Universal Healthcare Blog

We’re not ready for Single Payer Healthcare (because we disagree on basic morality)*

“A common incantation during debates on health reform… is ‘that we all want the same thing; we merely disagree on how best to get there.’ That is rubbish.”

– Uwe Reinhardt

In a 2011 Republican Presidential debate, candidate Ron Paul was asked a pointed question about what to do with someone who needed expensive healthcare but did not have insurance: “Are you saying that society should just let him die?” Some in the crowd jeered “Yeah!” Paul indicated that as a physician, he did not find it acceptable to do so and offered charitable care from “churches” based on his experience of practicing medicine in the in the early 1960s, before Medicare and Medicaid, eliciting applause from the crowd.

Last year, I attended the Keystone Progress Conference in Pittsburgh, PA for a few hours. I attended a panel discussion of progressive candidates who lost their elections in deep red districts. One of the things I heard was straight out of this Ron Paul universe – all four of these candidates said they were surprised that so many of the conservative voters were afraid, of having others “get over on them.” That these others would get free healthcare and they were going to have to pay for it, for “those people” to be freeloaders that they would have to subsidize, etc.

In 2013, Dan Munro, writing for Forbes magazine, on the anniversary of Martin Luther King, Jr.’s “I have a Dream” speech, pointed to several myths so common to conservative thought about America, in particular our backwards interpretation of the “bootstraps” fable:

“the myth that literally anyone – through hard work and determination – can rise out of any poverty and become rich and prosperous. We salute, praise and deify everyone who does. But there’s a dark side to this myth. Anyone who doesn’t isn’t working hard enough – or doesn’t have enough determination. In effect, they’re a loser – and nobody wants to pay for the healthcare of those losers.”

Veronica Combs paraphrased it as ”There is a real meanness in the conversation about who should have healthcare, an implication that people who need help somehow don’t deserve it, or that they are taking advantage of ‘the rest of us.’”

All of this, of course, is not really news. Making a moral case for universal health care in any form is denounced as socialism or “not the job of government,” or as Ron Paul said, that we must “assume responsibility for ourselves.” The American Medical Association has famously opposed movement towards universal healthcare, from the Truman Administration to the passage of Medicare and Medicaid and through opposition to major parts of the Affordable Care Act.

Martin Luther King, Jr., noted that “Of all the forms of inequality, injustice in healthcare is the most shocking and inhumane.” Many have railed about the inhumanity of Americans towards each other regarding healthcare, and the late Professor Uwe Reinhardt has asked for decades, “To what extent should the better off members of society be made to be their poorer and sick brothers’ and sisters’ keepers in healthcare?” Americans, capable of unbridled generosity in helping individuals pay for a transplant or some other services when the individual in question is deserving, are ruthlessly coldhearted when compassion is requested for those they deem undeserving, as the Tea Party crowd showed us in 2011.

Reinhardt was clearly stung by the idea that his adopted countrymen (he was German born US citizen) rejected this solidarity, in contrast to every other nation’s resounding “yes” to the question. He also pointed out that the way Americans avoid the moral question that faces us is to play the game framed by the introductory quote: we pretend that the problem is that we disagree on policy, writ small and large, and find ourselves down rabbit holes about the reimbursement for an anesthesiologist for a fifteen minute unit of time with or without a nurse anesthetist!

Every other nation has started with the moral and ethical question over their values as a society and worked towards a solution to provide healthcare to all their people, “deserving” or not. As another professor noted:

“The last time I taught in the Semester at Sea program, I found it necessary to interpret for our students the rich “social capital” that runs through the Northern European societies we were visiting. What they knew and had read in their guide books was that not many people are in church on Sunday morning, especially compared to the florid religiosity of the United States. So their working assumption was that Americans take religion seriously and Europeans don’t. The new thought that amazed them was that the unchurched Europeans live in social democracies deeply saturated with historic Christian values, while the much-churched Americans celebrate a society characterized by a ruthless social Darwinism that the God of the Bible, Old and New Testament alike, denounces.”

What is preventing us from having the basic moral argument about our values regarding health care? The answer is three-fold. The first is a strong puritanical streak in American culture that prompts many of us to divide our fellow citizens into camps of deserving and undeserving people. The second is a now unfathomably large industry that has much to lose should efficiency and order find their way into the American Healthcare system. The third is our human cognitive biases that lead us to sloppily assume political and moral positions that will take years of work to overcome, using cognitive psychology to reframe the debate and convince people that doing the right thing is the right thing to do — for everyone.

