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.
For all I’ve written about the Canadian healthcare system, I think that all things considered, it is probably better (as awful as it is) than what we know as Obamacare. I see the two recent candidates as a socialist (the winner) and a fascist (the loser). The socialist is a wealth redistributionist primarily, but moves in some fascist, public-private partnership circles to fuel his financial needs. The loser, while giving lip service to “liberty” and “freedom” is primarily a tool of the businesses that serve to benefit from their relationship to gunvernment, that is, primarily a fascist.
The fascist is certainly “pro-business,” pro-business in the sense that this policy results in riches for the businesses, regardless of the effect on the consumer. Ironically, Paul Ryan actually made this statement during the campaign, imploring everyone to distinguish between “pro-business” and “pro-free market.” Both candidates claimed that health care was a “right.”
Here is why I think that Obamacare is the greater of the two evils. In Canada, everyone is in the same boat. When the money is gone, the money is gone for everyone. The only option folks have for getting care is to leave the country and pay out of their pocket. The only motive to ration is national bankruptcy. Having already faced this reality, the provinces now receive a certain amount of money like a reckless teenager on a budget, and when it’s gone it’s gone. The failures of this system are transparent to all, particularly the Canadians, but everyone’s in the same boat, a very socialistic setup.
Paradoxically, Obamacare, bearing the name of a socialist, is fascistic. ”Private” companies (giant insurance companies) will collect premiums, that by law now, everyone must pay. The law is written in such a way that only a handful of the insurance companies that now exist will continue to operate, the smoking gun of industry consolidation that has Washington’s fingerprints all over it. These companies will work very hard (and with little competition to prevent them) to ration care for the sake of their profits and stock price. Major stockholders will advocate and profit from the rationing of care to those who need it most.
There you have it. Well-meaning socialist bureaucrats in Canada put their bleeding socialist hearts into prioritizing their fellow citizens’ health needs. In this country, the companies that the gunvernment has put in charge will pursue rationing and neglect as policies, this approach being in their and their stockholder’s self interest. Rationing as an unintended consequence vs rationing as a profit-generating policy.
Hayek saw little difference between socialism and fascism, writing famously that the central planning characteristic of both made them basically indistinguishable. I like to think about fascism as socialism with some of the central planning outsourced to quasi-private corporations. This allows for the scapegoating of the “businesses” when the gunvernment’s policies fail to satisfy the public. In this way, fascism innoculates the failed policy from attacks by adversaries, always maintaining a roster of fall-guys. The totalitarianism is therefore much more difficult to attack, hiding in a way that an overtly socialist policy cannot.
The failures of the Canadian health care system are seen by Canadians as the fault of their government. The failures of Obamacare will be seen as the fault of the greedy corporations running it, another one standing by to take its place. This may be the winner’s cruelest secret: that for all his popular socialistic talk, he’s really a fascist underneath.
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.
Let’s say you’re one of those well educated leftists believing in a significant role of government in our lives. You hate the republicans because they are just a bunch of crony capitalists, funneling tax dollars away from the poor and middle class to their rich friends in various industries. Part of your justification for your belief and faith in government is that after all, if the government doesn’t take care of the poor and regulate these cronies, who will? Your support of the democrats is based on their promises to soak the rich and other such things to better and more fairly distribute the wealth so that all of the poor and unfortunate can have this government-provided safety net, into which they can fall when hard times hit them.
Question: how does it feel to know that your democrat friends are funneling tax dollars away from the poor and middle class to their rich friends in various industries? Did you see hospital stocks yesterday with the court’s ruling? Did you see the stock of the various big insurers? If you owned Apple computer, and the government ruled that anyone that refused to by an Apple computer would basically be taxed an amount necessary to buy an Apple computer, and the court upheld this law, what would that do to your stock? This is exactly what happened with the court’s ruling and was the intent of the law from the beginning.
Big insurance, big hospitals, big pharma and the HIT (health information technology) industries wrote this health care law. They brought unfathomable amounts of money to the table to be at the table while the bill was crafted. It was written by them and designed by them to put their smaller competitors out of business. That was the purpose of the law. If this isn’t the crony capitalism that has characterized the republican party for the last 50 years, I don’t know what is.
