A Journal for Western Man

 

 

 

Government-Controlled Medicine:

The Destruction of the Physician-Patient

Relationship

Richard G. Parker, M.D.

Issue V- September 18, 2002

 

 
Approximately 2500 years ago Hippocrates, a physician-philosopher from Greek antiquity, put into motion one of man's greatest and noblest achievements--Western Medicine.   

The inheritors of Hippocrates’ rational Art--the physicians of today--are routinely performing such heroic acts as heart and liver transplants, rapidly diagnosing and treating heart attacks and safely treating once lethal infections with an enormous armamentarium of antibiotics.  Even the once impenetrable realm of the human brain is now the domain of the neurosurgeon who today removes brain tumors with his skilled mind and hands. 

Because of these and other enormous successes, however, today Western Medicine is under attack by the very generations who have reaped her greatest benefits, and who will also suffer the greatest losses from the inevitable consequences of this irrationalism.

No rational individual expects government decree to reverse the earth’s orbit to allow the sun to rise in the west, to reverse the laws of optics to allow the sky to turn green, to reverse the laws of gravity to allow a man to “fall” from the ground up to the Empire State Building once he has jumped--for government decree to reverse the law of cause and effect.

Yet in America’s high schools and universities, on America’s televisions, in government offices, in Congress and in the White House, the idea that government decree can somehow reverse the laws of causality, that government decree can change the fundamental causal nature of the physician-patient relationship is portrayed as fact.

The idea is that government, through the use of force, can fundamentally change the nature of the physician-patient relationship, can enslave physician and patient at the point of a gun and, by virtue of a gun, can produce a health care system that is somehow superior to the greatest health care system the world has ever seen.

The fact that the greatest, the best health care system in the world was not produced at the point of a gun, but in the context of individual freedom and liberty, this fact is evaded and ignored.

While dismissing the well known horrors of medicine in the former communist Soviet Union, the advocates of more state controls in medicine often portray socialized health care systems in the mixed economies of Europe as paradigms of virtue.  Nothing could be further from the truth. 

In Great Britain, the concept of state-enforced “universal coverage” has been a reality since 1946, and it has been a failure.  The cardinal feature of British medicine, as with any state-controlled health care system, is the “waiting list.”  

A prominent German newspaper in the summer of 1999  had a telling article titled “On the Waiting List Lurks Death” (1).  The article describes the fate of a 38 year-old reporter and father of two who suffered from coronary artery disease and died while on the “waiting list” for seven months for a life saving coronary bypass operation.   In America such a patient would have undergone his live saving operation within 72 hours.

A chairman of the medical staff at a famous British hospital has stated that overcrowding in British Hospitals has led to patient’s dying at home before they can be admitted to the hospital, of patient’s dying in the emergency department before receiving a hospital bed, of cancer patient’s waiting up to six weeks for treatment while their tumors spread (2). 

British orthopedic surgeons have admitted that an elderly person requiring a hip replacement will probably die before getting to the top of the “waiting list.”

One major reason that the Labor Party won a majority in the British Parliament in 1997 was its promise to reduce the number of patients on the waiting list from over 1,000,000 down to 100,000 (3).  To date this campaign promise is far from met.

In the nationalized health care system in Canada the government has shut down hospital wards that provided needed but expensive chemotherapy and radiology treatment for patients with cancer (4).  Even if patients with cancer are willing to pay for these services, they are unable to obtain them.  If they wish to live, they must seek health care in the United States where more freedom in medicine still exists.

Honest physicians in Sweden acknowledge the horrors of waiting lists under Sweden’s socialized health care system.  “Every Swede can inform a visitor,” says Dr. Erik Brodin, a Swedish physician, “about the reality of waiting lists as part of Sweden’s social medicine” (5).

In the famous Swedish University city of Malmo, for example, the waiting time for plastic surgery is seven years, for gall bladder operations the wait is three years.  Diabetics in Sweden sometimes go blind while waiting two years to get an appointment at Swedish eye clinics (6).

