U.S. health care debate — Part 1: Debunking leftist rhetoric by Miguel A. Faria, MD

Of a fallen tree all make kindling, says the old proverb, and like most refrains, it conveys an element of truth. The fact the Republicans are having difficulty agreeing on a winning alternative plan to ObamaCare makes both the Senate and House proposals looming targets for critics. The Left’s ultimate goal is to dismantle the American health care system and turn it into an instrument for people control — the government as single payer, in other words, fully socialized medicine “as in all other industrialized nations.” And they have not been unsuccessful in this arena. Aided by the mainstream media, the debate keeps shifting leftward, and the Republicans, despite majorities in both houses of Congress, do not seem to have a winning strategy.

Towards lending support to the Democrats, pundits and propagandists have spread more than the fair share of half-truths.

A recent writer for example lamented that “millions of Americans who were able to purchase insurance since ObamaCare was enacted would lose coverage if either plan [the Senate or the House version] became law, and most of the savings from the tax cuts in their plans would be reaped by those with higher incomes.”

The first part of the statement is questionable and disingenuous. The vast majority, about 18 million out of the estimated 20 million in question, had only obtained health insurance by compulsion, to avoid the penalty imposed by ObamaCare for not having insurance. The rest have subsidized coverage paid by others saddled with higher premiums. The second part of the statement is even more disingenuous because those “reaping the savings” are merely the ones being allowed to save some of their own money, instead of subsidizing others. The GOP plans revoke these impositions and brings more freedom rather than wealth redistribution.

But the verbiage in the writer’s statement is typical Democrat rhetoric pushing the debate towards socialism rather than freedom. In another article in the same newspaper, we read, “reductions in spending are needed to pay for GOP proposed tax cuts.” How is that for turning ideas upon their heads and pervert their meanings? In liberal mantra, reduction of wasteful spending and returning money to those who earned it, is considered the government having to “pay” for the tax cuts. Whose money is it to begin with?

By sleight of progressive authoritarian hand and the naked force of sophistry over reason, suddenly, one’s money becomes the government’s, and those who want to keep their hard-earned money are accused of “reaping the savings” of tax cuts. And when the government returns their money, they call it “paying for tax cuts”!

Envy and class warfare are instigated to ignite passion in this rhetoric. Invariably, the liberal mantra elaborates that those “reaping the benefits” of tax cuts or those for whom the government “slashes benefits to the needy to pay for the tax cuts” are the wealthy. The reality is different: the majority, at least 53% or so of middle class Americans who most heavily carry the load of taxation, are those who would “reap the benefits” of less taxation and wasteful government spending. The super rich are too few to pull the wagon by themselves.

To the world at large, the 26 million presently uninsured Americans are misrepresented by the liberal media as being the most needy, “vulnerable,” and the poorest of Americans who still do not have access to medical care in the U.S. This of course is not true. One of the most vulnerable, our senior citizens, as we all know in America, are covered by the federal Medicare program, and the poorest Americans are covered by the state-run Medicaid programs. And the truth is that eliminating waste, fraud, and abuse in some of those programs would go a long way to better cover even more of those in need.

But the liberal media, even when wanting to appear objective, is not only biased but demands the debate be limited to the points that fit their agenda. For example, as we have seen, they refuse to consider costs and the concept of wealth redistribution in expanding coverage. And their arguments soon degenerate to passionate rhetoric to push for their pre-planned agenda.

The liberal media also avoids reporting human interest stories of waste, fraud, and abuse, and shuns presenting sober and responsible analyses of projected costs (except to project downward) — much less report the burden those social and health programs impose on the middle class who pay for them; or the burden placed on small businesses that are saddled with exorbitant insurance premiums for their workers. Consider the verbiage of yet another unsigned editorial in my local newspaper, the Telegraph (Macon; July 2, 2017):

“Though it [the Senate version of the GOP plan] would only throw 22 million people out of the health insurance door — it would save the government, by cutting Medicaid, $772 billion over ten years and it would eliminate $408 billion in subsidies for low income people, those captured by opioids, pregnant mothers, the disabled and the most vulnerable in our society…. They have yet to put a human face on the issue.”

How is that for advocacy journalism! But despite the alleged good intentions, as declared in the above statement of looking out for the vulnerable and low-income people, these entitlement programs are not without serious unintended and harmful consequences. For example, numerous studies have shown that many Americans in their prime of life and able to work are dropping out of the labor force because of the expansion of the welfare state. They simply prefer not to work and collect benefits. Others malinger, faking illnesses and injuries, to obtain fraudulent disability. One can search the vast literature on the subject (avoided by the media) or just simply watch Judge Judy on TV to ascertain the reality of the statement. In both cases the government-dependent population continues to increase, and those sharing the burden have a heavier and heavier wagon to pull.

