David McKalip, M.D.
On Thursday I marched with lovers of liberty against the greatest threat to American patients in the history of our country: the rise of Medical Fascism. Some may wonder - what happened to socialized medicine, isn't that the great threat? While it is true that there are attempts to socialize medical care, the fact is that the power players in Washington are ready to set the rules and then hand the keys of health care spending over to large health insurance companies. This is the definition of fascism: the state decides what corporations will do and the corporations do their bidding while making a profit. As it turns out the very corporations making the profit also control the government. That is why I marched with members of the 912 project in Tampa today to spread the message that the government and large corporations should not control your health care dollar: you should.
Some may wonder how medical fascism could possibly come to pass with a democratic president. It is simple, Obama and Congress want to "solve" the problem of unaffordable health care. They want "Universal Coverage." They want to do it this year while they still have a political capital and the votes in Congress -- all to get re-elected later. They know that creating a "single payer" system will be politically impossible. That is why protesters from "Health Care Now" are also trying to get a "Medicare for All" plan on the table: Congress knows it can't deliver on such a promise. So the answer will be to look conciliatory and turn to the insurance industry for the "rescue". They will be willing partners. The Government will find some way to include them -- either through mandated health insurance purchase or heavily subsidized health insurance vouchers. The problem is that even if the large corporations are paying for health care they will still ration care since there is no amount of money that will satisfy the needs of the many interests. However they will take over through a new sort of socialized medicine "American style" or medical fascism.
The United Health Group recently indicated that they could save $500 billion in health care spending simply "by sending patients to less expensive, more efficient doctors, reducing hospital visits by the elderly and cutting unnecessary care." I am a physician victim of tactics mislabeled "efficiency" by United Health Care -- and so are my patients. I perform surgery of the neck for pinched nerves to treat arm pain. United Health Care believes that such patients should receive no more than about $17,000 worth of care. They noted that of seven patients I operated on, they received about $22,000 worth of medical care. They thus rated me as "inefficient" and actively worked to steer patients away from my practice by offering lower co-pays to patients and lower premiums to employers if they used the "efficient" doctors. They put me lower on available physician lists and forced my and my office staff to spend hours to have a non-neurosurgeon approve an MRI or even surgery! No matter that seven patients is far too low a number to calculate such an average or that 90% of the dollars went to hospitals where I have no control of the cost of services there. Such practices will become common place and will worsen when medical fascism becomes the norm. Your doctor will be forced to comply or forced to go out of business -- the patients lose, the doctors lose, the government and insurance companies win.
There are immense pressures to tell doctors how to practice medicine -- all to save the government and large insurance companies money. They would increase their profits by ensuring a patient doesn't receive advanced chemotherapy for breast cancer -- as is now done in England. They would intimidate doctors into ordering fewer MRI's that may be needed for early diagnosis or to not offer hip or knee replacements to older patients. The path to get there is different, but we will have the same sort of system as in England. These sorts of rationing protocols will be established by the "Federal Coordinating Council on Comparative Effectiveness" that was secretly created in the "Stimulus" bill earlier this year. This council is modeled after the rationing committee "NICE" setup in England.
One of the President's key advisors on health care is Zeke Emanuel, brother of his Chief of Staff Rahm Emanuel. Dr. Emanuel is a bioethicist who writes in his blue print for health care reform "Health Care Guaranteed" that the most advanced radiation treatment for prostate cancer costs $42,000 compared to the about $11,000 of more basic radiation. In public talks he dismisses the value of the highly targeted radiation stating that its "only" benefit is decreased side effects from about 13% to 5%. But that is entirely the point of doing the more advanced and more costly radiation: to minimize side effects so higher doses of more curative radiation can be delivered. It appears he is okay with more than twice as many people having rectal bleeding and painful prostate and rectal inflammation after radiation -- as long as it saves money for someone else. Zeke Emanuel also advocates creating a national sales tax (A Value Added Tax) that is the same means of financing health care in socialized systems in Europe. Only, in America, the health insurance corporation will get the money and you will be denied care as they get a large profit. Even if the government keeps the money to spend on health care, they will simply ration the care since there will never be enough money to pay for everyone. As long as Americans don't pay for their routine, annual health care out of pocket, they will constantly see every test and treatment as "free" and order more. That is where medical inflation comes from and is the source of the real crisis. The question for Americans is: do you trust government or insurance company to make the decision on what treatment to receive for you or would you rather make the decision yourself based on the advice of your doctor.
American deserve better than what is currently envisioned in Congress. They don't deserve Nancy Pelosi, Harry Reid, Max Baucus and others to meet in locked rooms and deliver a secret health care reform bill that will be voted on after three days of token debate. Americans deserve lower cost insurance and to be in charge of their own health care spending. Americans deserve the right to buy a less expensive insurance plan from another state or to pay actual cost if they are young and healthy, not increased cost to cover older and sicker patients. They deserve an individual tax break to buy health insurance, not just from their employer where they will get locked into a job. Americans should have greater access to "Super" health savings accounts where an employer can put tax free money in their account and they can use it to find a doctor they want. They can find a doctor that will spend time with them and help them understand their choices and what test or treatments they really do and don't need. After they use their health savings account, they should be covered by low premium, high deductible catastrophic health insurance. This would be a protection against the rare expensive medical conditions one may experience during their lives. If Americans want an expensive health insurance plan that pays for every visit they can buy that too. If they want an HMO that caps how much will be spent on care -- that is another free choice for them. In other words, Americans deserve medical freedom, not medical fascism.
To get medical freedom you will need to fight for it. Join up with your local tea party group for marches across the nation on Medical freedom planned by July 4th. Let Congress know you want medical freedom, not medical fascism.
Dr. McKalip is a Solo Practice Neurosurgeon in St. Petersburg Florida and President of the Florida Neurosurgical Society.
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