Contra David Brooks on ObamaCare – Blog of the Century

Contra David Brooks on ObamaCare – Blog of the Century:

This last point highlights aspects of political economy which Brooks prefers to ignore. He writes that there is no way planners can know]”how Congress will undermine any painful cuts the executive branch does make.” Brooks finds this a powerful insight regarding (say) single payer. The very same point applies to his own preferred solution: the extremely complicated and politicized mechanisms required for premium support. The firms which operate Medicare Advantage serve the healthiest segment of retirees with little apparent savings to show for it. Indeed these firms have been able to lobby Congress for wasteful additional subsidies beyond those required in traditional Medicare.

Brooks is right to worry our health system’s administrative complexities and its political vulnerabilities to special-interest lobbying. He’s wrong to believe that a centralized approach to health policy created either problem. He’s also wrong to believe that health reform has made these problems worse. He might ponder, for example, why so many privileged interests from the insurance industry on down dislike or oppose the new law, and are so keen to destroy measures such as the Independent Payment Advisory Board.

As Paul Starr notes in his essential Remedy and Reaction, our overly fragmented, overly incremental approach to politics is the real culprit here. It makes our resulting health policies too complex, too costly, too vulnerable to special interest pleading.

Hamilton and his friends created an amazing political system which served us well for 200 years. That system does not always serve us well today.

Well said. I like to think of the scene in Animal House (when they walk out and say they’re not going to listen to anyone badmouth the US of A) whenever I hear someone argue that we cannot match the quality and efficiency of our European cousins, particularly those in Germany and France. Consider that they are having serious debates about how they are spending too much – while covering everyone and getting better results with no waiting times, mind you – when they are spending a third to half less of their GDP on health care than we are!

Finally, listening to the SCOTUS today, the catastrophic illness and ER visits kept coming up as the talking points about the need for insurance. As anyone in health care knows, the other key to having access is to PREVENT catastrophes and ER visits and maintain health and reduce costs for everyone!

That Government Takeover Thing

[Cross posted from Doctors for America Blog.]

As many of us in DFA know, one of the more fevered arguments against the PPACA, both before and after its passage, was the cri de guerre, “It’s a government takeover of health care!”

This argument left me often fumbling for an answer. I know enough about international health care, and enough about our true homegrown versions of government health care (the VA, TriCare, the Indian health Service) to know that PPACA ain’t it. Not even close. Trying to explain the difference among single payer systems and true government runs systems and private but universal systems, did not cut the mustard (or get through the neural programming, George Lakoff would say). “Obamacare” was a government takeover, and I was just a dupe if I couldn’t see it.

Apparently, the answer was in plain sight, and I just was not aware of it. While researching another topic, Google took me to an interesting, but very public place that I had overlooked before. It is on the GOP.gov web site from over a year ago, and billed as “Courtesy of the Senate Republican Policy Committee”: 159 Ways the Senate Bill Is a Government Takeover of Health Care

As you scroll through the list, you might get the feeling that every single line in the bill represents a fundamental alteration in health care as we know it, changing our current “system” into some form of crypto-socialist mockery of the free market system we’re all so pleased with. I guess a conservative minded person might indeed scroll through all of these initiatives and gasp in horror, but as I read through it, it seems like a very good list for us to trot out and show all of the good stuff actually in the bill!

The idea that various projects and initiatives to promote administrative simplification on insurance claims, to promote quality of care in the Medicaid program, to promote Patient Centered Medical Homes, grants to support physicians and others entering primary care and geriatrics, to develop quality measures, to figure out how to align payment incentives to promote the best patient care, and on and on, that these somehow represent a sinister plot requires epic, delusional almost, paranoia.

One of our kids’ favorite books growing up was “A House is a House For Me.” It was a delightful exploration of how, when looked at with the appropriate viewpoint, everything was a house: a sock for a foot, a shell for a hermit crab, or a tree for a monkey.

