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.