If you asked most physicians in the past what one thing characterized their profession, the most likely answer would have been fierce independence. Unfortunately, this is no longer the case. We have been and continue to be battered from an all-out assault of collectivist forces that infest our society and the legal profession that drains our substance. As a result of this assault, we have become daunted — lot, leaderless, frightened, and overwhelmed with a sense of helplessness and doom in the face of sundry forces working tirelessly to affect our demise.
It pains me to see men and women who are brilliant physicians, dedicated to the art of healing, humanitarians who work tirelessly for their patients, shaking their heads in despair, wondering how much longer they can last in the private practice of medicine. Unfortunately, many have given up the struggle. They no longer dream of being able to preserve their independence, an independence that they should know is necessary for the practice of the art of medicine. Instead, they allow themselves to be herded into managed care plans that corral physicians into work cooperatives designed not to provide quality medical care but to make money for corporations — physician-owned or otherwise. Most physicians recognize such collectivist systems are not in the best interest of their patients.
When a herd of cattle is frightened by a loud noise, such as a clap of thunder or gunfire, they all stampede away from the sound, even when they are being driven over a cliff or rounded up to be sent off to the slaughter-house. Without seeing where they are being driven, they follow the others in the herd.
It is this herd instinct that has been driving physicians to their destruction. As with the herd of cattle analogy, some will always separate from the herd. These are characterized by those physicians who have isolated themselves as independent solo practitioners or otherwise, and in some instances, have given up their practices altogether. These few see clearly the handwriting on the wall. They know that to capitulate to the collectivist forces is to commit professional suicide. The herd, meanwhile, thinks it is escaping a worse alternative. But the time it wakes up, it is too late to escape the slaughter.
The members of the herd have put themselves in an inescapable situation. Most rationalize their irrational decision to form or join existing health networks (collectivist associations), by saying, “If we don’t do it ourselves, they will do it for us,” which is like saying, if we don’t kill ourselves they will kill us. Either way you are dead. Others defend their “herding” by saying, “Well, it at least delays the inevitable,” which is to accept the socialist premise that collectivism is inevitable — the result of inexorable natural laws of society.
A few years ago in a state where managed care was threatening to rear it ugly head, I tried to foreworn my medical colleagues about what was coming and why. Notwithstanding my warnings, they went on to make the same mistakes many others have made when faced with socialism in any of its various forms. These physicians assumed bureaucrats could be reasoned with, that they were interested in the health and welfare of the patient, and that they wanted our input into how to make the system more humane. Socialists have employed these tactics to lure those they wished to snare and control. This method was most effectively used by Aneuran Bevan to deceive British physicians into accepting the National Health System. Bevan told the doctors that their representatives would sit on the administrative decision-making boards. After a few months of token participation, the physician representatives were simply removed. Only the representatives that would go along with the socialist planners were allowed to stay (Judas goats). Unfortunately, even today, too many continue to take the bait.
One of the problems is that far too many American, particularly physicians, are unfamiliar with history, especially the history of socialism (collectivism). Most Americans think socialism means the government owns the means of production, lock, stock and barrel. This is only one form of socialism (communism). But there are many others: syndicalism, Fabian socialism, corporatism (or corporativism), National Socialism, fascism, and guild socialism, to name a few.(1)
It has been pointed out by many brilliant observers that developing American socialism more closely resembles National Socialism of Hitler’s Germany than it does Marxism-Leninism. This is because Hitler’s socialism allowed business to exist as privately owned entities, but they were controlled by the state. President Clinton’s Secretary of Labor, Robert Reich, calls this “industrial policy,” which he promotes enthusiastically, While capitalists may continue to own their companies, the state determines hiring policy, production quotas, distribution, and research and development. Sound familiar? It is exactly what has happened to medical care. We are told who to hire (Americans with Disability Act; ADA), which patients we will see (ADA and Civil Rights Act of 1992), what treatment we will provide (Medicare and Medicaid rules, OTA, AIDS policy, ADA), and how we will run our offices (OSHA, ADA, EPA). Our charges are controlled by government as well as private organizations that behave as autonomous governments (managed care facilities, HMOs, and insurance companies). Physicians really have very few freedoms left. And, the few decisions we are free to make are currently under attack by the collectivists.
Remember, PPOs, HMOs, and other managed care organizations have the government’s approval, and to add insult to injury, benefit from special protections. This is why the Clinton health plan depended on these existing organizations for its operation. It is easier to control and regulate physicians through a few large doctor organizations, than it is to fight a half-million, independent physicians. Herding doctors into managed care systems merely represents the first stop in the process of total collectivization of medical care.
Reading the Clinton health care plan provided a glimpse as to just how totalitarian the “experts” — the statist policymakers — really are. As you will remember, the plan called for retaining specialists for general medical care. This is allocation of resources (doctors) based on state planning. The use of people as expendable resources by statist elites is a central tenant of both Marxism-Leninism and National Socialism. It doesn’t matter what you want or how many years of special training you have devoted to your chosen field, all that matters is the planner’s instructions. For those who rebel, there were fines and possible imprisonment. And let’s not forget, they were also asking for federal licensure for physicians. No license — no practice, no livelihood.
