I blog about free markets in medical care and transparent pricing.
Here is a view from the New York Times of an almost uncontaminated health cartel arrangement in Idaho, a preview of what’s in store for us with the Unaffordable Care Act and an indication of why the corporate health stocks went wild after Roberts’ Supreme Court ruling and the re-election of the current head of state. Notice that hospital control of the physician’s practices is an essential part of the cartel’s strategy. The hostile takeover of physician practices by the hospitals was a predictable result of the Unaffordable Care Act, lower reimbursement for independent physicians (as opposed to the higher compensation for hospital-employed physicians) and additional overhead burdens (electronic medical records, for one) key parts of this health law.
Interesting too, that only now, is the NYT reporting on a situation that has many clones all over the country and reporting on something that has been going on for many years.
G. Keith Smith, M.D.
I’m writing this from Washington D.C., just having experienced the TSA experience many have come to know and love. The Association of American Physicians and Surgeons invited me to participate in a congressional briefing with Rep. Paul Broun, GA and I feel compelled to make a report.
Very few in power here have shunned the influence peddling that seems to go along with the job. Those who are principled seem a bit sad, much of their vigor gone with Justice Robert’s ruling.. Lost with Robert’s ruling was a real opportunity to roll back the commerce clause’s grip on states and on the federal overreach. The likelihood that a court challenge will occur again in our lifetime presenting this opportunity is remote, according to one legislator speaking to me. The beast of big government has the upper hand, like never before.
The beast is bankrupt, however. One libertarian congressional staffer told me openly that Medicare is going to vaporize whether this is politically palatable or not. The money coming in doesn’t remotely cover the anticipated expenses by as early as 2017. The implosion of this Ponzi scheme will be accelerated by the court’s decision to uphold the Unaffordable Care Act (UCA,) bringing fiscal insolvency to this program likely prior to 2017. Any legislator in office when that happens is probably finished. I found it interesting that there was more discussion about how to unwind or dissolve Medicare and Medicaid than how to reform this ill-conceived entitlement program.
The legislative “kick the can” approach, always leaving tough decisions and issues for the future legislators continues and will bring collapse and chaos to the medical arena and many others. So many corporatists have bet their future on loot from Uncle Sam to fund their various market-unworthy scams. These folks will soon be bankrupt and deservedly so. Hopefully, more bailouts will be politically impossible and these companies will be reorganized and sold off, cleansing the marketplace of this mall-investment.
What will happen after the government medical juggernaut hits bottom? We will have to fiercely oppose any “top down” solution that does anything other than remove all federal interference. I’ve come to some conclusions. Health care is not a federal issue. It is not a state issue. It is not a government issue at all, at any level. Making health care a government problem makes one’s health, another’s liability and begs for control, rationing and euthanasia, ultimately.
Health care is a service that physicians provide to patients utilizing whatever necessary resources are at their disposal to achieve the best outcome. That ‘s it, isn’t it? Anything that interferes with this process is the “issue.” Robbing one individual for the health benefit of another is an “issue.” Government created scams like PPO repricing and uncompensated care, two of the primary culprits of the high cost of medical care, are “issues.”
Government has been the massive “issue,” interfering with the delivery of health care for several decades now and bringing us from a time when no one needed insurance to a time when even with insurance, bankruptcy is a reality for the sick. Federal “solutions” to health care have focused on insurance coverage, rather than an examination of the true costs, an approach designed to distract attention from those profiting from the finance of health care while having nothing to do with its delivery.
There are some glimmers of hope, though. There is general acknowledgement that the high price of care is Washington’s fault. There is a realization that the politicians must choose their path: take the money or lose their power. The collapse of government health care will be a rough political ride for those who are in office when it happens. If for no other reason than preserving their own political fortunes, we might yet see a roll back, one that will occur in tiny, almost imperceptible bites, though.
There are some good people in D.C. Not very many though. “The reason people think politics is dirty, is because it is dirty,” as Lew Rockwell has said. I think this is why I always feel like I need a hot shower when I get back.