The health care system in Sweden is often used as a model of the alleged virtues of nationalized health care by the most zealous advocates of “health care reform” in the United States.  For obvious reasons, the failures of the Swedish health care system are evaded. 

Between 1986 and 1990 the average five year survival (medical standard for “cure”) for lung cancer in England was 6%; that of other European countries with less socialized health care systems was 10.5%; that of the United States which still has the freest health care system was 14.5%, more than double that of England.  The same trend is evident for bowl, lung and breast cancer (7).

The correlation is clear: the freer (less government controls) the health care system, the higher the quality of care.  Yet, these data are evaded and never reported by those who demand more regulation of the health care industry in America. 

Waiting lines are the inescapable sign of price controls, in health care as well as in any other industry.  A cardinal feature of any socialized health care system is that health care becomes a rationed commodity, and medical “waiting lists” are one of the earliest indications that the state’s regulation of health care is bankrupt, morally and financially.  Medical services go to those willing to wait the longest or those with the most political pull.  In a free market system, health care goes to those who value them the most (8).

A major motive of those who cry out for “universal coverage” is not the quality and availability of health care.  If the quality and availability of health care were their concern, then an honest look at reality would end their advocacy of a system that has proven to produce the exact opposite of what they claim to be advocating. 

A fundamental motive of those who demand more government intervention in medicine is the re-distribution of wealth.  It is an attempt to sacrifice the productive to the non-productive, the healthy to the non-healthy.  The chronically ill, the hypochondriac, the unproductive worker take out far more than they put in.  The young, the healthy, and the productive worker bear the brunt of taxes (9). 

The inefficiency of government bureaucracy has been proven time and time again, and medicine is certainly no exception.  Yet the cry for more government intervention in the health care industry continues.

The moral basis of the physician-patient relationship is that value is traded for value, with the standard being the physician’s and patient’s best self-interest.  Replacing the physician’s and patient’s self-interest with the use or threat of government force destroys the moral foundation of the physician-patient relationship and ultimately destroys medicine.  The only one who derives any short term benefit from this situation is whoever is applying the use of force.

One of the most tragic effects of state controlled health care is the phenomena of “brain drain.”  No young bright individual, no dedicated physician who has spent years mercilessly studying and mastering his art wishes to be a slave to the government.  For a competent individual, the prospect of sacrificing his talents and hard earned skill to a bureaucrat who’s only qualification to rule him is a gun placed in his hand by politicians is a moral outrage.  Such an individual will never enter the field but will choose a career where more freedom exists, or, if the state begins controlling medicine after he has already started a medical career, such an individual will continue to work in the medical field until early retirement is possible or has acquired sufficient skills for another field where more freedom exists.   Ultimately the medical field is left to individuals who are less and less competent and less concerned with what happens to their patients.

The phenomena of “brain drain” and the extremely low morale of physicians has been well documented in the socialized health care system of England (10).  As more and more physicians leave in disgust, the care delivered becomes worse and worse.

Today Americans do not even have to look to Europe to see what a miserable failure government regulated and controlled medicine represents.  American Indians have had “National Health Insurance” since the 1920’s (11).  The poor quality of health care delivered under this program is legendary. 

In Oklahoma the Indian Health Service can provide care for only about one half of Native Americans in one area, clinics are decrepit and dirty and open only 9 to 5, five days a week, even for emergency care.  All this despite spending $1,800 per individual per year in the late 1970s--the average figure for all Americans during this time was approximately $740.

Medicaid and Medicare provide another example of the failure of socialized medicine in America.  Despite projecting a much slower rate of increase, the government spent $24.9 billion dollars for medicaid/medicare in 1970 and $280 billion dollars in 1990.  This is one of many examples of how unrealistic spending projections by the government really are.

Despite such enormous increases in spending, the rationing of services under medicare/medicaid has already begun.  Typical reimbursement for medicaid/medicare is currently 80%.  There is mounting evidence that medicare/medicaid rationing has lead to increases in patient mortality rates (12). 

