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Health See other Health Articles Title: Why Medicine Is Slowly Dying in America The American Medical Association recently voted to form a national union for physicians. It’s official. Doctors are now unionized—just like public school teachers, postal workers, and truck drivers. In one sense, unionizing is a good step for doctors. Everybody asserts their health-care “rights” today except for physicians. We hear about patient rights and HMO rights and government rights. We never hear about the doctors’ rights. It’s time doctors stood up for themselves too—for their patients’ sake as well as their own. If they don’t, the quality of medical care will deteriorate (as we already see happening), and we’ll all suffer the consequences. Why didn’t doctors need unions in the past while they do today? Turn back the clock to the 1960s when Medicare became law. Medicare, for all practical purposes, socialized medicine for the elderly. At first, it seemed like a good deal for everybody. The best health care imaginable—all for free! Who could argue with the goodies? Excellent reimbursement rates for physicians. High-quality care for elderly patients—with little or no cost. Low payroll tax rates—at least initially. Then reality set in, slowly, as it usually does. By the 1980s, it was clear that medical costs were skyrocketing. It’s not hard to figure out why. Elderly patients no longer had to worry about costs. Doctors felt no competitive pressure to keep rates reasonable to stay in business. Guess what happened? Demand for health care skyrocketed. So too did cost. The Law of Mandates The extent to which the government mandates a product or service as free is the extent to which demand for it will rise. If the government suddenly legislated that all cars were free, then everybody would clamor to have three or four cars, rather than one or two. People who normally would be content not owning a car at all—perhaps because they lived in a city or relied on a close friend—would want a car because, what the heck, the government’s paying for most or all of it anyway. And people who used to be content with Chevrolets would want BMWs and Mercedes-Benzes. With demand for Medicare shooting ever upward, the government had to do something. If not, we would all soon be paying 85 percent of our income in payroll taxes just to cover Medicare. In a strange sort of way, government and HMO bureaucrats have saved us from this fate. They started to make the cost-cutting decisions that we, as individual patients in the medical marketplace, righteously refused to face. When costs began to skyrocket, voters in effect told their politicians, “For heaven’s sake, do something. I don’t care what. Just something.” And “do something” they did: in the form of ever-increasing controls. Somebody has to do it. If patients and doctors are not going to control costs—and it is most certainly not in their interest to do so under a free-lunch, socialized program like Medicare—then clearly the government will have to do it for them. Ironically, as legislation has sought to remove capitalism from the medical sector, medicine has become more concerned with money than ever before. Prior to Medicare and government regulations, you did not hear horror stories of patients who were turned away from life-preserving surgery or medication because bean-counting bureaucrats were trying to save money. Now such tales are commonplace. Yes, the sanctimonious Great Society “liberals” of the 1960s were successful at removing the “stench” of business from medicine. And look what they gave us in its place. The kindly family doctor has been replaced by the cool, terse HMO physician—whose primary incentive is to see as many patients as possible, as rarely as possible. Medicine is slowly evolving into a war of all against all. Doctors find patients increasingly demanding and greedy in their use of medical services they do not have to pay for. Patients find doctors increasingly arrogant and uncaring because, after all, the doctors don’t really answer to them. Thanks to government regulations, doctors now answer to the third party who pays their bills and tells them how to do treatment. No wonder there’s a call for a “patient bill of rights” as well as a union for doctors. Has the elimination of freedom and capitalism really been good for patient and doctor? Has our four-decade experiment with socialized medicine been a success? No, most would reply. Yet these same people cling to Medicare and government regulation with the tenacity of a child clinging to his teddy bear. Spreading Control In the 1990s government controls slowly spread from Medicare to what remained of the “private” sector. Non-elderly patients were, for the most part, shoved into HMOs and other managed-care programs. In 1993 the government tried to force everybody into managed care by decree. The infamous Clinton plan sought to equalize the mediocrity. The plan failed to pass, but for the most part medical care today is managed care. Government- inspired managed-care companies are running the show, much more than doctors and patients are. Instead of socialized medicine, we have fascist (superficially private) medicine. In formerly communist countries, and in socialist democracies such as Canada, France, and Great Britain, citizens are used to things being this way. They don’t even have HMOs. Instead, monolithic government agencies, similar to our Department of Health and Human Services, control medicine. It’s called “single-payer” insurance, which will become the next big push in the United States if people like Ted Kennedy and Hillary Clinton have their way. Most Europeans and Canadians have no concept of genuine medical excellence because they’ve never experienced private medicine. Americans are different. We prefer to have more control over our lives than people do in other nations. We used to have private medicine