So, in the minds of the GOP Senate Republican Policy Committee, any law or regulation or initiative, can be a “government takeover.” This is not new, of course, Ronald Reagan famously opposed Medicare as the clear path to Soviet style communism, and the John Birchers, now resurgent, thought former Supreme Allied Commander and then President of the United States Dwight Eisenhower was a Soviet agent. The difference now is that this is mainstream political rhetoric, even articles of faith, in many circles.

So, in our new book, “A Regulation is a Government Takeover To Me!” we will explore how there are really no legitimate functions of government, Constitution notwithstanding. Protecting air and water safety is a government takeover of drinking and beathing, food safety rules are takeovers of eating, and promoting homework and hard work in school is a takeover of parenting. See how that works? Although, I understand that all limitations of birth control and sex education are intrinsically appropriate uses of government.

Swiss Model for Health Care Is Gaining Admirers – NYTimes.com

Swiss Model for Health Care Is Gaining Admirers – NYTimes.com:

ZURICH — Like every other country in Europe, Switzerland guarantees health care for all its citizens. But the system here does not remotely resemble the model of bureaucratic, socialized medicine often cited by opponents of universal coverage in the United States.

Swiss private insurers are required to offer coverage to all citizens, regardless of age or medical history. And those people, in turn, are obligated to buy health insurance.
That is why many academics who have studied the Swiss health care system have pointed to this Alpine nation of about 7.5 million as a model that delivers much of what Washington is aiming to accomplish — without the contentious option of a government-run health insurance plan.

In Congress, the Senate Finance Committee is dealing with legislation proposed by its chairman, Max Baucus, Democrat of Montana, which would require nearly all Americans to buy health insurance, but stops short of the government-run insurance option that is still strongly supported by liberal Democrats.

Two amendments that would have added a public option to the Baucus bill were voted down on Tuesday. But another Senate bill, like the House versions, calls for a public insurance option.

By many measures, the Swiss are healthier than Americans, and surveys indicate that Swiss people are generally happy with their system. Switzerland, moreover, provides high-quality care at costs well below what the United States spends per person. Swiss insurance companies offer the mandatory basic plan on a not-for-profit basis, although they are permitted to earn a profit on supplemental plans.

And yet, as a potential model for the United States, the Swiss health care system involves some important trade-offs that American consumers, insurers and health care providers might find hard to swallow.

The Swiss government does not “ration care” — that populist bogeyman in the American debate — but it does keep down overall spending by regulating drug prices and fees for lab tests and medical devices. It also requires patients to share some costs — at a higher level than in the United States — so they have an incentive to avoid unnecessary treatments. And some doctors grumble that cost controls are making it harder these days for a physician to make a franc.

The Swiss government also provides direct cash subsidies to people if health insurance equals more than 8 percent of personal income, and about 35 to 40 percent of households get some form of subsidy. In some cases, employers contribute part of the insurance premium, but, unlike in the United States, they do not receive a tax break for it. (All the health care proposals in Congress would provide a subsidy to moderate-income Americans.)

The German system also does fine without a “public option,” and is my favorite model, but this type of advance will take us a few years, but I think we will get there eventually. Having a successful public plan pulling the private insurers, including the not-for-profit-in-name-only ones, into some sanity will help tremendously. The bold, italicized part above is really the key to real reform and universal access: “Swiss insurance companies offer the mandatory basic plan on a not-for-profit basis, although they are permitted to earn a profit on supplemental plans.”

Another interesting tid-bit:

As in the United States, practitioners typically are paid on a fee-for-service basis, rather than on salary. But they make less than their American counterparts. According to the O.E.C.D., specialists in Switzerland earn three times more than the nation’s average wage, compared with 5.6 times for American specialists. General practitioners in Switzerland make 2.7 times more than the average wage, versus 3.7 in the United States.

So specialists:PCP income here in the US is $1.51: $1
Switzerland is $1.11:$1.00
Interesting…

TR Reid Busts International Health Care Myths

This was in my Pittsburgh Post-Gazette, but also in other papers as well. TR Reid, of PBS “Sick Around the World” has done the leg work and homework to become perhaps the most knowledgable journalist in the world on internation health care.

As Americans search for the cure to what ails our health-care system, we’ve overlooked an invaluable source of ideas and solutions: the rest of the world. All the other industrialized democracies have faced problems like ours, yet they’ve found ways to cover everybody — and still spend far less than we do.

