Latest posts by Jane M. Orient, M.D. (see all)
- Setting National Health Priorities: Trump and Climate Change - December 21, 2017
- The Opioid Disaster—Who Benefits? - October 11, 2017
- John McCain and the Partisan Farce on “Healthcare Reform” - August 8, 2017
Republicans are lambasted for not having a Plan. In fact, they have had many proposals to decrease costs, improve patient care, and expand access to medical care. But the great universal Plan for healthcare reform? That’s one the Republicans, and most Americans, oppose—if “healthcare reform” means compulsory government-funded “insurance” and the destruction of private medicine, private insurance, freedom of choice, and traditional medical ethics. This used to be called “socialized medicine.”
In various forms, complete or incomplete, socialized (tax-funded) medicine has been proposed many times in the U.S., at least since the Wagner-Murray-Dingell bill in 1943. We now have socialized medicine or single payer for the elderly (Medicare) and for the poor (Medicaid). The strongest and most consistent proponents of “healthcare reform” want socialized medicine for all (except for the ruling elite). They call it “universal coverage.”
ObamaCare doesn’t quite get us there. Not yet. But it clearly aims to destroy the free-market payment mechanism (fee for service) and replace it with a collective system, Accountable Care Organizations, in which physicians are accountable to the ACO, not to individual patients. It is calculated to destroy voluntary insurance, with risk-based premiums, and replace it with collectivized prepayment for government-approved services, with income-based funding (a combination of community-rated “premiums” and tax subsidies). Tens of thousands of people have already gotten notices of cancellation of their insurance. Independent physician practice is becoming increasingly difficult, and all but about 40% of physicians are already employees.
Destroying the old may be necessary for building the new. In the German film Downfall (Der Untergang) about the last days of the Third Reich in the Hitler bunker, Hitler told Albert Speer that the Allied bombing had a good side: It saved the trouble and expense of demolishing the old, so Germans could build the glorious new Thousand-Year Reich.
It is absolutely clear by now that socialism doesn’t work—at least for achieving a decent life for the common man. In her 1986 book Life and Death in Shanghai, Nien Cheng, who wrote of her experiences during the Cultural Revolution in China, quoted the Chinese Communists: “We would rather have socialism’s lower production figures than capitalism’s higher production figures.” But radical reformers want equality (of all except the ruling elite) more than prosperity—even if it means equality of misery.
Publications of the American Medical Association and the American College of Physicians in the late 1970s and early 1980s put a generally positive spin on the Cultural Revolution. They never ever alluded to the mass casualties. The terms for things they admired in Mao’s China permeate the American healthcare reform literature today: wellness, prevention, and “team effort.” The Maoist hostility to private profits and instigations to class warfare are echoed in the constant drumbeat about “disparities” in the U.S. healthcare system.
“The changes in healthcare in China would, I believe, have been impossible except in the context of revolutionary change in the entire society,” wrote Victor Sidel in 1975 in the Archives of Internal Medicine. “As we think about the necessary changes in our healthcare system, we will…have to examine those changes in the light of the maldistribution of resources and of power in our entire society.” He thought that the Chinese experience “teaches us that we must broaden [our efforts] to include major social changes as well.”
The fundamental transformation of America has been contemplated for a long time. On the way to the glorious utopian future, bridges to the past are being blasted away.
The very acceptance of the idea that we need one central Plan to organize and direct our lives—and that doctors who were once captains of the ship need a boss—signals what we are losing.
Americans have the right to be the master of their fate, and the captain of their soul. The Plan is the enemy, and its replacement is not another Plan, but freedom.
[First Published by AAPS]