Medicaid spending has increased dramatically both under the administrations of Presidents Barack Obama and George W. Bush. In 2000, Medicaid spending was $209 billion. By 2016, it had more than double to $575 billion. Americans with the lowest incomes and the “disabled” are not falling through the cracks as claimed. The deficit accumulated from this program alone is in the trillions of dollars.

As intimated earlier some, if not the majority, of the 26 million uninsured Americans includes a large segment of the middle class that is not eligible for either of those programs, a population that chooses to remain uninsured. This admittedly is because health insurance coverage is expensive. These Americans make the conscious choice to spend their money elsewhere because they consider themselves in good health. They believe that were they to participate in the government-approved insurance cartel, they would be subsidizing others, particularly those with pre-existing medical conditions.

Wise decision or not, under ObamaCare, these Americans chose to pay the penalty for not having insurance. People look after their self-interest, and in a free society, they should be allowed to do so, rather than being forced to participate in wealth redistribution schemes dreamed up by pandering politicians or conceived by others to forge presidential legacies.

Despite the impression created by the progressive-liberal media and even Hollywood celebrities, the health care problem is more about waging partisan politics and inciting class warfare by the Democrats and about furthering government control over individual Americans than it is about “people dying in the streets for lack of medical care” — another hyperbolic mendacity.

We have already mentioned Medicare and Medicaid. Veterans are covered by the Veterans Administration hospital system. True, many people complain about the VA system’s inefficiencies and waiting lists, but that is exactly what they will get with the single payer system of socialized medicine that liberals, behind their partisan politics, are striving to implement through the back door.

Truth be told, no one is being left behind. And as falsely claimed, no one is dying in the streets of America because of lack of access to medical care. That is an outright lie, even if it is implied or stated by a Democrat or Republican president. By federal law, anyone who seeks medical care at an American hospital has to be treated despite ability to pay.

Just disclosing this fact, making an effort to decrease their bias, and toning down the rhetoric, the liberal mainstream media could go a long way to improve the quality of the debate — and regain a portion of their damaged credibility.

Read Part 2 of this article

Written by Dr. Miguel Faria

Miguel A. Faria, M.D. is a retired clinical professor of neurosurgery and long time medical editor. He is the author of “Vandals at the Gates of Medicine”; “Medical Warrior: Fighting Corporate Socialized Medicine”; and “Cuba in Revolution — Escape From a Lost Paradise.” His website is http://www.haciendapub.com.

This article may be cited as: Faria MA.  U.S. health care debate — Part 1: Debunking leftist rhetoric. HaciendaPublishing.com, July 4, 2017. Available from: https://haciendapublishing.com/u-s-health-care-debate-part-1-debunking-leftist-rhetoric-by-miguel-a-faria-md/

Similar versions of this article have appeared in The Telegraph (Macon, Georgia), GOPUSA.com, and AIM. The AIM version was titled, “No Media… 26 Million People Won’t Die If ObamaCare is Repealed” and appeared on July 21, 2017.

Copyright ©2017 Miguel A. Faria, Jr., M.D.


Free market or socialized medicine for the future of US health care?

This is a commentary written in response to an article published in Surgical Neurology International and penned by the retiring neurosurgeon Dr. Clinton Frederick Miller that was highly critical of American medicine. He opines that a major overhaul, or rather overturn, of the American health care is necessary to correct the myriad of alleged abuses he perceives in the system. In his quest for reform, Dr. Miller also made a pitch toward supporting ObamaCare as a stepping stone in the implementation of socialized medicine in the US.[17]