I’ve traveled the world from Oslo to Osaka to see how other developed democracies provide health care. Instead of dismissing these models as ‘socialist,’ we could adapt their solutions to fix our problems. To do that, we first have to dispel a few myths about health care abroad:

Myth 1: It’s all socialized medicine out there.
Not so.

Read on about myths 2-5:

MYTH 2: Overseas, care is rationed through limited choices or long lines.
MYTH 3: Foreign health-care systems are inefficient, bloated bureaucracies.
MYTH 4: Cost controls stifle innovation.
MYTH 5: Health insurance has to be cruel.

Survival for $25,000 – TIME 1971

Survival for $25,000 – TIME:

This is an article about the trials and tribulations kidney failure patients faced before Medicare expanded in 1972 to cover kidney diseases theough its End Stage Renal Disease (ESRD) Program.

At 29, Don Shevlin was just two months away from taking his oral exams for a Ph.D. in English at U.C.L.A. Today, two years later, he has neither the degree nor any prospect of a teaching job. Says he: ‘I see myself as perennially pauperized.’

Shevlin suffers from chronic kidney disease, an incurable type that necessitated the removal of the organ. Now, in order to prevent a fatal buildup of toxins in his blood, he must report to the university hospital three times a week for kidney dialysis, a six-hour cleansing process that enables him to survive until he can get a kidney transplant. Since his illness wiped out his small savings, Shevlin lives on welfare payments of $178 a month, while the State of California pays for most of the cost of his treatments —which amounts to $3,000 a month.

Shevlin’s position is not unique. Nearly 5,000 Americans are currently undergoing regular kidney dialysis. Thousands more would choose such treatment if it were more widely available, but none can escape the gigantic cost of staying alive.

One of the questions I get asked is, “Aren’t you worried that ‘The Government’ will take over and start cutting off care or rationing care?” Not under Democrats.

Medicare and the ESRD program are examples of America’s liberal social justice tendencies accomplishing something.

Too bad kidneys aren’t the only organs that go bad, or we’d already have universal health care.

The Best Medical Care In The U.S.

The Best Medical Care In The U.S.:

Every day some 1,400 patients pass through the Buffalo VA’s unprepossessing entrance, into what many might assume is a hellish health-care world,
understaffed, underfunded, and uncaring. They couldn’t be more wrong. According to the nation’s hospital-accreditation panel, the VA outpaces every other hospital in the Buffalo region. ‘The care here is excellent,’ says Roemer. ‘I couldn’t be happier, and my friends in the POW group I belong to all feel the same.’

LOWER COSTS, HIGHER QUALITY
Roemer seems to have stepped through the looking glass into an alternative universe, one where a nationwide health system that is run and financed by the federal government provides the best medical care in America. But it’s true — if you want to be sure of top-notch care, join the military. The 154 hospitals and 875 clinics run by the Veterans Affairs Dept. have been ranked best-in-class by a number of independent groups on a broad range of measures, from chronic care to heart disease
treatment to percentage of members who receive flu shots. It offers all the same services, and sometimes more, than private sector providers.

According to a Rand Corp. study, the VA system provides two-thirds of the care recommended by such standards bodies as the Agency for Healthcare Research & Quality. Far from perfect, granted — but the nation’s private-sector hospitals provide only 50%. And while studies show that 3% to 8% of the nation’s prescriptions are filled erroneously, the VA’s prescription accuracy rate is greater than 99.997%,
a level most hospitals only dream about. That’s largely because the VA has by far the most advanced computerized medical-records system in the U.S. And for the past six years the VA has outranked private-sector hospitals on patient satisfaction…

read on…

When I talk about the VA, I always make this qualification: I know that they are struggling to deal with the epidemic of PTSD and the influx of Veterans from the past seven years, and they need the help of us as taxpayers. Go show IAVA that you care.

Health Care Reform – Old School!

Donald J Palmisano was President of the AMA for the 2003-2004 term. You can jump to his bio at his company’s website. Apparently he also sends out his opinions via an email newsletter which a friend forwards to me on occasion. Here is the newest one, and since I haven’t responded line by line to the conservative arguments on health care reform in a while, I thought now would be a good time to do so. I’m in italics.

DJP Update 6-1-2009: Health System Reform & AMA – Additional Reflections; comments on recent AMA writings.