here, and to a limited degree we still do. We liked—and still like—the results of private medicine, which include dignity and respect for both doctor and patient. Yet most of us have accepted a lethal contradiction. We have endorsed the idea that trading value for value—in the form of dollars—is somehow tasteless or wrong in the medical arena. So we call on government to handle the dirty economic business for us. Observe the results. In a sense, medical care is less valued by today’s patient, because it’s cheap and looked on as a “right.” Such a mentality is a breeding ground for mediocrity. Look at how the public school system has evolved into mediocrity (and even violence). Kids have a right to “free” education, run by the government and unionized teachers—but how much of a value is it? The same is starting to happen in health care. We’re in the earlier stages of the same kind of breakdown currently becoming more obvious in the public school system. How long before some crazy patient shows up in a doctor’s office with a gun, frustrated by the lack of service his $5 copayment is buying him? (Indeed, indignant that he has to pay the $5 at all.) It happened to public education. Why will it be any different with public medicine? Consider Medicare. People cling to Medicare just as they do to the public schools. They seem to think it’s some kind of mystical oracle that can make something out of nothing—when in fact (as even its government overseers admit) it’s a fiscally bankrupt actuarial disaster that destroys the rights and responsibilities of doctors and patients. Watching pressure-group representatives shriek on the evening news that “Our Medicare must be preserved!” is like watching grown, educated adults cry, “The tree that grows money must not be cut down! How dare anybody think of cutting it down!” It’s absolute madness. Today, most doctors and patients clamor for increased rights without increased responsibility. Yet if they are going to support government programs like Medicare and the many state and federal regulations that increasingly grant a “right” to this or that form of medical care on demand (or, at most, for a small copayment), they have to live with the consequences of such legislation. The consequences include losing control over who your doctor will be and over medical decisions that affect you. Neither doctors nor patients like those consequences, but they continue to push for more government regulations and mandates anyway. If you want less government control (including indirect government control, such as HMOs and managed care), you need to support privatization of the medical care system. This will require all patients to shop more carefully and rationally for services, the same way they now shop carefully for cars, computers, and groceries. Privatization will also require doctors and insurance companies, competing in the marketplace, to keep costs reasonable in order to meet the demands of the patient-consumers. If Dr. Jones charges too much for foot surgery, Dr. Smith can open a clinic across the street and charge less. In a free market, where rates are not uniformly imposed by the Health Care Financing Administration or some HMO board of directors, Dr. Smith will have every incentive to do so. The new government policy must be: “Take responsibility for your own health care—and we’ll lift the legal and tax burdens off your shoulders immediately.” Young and middle-aged people must be put on notice that Medicare’s days are numbered, and they must start saving and investing on their own. If you don’t want all this added responsibility, then just leave things the way they are now. Don’t pressure your representatives to privatize health care. The government will just keep taking more and more control, which means: taking more and more control over your bodies and your lives. Then in another few years everything will probably be run by the state or federal Department of Health and Human Services. (They will call this “streamlining.”)You’ll have lengthy waits for surgery, just like they have in Britain and Canada. Doctors will already be unionized, making them more defensive, arrogant, and adversarial than ever. Lawsuits will increase, driving medical costs still higher. Medicine, for everyone except the highest government officials, will work like the post office—only the stakes are much higher than the delivery of your mail! The waits will probably be longer too. Today, most Americans righteously expect the best health care in the world. Government and intellectual elites have convinced them that they have a right to it on demand, whether they want to pay for it or not. But sooner or later reality always asserts itself. He who picks up the tab eventually runs the show—indeed, has to run the show. Patients and doctors are getting what they voted for and demanded. In the end, the politicians are simply following the voters’ orders. At the dawn of the 21st century we enjoy a window of opportunity. A strong economy makes ending government programs such as Medicare more feasible than ever. It may be our last chance to privatize medicine without even more painful results. We had better move quickly.
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#2. To: F.A. Hayek Fan (#0)
Yeah, because people have caught on that the doctors are killing them. Reality is that doctors annually kill more patients than are murdered annually.
Reality is that doctors annually kill more patients than are murdered annually. No one is making you go to one.
Not yet anyway. And other than a physical, and a podiatrist, I have not used a doctor in more than 20 years. They have their uses but their expertise and effectiveness are vastly overrated and is mostly a lot of PR.
That's an opinion I guess. Something tells me though that if you ever have a heart attack, need surgery or get into a bad car accident that you will have no problem with having a doctor treat you.