G. Keith Smith, M.D.
I’ve been asked how physicians and patients will be affected by the Court’s declaring the Unaffordable Care Act unconstitutional. My sources tell me that this is extremely likely. I am reminded of the comment of the brilliant Joe Sobran, who said, “…if Iraq needs a constitution let them have ours…we’re not using it.” Incredibly, this “brother-in-law” court appears poised to reject Obamacare based on “the constitution.” It is useful to review the reasons this legislation was passed in the first place to keep any specifics about the bill in proper context. The bill served at least two purposes, neither of which has anything to do with health care.
A tax increase: Taxes are sent to the government with the hope that some of them will be returned for roads and bridges, that kind of thing. Politicians make more money, however, by doling taxpayer loot out to those who bribe them. We all remain hopeful that some of the bribers will be road and bridge builders, I suppose. Insurance works the same way. We pay premiums, hoping that when the day comes and we need to make a claim, some of our premiums will be returned. Insurance companies are prevented from becoming too abusive (refusing to pay claims) through competition. If one insurer is too abusive, another will gladly accept a disgruntled customer. With the government acting as the only “collector of premiums,” customers (patients) are disarmed, unable to retaliate against poor service. To the extent that claims are denied or delayed this amounts to a simple tax increase. The federal budget will look improved at first with loot from this new robbery rolling in and rationing of care in full swing. Later, as demand outstrips supply, the program will become bankrupt, the bankruptcy assuming the form of long lines for care. The political hacks that dumped this on us won’t care a flip, as they will be long gone, leaving future politicians to deal with the politically impossible chore of dismantling a federal program, or alternatively will be smeared as mismanagers of the earlier politicians’ great idea. FDR understood this. To this day he is considered one of the great ones because he introduced the Ponzi scheme of old age pensions, a program that threatens to bankrupt us today.
“Return on Investment”: Health information technology companies, big pharma, big hospitals and big insurance companies either have already received huge benefit from this law and/or stand to in the future. This quid pro quo of political bribery was very successful. HIT companies were successful in getting Uncle Sam to declare the purchase of their products mandatory. Incredibly, 20 billion dollars in taxpayer subsidies were doled out to buy this product. I like to refer to this as a “bail in,” as opposed to a “bail out.” Close negotiations with the big pharma lobbyists in connection with the health care law insured maintenance of their profits. Big hospitals were granted the upper hand in hostile takeovers of physician practices and smaller hospitals due to the intentionally expensive mandates that the little guys couldn’t handle. The big insurance companies supported this effort in anticipation of the country being carved up into regions over which these big boys will have complete control. The medical loss ratio provision of the bill insured that their smaller rivals would be destroyed, a political gift, the deception of which can not be overstated.
The players haven’t changed. Bankruptcy due to cancer is the fault of the government-created cartel of big hospitals, big pharma and big insurance companies. Death from rationing (the favorite budget-balancing tool in the universal health care bag) will likewise be inexcusable, but will be implemented by the same cast. The free market, one characterized by real competition and transparent prices, has brought a standard of living to the world that no other economic system could have produced. Why do most continue to believe that the application of this mutually beneficial system of exchange does not apply to medical care?
After this law is overturned, lawmakers will be in a heat to “fill in the gaps.” My advice: take some deep breaths. A real opportunity to return to healthcare sanity is upon us and the solution (a transition to a free market) will not come from Washington, short of repealing countless past laws bought with bribery. Application of the libertarian principle of non-aggression is indicated. By this I mean that no individual’s health needs should be the involuntary responsibility of any one else. Short of this, the feds should turf as much of this as possible to the states for them to figure out on a local level, as local politicians are more accountable to their electorate. Washington politics has made millionaires too numerous to count already, as a result of this fiasco. That is what politicians do: make already rich folks (who agree to kick back bribes) richer. To paraphrase the great libertarian Harry Brown, “..this is much too important to leave to the incompetent, inefficient and corrupt officials in the federal government.”
G. Keith Smith, M.D.