HMOs are government controlled and subsidized entities and provide the latest example of what happens when the state attempts to nationalize the health care industry.  As is currently occurring with HMOs, the typical mode of operation of those who cry out for increased government control is to first destroy capitalism and replace it with a government controlled and subsidized entity (HMOs, Managed Care, medicaid/medicare).  Once the inevitable failure of these state controlled entities becomes too obvious to continue to evade, their advocates begin to cry that they are actually examples of the failure of capitalism and demand more controls, more servitude and slavery, more government “oversight” (13). 

This is precisely what is now occurring with HMOs under so called “HMO reform” and with medicaid/medicare under so called “medicare reform."

HMOs are increasingly denying claims and have attempted to restrict patient choices by imposing “gag rules” on physicians which prohibit physicians from even mentioning possible alternative treatments that are deemed “too expensive” (14). 
The real function of HMOs, as with the bureaucracies controlling and implementing socialized medicine in Europe and the former Soviet Union, is the rationing of health care.  As with any system that promises to deliver a “free” good or service, socialized medicine initially causes an explosion in demand with the government ultimately rationing the good or service.  This is the point in the evolution of socialized medicine that America currently is in.

Bureaucrats working for such government agencies as HCFA, COBRA, FDA, DHHS, Medicare and Medicaid, HMOs etc. have and continue to replace freedom in medicine with complex and unintelligible statistical models attempting to determine the “true medical needs” of present and future generations of Americans (15).  The government controlled and sponsored entity that is to implement all these controls is to be the HMO, the latest Trojan Horse for socialized medicine.

The present health care system in the United States is a far cry from what it was in the late 19th and early 20th century.  This period in American history was marked by unprecedented freedom, in medicine and across all industries.  During this period anesthesia was discovered, opening the door for modern surgery.  Medical giants such as Drs. Osler and Halsted established the American system of training the best physicians in the World, Dr. Harvey Cushing pioneered modern brain surgery and two physician brothers moved to untamed land in central Minnesota and in a few years built the Mayo Clinic, one of the best medical centers in the World. 

American physicians today no longer enjoy the freedom of physicians one generation ago before Medicaid and Medicare opened the door for socializing America’s health care system.  The physicians of one and two generations ago developed antibiotics, eradicated smallpox, pioneered open heart surgery, organ transplantation, and so the list goes on.  America’s present health care system has suffered a great deal from the incremental socialization of medicine and the degree to which this incremental assault on medicine is suffocating innovation and progress is immeasurable.

Under “managed care” (HMOs, PPOs, etc.) the late 19th and early-mid 20th century physician-scientist-medical pioneer is slowly being replaced by bureaucrats who’s sole purpose is to “cut costs”, to ration medical care, to ensure “compliance,” to literally stifle and destroy innovation. 

The original American concept of freedom does not mean the freedom to enslave physicians, to loot, to take by force the productive efforts of others.  The moral foundation of America is the principle of individual rights, which includes the individual rights of physicians.  As the producers of health care, physicians have the moral right to practice medicine freely, without government coercion or force.  They have the right to practice medicine on their own terms without the constant threat of coercion, the constant threat of the loss of their right to life, liberty and the pursuit of happiness. Health care is not a right (16).  To claim that one man has a right to the products, to the goods and services of another is to simultaneously hold that it is moral to enslave the individual who produces that good or service.  It is the erosion of the concept of individual rights—the individual rights of physicians—that is responsible for the decline in the availability and quality of health care today.

In a moral inversion, Washington has recently declared open season on physicians (17).  The justice department and the FBI have joined ranks in prosecuting physicians under the draconian criminal provisions of the Kennedy-Kassebaum Bill passed in 1996.  It has become politically fashionable to blame physicians for the gross failure of socialized medicine under medicare/medicaid.

