives and who dies.  This entity we call the “state” is responsible for more murder and suffering than any other invention of man.  Unfortunately, I don’t think we’ve seen the worst.

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.

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.

Ludwig von Mises adopted as his life motto a verse from Virgil:  Tu ne cede malis, sed contra audentior ito.  The translation is:  Do not give in to evil, but proceed ever more boldly against it.  His writings and his life reflect the extent to which he truly adopted this wisdom.  His refusal to compromise, while closing many doors to him (and nearly costing him his life, as he was forced to flee Nazi Germany), has inspired some of the greatest thinking about economics and its relationship to human behavior.  Lew Rockwell’s dream of an institute dedicated to the field popularly called “Austrian” economics, is named after Mises, no doubt signaling to all that compromise of principle would simply never be entertained.  

I’ve always liked Mises’ motto, wondering what a world would be like where more people adopted this way of thinking.  I ran into another saying this past weekend at the annual meeting of the Association of American Physicians and Surgeons (AAPS) that I wanted to share with you, no less powerful in my opinion, than Mises’ favorite quote from Virgil.

Principiis Obsta, Finem Respice.  The translation is:  Resist the beginnings, consider the ends.  Interestingly the author, Publius Ovidius Naso, known as Ovid in the English world, was, like Virgil, a poet of Latin literature.  This quote was revealed at the AAPS meeting as used by a former Nazi to describe the sequence of events in Germany that led to their fascistic insanity.  Very small steps, unnoticed by most, led to the totalitarian regime we all now know well.  

I think these two quotes have affected me because they are unfortunately applicable in our time.  Bob Dole of Kansas was asked in a debate once if there was an issue over which he was willing to lose an election.  His opponent was making the case for an absence of principle in Dole’s career.  Dole simply did not know what to say.  He, like almost anyone in politics or with power, chose victory and the maintenance or growth of their power and influence, over principle.  It seems like people will say anything these days to gain power, knowing their future actions bear no resemblance to prior pledges and promises.  

So what does any of this have to do with health care?  Universal health care was the issue that eventually brought power to the Nazis.  This is an extremely inconvenient fact for those promoting it.  Countries that have embraced this insanity have wholeheartedly embraced rationing of care to the sick and euthanasia, as an individual’s health, rather than staying an issue for that individual, became a matter for the “state.”  In Great Britain (a country Hayek warned in his Nobel prize winning “Road to Serfdom, was embracing the very economic policies of the Nazis they were fighting!) euthanasia has morphed into murder, as their Liverpool Care Pathway is used to “free up” hospital beds.  

“But that can’t happen here,” you say!  The Independent Payment Advisory Board screams otherwise.  The data mining through electronic medical record systems screams otherwise.  ”Meaningful use” and “best practices” cookbook medical approaches scream otherwise.  Accountable Care Organizations, HMO’s by another name, scream otherwise.  I think none of these small steps would have occurred had we heeded the advise from Virgil and Ovid.

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.

What will single payer health care look like?  There are so many places to look it’s a little confusing.  Here’s a partial list.

Canada

I pick on Canada a lot.  Why?  Lots of Canadians come to our facility for their health care.  Do I really need to say anything else?  These are people who have been told to wait for years before they can see a specialist (because there are budget “caps”).  When the money is gone, the doctor’s office is closed.  Surgeons are limited on the amount of operating room time they can have in a month.  When they have used up their time, they can do no more surgery.  Rather than have the market determine the allocation of resources, a Canadian bureaucrat creates a budget and that’s that.  Presto!  This is how the “right” to health care is born.  Doesn’t feel like a right to health care for those who come to the states for their care, though.  Probably doesn’t feel like that to the patients who die waiting in line for care, I’ll bet.  Imagine that the government guaranteed a “right” to blankets.  They then dictated how long the blanket makers could stay open manufacturing blankets.  Is it really that surprising that this approach would lead to lots of shivering blanket-less people waiting in line for their ration?  

Great Britain

I like to pick on the Brits because they harbor such nationalistic pride in regards to their health care system, even though it is based on the same faulty economic premise as their Canadian brethren.   I like to pick on the Brits because they not only euthanize their sick citizens to free up scarce hospital beds (duh…wonder how this shortage of beds came about?) they are proud of this and have even given this highway to the cemetery  a fancy name:  The Liverpool Care Pathway.  British patients that become extremely ill have a better chance of survival at home, surrounded by family and friends, as no one stands a chance once on the Pathway.  Recovery from severe illness can occur without the help of modern medicine, but recovery of the very sick isn’t likely when the hospital staff is actively murdering them.  