My friend and colleague Dr. Russell L. Blaylock has already written an excellent rebuttal as far as moral and political implications in Dr. Miller’s treatise to the effect “While some of the observations in the article may be correct, the type of liberal/left proposals to solve the problems are harmful.”[17] Dr. Miller argues several points that are misleading and tendentious. Thus, I agree with Dr. Blaylock’s statement. Moreover, when Dr. Miller blames the free market for the problems in the US medical care system, I would argue that the reality is quite the opposite.[11] A two‑level cervical fusion may cost $11000, but if the free market was fully allowed to work, the price would be far less because of unfettered competition, as occurs with the services in other professions and trades. The same would happen with the stereotactic biopsies at $4000–8000.[17] Price would come down if the free market was allowed to work. For this to happen, though, patients and their families would need to be educated to become prudent consumers of medical care and shop around for quality as well as the most affordable medical care—same as they do with other services and purchases of household items as well as homes and automobiles.[7,8] Dr. Miller himself has pointed out that 96% of illnesses are not serious. I agree; this means that in most situations patients could act as prudent consumers and with freedom of choice in seeking medical care. This is what should be happening, but as we all know, it is not. If we truly had an unfettered free‑market in medical care, medical care would be competitive, more efficient, cheaper, and still humanitarian, as has been the case from time immemorial for the medical profession.[7,8,16] This is no longer happening to a significant degree because of the strain of modern living, the high cost of and depersonalizing influence of advanced technology, and more apropos in our discussion because of the distortions in the medical marketplace—namely the third‑party payer system and the antipathy of the government and insurance companies to allow for patient empowerment via medical savings accounts (MSAs) or health savings accounts (HSAs).[7,8] One only has to compare the price of dental care where the free market is less restricted to medical care (where third party payers and the government are involved) to immediately recognize the distortion of the fee‑for‑service US medical care system. Despite the misconception of the US having an unrestrained, laissez faire free market in medical care, the reality is quite the opposite—i.e., already more than halfof the system is socialized and the rest is under managed care, a highly regulated system in which cost‑containment is the raison d’être and the managed care entities and insurance companies work hand in glove with the government, which is a collectivist and corporativist partnership.[12,13]

Third party payers (insurance companies as well as the government) are problems because the system is perceived and, in fact, mishandled as if somebody else other than the patient is paying the medical bills. In other words, patients act as if they are spending somebody else’s money when they seek medical care. This also makes the system terribly expensive. In the present milieu in the US health care system, the invisible hand of the free market is hampered. I need not mention the cost of defensive medicine because of the adversarial litigious climate in which physicians practice.[10] The system is abused on all sides and these abuses escalate unchecked. Insurance companies are stuck with huge medical and hospital bills, and they are able to pass the costs to the enrolees, ultimately the patients. This is a problem that, like the other shortcomings mentioned above, needs addressing. Reform is needed, but with ObamaCare, US medical care will be further disrupted and what is left of the free market will be further distorted. Dr. Miller warns us about the healthcare‑industrial complex and likens it unfavorably to General Dwight Eisenhower’s military–industrial complex,[17] but the fact is we should be much more concerned when government enters the equation in these corporativist partnerships, as in ObamaCare, which is a more advanced level of corporate socialized medicine, a higher degree of collusion of government, managed care networks, and big businesses—threatening more regimentation, more socialization, and less freedom.[2,3,11]

As to the specifics, Dr. Miller alludes to over‑diagnosis and over‑treatment of breast and prostate cancer, and goes to mention that 85% of men over the age of 60 at autopsy harbored microscopic evidence of in situ prostate cancer, suggesting that this is a benign condition requiring no treatment.[17] Let me just state that a dead octogenarian at autopsy is one thing; it is another for a symptomatic but very active octogenarian to be refused treatment simply because of his age with the medical pretext that his prostate cancer or her breast cancer is deemed probably not serious, probably not invasive, and ignored because of age discrimination, a tenet of population‑based utilitarian bioethics and not the individual‑based, traditional medical ethics.[6,9,15,16]

Dr. Miller then goes on to lambast over‑treatment in neurosurgery, and opines, based on a 2007 New England Journal of Medicine study, that conservative treatment of lumbar radiculopathy is as good as surgical treatment with microdiscectomy.[17] That may be true in the long run in some patients but not in others, and he glosses over the fact that patients experience less pain and recover faster with microdiscectomy. He then impugns venal motives to his colleagues for advising surgery when medical treatment is supposedly just as good, claiming, “experienced spine surgeons have known this all along” but because of “selfish motives” fail to disclose this to the patients. Not necessarily so because the art and science of medicine and neurosurgery is imprecise and different surgeons have better or worse results with one method or the other. Patients (and surgeons) are unique individuals, not statistics. Despite the efforts of socialists to collectivize, one size does not fit all! Then, Dr. Miller accuses others colleagues equally of mercenary motives for criticizing the design and results of the study. He writes, “certain vocal elements within the spine surgery community” contended the results of the study because “obvious selfish intent to protect a ‘bread and butter’ source of income.”[17] That may be so for some, but not for other honest critics, and as Dr. Miller himself had to admit, there were shortcomings in the study, as well as qualitative differences in the results.

