President Obama’s delusional State of the Union address last week came amid the rise of tyranny and genocide abroad and the descent into centrally planned chaos at home.
Nowhere is the latter more evident than in the destruction of our once great medical system.
Obamacare is the culmination of a decades-long effort by the left to seize control of the medical profession. Statists throughout history have sought this in order to dominate the population.
Independent physicians caring for individual patients are an obstacle to masterminds trying to impose their versions of utopia on society. A good example of this is the eugenics movement, which had a large following in academic circles both in the United States and in Europe during the 1930s.
Proponents, including the avowed communist Margaret Sanger, pursued the perfection of the human race through selective breeding, abortion, sterilization, and euthanasia of the unfit. This doctrine never had a chance of wide adoption in the U.S. because our independent doctors wouldn’t countenance it. But in Hitler’s Germany, where most doctors were under state control, the medical profession went along, with disastrous consequences.
These issues haven’t gone away — physician assisted suicide is gaining proponents; end-of-life-care increasingly involves active measures to hasten death; and Ms. Sanger would be proud of the number of abortions her Planned Parenthood performs each year, amounting to a veritable black genocide. Doctors need to strongly oppose measures that arbitrarily end human life.
What is most chilling about our current predicament is the active collusion between big government and big business in taking over the practice of medicine. This is unprecedented.
Recall that Hillarycare failed to pass in the early ’90s largely because the insurance industry opposed it. The “Harry and Louise” television ads successfully and accurately portrayed the proposal as managed care for all, which the public despised. Not so with Obamacare.
Big insurance, along with big pharma, big information, big hospital, and big labor actively lobbied for and promoted the legislation. And they all are reaping huge rewards.
Combined with an increasingly totalitarian executive branch and ineffectual Republican opposition in Congress, these special interests are pushing independent medical practitioners into a vanishingly small corner.
Consider that the proportion of physicians in private practice has dwindled from two-thirds to one-third over less than 10 years. Independent doctors are being price-controlled and mandated out of existence by Medicare, big insurance, big information, and into the open arms of big hospital.
Since medical services typically cost twice as much delivered in the hospital setting, total spending is going to increase. And doctors, once ensconced in a salaried position are likely to become less productive, which will exacerbate the doctor shortage and worsen patient access to quality physicians. Doctors will be constrained by hospital contracts, such as the Accountable Care Organization model, and will be under pressure to limit spending.
Big insurance is getting bigger and fatter off Obamacare. Federal mandates (on top of state mandates) have provided cover for large premium increases. Coupled with higher deductibles, many will not activate their insurance. Inflated, taxpayer subsidized premiums thus flow directly to the bottom line.
Big pharma will get their piece of the action. More patients will have access to prescription drugs through Obamacare third-party contracts, involving overpaid middlemen “pharmacy benefit managers.” And doctors will be pushed into overprescribing these drugs to mostly healthy people by practice guidelines that will be built into the electronic health record.
Big information is rewarded by Healthcare.gov, and as use of the EHR becomes mandatory. The main purpose of the EHR is to furnish clinical information (“meaningful use”) to the government and to other third-party payers. There is zero chance this information will remain confidential.
“Big labor” benefits from expansion of Medicaid. Most of the billions of Medicaid dollars flow to hospitals and nursing homes, whose employees are often under SEIU/1199.
Remember that Andy Stern, the communist president of SEIU was the most frequent White House visitor during Obama’s first term. I fear that hospital physicians will be squeezed by management and forced to join the SEIU.
The stated goal of central planners, and many academics, is the elimination of fee-for-service payment for medical services. Erroneously blamed for cost inflation, fee-for-service assures timely care.
Its elimination will certainly lead to long waiting times for medical care. It will also spell the end of private medical practice. The recent decision by HHS to push full speed ahead with the ACO (the new, “improved” HMO) despite their marginal performance in trials, will hasten this trend.
Such is our depressing state of collusion. The good news is that the American people, who never wanted Obamacare, like it less each day as more of it is revealed.
The King v. Burwell case, which will be heard by the Supreme Court in March, has a good chance of success. If subsidies issued without authorization through the federal (as opposed to state) exchanges are pulled, 90 percent of Obamacare enrollees will be unable to afford their premiums.
This could collapse the law, and is providing impetus for Republicans in Congress to come up with an alternative plan that could boost individual choice and liberty. I’m not holding my breath, however.
Since 1990, Dr. Amerling has been on staff at the Beth Israel Medical Center (now Mount Sinai Beth Israel) in New York. He served as director of Outpatient Dialysis from 1995-2012. Amerling is board certified by the American Board of Internal Medicine for Internal Medicine and Nephrology. He also is president of the Association of American Physicians and Surgeons. He has been published in many journals. For more of his reports, Go Here Now.
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