I blog about free markets in medical care and transparent pricing.
Check out this article by Reason Magazine’s editor in chief, Nick Gillespie (many thanks to Brandon Dutcher of the Oklahoma Council of Public Affairs for bringing this article to my attention). It turns out that the uninsured folks the Unaffordable Care Act was meant to help, don’t want this help after all. That’s kind of hard to comprehend, isn’t it? Let’s take a closer look.
Why would the federal government shove a national health care scheme down not only the throats of these folks who don’t want it, but disrupt and basically ruin the insurance everyone does have? Premiums are expected to increase by 100% in most markets using conservative estimates. Are they incompetent or just plain evil?
Put yourself in the shoes of the giant insurance company execs. Fewer and fewer folks are buying health insurance. These companies have priced their product increasingly above the market clearing price. They therefore have a surplus of product and not as many buyers. In a healthy marketplace, they would lower their price and deal with their increased “inventory” in this way, luring customers back to the table.
Or….they pick up the phone and call their congressman! ”I want you to fix things so the purchase of my insurance product is mandatory!” Bingo! Inventory goes flying off of the shelves. Stock prices go through the roof. 25 year old healthy people are now paying $2500/month for an insurance product they don’t want, subsidizing the sick and elderly and those otherwise uninsurable folks entering the market with pre-existing conditions. Pretty sweet deal for the insurance execs if you know who in D.C. to call and how much to pay them to get this kind of thing done.
The rest of the phone call looks something like this: “By the way, let’s throw in a Medical Loss Ratio formula that will destroy my smaller competitors giving these folks even fewer buying options. That will more likely funnel them to me. And you guys get your rationing game face on and cover my back with an Independent Payment Advisory Board so I don’t have to pay much on all these claims. In fact, you could price the physician services so low that no docs will see folks for the more expensive conditions and everyone will blame the “greedy” doctors! There’s a budget balancer for ya! You’ll have all the data you’ll need to get all of this done after you mine the Electronic Medical Record Systems you make all of the docs buy.
Obamacare, just like almost any other “law” oozing out of D.C., was meant to line the pockets of those who wrote and promoted it. Prior to this “law” the medical industrial complex had squeezed about as much money as they could out of folks willing to buy insurance from an increasingly consolidated market. The only way to increase their revenue was to enlist the firepower of Uncle Sam, employing the political means (as opposed to the economic means) of obtaining wealth. This “law” turned non-buyers into unwilling buyers and current purchasers were made to pay more. Their next goal is the destruction of the stop loss industry so that those companies that have seceded by self-insurance are thrust involuntarily into this arena. See my blog earlier this week for details on this.
I may start calling Obamacare “BIFOPE,” for “Buy Insurance From Our Pals or Else.” This conveys the true impetus behind this “law,” I think. And you thought they just cared about you.
G. Keith Smith, M.D.
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.
Some of you reading this are celebrating. ”Now we all get to have free health care!” ”It’s about time the government took over this industry!” I have tried to connect some dots from the physician’s side by asking the question,”..from whom do you now have a right to health care?” Now let’s take a look from the patient’s side.
This is an emotional issue because people’s lives are at stake and it is therefore understandable that not all the arguments about this issue have been rational. We are where we are in healthcare now, I have argued, precisely because of government intervention, not from some lack of it. This is very tough for most people to see, but articles like the one from the Associated Press’s Chief Medical Writer, Marilynn Marchione, make it more clear. Unintentionally. ”Large Study Finds That Mammograms Often Bring About Unneeded Treatment,” reads her headline.
Those of you supportive of national health care wearing your pink ribbons to raise breast cancer awareness need to try to connect the following dots. I’ll see if I can help you.
1) Government promises to provide health care to all
2) Government sets up “exchanges,” containing only health plans that provide a federally-defined set of services.
3) Government accepts applications for “scientific grants” to determine which services are “necessary.”
4) Government justifies removal of certain services from the “approved list,” citing certain study results.
The study in the New England Journal of Medicine says the following according to Marchione: …”more than a million women have been treated for cancers that never would have threatened their lives, researchers estimate.” ”Up to one-third of breast cancers, or 50,000 to 70,000 cases a year, don’t need treatment, the study suggests.”
Did you get that? You see, now that the government is going to pay for the care, the government is going to decide what care you get. They will have no trouble finding “scientists” to find whatever they need for them to find, not unlike the global warming “scientific” findings. I guess the federal government doesn’t have to list their conflicts of interest when they are commissioning a study!
I was taught in medical school that a surgeon who has never taken out a normal appendix has missed the diagnosis many times. In other words, a certain percentage of these operations are necessarily unnecessary in order to catch all of the sick patients. Then there’s the piece of mind issue: ”Your breast has a cancerous lump, but studies show that we should leave it in you and the government won’t pay for its removal anyway.” Shouldn’t the patient and her physician decide together? Is it not clear that deciding what care you receive goes hand in hand with ceding authority to pay for your “care”
Mammograms are the poster child of preventative health screening. Prostate antigen screenings are another preventative tool that are under scrutiny by government-paid researchers, finding (SHOCK!) that this is also unnecessary. So much for a focus on preventing disease. If government is going to make women keep their cancer, I think they should let them keep their large sodas too.
