It is mentioned, almost in passing, that the “healthcare reform” on the verge of becoming law starts collecting premiums and taxes immediately, and promises benefits only in about four years. What kind of emergency is that?
It is not a healthcare emergency. It’s what might be called a Madoff emergency. Whether starry-eyed utopians or cynical malefactors, the unnamed, possibly unnameable they have high ambitions for Washington to achieve their objectives. The stars are aligned for their coup d'etat, but there is one little problem: the country is out of money.
This problem threatens to stop not only their agenda, but the whole game. Washington has 2 million employees on the payroll, earning on average twice as much as those in the private sector. And probably more than a hundred million dependents –recipients of Social Security, Medicare, Medicaid, and grants and subsidies of all types. What happens if the checks stop coming?
David Brooks spilled a key insight in the New York Times: he noted that health care has become the “bank” out of which President Obama plans to fund the bulk of his agenda. “By squeezing inefficiencies out of the health care system, he could have his New Deal and also restore the nation to long-term fiscal balance.” (See http://www.nytimes.com/2009/05/15/opinion/15brooks.html?_r=2.)
But most politicians and commentators appear to be in deep denial. The country has accumulated unpayable debts – not to mention future unfunded liabilities – that threaten its survival even without any new entitlements. To keep the music going a while longer, Washington needs to suck what remains of private capital into its coffers. Healthcare is one of the few remaining healthy industries. And it is something on which human beings voluntarily spend their last dime.
While overall employment has been falling, healthcare employment has been growing. As Richard A. Cooper, M.D., former dean of the Medical College of Wisconsin, pointed out, without the 2.8 million jobs added in the healthcare sector in the past decade, unemployment last April would have been 10.5% rather than 8.5%. (See http://buzcooper.com/2009/04/.) Washington needs to bleed American medicine, in order to transfuse the Federal government.
To do this, it needs mandated premiums and taxes, and increased control. The degree of micromanagement is reflected by the occurrence of the word “Secretary” 2,489 times in the House bill, and 2,500 times in the Senate bill. (See http://www.cchconline.org/pdf/ObamaCareWordWatch.pdf.)
To buy just enough votes to pass a monstrous bill, the Democrat leadership has been willing to promise whatever it takes: indefinite Medicaid subsidies, abortion rights, abortion restrictions, “mental health parity,” a “doc fix,” a continued ban on drug reimportation, and probably lots of other things that haven’t come to light.
None of these have anything to do with the heart of the bill: forced purchase of “insurance,” and a massive transfer of power to executive agencies. And if an all-powerful executive breaks a promise, what are you really going to do about it?
A government that is already beginning to default on Social Security, by withholding cost of living increases, cannot be trusted with lesser obligations either.
So what’s the point of delaying the day of reckoning? Current officeholders might hope to be out of power, with a fat pension. But then, maybe they won’t be. How will a population reduced to penury, dependent on government for the means of survival, bring about a regime change? No money to fund political opponents, no time to think of anything but providing for minimal food and warmth, no freedom to protest without fear of loss of eligibility for ration coupons – likely not even any pitchforks or a bus to get to Capitol Hill.
The battle for freedom in medicine is the battle for freedom.
- - -
Jane M. Orient obtained her undergraduate degrees in chemistry and mathematics from the University of Arizona in Tucson, and her M.D. from Columbia University College of Physicians and Surgeons in 1974. She completed an internal medicine residency at Parkland Memorial Hospital and University of Arizona Affiliated Hospitals and then became an Instructor at the University of Arizona College of Medicine. She has been in solo private practice since 1981 and has served as Executive Director of the Association of American Physicians and Surgeons (AAPS) since 1989. She is the author of YOUR Doctor Is Not In: Healthy Skepticism about National Healthcare, Sutton's Law (a novel about where the money is in medicine today), and the second-through-fourth editions of Sapira's Art and Science of Bedside Diagnosis. She coauthored two novels published as e-books, Neomorts and Moonshine, and books for schoolchildren, Professor Klugimkopf's Old-Fashioned English Grammar and Professor Klugimkopf's Spelling Method, published by Robinson Books. More than 100 of her papers have been published in the scientific and popular literature on a variety of subjects including risk assessment, natural and technological hazards and nonhazards, and medical economics and ethics. She is the editor of AAPS News, the Doctors for Disaster Preparedness Newsletter, and Civil Defense Perspectives, and is the managing editor of The Journal of American Physicians and Surgeons.