In the Clinton health care plan, the independent practice of private medicine outside managed care would have become essentially illegal.(2) Physicians would have been forced to join and obey, or give up the practice of medicine.
And what about provisions mandating physicians to relocate to areas that the government deems more in need of your services? You might say, “ I would refuse to go!” But there would be fines, prison terms, and loss of practice privileges for those who refused. Sound too far-fetched? Well…
On September 16, 1995, an article appeared on the front page of Canada’s The Globe and Mail announcing a new government plan that would dictate where doctors could practice, what specialty they would e trained in, and what could be taught in medical schools. Ontario’s health minister, Ruth Grier, announced the plan, and stated that physicians would be forced to comply through the use of licensure control and reimbursement regulation. And I bet you told yourself that the government could never do such a thing. Many Germans told themselves the same thing in the 1930s and 1940s during the reign of the Third Reich.
“But, this couldn’t happen in America,” you would say. The truth is the Clinton health care bill represented a serious and concerted effort to pass such laws as a national health plan. Today, there are planners calling for even more draconian measures. Don’t think for one moment that because the Clinton health care bill was defeated on its first try, the plan with all its socialist objectives is dead for good. Remember, one of the mail characteristics of socialism is persistence.
I suspect that through incremental reforms, congressional compromises and misinformation as to what constitutes free-markets, oppressive parts of the bill will be added piecemeal (a characteristic of Fabian socialism — called gradualism). There will be more legislation proposed, seemingly less draconian but containing the same arbitrary and vague language.(3) And don’t be surprised if at a later date when no one is looking, the worst (or additional) measures are added as administrative provisions in the Federal Register (which are never voted on in Congress and rarely come to the attention of the public). These mandates, nevertheless, have the full power of judicial law. Another ruse is to bury them in the voluminous text of appropriation bills, as to hide them from suspicious congressmen and the unsuspecting public.
To fully appreciate the growth and expanse of state power, let’s look at other areas of federal control. The IRS, for example, has more employees than the FBI and CIA combined and has considerable more power. It can take your savings, your home, and your business, garnish your wages, all without proof you have done anything wrong. The IRS ahs the unconstitutional power to become the judge, jury, and enforcer.
The Department of Housing and Urban Development (HUD) can decide to move a drug treatment center into your neighborhood; and if you protect publicly, even by a letter to the editor to your local newspaper, they can fine you $50,000 and imprison you. Such instances have occurred in a dozen cities throughout the United States.
On college campuses, students can be forced to attend sensitivity sessions and/or appear before a tribunal to answer charges — for an inappropriate look, laughing at a politically incorrect joke, or requesting a straight roommate. And you delude yourself into thinking you still have freedom of speech and that the power of the federal government is limited by the Constitution?
How many of you are award of the danger wetland legislation poses to the right of private property? Few are aware of the abuse perpetrated by these environment laws. Millions of acres of privately owned land are being declared wetlands and placed under federal control. If your land is so declared, you cannot develop it, cut the grass, chop down a tree, or improve the land in any way. To do so, will land you in jail and you will face huge fines.
So how does the government decide what constitutes a wetland? Robert J. Pierce, who helped write the law, states, “…a wetland is whatever we decide it is.” According to the EPA, even land that is dry 350 days a year could be declared a wetland. Do you still believe the power of the federal government is limited? Do you still believe the Constitution will protect you? Think again.
In the case of the medical profession, the federal government has imposed so many laws and regulations, it has essentially made all of use criminals. For example, do you have monthly meetings with all employees to review safety procedures managed by the federal government? Do you have OSHA labels on all products in your office, including inkpads and white out fluid? If you have WD-40 in your office but not the chemical and safety data pertaining to it, you are in violation of federal law that can mean imprisonment and heavy fines. So, essentially the state has made all of us criminals.
This puts physicians in a dangerous position. If we rebel against socialized medicine and speak out publicly against these injustices, federal officials can invade our offices, cite some cryptic federal code violation and either throw us in jail or impose such heavy fines that it will drive us out of business. Again, this is exactly what Hitler and Stalin did. Totalitarians use the law to control the citizens. Yes, these are very dangerous times.
Those familiar with the growth of collectivism in Europe during the latter part of the 19th and 20 centuries understand these intrusions by the state represent the methodology by which socialism controls society. Every program proposed during the Third Reich was sole to the people on the basis of a benevolent need or desire “for the common good,” just as it is being done in this country.
