Universal Health Care is Not the Solution

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This article was first published in 2003 in the journal Orthopedics. It was written in response to a fellow Orthopedist's call for government single party payer.  Little did I know at the time how serious an attempt would be made within the next 7 years to "transform" medicine in America.

Lee D. Hieb, MD

 

Universal Healthcare Myths

 

Several superficially compelling reasons for universal healthcare are usually put forward. First, as the business of medicine becomes more complex, some physicians believe universal healthcare would be less of a hassle. Recently, a neurosurgeon commented, “I would be happy if the government would pay me $250,000 a year and took care of all running of the office so that I could see patients.” The second argument preys on physician ethics. It is often stated (and Dr Weiner discussed it in his article), that physicians under a capitalistic system fail to care for needy and sick patients. Presumably, universal healthcare, with the government looking after everyone, would somehow do charity better, and would “leave no patient behind.” The third myth is that the economy of scale would somehow cause medicine to cost less if run by a single-party payer. It is argued that the cost of the various insurance companies and government paperwork would be lessened if one unified form and one unified payer existed.

Universal Care Around the World

 

In the Soviet Union, medical care was free to all, but only the Polit Bureau (eg, high-ranking officials, their family, and friends) received any good care. When Boris Yeltsin required cardiac surgery, he went to a special hospital only for government officials, and was treated by American-trained surgeons. He even flew Dr Debakey from America to Russia to make judgements about his case. Why? Because he knew that he could not trust the physicians, nor the system he had helped create. As Ayn Rand wrote in Atlas Shrugged, “It is not safe to trust one’s life to a man whose life you have throttled.” According to Ann Ebeling (her husband, Dr Richard Ebeling, is President of the Foundation for Economic Education), who was raised in the Soviet Union, quality medical care was simply not available through state run medicine. To get help, patients would bribe doctors to come to their apartments and bring whatever equipment could be mobilized illegally from the hospital to perform lifesaving procedures. Black market private practice was the only effective medicine during the 70 years of economic decline and tyranny of Soviet Socialism.

Immoral Medicine

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by Dr. Lee Hieb 

First Published, HumanEvents.com 11/09/2009

The magician distracts the audience by doing meaningless but fascinating things with his right hand, while his left hand is doing the really meaningful activity unnoticed by the crowd.  The bigger the trick, the bigger the distraction required.

Democrats and President Obama should make David Copperfield proud.  With one hand they are distracting the American people with a nonstop barrage of bills and discussion:  What will happen to the budget? How many are really uninsured?  Is the Congressional Budget Office to be believed?

And for the ultimate distraction, Mr. Obama paraded a group of “doctors” in borrowed white coats for a great visual effect wholly devoid of  substance.  For all we knew, these guys could have been a group of actuaries at a DC convention bussed in as props for the day. (More likely they were doctors of the government paid variety, like Rahm Emanuels’s physician brother Ezekiel, sheltered in research institutions and teaching hospitals where they don’t have to run their own small businesses.)
  
While this diversion is going on, the real issues are hidden from the public -- the consequences of government funding of medical care on individual liberty and our moral compass.

Pay for Performance Treating the Well and Avoiding the Sick. (Letter to the Ft. Dodge Messenger)

Pay for Performance--Treating the Well and Avoiding the Sick.

On March 27^th, a column in your paper appeared entitled “The one-word answer to health reform”.  For the most part I agreed with the sentiments and ideas expressed in the op ed, however I thought it ironic that under the heading of “Lowering Bureaucratic barriers”, the authors unwittingly touted a government program which will erect significant and immediate barriers that will affect the sickest among us.  Specifically they laud the idea that hospitals (and this will apply to individual physicians as well) will be paid for, as they put it, the “best care” not the “most care”. 

This program sounds good, as all government schemes do initially.  It is called P4P or Pay for Performance, and it seems reasonable that we should pay the better doctor and the better hospital more than we pay the bottom tier.  BUT, and this is a big but--how is this determined?  Government bureaucrats count what they can count, not what is ultimately important--very much like judging art by counting the brush strokes.  In the case of P4P, for example, doctors whose diabetic patients are under good control will be paid a higher fee than those with worse average monthly blood sugars.  The assumption is that the doctor totally controls the blood sugar.  The truth is that patients may choose to drink and eat bon bons, they may be too poor to get their medicine in a timely fashion, or may simply have very brittle diabetes that is difficult to control by even the best of doctors.  They may have learning deficits which make it difficult for them to be in perfect treatment compliance. What will happen to these people?  They will be discharged from the doctors’ “panels” because doctors have to run their offices and pay their increasing overhead, and they cannot afford non-compliant patients who will lower their “grade” and therefore their revenues.  Hospitals are already omitting the highest risk renal transplant candidates from the waiting lists because they will lower their “performance”.  In short, the people who least need a doctor will have one, and the sickest among us will be out in the cold. 