Where has the skepticism of the left gone? Why do you on the left continue to discriminate, favoring one political party over the other, not understanding that the only rational approach is to distrust both sides? How can you believe so easily? Why is there such little distrust when the track record of truth-telling by government for quite some time is so dismal?
It isn’t always necessary to learn things the hard way, but the faith that many on the left have put in government by this administration, grants them undeserved legitimacy and guarantees more tough first hand lessons. Make no mistake, I have little faith in either side. Rather than say “my guys are good and your guys are bad,” why can’t we stop discriminating and declare them all bad?
This crony capitalism from the left should leave many of you on the left breathless. I would encourage you to watch events unfold keeping your mind open to the idea that you have been duped. Ask questions as you see the poor and elderly, those clinging to the promise of Obamacare, increasingly disenfranchised by this legislation. Remember to test not what you hear but what you see with Murray Rothbard’s penetrating question, cui bono (who benefits). Try to get back in touch with your inner hippy and reject the fascistic version of economics traditionally championed by the GOP.
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.
Professor Robert Higgs toward the end of his brilliant book, “Crisis and Leviathan,” discusses the errors of the renowned social scientist Joseph Schumpeter with regards to his prediction of a socialist U.S., post WWII. Higgs describes a post-war march toward a more mixed economic result, one characterized by a government that gives lip service to private property but whose intense regulation of this private property resembles the fascistic regimes of wartime Italy and Germany. Higgs faults Schumpeter for clinging to a Marxist model with the bourgeoisie or “business class” on one side and the labor unionists, intellectuals and government bureaucrats on the other. Consistent with this “two-class theme” Schumpeter portrays those in the business class as the last defenders of capitalism (much like Ayn Rand). Quoting the brilliant Higgs,”He (Schumpeter) failed to appreciate how much the abandonment of traditional economic liberties over the long run had resulted not from the acquiescence or defeat of businessmen but from their enthusiastic sponsorship.” Later, “Businessmen have done more than their full share to foster the active regulatory state from its very inception.”
Examples of medically related businesses that have embraced this fascism are too numerous to list. Operationally, it is critical to understand that while the political contributions and bribes these medical mercantilists pay are substantial, the loot they later receive dwarfs their “investment.” The poor-mouthing and complaining about the regulations or new government hoops and hurdles that these medical “businesses” must overcome create the needed distraction, one that deflects attention from the promised future payoff. Giant hospitals are a prime example of this “business” model. Being the only medical facilities big enough to deal with the most onerous government curve balls, behind closed doors the administrators of these facilities cry in their champagne as they watch their smaller rivals whither due to these same government curve balls.
One can only imagine what kind of dough the HIT (health information technology) companies threw down to obtain a government mandate to buy their product. This is a more blatant and obvious bribery. The distraction effort took the form of an intense propaganda campaign to convince the public that this HIT emergency was all in the interest of patient safety. This campaign continues today.
“Businessmen” that have made their millions through government contracts are nothing more than fascists as they essentially lobby for the stolen property to capitalize their “pubic-private” partnership. As intensely ingrained as these men are in the medical business, their footing is precarious, as the source of their funding is unstable, essentially the product of a robbery. True and free markets raising their heads out of the medical mud are devastating to even the biggest of the crony’s flagship “businesses” and facilities.
As more and more physicians and medical facilities display their prices the tactics and true colors of the fascist conglomerates will become more clear. I believe that this medical industrial complex will fall just like the Berlin Wall, as the unsustainable and unstable business model, embraced in this country for the last few decades, has run its course. The free market, with its creative destruction, will once again bring to ruin those who deserve it dearly.
G. Keith Smith, M.D.
A large hospital in Oklahoma City has just implemented its electronic medical records system (EMR). According to the physicians who work there it is a disaster. Inefficiencies have been introduced that have made patient care in an already burdensome and bureaucratic environment frustrating, almost impossible. Patient histories all look the same except for the exceptions. There is no opportunity within the “check the box” platform to create a patient record distinguishable from the next. The result is a meaningless patient history.