G. Keith Smith, M.D.
“Germans can’t fathom US aversion to Obama’s health care reform.” That’s the headline on “Spiegel Online.” You can read it here if you are so inclined. To be fair, the article should have been titled, “Some Germans can’t fathom US aversion to Obama’s health care reform.” It’s easy to put people in an ideological box isn’t it? Assigning a belief system to an entire country’s residents makes it easier for our minds to grasp, doesn’t it? Some Germans understand and envy the vestiges of liberty in this country, including one’s right not to buy insurance. Some Germans are unapologetic socialists and communists. Some people in this country are ideologically with them.
But for Germans to express indignation is delicious. You see, Germany is the birthplace of Karl Marx and the beginnings of the death of individualism. His writings were instrumental in bringing a popularity of the primacy of the state, not the primacy of individual rights. This concept bonded the fascism of the Nazis with the politics of Lenin: central planning and individual subservience to the state. Stated otherwise, the individual’s purpose was the furtherance of state objectives. That this happened in Germany is ironic as some of the most radical individualist philosophers also came from there and immediately preceded this insanity.
So how did the Germans develop their current concept of health care delivery? The great libertarian writer Richard Ebeling, writing for The Future of Freedom Foundation wrote this about the birth of German health care:
The modern welfare state arose in Imperial Germany in the late 19th century. Under pressure of growing support for the Social Democratic Party in the 1870s and 1880s, Kaiser Wilhem II and Chancellor Otto von Bismarck attempted to preempt the appeal of radical socialism by establishing a series of socialized insurance programs for retirement, unemployment and medical care.
In the 1890s, Bismarck explained his rationale to American historian and Bismarckian sympathizer William H. Dawson: “My idea was to bribe the working classes, or shall I say, to win them over, to regard the state as a social institution existing for their sake and interested in their welfare.
Did you get that? Bismarck gave the national socialists (Nazi’s) “free” health care as a way to buy them off and politically destabilize their movement. It’s what the Nazis wanted, so he gave it to them. Current German health care and all “managed care” for that matter is one of their enduring legacies.
You can read the entire, three part brilliantly researched essay, “National Health Insurance and the Welfare State”, here. It was this German system that gave birth to eugenics and human experimentation (for the greater good, of course) that is all too well known now. This was the natural extension of the abandonment of the rights of the individual with the interests of the state taking central stage. Here is another excerpt from the article:
In 1885, a year after socialized health insurance began, the average number of sick days taken by members of the system each year was 14.1. In 1900, the annual average number of sick days per member had gone up to 17.6; in 1925, it had increased to 24.4 days; and in 1930, it was an average of 29.9 days. People also were noticeably sicker around weekends and Christmas and New Year’s Day, particularly in those occupational insurance funds that waived the four-day rule before receiving cash benefits (The cash benefits were also tax-exempt, so the take-home pay lost by not working was less than fifty percent.).
The ease with which an increasing number of insured workers were able to receive benefits from longer or more frequent periods of illness was not independent of the behavioral incentives at work on the physicians who were part of the system. Originally, the insurance funds set the fees for services rendered. But in 1913, a doctors’ strike almost occurred, and was only averted at the last minute. After that, the fee schedules were determined by a joint committee comprised of representatives of the medical profession and the insurance funds. An essential ingredient of the fee system was that similar fees were paid for similar services, regardless of the patient’s ability to pay. In other words, the frequent practice of private physicians to charge higher fees to wealthier patients as a means to earn higher income and to subsidize voluntarily the treatment they provided to poorer patients was outlawed. Hence, the determination of income earned by doctors in the system was purely on the basis of “quantity,” i.e., the number of bodies examined at the fixed fee per period, as opposed to the quality of the service provided.
At the same time, the tendency of a conveyor-belt view of patients resulted in workers insured under the compulsory system demanding freedom of choice in selecting a physician, rather than being assigned to a doctor participating in the system. This was established as part of the agreement of 1913. But it also meant that a doctor now had an incentive for greater leniency in diagnosing an illness and prescribing sick leave. A less accommodative physician ran the risk of losing his steady patients and suffering a decline in his income as fewer patients entered his examination room.
Sound familiar? This situation represented a heavy drain on the Nazi economy before and during WWII. What’s even more interesting is that this remains the situation in Germany today.
The Spiegel Online article made another point. Part of the outrage of the Germans was directed at the US as a religious country and how in the world could a religious country not have universal health care? How can we reconcile our religious beliefs with a lack of a health safety net for the sick?
This type of pretentious socialism used to make me mad. It is so ignorantly comical that I find it boring now. It isn’t that hard to draw the distinction between charity and theft, is it? The US is primarily a secular society, whatever the Germans think, but compared to the society in Germany, the US is a holy land. The utter rejection of private charity, primarily through churches, has occurred in Germany as the almighty “state” has taken its place. The institutionalization of “state worship” in Germany and other European countries has resulted in the dangerous slide toward the complete tyranny many deplored on the other side of the Berlin Wall not that long ago. Memories are short, aren’t they? The old and increasingly the new German government is what Lew Rockwell hilariously calls a pharaoh government, one where the government assumes the role of God as well. No wonder many Germans embrace cradle to grave government assistance.
German socialists have shown us over the years, that unopposed, their healthcare and welfare ideas lead to Dachau, with the interests and rights of the individual taking a back seat to the “state.” That they are disturbed by certain individual freedoms here is something to celebrate, I think.
G. Keith Smith, M.D.