The advantages of being an American and living in the USA are many. One of the great liberties we enjoy is the First Amendment to the US Constitution (part of the Bill of Rights) : http://www.archives.gov/exhibits/charters/bill_of_rights_transcript.html
AMENDMENT I: Congress shall make no law respecting an establishment of religion, or prohibiting the free exercise thereof; or abridging the freedom of speech, or of the press; or the right of the people peaceably to assemble, and to petition the Government for a redress of grievances.

I always find it ironic when conservatives quote the Constitution given the penchant for the authoritarian-submissive personality among them. If that seems gratuitous, sorry, but I am always irritated when conservatives quote the Constitution as if it’s news to the rest of us.

Also, one of the advantages of being an AMA member and getting elected to be a delegate (or have the privilege, as I have, as a former AMA president) and to sit in the AMA House of Delegates is the right to discuss, debate, and yes, offer alternative views if one perceives the ship of state is heading in the wrong direction. That is part of leadership. Without the courage to enter the debate, one cannot earn the title of leader. Of course, one’s view may be defeated but then you have the comfort of the wisdom of Kipling’s poem “IF” and President Teddy Roosevelt’s words in his famous speech at the Sorbonne in 1910. See page 56 of my book, “On Leadership…” or go to:http://www.kipling.org.uk/poems_if.htm and http://www.theodore-roosevelt.com/trsorbonnespeech.html

Interesting bit from the TR speech: “It is a mistake for any nation to merely copy another; but it is even a greater mistake, it is a proof of weakness in any nation, not to be anxious to learn from one another and willing and able to adapt that learning to the new national conditions and make it fruitful and productive therein.”

This would, unfortunately, require us to look past the end of our noses for potential solutions and, as Churchill might say, “This is something up with which I will not put!”

Another bit, “The poorest way to face life is to face it with a sneer. There are many men who feel a kind of twister pride in cynicism; there are many who confine themselves to criticism of the way others do what they themselves dare not even attempt. There is no more unhealthy being, no man less worthy of respect, than he who either really holds, or feigns to hold, an attitude of sneering disbelief toward all that is great and lofty, whether in achievement or in that noble effort which, even if it fails, comes to second achievement.”

This is always how I see the conservatives sneering at the idea of universal health care. To quote JFK, “We choose to go to the moon. We choose to go to the moon in this decade and do the other things, not because they are easy, but because they are hard, because that goal will serve to organize and measure the best of our energies and skills, because that challenge is one that we are willing to accept, one we are unwilling to postpone, and one which we intend to win, and the others, too.”

Enough time spent laying the foundation for the following. Consider this note a part of a “disconfirming opinion” as taught by Dean Donald Jacobs at Northwestern. Plus some praise too! Why has our AMA not put forth in writing to the world, and to those in government we negotiate with, our AMA policy of “unwavering opposition against the encroachment of government in the practice of medicine…” “including the right of physicians and patients to contract privately for health care without government interference.” Or “It is the policy of the AMA: (1) that any patient, regardless of age or health care insurance coverage, has both the right to privately contract with a physician for wanted or needed health services and to personally pay for those services; (2) to pursue appropriate legislative and legal means to permanently preserve the patient’s basic right to privately contract with physicians for wanted or needed health care services; …” See multiple AMA policies below and if you want more on the same topic, go to the PolicyFinder at the AMA Website: http://www.ama-assn.org/ama/no-index/about-ama/11760.shtml Is there something that is not clear about the wording in our policy? I conclude no. Hasn’t it been repeated enough times in various policies? Certainly.

He is absolutely right here, and I have posted about these AMA policies and the one about single payer in the past, just to serve as a warning that, when it comes down to brass tacks (in the AMA’s case, when it comes down to its’ (our) House of Delegates), the AMA policy remains staunchly conservative.

Here is the problem. Our government controls our fees. That is a violation of our liberty.

Really? I see conservative physicians posting all the time about opting out of Medicare and other insurance plans precisely so that the government and insurers cannot control our fees. Virtually every nation (Canada a partial exception) allows physicians to practice outside or alongside the national system.