The other very bad aspect of P4P is its total lack of respect for the individual.  In an age when we have sequenced the human genome, and could deliver medicine tailored to the individual patient, government is enforcing a one size fits all program.  Under the rubric of “quality” we are forced into uniformity.  People become statistical ciphers.  As a surgeon, I am being told to treat patients by algorithms or face financial penalty, even when my individual patient may fall outside those guidelines.  (So far I have been able to dodge an out and out confrontation, but the shootout at the medical OK Corral looms large).

Ultimately, when you take the king’s dime, you take the king’s rules.  The only way to really give “Best Outcome to Every Patient Every Time” as written in the editorial, is to return the practice of medicine to patients and their doctors and hospitals.  Government medicine, wherever it has been applied increases cost, decreases quality, reduces patients options, and ultimately results in patients dying needlessly.  As Ronald Reagan said, “When government is the problem, more government is not the answer”.  For more information on medical economics please check out AAPSonline.org

Lee D. Hieb, MD

Government Medicine, a Formula for Mediocrity.

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First Published Nov 2010 in Orthopreneur

There are many reasons to avoid government medicine.  Cost is one.   Although cited as a reason in favor of government intervention, does anyone with at least an eighth grade education really think the government will save money by providing more efficiency and effectiveness than the free market?  Has it in any other area?  With all its regulation, the same government that brought you the $600 toilet seat brought you the $18 aspirin.  (I checked, and that is the going price in our facility which accepts Medicare).  And, then we could discuss the huge moral issues at stake here when doctors become agents of the state.  Few today remember the conclusion of the Nuremburg Doctor Trial wherein they hung the Nazi doctors responsible for the euthanasia program and experimentation on prisoners.   Allied prosecutors concluded that German doctors were not intrinsically evil, but rather, their fault lay in working for the government. Only 18 years before the implementation of Medicare, these prosecutors all agreed with the words of Leo Alexander of the American team when he opined  “We should never let doctors work for the government again.”

Another concern, and the one I wish to discuss today, is how government medicine-- by its very nature-- insures mediocrity in our profession.

In the big scheme of things government induced mediocrity is demonstrated easily.  Politicians and the elite may let the common folk get “average” care, but they themselves want EXCELLENT care.  Which is why two prime ministers of Canada snuck across the border in the dark of night to come to the USA for their own medical care.  If government medicine was so great why didn’t they stay home?  When Boris Yeltsin, needed heart surgery he employed American trained doctors, and even then flew over Dr. DeBakey to the Soviet Union to supervise, because he knew what Ayn Rand had written that, “It is not safe to trust your life to a man whose life you’ve throttled”.  

Healthcare Bill Takes Away Our Liberty

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by Lee D. Hieb, MD

First Published at HumanEvents.com  03/30/2010

Make no mistake. Every time the government offers you any form of safety or security, it takes away your ability to make choices about your own life. No matter how noble, every government safety imposition diminishes your individual liberty. This principle is no more obvious than in the current healthcare reform, which is why there are so many voices in chorus against this “transformation” of America.

When this law is in full force, individuals cannot choose to self insure, no matter how much they may be able to afford to do so. Now, you can be thrown into jail for not complying with the government’s plan for your own safety. This sounds like something out of a Stalinist show trial: “Comrade, you are guilty of “insufficient self protection”—five years in the gulag!”

Health Care: The Best Plan is to Have No Plan.

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 In response to the Obamacare health plan, groups from doctors to union bosses to Republicans (not in any particular order) have put forth their alternative plans.  Today, there are more plans floating around D.C.  than those we used to win World War II.  (And at least the military readily admits that war plans don’t survive the first armed encounter.) No, we do not need any more plans.  The best plan, is to have no plan.  None.  Because plans require planners, and if the Twentieth Century should have taught us anything it is that central planning doesn’t work.

AMA Doesn't Speak for Most Doctors

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 First Published at HumanEvents.com 1/5/2010

The American Medical Association officially endorsed the Democrats’ health reform bill.  An eager Barack Obama, of course, used this endorsement to claim that “doctors” support his healthcare takeover.  This misleading statement plays on the common misperception that the AMA represents some huge block of American  physicians.  Not true.  In fact, excepting membership given to students and residents in training, the AMA represents only 17-19% of physicians actually in practice.

Did Natasha Richardson Have to Die?

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by Dr. Lee Hieb
First Published at HumanEvents.com 03/30/2009

Liam Neeson, one of my favorite actors, experienced a great tragedy last week in the death of his wife, actress Natasha Richardson. I don’t usually pay too much attention to celebrity lives, but having two teenage boys similar in age to hers, I found Natasha Richardson’s death especially poignant.

As a mom, I must express my sorrow for the family’s misfortune. And as a physician, I have to ask: what can be learned in this case?

For the two or three Americans who haven’t read the details, Natasha’s death was the result of a head injury while skiing -- not a high speed Sonny Bono-type wipe out, but apparently a fairly innocent fall during a lesson. She developed an intracranial bleed, and by the time she was able to receive the necessary level of care in Canada, her intracranial pressure was excessive and ultimately fatal.