I blog about free markets in medical care and transparent pricing.


Virgil, Ovid and Obamacare

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.

British National Health Service Metastasizes

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.

DMV: A National Health Care Business Model

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.


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.

What’s Five Years After All?

Today I anesthetized a Canadian woman who had waited two years to have a hip operation and had three more years of waiting to go.  No one argued in Canada that she needed surgery, they just weren’t going to do it for five years.  Her condition was one that left untreated, would result in the complete destruction of the articular surface of her hip joint, a situation then treatable only with a hip replacement.  

She found a hospital in Montreal that agreed to do her surgery as a “private” patient for $20,000.  She didn’t have $20,000.  Then she found us.  We did her surgery today for $5500.  She will do well and will be spared a total hip replacement. 

What are the lessons here?  

1)Canadian health care stinks.  Actually, any health care system combined with a governmental role stinks.  The current occupant of the white house believes that more government is the answer in the U.S.  This Canadian woman would disagree.

2)”Private” health care in Canada suffers from a lack of competition.  If a real market were active in Canada, the price would more closely resemble ours.  The Montreal facility charges $20,000, because they can get it.  We are going to assist this facility in discovering a more patient-friendly market clearing price.  Remember the market clearing price is the one at which no surpluses or shortages exist, one where the buyer and the seller exist in perfect equilibrium.

3)Rationing of early care leads to more expensive later care.  DUH.  We have seen this with hernia surgery too, where routine herniorraphy is delayed only to become a life-threatening bowel obstruction.  Routine knee arthroscopy to remove or repair a torn meniscus, delayed long enough, results in a knee treatable only with a total joint replacement.  Lumbar spine surgery delayed long enough results in irreversible nerve damage to the lower extremities or worse.  You get the idea.

4)The “right to health care” in Canada is a myth.  Canadians have a right to a place in line.  They have a right to hope for care.  They have a right to die in line.  That is it.  The “right” to health care is a lie, one that has enjoyed one of the most successful propaganda campaigns ever.  No right can exist, the exercise of which violates the property rights of another.  

5)The Surgery Center of Oklahoma’s fondness of free market principles resulted in this woman’s affordable and high quality surgical experience.  She is not alone.  We have more Canadians on our future surgical schedule now than ever before.  

6) This woman didn’t go to the “not show a profit,” charity, “critical access,” hospital across town.  Enough said.

7) The difference between what we charged ($5500) and what she would have paid in Montreal ($20,000) will be put to unknown use, but would never have the opportunity to be put to use had it not been for the competitive pricing at our facility.  Remember Bastiat’s “What is not seen.”  

8) A pricing system free of interference from the government results in prices that are affordable and quality that is actually better.  Yet the U.S. government has assumed a more active role in health care than ever!

9) This woman’s surgery was cheaper for her than for an American with insurance!  Due to the cartel-like arrangement between hospitals and insurers in the U.S., this procedure would have cost a U.S. citizen significantly more than this Canadian paid at our facility, had it been done at a “not show a profit” facility.

10) Those who continue to deny the facts and embrace a “universal care” model, one like the Canadians and the British and others have endorsed and endured are living in a dreamworld.  That Canadians are coming to our facility is all the evidence one should need to suspect that a government system is a failure.  Period.

11) A physician-owned facility (ours) gave this woman the best pricing she could find anywhere in the world.  Greedy doctors!

I’m sure there are other “lessons.”  I would happily entertain any additions to what I have listed above.

G. Keith Smith, M.D.

"Please Waterboard Me!"

Here’s an interesting article.  In it is a description of a man in a British hospital dying of thirst.  Actually, he died of thirst.  Not before he called the police asking for help from his hospital bed, though. 

By passing on this description of hospital complications I in no way mean to suggest that hospitals in the U.S. can’t stand improvement.  Followers of this blog know that I am no defender of the cartel system of health care we have in this country.  That said, there are those who believe that now that we have “universal care” everything will be just great!  It is for that reason that I pass articles like this one along.

I suppose this man should have been thankful that he wasn’t actively killed by the hospital with their Liverpool Care Pathway.  Which is worse?  The indifference and neglect inflicted on this poor man or premeditated murder by the same staff with their euthanasia pathway?  Not much of a choice, is it? 