Returning to more general concerns, Dr. Miller mentions Hippocrates and the Oath, and I am happy that he does.[17] But it is not socialized medicine, not even managed care, that upholds the tenets of the Hippocratic Oath, but the individual‑based (not government‑based), patient‑oriented, free market medical care.[14‑16] It is of interest that Dr. Miller is supposedly concerned with the trend that physicians are “not fulfilling a physician’s sacred first duty to engage in responsible and humanistic collaboration with the patients we are privileged to serve.”[17] Here, I tend to agree to some extent, but then I wonder if the word “humanistic” was chosen with an oblique purpose in mind, or whether he meant “humanitarian” or “compassionate.” The term “humanistic” has today, even as Wikipedia notes, so many meanings from “man‑centered” to “humanitarian,” that it is difficult to discern which one is meant within the context of his narrative. I suppose Dr. Miller meant “humanitarian.” If he meant “humanistic” with alternative meanings, the term is incorrect at best or disingenuous at worse.[14‑16]

Over‑treatment and alleged unnecessary medical care, too much surgery, heroic care, all of this happens—but they do not all mean greed and the implied (immoral) profit motive, as ascribed by Dr. Miller, but also the penchant of Americans to live longer sometimes without considering quality of life—after all, somebody else (government or insurance companies) is paying the medical bills! It is not always the doctors’ fault, but the imprecisions of the art and science of medicine and our way of life and our way of thinking. And the American way is not always wrong.[1,6,9,16,18] We need education and information, and how to take care of ourselves, but we in the US do not need further regimentation and collectivization.[2,3,7,8,16] Some of the problems enumerated by Dr. Miller do exist as noted, but some of the proposed solutions, such as full implementation of socialized medicine, are far worse.[1,7,18] Moreover, some of the accusations heaped on the American medical care system is based on alleged inequalities in access for the poor, the elderly, and the indigent or disabled. These are outright false accusations perpetuated by the misinformed, and the drama of Hollywood movies and the popular culture. The poor, indigent, and disabled are covered by Medicaid, a nationwide State program; the elderly by Medicare, funded by the Federal government. In some cases, individuals and families are covered by both. Furthermore, it is illegal by Federal law to turn away anyone in the emergency room under any circumstances. Everyone gets medical care in the US in one form or another, or eventually in the emergency room. The shortfall in funding is paid by the working middle and upper classes in Federal and state taxes. Paradoxically, it is these same entrepreneurial groups, including individuals, small and family businesses and the self‑employed, in the middle class that face problems with access to medical care because insurance premiums are so high, and now with ObamaCare must pay fines if they chose to remain uninsured and self‑pay. It is the American middle class that carries the burden, pulling the wagon in which everyone else rides! And, for the record, despite the demagogic allegations of some American politicians (Democrats), no one falls through the cracks in America. The poor in the US are on welfare and served by an alphabet soup variety of government programs, entitlements, and benefits (e.g., WIC [Women, Infants, and Children], EBT card for SNAP [food stamps], Medicaid, free cell phones, free or subsidized housing, etc.) tending to their every need and that of their families—subsidized again by the American middle class. Americans, as you can see, are very compassionate and generous people.

Modern liberals, who frequently prefer to call themselves progressives (and in the US usually resent the term socialists with the notable exception of Democrat Presidential candidate Senator Bernie Sanders), have also a predilection to compare the US with other industrialized nations when it is deemed politically convenient. Immediately, two items come to mind: The purported statistics of health care and gun violence. Let me state from the outset that selection bias has no place in scientific methodology, and the usage of numbers that usually accompany these discussions brings in a method of science, statistics, that abhors biases. Second, why should the rest of the world be ignored as if they were no part of the community of nations, nations made up of human beings with aspirations, yearning to live in peace, and with the same natural rights as anybody else? I have already discussed the issue of guns and freedom in terms of the history and culture of America and the rest of the world.[4,5] I will thus continue with a similar comparison of the US and the Europe in terms of health care.

I do not wish to offend our European friends and colleagues. After all, the US is only the culmination of European (Western) civilization. But Western Europe has a largely stagnant, and in some countries, an aging population that has difficulty sustaining itself. Until recently, Europeans have been able to ration health care very efficiently with socialized medicine because of the much more homogenous population and culture it serves. This situation would be very difficult to accomplish in America without establishing an authoritarian government, curtailing freedom, regimenting, and changing the American way of life—very likely for the worse. Scandinavia has had a long tradition of socialistic Nordic tribal welfare that is time‑honored, and thus, frequently not abused, serving its temporary purposes (e.g., socioeconomic and moral support) until the afflicted persons get back on their feet. In the US, welfare services are abused as they are largely politically motivated, rather than time‑honored social and traditional mores.