Property rights are an important component of our liberty. We have to recognize that government has the right to decide how much money to spend on some benefit, BUT government doesn’t have the right to determine what we charge for a service. AMA leaders for years have advocated defined contribution approach by government with ownership by the patient, and an array of choice of insurance options. Read some of the speeches of Dr. Stormy Johnson, Dr. Nancy Dickey, and mine. And of course, read anything you can find from another AMA president, Dr. Ed Annis, the gold standard for liberty in medicine. Not a price-control system that ends up creating loss of access to care for patients because the fixed payment is below the cost of delivering the service. Throughout history, price-fixing equals loss of availability of the product or service.

Isn’t it just hilarious that in a nation of nearly 50 million uninsured and another similar number underinsured, in a nation where we are all at risk of financial ruin due to health care catastrophes, that he expresses concern over “loss of access?” “Throughout history,” etc. Again, one does have to look past the end of one’s nose to see that this is wrong, wrong, wrong.

AMA has been “at the table” and we are told our policy is being advocated. Great. But has this policy been advocated? Certainly not in our AMA writings. The quest to end the SGR payment formula is good and AMA has advocated that. Unfortunately, we still granted the government the premise that it has the right to control our fees.

First, as noted, you can opt out. You can opt out of the Private Health Insurance market too, except, oh, yeah, unfettered markets have led to dominance by one or two insurers in virtually every large market in the country.

Secondly, this reminds me of President Eisenhower’s comments to his brother, “Should any political party attempt to abolish social security, unemployment insurance and eliminate labor laws and farm programs, you would not hear of that party again in our political history. There is a tiny splinter group, of course, that believes that you can do these things. Among them are a few Texas oil millionaires, and an occasional politician or businessman from other areas. Their number is negligible and they are stupid .” This is true of Medicare as well.

In a recent message from AMA, we are advocating a MEI index approach in the negotiations. If one negotiates and allows the other side to set the framework of the debate, you will lose every time (See “On Leadership…). Why do we let government continue to set the paradigm that we don’t have a right to set our fees? Note the RECURRENT policies that direct action about privately contracting. AND reaffirmed many times! This is not optional. This is the command of the AMA House of Delegates, the policy setting body of the AMA. AND note the policy about government medicine. Why are we not speaking out against the “public option”? Medicare is going bankrupt, restricting our liberty, and we are not opposing expansion of government medicine? Why not? This is not optional based on our clear AMA policy. Thus you can see I do not share the enthusiasm of my friend Dr. Joe Heyman, AMA Board Chair, in his AMA opinion column dated June 1, 2009, entitled “Health system reform is coming — and you all helped”. I hope AMA’s help has not sanctioned a public system enlargement.

He is right about this. In spite of some of the AMA leadership’s conciliatory remarks, speeches, etc., AMA policy stands directly opposed to significant reform. The AMA Annual meeting is coming up June 13-17. It’ll be interesting to see how that goes.

However, what I do strongly agree with is the praise he gives to the Litigation Center of the AMA and State Medical Societies. I served on that committee when I was on the AMA Board and it does outstanding work. It fights the abuses of managed care, medical liability injustice, and much more. I wish every doctor in America knew of the great work it does. I also applaud our AMA putting in earlier writings that we need medical liability reform and antitrust relief for negotiating against the monopsony power some health insurers have. However, all of this will be wasted if physicians end up as captives of a government takeover of medicine. Hard to compete against government when it has unlimited taxpayer dollars and the power to punish by mandates and tax treatments. Before agreeing to a “better system” read the fine print carefully. One person’s version (or the government’s) of “better” may be entirely different than ours. Just like some caps on “non-economic” damages are great and others are worthless. Fine print!

Medical liability is still a hot issue for many physicians. In a recent survey by the California Medical Association, 40% still thought it was their number one concern. I do not know the political make up of the responders to that poll [though 67% were in practice more than 20 years – MY cohort!], nor of physicians in general [95% were CMA members], but my guess is that the 40% who still list that as their top concern are the older, whiter, male-r, and more conservative members of the profession.

We have to ask why membership continues to drop and what needs to be done to end the internecine battles among the various specialties. Why join AMA if my specialty does everything for me, including lobbying? Of course we know why everyone should be an AMA member and the Litigation Center is just one of many reasons. If everyone could balance-bill for the additional amount needed, there would be no need for different specialties to run to Congress and say, “Give me more of the Golden Apple as I am the fairest.” Remember Paris, the golden apple, and the three goddesses, Hera, Athena and Aphrodite? To the fairest goes the golden apple. The story ended badly and so will the present course our medical ship is on.