Those celebrating the court’s decision should keep their eyes open to the atrocities that will become increasingly common once this system is fully implemented.  I predict that we’ll look back and realize that some of the sick and uninsured would have avoided the hospital and recovered on their own or died in the presence and under the loving care of family members, rather than entered the hospital only to be murdered to save the state money.  Ich existiere fur das Wohl des Staates (I exist for the good of the state).

G. Keith Smith, M.D. 

"After Obamacare." Could be a country song.

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.

"Let me know if you want me to stop killing you."

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.

Anya Rader Wallack, Hayek and Illegal Health Aliens

Allow me to introduce you to Anya Rader Wallack.  Her career and background read like a most wanted list for fans of the free market in health care.  Let’s just say that she is to free markets in health care what Ron Paul is to the federal reserve system.

Ms. Wallack is president of Arrowhead Health Analytics.  Their website is here.  This outfit has been created to help private and public sector businesses deal with the health regulations and reforms that Anya, their president, has advocated for many years.  Can you say cottage industry?  Remember my blog about the lady I met on the plane who ran a consultant company to help others deal with the rules and regs from the consumer product safety commission…..which she wrote as their chairman?!

She is considered an expert on health reform.  Her experience includes a term as interim president of Blue Cross Blue Shield of Mass. Foundation.  She worked on Hillary Clinton’s Health Task Force.  Her testimony has been sought by our friends in Washington.  She tried unsuccessfully to implement a single payor plan in Vermont under Howard Dean’s government.  She has a Ph.D in social policy from Brandeis (don’t think she’ll be voting for Dr. Ron Paul).  She is a former employee of the ultra-leftist lobbying firm, Kimbell, Sherman and Ellis.  She developed a cost-containment plan for the state of Massachusetts (gee…I wonder why they needed that??). Now she is special assistant to the governor of Vermont and also the chair of the Green Mountain Care Board, a five member panel that will create a universal care system for the state of Vermont.  This board is busy “holding education meetings twice a week to get up to speed on health care data and evaluation systems,” according to Alan Panebaker who recently interviewed her.  She has recently written in the New England Journal of Medicine: 

we must align incentives for payers, providers and consumers so that the risks and rewards embedded in provider payment systems, benefit designs and cost sharing all promote a higher value health system and better health.  Continuing, “..the project will expand to include ‘anchor’ specialists attached to advanced primary care medical homes, with bonus payments linked to both quality and total cost of care.”  The New England Journal is demonstrating the same socialist editorial skill as the Journal of the American Medical Association, it seems.  I am unable to find articles about the provision of high quality and reasonably priced health care brought about by the adherence to the principles of the free market in either one of those rags.

I have written before about Hayek’s “Fatal Conceit.”  This refutation of all forms of socialism relies on the fact that society has evolved, a process completely disregarded by socialists who want to plan society, by contrast.  Ms. Wallack demonstrates this logical error as well as the hubris of knowing, of course, what is best for everyone else.

I’d never heard of Ms. Wallack until today when I noticed a small news piece announcing her travel plans to New Hampshire.  She plans to cross the Connecticut River, leaving Vermont for New Hampshire, to discuss her views on universal health care for the state of Vermont, to a gathering on the Dartmouth (New Hampshire) medical campus.  This is interesting because many patients in Vermont, seek their medical care across this same river in New Hampshire.  Ms. Wallack’s problem is clear, isn’t it?  Vermonters with the health coverage she proposes will either have to stop travelling across the river to New Hampshire, or those in the medical business in New Hampshire will need to be on board with her plans.  This is typical of planning of the type she admires.  Wallack has to have the support of the facilities in New Hampshire or her plan goes down the toilet.  This is an example of how a “great idea!” expands, becoming more and more coercive to cover for the unintended consequences of socialist planning.  All of this would of course be solved if the entire country were required to subscribe to her plan!  Or the whole world!