Then there’s patient confidentiality. That the federal government passed legislation to punish those not agreeable to adopting EMR and furthermore paid for about half of the expense should have raised some eyebrows. Isn’t it enough to know that as badly as Uncle Sam wanted this implemented, that it must be a bad idea?
As of this moment, right now, this very instant, I am declaring the absence of EMR at The Surgery Center of Oklahoma part of our marketing strategy. Isn’t it enough for you to know that we have refused to implement the EMR rationing tool of the government goons? Dont’ you feel better about the security of your confidential medical information, knowing that we have refused to follow the other lemmings dropping off the cliff? Seriously. Isn’t this a consideration, in addition to price and quality when deciding where to seek care?
Once your medical information is digitized in a hospital setting, it is no longer secure. The “benevolent” state will use that information to determine if you belong to one of the “expensive groups,” groups that hurt the state’s profit and loss statement. What do you think they’ll do with this data? The good of the state outweighs the rights of the individual, no? Let’s state this in German: Das Wohl des Staates überwiegt die Rechte des einzelnen, nicht? Much better in the German, I think. Someone once said, “..the only thing new to you is the history you don’t know.” This “free” health care, and the central health planning that goes along with it are the spawn of the Nazis. You can read Richard Ebeling’s article here if you doubt my last provocative sentence. Where do you think we’ll end up, following this path?
Your medical secrets are safe with us at The Surgery Center of Oklahoma. We have no plans to adopt an EMR system. Ever.
G. Keith Smith, M.D.
Ricardo Alonso-Zaldivar of the Associated Press (and an apologist for the current occupant of the white house) has written an article about the health insurance rebates mandated by the Unaffordable Care Act, aka Obamacare. The overall amount to be rebated may top 1 billion, Oklahoma’s share to be about 22 million. As you open your mail and find these checks try to wrap your mind around one of the most sinister parts of this health care bill, as these rebates are really a smoking gun of government and business, allied together, at its worst.
These rebates are the result of insurance companies’ failure to meet the “medical loss ratio” demands of the Unaffordable Care Act (UCA). This ratio requires insurance companies to pay in claims 80-85% of what they collect in premiums, no more than the remaining 10-15% to be used for salaries and administrative functions within the insurance company. Sounds great, doesn’t it! It is great if you are one of the following:
1)A GIGANTIC insurance company: 10-15% of 100 billion dollars is plenty of money, for instance, to pay administrative functions and giant salaries of the CEO’s of companies this size. This is a virtual guarantee that these GIGANTIC companies will receive the gift of the total destruction of their smaller competitors. The SMALL insurance companies will have serious difficulty complying with this. Fewer players in the insurance market will necessarily drive business to the GIGANTIC players and these “rebates” they are being “forced” to pay will be returned many times in terms of new revenue as small companies fold and their business goes to the giants.
2)BIG GOVERNMENT: if your goal is a single payer national health plan this is a big step. By eliminating the smaller insurance carriers, the entire health insurance market is destabilized and creeps closer to that “no other choice,” “against the wall,” situation that those in government seem to love. Rather than have government run health care, large carriers will run the government plan, carving the country up into regions, like meat for the wolves. OK. Here is the word that I hesitate to use but there is simply no other word for it. This is fascism. Professor Robert Higgs uses the phrase “participatory fascism.” This marriage of government and big business has been called “mercantilism,” or “public-private partnership,” more recently, but this conspiracy between big business and government in health care deserves the term “fascism,” as people’s live are truly at stake here.
Did you wonder why the largest insurance carriers supported the UCA during the “health care debates,” prior to its passage? Keep in mind they knew about the Medical Loss Ratio provision and these rebates when they supported the bill.
Late in the AP article, the author refers to certain “exemptions” granted by the feds. Why do you think some states received exemptions from the UCA, this part of it in particular? Why do you think that certain labor organizations’ health plans received these same exemptions? You don’t think that there is any politically motivated quid pro quo, do you?
I’d like to say that I’m disappointed that the writer didn’t mention any of this in his article. I guess disappointed but not surprised.
G. Keith Smith, M.D.