Today, physicians are practicing within the advanced states of collectivism — most of it, self-induced. Because we refused to reject these collectivist ideas from the very beginning we are now faced with utter capitulation. Medicare and Medicaid should never have been accepted by the medical profession. Collectivist care — HMOs and managed care — should have been rejected out of hand. It was accepted because of the herd instinct. Doctors were scared and didn’t want to be left out. Physicians assumed, incorrectly (like their British and Canadian counterparts), they could control these collectivist systems because they would have input. They were wrong. Physicians who went along were deceived — much of it, self-deception. And by the time they finally discovered they could not control these systems, it was too late — physicians had by that time become financially dependent on and trapped by the nefarious system.
Here in Mississippi, doctors (especially the specialists) remain more independent. When managed care was proposed, we said “No.” We participated in no negotiations and made no deals. We just said, “NO!” Will corporate socialized medicine eventually take over here? Perhaps. Most likely, they will try the divide and conquer technique next. Some physicians will be enticed to join, and others will be scared into signing. And, if the herd instinct is not controlled, we will be led to the slaughterhouse.
Can the independent practice of private medicine be save? It is possible, but only when physicians place principle above dollars. When doctors act together, support organizations fighting for the practice of private medicine (e.g., as when we, as the AAPS, acting on such a premise filed the lawsuit against Hillary Clinton to force disclosure of the minutes of the secret meetings), and are willing to commit themselves to the battle, then and only then, can we win. Anything less than body and soul committed to victory is doomed to failure.
One of the main tenets of collectivism is based on the knowledge that most non-socialists believe in compromise and in being “reasonable.” The socialist, however, views this as a weakness and utilizes this “weakness” to their advantage. Initially, the socialist will propose a radical program fully cognizant such a program would never be accepted. The non-socialist responds by compromising and in doing so, accepts a program somewhere between the status quo and the initial radical proposal. Once this first step is accepted, the socialist then makes another proposal moving closer toward his initial goal. Again, the non-socialist compromises. This Fabian process of unending, socialist progression, aided by non-socialist compromises, continues until one day we find ourselves harnessed by the very radical proposal we originally rejected as being too extreme (again, gradualism).
Nowhere has this process been better applied, utilized, and demonstrated than in the health care field. First, universal care was proposed. It was rejected as being too radical. Next, federal health care for the aged was proposed — Medicare. We accepted the compromise. Then, federal health care for children was proposed. We rejected it; but later, we compromised with care for the indigent — Medicaid. Since that time, we have witnessed a dozen proposals to expand the scope of each of these programs including the number of enrollees covered by these programs. Each time we compromised. Soon federal health care was consuming hundreds of billions of dollars and many physicians because dependent on this money. Further growth of socialized medicine has occurred through the step-by-step implementation of administrative laws via the Federal Register.
Once physicians have become dependent on federal monies, the second step, herding physicians into federally sponsored programs could be implemented. Initially, physicians would be herded into HMOs that are federally sponsored, then into other forms of managed care, e.g., PPOs, PHOs, etc. This accomplishes two purposes. First, it accustoms doctors to regimented practice. Second, it makes it easier for the government to control medical care by simply controlling the “private” managed care facilities.
Managed care allows the government to determine physician income, which will practice what specialty, and allocation of doctor resources (where you will live and practice). “But how can government do these things?” you ask. “These organizations are privately run.” Remember, Hitler allowed private ownership of companies, but the state determined how the companies would be run. The government would set practice guidelines, quotas for specialty allocations, and regulate locations, income, and virtually every aspect of your medical practice. The managed care companies are merely handmaidens of the state. The Clinton plan did not pass; yet, we are still headed in the same direction.
We must not depend on politicians for our defense. The Republicans, despite the November 1994 election, have been too timid. Deceived by a “mislabeled” free-market, they have accepted another form of socialism — corporate socialized medicine I the form of managed care. This compromise will only invite more socialism.
If you decide the course of action I have outlined — total resistance — is too hazardous, then at least fight from within. Demand control of all medical decision making from the administration of managed care facilities. Inform your patients when management is being obtrusive and proposes medically dangerous control. Challenge the “gag” clauses in contracts and agreements and keep the public informed when their health care is being endangered. Remember, bureaucrats cannot provide your services only you can do that.
Apply these strategies and tactics to protect your patients. Patients trust their physicians more than they trust slick bureaucrats from managed care. It is time we speak out on behalf of our patients and for the future of medical care in America. Besides, in the end, we and our loved ones will all be patients and would suffer the consequences of a socialized health care system.
1.For a socioeconomic and historic perspective on the various forms of socialism, see Von Mises L. Socialism. Indianapolis, IN, Liberty Classics, 1979.
2.The Health Security Act of 1993.
3.Kassebaum-Kennedy Bill (HR 3103) that will, in effect, criminalize the practice of medicine.
Dr. Blaylock is a neurological surgeon in Jackson, Mississippi, and a member of the Editorial Board of the Medical Sentinel. His address is 9 Lakeland Circle, Jackson, MS 39216.
Originally published in the Medical Sentinel 1996;1(2):14-17.
Copyright© Russell L. Blaylock, M.D.