If health care is “free” in Vermont, will folks from New Hampshire cross the river the other way?  Will the Connecticut River more resemble the Rio Grande with health illegals streaming across to Vermont to get their free health goodies?  Once the health care is “free” in Vermont, Vermont won’t need raiders from New Hampshire to bankrupt their system.  Their own state residents will be sufficient for that purpose.  Every state that has tried this has failed.  Tennessee, Washington, Massachusetts.  It seems that Vermonters like Ms. Wallack are determined to fail as well.  Ho hum.

G. Keith Smith, M.D.

Hugo Chavez: Medical Tourist

Hugo Chavez, the socialist dictator of Venezuela, went to Cuba to have his cancer operation recently.  I figure this makes him a medical tourist.  His trip to Cuba for medical treatment raises many questions, too.

First, why not have his treatment/surgery in his own country?  Maybe because the care there is…well…awful.  Yes, I said it.  Check outthis article on health care in Venezuela.  “But the health care in Venezuela is free,” you say.  Of course, nothing is free.  And apparently what care you can receive there is of such poor quality that this man opted to become a medical tourist.  He’s not the only government thug who has done this.  Check out this article on one of the Canadian bureaucrats, Danny Williams.

Second, why Cuba, of all places?  This is perhaps the most interesting part.  Apparently his surgery was done in Havana, but there is no listing of the hospital or facility.  Cuba has a large medical tourist business but none of these facilities are available, of course, to the locals, since their health care is…well….you know, free.  Or, was Chavez simply afraid that a Venezuelan anesthesiologist might not wake him up?

Third, who paid for his care?  Whoa, wait a minute.  His treatment in Venezuela would have been “free.”  It is illegal (just as it is in Canada) to pay out of pocket for care outside of “the system.”  Do you think he paid for this care himself?  Right!  I guarantee you the Venezuelan government (Venezuelan slaves)  paid for his care, just as the Canadian government pays for their bureaucrat’s care when they come to the U.S.  Wait, you don’t think that the Cuban facility did this operation for nothing do you?  Hah!

Fourth, doesn’t he know that he could have received free (I mean absolutely free) care from any number of medical tourist destinations that would love to have held their facility up as the preferred medical destination of the world’s richest and most powerful?  I think that some of the international medical tourist destinations might have even paid him to have his procedure at their facility just for the bragging rights!  But then, he’s a socialist and probably didn’t think about that.

If the purveyors of Obamacare all have their way, they may get to be medical tourists, too.

G. Keith Smith, M.D.


What are people in this country supposed to think when the AMA endorses a single payor government health care scheme?  Doesn’t that mean that the physicians are by and large in favor of it?  Or is it possible that the AMA is not on the same page as the physicians?  But if the AMA is charting a course that is not consistent with the wishes of the physicians, wouldn’t that affect their membership and hence their revenue?  This would be institutional suicide, wouldn’t it?  Unless…..well unless the AMA’s revenue didn’t depend on the physicians.  What?  Where does their money come from then?  If you guessed the federal government, you go to the head of the class!  Yes, that’s right.  Back in the early nineties when Medicare forced a new method of calculating physician payment (it was called the RBRVS…resource based relative value scale and was the result of  the efforts of academicians at Harvard), the government wanted the AMA on board, that is, they wanted the endorsement of the AMA.  They got it.  The feds bought it.  The AMA was granted an exclusive contract to print the code books that everyone had to use (…cough…buy!), freeing them from any future need to craft policy statements consistent with their membership’s wishes.  All they had to do was say whatever the feds wanted them to say and their revenue was secure.  Of course this is a two-edged sword.  If the AMA didn’t say what the feds wanted them to…well…that’s right, they would put their juicy contract in jeopardy.

Single payor system?  Any honest physician will tell you this is a disaster.  But the feds gain credibility with an AMA endorsement…which they were able to buy.

Who should the American people look to as representative of the average physician’s wishes or views, then?  If the AMA doesn’t represent the physicians, who does?  The Association of American Physicians and Surgeons is the only group I know of that represents physicians free from the bribes and shackles of the feds.  Their efforts (primarily those of Dr. Jane Orient and a brilliant lawyer Andrew Schlafly) brought the Clinton health care plan down.  They are fighting a tough fight right now against the new threat, Obamacare.

Check out their website.  And remember, whenever the AMA endorses anything, their compromised status must be kept in mind.

G. Keith Smith, M.D.