As I said they have their uses. However, the AMA and hence most M.D.'s are in thrall to Big Pharma and while there are no doubt many well intended doctors the practice of medicine has come to be governed first and primarily by the bottom line. While I don't have a link handy, although the data is not hard to find, doctors kill about 120,000 "patients" annually. The modality of allopathic medicine is to treat symptoms not causes. As well because of the dominance of the large pharmaceutical concerns, whose sole concern is profit even to the point of marketing drugs that are worse than the disease (and they OWN the FDA), the practice of AMA Brand "medicine" has a very limited world view. Natural treatments are eschewed, regardless of effectiveness, because there is no 100,000% margin for Big Pharma - you can't patent a natural plant based substance therefore you cannot have a monopoly and a monopolists profit margin. You get a normal rate of return of about 8%. How are you going to buy an enclave in the Bahams on that? One of the better factual anecdotes is that when ER Doctors in L.A. went on strike the numbers of deaths in ER's went down. Here is an interesting article that links to an article in JAMA which puts the number of patients killed by doctors annually at about 225,000. Excerpt: DEATHS PER YEAR: No, for some types of emergency care Allopathic M.D.'s have their uses, but I fall short of worshipping them or having unreserved trust in their modality and expertise. I have spent a lot of time reading on the subject, and have posted quite a bit on it, and the more I learn the more I avoid them.
The Horror! Doctors running their practices as a business and making a profit! Bastards! While I don't have a link handy, although the data is not hard to find, doctors kill about 120,000 "patients" annually. If you can find an industry that does not suffer from human error let me know.
The Horror! Doctors running their practices as a business and making a profit! Bastards! Your knee jerk reaction does you ill. Look again at what I wrote - "...the practice of medicine has come to be governed first and primarily by the bottom line" Think about that. Is the highest motivation of existence to turn a buck by whatever means? I am not being critical of the desire to receive a fair exchange and a good living. Neither am I being critical of the desire to have a well stocked Bank Account. Think about it. Is that really the sum total of human existence? To make a buck? "He who dies with the most toys is still dead." When profit, the acquisition of material wealth by any means becomes the sole ruling passion, when the amoral exchange of a defective product becomes the norm, and is justified only on the grounds it was "profitable" to what heights has one risen, or what depths fallen? So, is there any aspiration, or goal, which reaches higher than the acquisition of money? Are there goods and human qualities which reach up and well beyond the grasp of materialism? And that is what profit at any cost by any means is: Materialism. Can all human goals and aspirations be measured in dollars? How much is a child's smile worth? What is the price of the satisfaction of knowing that you helped another simply because it was the right thing to do? How does one measure love in dollars? True and genuine happiness? Not the forced gaiety of the person who surrounds themselves with "things", but that true state of being, where one is living, alive with all those joys which are not within the province of mere money and profit. There is no one less happy than the idle rich who spend their time numbing their existence with drugs and alcohol. And so is the Surgeon who conducts an unnecessary surgery happier because he got paid? Because he turned a profit? Or does the misdeed rebound and torture his or her existence because they KNOW what they did was neither right nor just merely profitable? So you see the fundamental fallacy of Capitalism is that greed is good. That profit overrules all other considerations of existence and that merely because one has received a "profit" that the action was justified. Profit, the pursuit of material wealth, is not a spiritual reward, it is merely a necessity. When one substitutes money for those things which have no price and cannot be measured in dollars then one has entered a zone of spiritual death. You might as well just put a gun to your head and pull the trigger. And here you simply commit a logical fallacy. The following two statements are non-sequiter (Latin for does not follow). They are disrelated and neither justifies the other. You are basically making an unfounded assertion i.e., that perforce all of those deaths proceeded from excusable errors and were unavoidable. How so? And in what way? You can't have missed the numbers I posted as well. So, the 8,000 deaths from unnecessary surgeries can be attributed solely to human error? And what of the deaths from drugs which were rammed through the corrupt approval process at the FDA? Are those then justified because they were "profitable"? There is an even deeper fallacy implicit in your own train of reasoning and it is that we each live in a bubble where our actions have no effect upon others, for good or ill, and that the only good is that which is good for the individual themselves to the exclusion of all others. Such is perforce the rationale of a Pirate, a Stalin, or a Mao. What is good for me is the only good. Thankfully not all of mankind truly lives in that egocentric bubble or it would have long since ceased to exist. So, when a Pharmaceutical Company knowingly markets a product which kills the user or makes their life more miserable, is it justified because it was profitable? So, your argument that all can be attributed to human error is specious, and unsupported. I have no desire to humble or humiliate you, but I would encourage you to reason, and to expand your horizons a bit, as the path you have marked out is a very unhappy one.
not to sound goofy, but reading that was like listening to a symphony! lol! interesting thread & eloquent as usual.
#20. To: Artisan (#17)
I am humbled by your kind words. Thank you.
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