The physician-patient relationship is one that is based on the principle of mutually beneficial trade between physician and patient.  This requires that the producer of medicine—the physician—exercise his natural right to act independently and freely in accordance with his own best judgment.  This requires that the patient exercise his right to seek health care in accordance with his best judgment.  The moral foundation of this relationship is the principle of trading value for value.

The principle cause of this relationship is not the patient’s need, but the skill and ability of the physician.  Socialized medicine and its various acronyms (HMO’s, managed care, PPOs, etc.) destroys the causal nature of the physician-patient relationship by attempting to enslave physician and patient.

An individual can only act in accordance with his nature.  By waving a gun in the air and decreeing that the laws of nature are to reverse, the government cannot change the fundamental nature of the physician-patient relationship—it can only destroy this relationship and ultimately destroy medicine.

Such free market “reforms” as Medical Savings Accounts and 100% tax-deductibility for medical expenses and insurance premiums offer America a practical and moral means of improving the quality and availability of health care.  These free market reforms hold the promise of restoring the integrity of the physician-patient relationship and improving the quality and availability of health care for all Americans.

REFERENCES
  
1)         “On the Waiting List Lurks Death,”  Frankfurter Allgemeine Zeitung, Christian Schubert, September 1, 1999.

2)         “The Health Hazards of Government-Controlled Medicine,” The Intellectual Activist, Llewellyn H. Rockwell, Jr., volume I, number 10, March 1, 1980.

3)         “On the Waiting List Lurks Death,”  Frankfurter Allgemeine Zeitung, Christian Schubert, September 1, 1999.

4)         “The Health Hazards of Government-Controlled Medicine,”  The Intellectual Activist, Llewellyn H. Rockwell, Jr., volume I, number 8, February 1, 1980.

5)         Ibid.

6)         Ibid.

7)         “On the Waiting List Lurks Death,”  Frankfurter Allgemeine Zeitung, Christian Schubert, September 1, 1999.

8)         “The Health Hazards of Government-Controlled Medicine,”  The Intellectual Activist, Llewellyn H. Rockwell, Jr., volume I, number 8, February 1, 1980.

9)         “The Health Hazards of Government-Controlled Medicine,” The Intellectual Activist, Llewellyn H. Rockwell, Jr., volume I, number 10, March 1, 1980.

10)        “The Health Hazards of Government-Controlled Medicine,” The Intellectual Activist, Llewellyn H. Rockwell, Jr., volume I, number 10, March 1, 1980.

11)        “The Health Hazards of Government-Controlled Medicine,”  The Intellectual Activist, Llewellyn H. Rockwell, Jr., volume I, number 8, February 1, 1980.

12)        “Quality and Equity in Dialysis and Renal Transplantation,” The New England Journal of Medicine, Norman G. Levinsky, M.D., volume 341, number 23, December 2, 1999.

13)        Ibid.

14)        “While Rome Burns:  The Immolation of Medicine,” The Intellectual Activist, Paul Blair, volume 10, number 1, January 1996.

15)        “The New Health Planners,”  The Intellectual Activist, volume I, number 19, August 1, 1980.

16)        “Health Care is Not a Right,”  Leonard Peikoff, pamphlet published by Americans for Free Choice in Medicine, 1994:  http://www.afcm.org/hcinar.html.

17)        “While Rome Burns,” The Intellectual Activist, volume 10, number 1, January 1996.

Dr. Richard Parker, a practicing emergency physician in the Dallas, Texas area, is a senior writer for the Ayn Rand Institute in Marina del Rey, Calif.  The Institute promotes the philosophy of Ayn Rand, author of Atlas Shrugged and The Fountainhead. He is also a writer and editor for Objective Medicine, an site devoted to presenting intellectual fuel to doctors and other rational individuals who wish to contribute to reversing the destructive nationalization of medical endeavors. You can visit Objective Medicine at http://www.objectivemedicine.org.

This TRA feature has been edited in accordance with TRA’s Statement of Policy.

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