I think the answer about AMA membership is clear, but it is not at all the same answer arrived at by Dr. P. There are a large number of physicians who focus primarily on income or revenue and see medical liability premiums as a scourge to their take-home pay, but for most, this is not the focus of their lives, professional or otherwise. I would like to see us continue to make inroads into medical liability reform, but not through caps, but through honesty, alternative dispute resolution, and taking responsibility, as a profession, for our colleagues who have fallen behind.

On D-Day all allied forces agreed to land on the same coast of France and worked together for a common goal. Perhaps all physicians and every American citizen should watch the HBO special on Winston Churchill that played last night entitled “Into the Storm”. Read about it at:http://www.hbo.com/films/intothestorm/ Outstanding and a gold standard how to rally the nation against what appeared to be overwhelming force directed against Europe. No appeasement; no giving up; no “You don’t understand”. Instead, a fight to the end for important principles.

I am prone to hyperbole as well, so will let this pass…

But on the larger point, D-Day was about solidarity, exactly what we who are advocating for serious, comprehensive healthcare reform are promoting. We are in this community, this society, this national life, together. There is no religion, no school of thought (I always have to add, “except Ayn Rand’s”) whose central message is “every man for himself.”

As Uwe Reinhardt says, “Go explain to God why you cannot do this. He will laugh at you.”

Review the following AMA policies on privately contracting and unwavering opposition to government medicine. Trust but verify. Here is your chance to verify. [DJP here sites the policies I linked to earlier.]

In 1976 (yes, 1976) I testified before the U.S. House of Representatives’ Ways & Means Committee opposing the government takeover of medicine and opposing a single-payer system. Representative Rostenkowski was the chair of the committee. Since that time, I have not found any evidence to change that view and I now have had the opportunity, thanks to AMA, to visit the Canadian Medical Association and the British Medical Association’s annual meetings and learn directly from the doctors there about government promises and the failure to keep them. Check out one of my writings about this at: JAMA — Proposals for US National Health Insurance, December 3, 2003, Palmisano 290 (21): 2797. It contains the following:—–In June 2003, the Chairman of the British Medical Association characterized his nation’s single-payer health care system as “the stifling of innovation by excessive, intrusive audit . . . the shackling of doctors by prescribing guidelines, referral guidelines and protocols . . . the suffocation of professional responsibility by target-setting and production line values that leave little room for the professional judgment of individual doctors or the needs of individual patients.”4 His strong words come from long experience with a single-payer health system.——I also witnessed how the government breached the promise in Section 1801 of the Medicare law, (“Prohibition Against Any Federal Interference”), not to interfere with the practice of medicine. See Notes section of my book, “On Leadership…” at pages 255-258.

Yes, if you ignore everything wrong in our system, every other system looks awful. If you ignore every good thing in every other system around the world, our system looks great. If you focus on Canada and Britain, the two countries that perform near the bottom in the world for health care system performance (you know, down there close to as poorly as we do), our system looks pretty good. On the other hand, if you look at the high performing systems with great outcomes, satisfied patients and physicians, great high tech medicine and great primary care and low cost, we don’t look so hot.

This is the same ignorant line of reasoning promulgated by the Right Wing Noise Machine, Health Care Edition.

Most importantly, I have seen the sacrifice of the brave men and women who fight for our USA to preserve our liberty. I had the privilege during my tour of duty at the time of the Vietnam War to treat them at our airbase when they rotated back to the USA for 6 months. And I write about other military heroes in my book. Surely we cannot dishonor them by giving up our liberty. Sounds too strong? Have at it.

Oh, yeah, conservatives loves them some soldiers. That’s why they’re in our US Socialized Medicine system, the VA. You know this one. [In the interest of full disclosure, I have a friend whose son has PTSD, from Iraq, and the VA is failing him. We need to put pressure on our Congress to step up and make this right.]