But there is no need to go outside of the U.S. to see the wonders of socialism in medicine.  The VA hospitals and the Indian hospitals provide examples of the wonders of efficiency brought to us in medicine from government bureaucrats.  

Our local paper’s lead article today informed us that the Department of Public Safety (office administering driver’s tests) was closing their offices for the day to participate in training their employees on how to be more efficient and friendly.  Zeke Campfield of “The Oklahoman” writes that the “operator of a local Chick-fil-A restaurant will teach examiners how to be patient and courteous.”  Wow.  That can be taught?  And in one day?  

What would happen to an employee at Chick-fil-A that was not patient with and courteous to customers?  What would a patron of Chick-fil-A do if they were not treated in a timely manner and with respect?  What would happen to Chick-fil-A if this treatment of customers were widespread?  

Campfield’s article also talks about a mother getting in to line outside of the testing center at 4:15 am, only to be turned away at the end of the day because there were simply not enough examiners to get to her son.  Three mornings in a row.  The spokesman for the Department of Public Safety muttered something about budget cuts so I’m guessing we’ll see government’s usual response, that of throwing even more money at failure.  

Try to imagine the Department of Public Safety in charge of your medical care.  Rude and inefficient staff.  No competitive fears.  Hospitals working together to institutionalize mediocrity so no one stands out as better, eliminating troublesome comparisons.  Long waiting lines.  Always blaming the lack of funding or budget caps.  

The efficiencies and quality of the private sector cannot be superimposed on government agencies for one simple reason:  without competitors, government doesn’t have to care.  Ever.  Our state government wants to introduce private sector ideas into a failed government organization.  Ironic, isn’t it, that nationally, health care bureaucrats are increasingly embracing the business plan of the Department of Public Safety (DPS), even as the DPS is looking for private sector answers?  At least the DPS hasn’t started euthanizing applicants waiting in line to free up examination spots.  

G. Keith Smith, M.D.

I anesthetized a man with laryngeal cancer the other day.  Nice guy, no insurance.  He will soon be bankrupt, but not because of any bill we sent him.  Not because of any bill that his surgeon will send him. 

He will be bankrupt because the system is corrupt.  He ultimately will require chemotherapy and radiation, neither one of which is available to him without going to a big hospital.  His radiologist (even though working at a hospital) will not send him huge bills.  His oncologist (unless they are a hospital employee) will not send him huge bills.   The hospital will bankrupt him.  The drugs he will receive are unnecessarily expensive for a number of reasons, all but one of which are due to government interference.  The FDA, whose purpose is to limit new competing manufacturers by enforcing rules and regs which only the big boys can comply with, drives the price of new drugs through the roof (you didn’t think the FDA was there for your safety did you?).  This occurs due to the rules and regs themselves and also due to the lack of real competition that results from enforcement of the rules and regs.  The hospital adds the final blow by adding a markup to these drugs of up to three thousand percent.   That’s right..no typo. 

If he needs to actually enter a hospital or requires a tracheostomy, his bills will easily overwhelm his finances.  Merciless hospitals will gladly keep adding to his tab as their take from the uncompensated care scam (where they get rebates from taxpayers for the amounts they bill for which they aren’t paid) depends on generating large and un-payable bills.  All the while these hospitals will “poor mouth” it talking as if they are going broke from patients like this man.  They will also make a point to educate all of us about their value to the community, as if bankrupting this man qualifies.

This man’s bankruptcy will be the work of the American Hospital Association.  It will be the work of the big insurance lobby and that of big pharma.  It will be the product of their greed and that of those in government all too willing to accept their bribes to make their bankrupting way of doing business the law. 

These corporate suits have now written a health care bill that will completely finish off their small competitors, paving the way for the abuses that only companies without competition can get away with.   This is corporatism.  This is fascism.  This is what Frederick Hayek warned us about in his “Road to Serfdom.”  The only thing worse than government, is government in bed with big business.  We don’t need to make sure everyone has insurance so these companies can make even more money.  We need to talk honestly about the costs, as very few of the costs in the health care marketplace can be justified, let alone even discovered. 

Unless we wake up to the government-enabled scams of the health cartel, we will find ourselves on “kill” lists to spare their stock prices.  I don’t think our soon-to-be bankrupt laryngeal cancer patient will survive to  see the kill lists, but you and I will, unless a bold and fresh market-driven approach is adopted.

G. Keith Smith, M.D.