Let me end this discussion by again recommending that everyone read “The Road to Serfdom”.The author is F.A. Hayek, the co-winner of the Nobel Memorial Prize in Economics in 1974 and recipient of the Presidential Medal of Freedom in 1991.Here is what the back cover of the paperback edition (ISBN-13: 978-0-226-32055-7) of “The Road to Serfdom – The Definitive Edition”, edited by Bruce Caldwell, says:”For F.A. Hayek, the collectivist idea of empowering government with increasing economic control would lead not to a utopia but to the horrors of Nazi Germany and fascist Italy.”The original text was in the book was written in 1944. Think about it. At the start of Chapter Nine, he has two quotes: Here is one: In a country where the sole employer is the State, opposition means death by slow starvation. The old principle: who does not work shall not eat, has been replaced by a new one: who does not obey shall not eat. —Leon Trotsky (1937) Think about how that applies to medicine. Would it not be better to bring about change in medicine by testing rather than just getting an idea and implementing it for the whole nation? Imagine if we gave patients new drugs without proper testing. I believe there would be many disasters. As Louis Pasteur said,”Imagination should give wings to our thoughts, but we always need decisive experimental proof. “The debate in our Land of Liberty is upon us. We may hear things that are not true. As scientist, it is our duty to insist on due diligence. As George Orwell said, “In a time of universal deceit, telling the truth becomes a revolutionary act.” It doesn’t have to be universal deceit, it can be universal failure to do the homework and testing and a rush to pass bills. It can be erroneous statistics with sampling errors and failure to compare apples vs apples. You get the idea. The quest for truth can be a lonely path. Leaders must courageously pursue it. Let’s be a revolutionary for truth!–

One would think this is a satirical critique on the modern conservative-authoritarian movement, the failure of regulation of the marketplace, and the interjection of commercial interests into medical research, but sadly, no.

Liberals are anti-authoritarian, for goodness sake. You think Thomas Jefferson was a conservative authoritarian?!?

It’s just not worth wasting the time on.
*sigh*

—I look forward to the debate at the June AMA House of Delegates in Chicago. Watch for “Resolution 203 – Right to Privately Contract” at AMA June Meeting in Reference Committee B. Resolve two of that resolution deals with the right to restore fairness to negotiations with the private health insurers and the government. There are at least 19 state and specialty co-sponsors. This resolution elevates the issue to highest priority. The people of America need to know what is at risk with their medical care. If we don’t sound the alarm, I believe other grassroots groups will take the leadership for a clarion call to action and the world will wonder what happened to our AMA.

Well, I hope the HOD has the chutzpa to smack these people down once and for all, but I’m not counting on it.

What Is ‘Socialized Medicine’?: A Taxonomy of Health Care Systems – Economix Blog – NYTimes.com

What Is ‘Socialized Medicine’?: A Taxonomy of Health Care Systems – Economix Blog – NYTimes.com:

“Socialized medicine refers to health system in which the government owns and operates both the financing of health care and its delivery. Cell A in the chart represents socialized medicine.

“Social health insurance, on the other hand, refers to systems in which individuals transfer their financial risk of medical bills to a risk pool to which, as individuals, they contribute taxes or premiums based primarily on ability to pay, rather than on how healthy or sick they are.”
………..
“Former Mayor Rudolph Giuliani of New York has exemplified the perennial confusion in this country over socialized medicine. In his ill-fated presidential bid, and subsequently as a supporter of Senator John McCain’s bid for the presidency, Mr. Giuliani routinely decried as socialized medicine (or “socialist”) any proposal presented by Democratic candidates, because typically the latter advocated tax-financed subsidies toward the purchase of health private insurance or expansions of public insurance programs. But technically none of them advocated socialized medicine.

“Perhaps Mr. Giuliani was unaware that Americans all along the ideological spectrum reserve the purest form of socialized medicine — the V.A. health system — for the nation’s veterans. I find this cognitive dissonance amusing. Indeed, if socialized medicine is so evil, why didn’t Republicans privatize the V.A. health system when they controlled both the White House and the Congress during 2001-06?

“Mr. Giuliani also seems to forget that, in 1996, he found social health insurance a perfect solution to the financial problems faced by former Mayor John V. Lindsay, who fell on financially hard times during the 1990s as a result of chronic illness. “

The chart in the piece is a little tough, the text is better, specifically the first two paragraphs above.

But to me, the key is do we want to continue to decide who can get health care and health insurance based upon their luck? And I don’t mean luck in being financially successful, I mean luck in not getting a chronic, life threatening, debilitating illness. And if we get lucky, and make it to Medicare without a big illness, do we really want to rely on that luck holding out for our children, our nieces and nephews, our grandchildren? I don’t.