In Spain, Greece, France, and the rest, the economies are sinking because of their uncontrolled spending in social (including medical) services they can no longer afford.[1,7,18] I recommend the papers by Drs. James I. Ausman and David C. Stolinsky comparing health statistics between the US and the rest of the world.[1,18] Collectivism has been a failure wherever it has been established, and socialized medicine, in particular, has been the key arch of that socialization, an essential component of collectivism used by demagoguing politicians to seduce the people, making it easier for them to accept tyranny. Europe has been free to pursue their pacifism and social safety net, including socialized medicine, in large part from the goodwill of the US with liberation in World War II, the enactment of the generous post‑war Marshall Plan, and the protection that America (and her gun culture) provided during the cold war. But what worked for Europe may not work for the US. Collectivism, in any of its  incarnations, socialism, fascism (National Socialism), communism, and even corporativism (the unholy partnership of big business and government as in corporate socialized medicine) is supported by a faulty, if not an unnatural and evil ideology. Humanity has paid the price in lives (i.e., 100 million lives in the 20th century alone) for the evils of collectivism! For all the criticism, capitalism, even “crony capitalism,” at its worst, may deal with greed and profits, but not with the taking of lives and the support of tyranny.[13,14]

It is worth reiterating that despite the shortcomings, drawbacks, and alleged abuses of the American medical care system, that fee‑for‑service American medicine is still the best in the world. This is particularly true given our uniquecultural situation, the growing and heterogenous population that it serves, rampant immigration, popular expectations, and other political and cultural considerations.

The pharmaceutical industry has also been attacked elsewhere and not always unjustifiably so. The abusive high‑price of US drugs has also been cited as a shortcoming of the American “free‑market” medical care. But pharmaceutical companies will gradually be paying the price in lost market share, as many Americans who pay for their own medications will buy them abroad via the internet at a fraction of the cost. Further competition from abroad with the development and mass production of high quality, generic drugs will become a pharmaceutical bonanza for patients. People paying for medical care (fee‑for‑service) and medications from their own pockets will shop for the best prices, which is the free market at work, but education and freedom of choice are essential for the free market to function.[8,11]

Third party payers, as mentioned, are a major problem and my concerns are worth repeating: The system is perceived as if somebody else other than the patient is paying the medical bills; thus the free market is hampered. It is abused on all sides and these abuses escalate. Even insurance companies are getting ripped off, but they easily pass the costs to the enrollees, ultimately the patients. This is a problem that, like the other shortcomings mentioned, needs addressing. But ObamaCare is not the answer.[11‑13] With the implementation of ObamaCare, the US health care medical system will be further distorted placing an undue burden on the American middle class and small businesses. And unlike any other health care proposal implemented in the U.S., ObamaCare is compulsory and those who choose not to participate are fined by the government. So, when ObamaCare fails to deliver all that it promises, it will be the same progressive politicians who will clamor for more socialization and more compulsion.

Socialized medicine in other countries is frequently lauded even by citizens, as in Canada and Great Britain. Why? Because it has become, for many, a national symbol of pride as well as a false measure of security. Only 4% of people are sick enough to need the system at any one time, and when they do they find queues to see specialists, waiting lists for radiographic studies, and surgery, restrictions of services, and various forms of rationing.[1,6,7,18] In some cases, pets can obtain tests faster than human patients because veterinary care is fee‑for‑service, whereas medical care is socialized! ObamaCare in the US will be a more advanced level of medical corporativism, another step toward fully socialized medicine with further regimentation and less freedom. I have provided supportive articles (which themselves contain useful references from various sources including other countries) that I hope are helpful to the uninitiated and to those who are researching the subject, and simply those who may want to learn a bit more about the U.S. medical care system—the good, and the supposed bad and the ugly.

REFERENCES

1.  Ausman JI. Perinatal mortality, free care, and other misconceptions — Socialized medicine vis-à-vis American medicine. HaciendaPublishing.com,  November 27, 2012. Available from:  http://www.haciendapublishing.com/articles/perinatal-mortality-free-care-and-other-misconceptions-%E2%80%94-socialized-medicine-vis-%C3%A0-vis-amer [Last accessed on 2016 Jan 29].  

2.  Blaylock RL. Regimentation in medicine and the death of creativity (Part 1). HaciendaPublishing.com, March 14, 2015. Available from: http://www.haciendapub.com/articles/regimentation-medicine-and-death-cre… [Last accessed on 2016 Jan 29].

3. Blaylock RL. Regimentation in medicine and its human price (Part 2). HaciendaPublishing.com, March 20, 2015. Available from: http://www.haciendapub.com/articles/regimentation-medicine-and-its-human-price-part-2-russell-l-blaylock-md-ccn [Last accessed on 2016 Jan 29].

4. Faria MA: America, guns and freedom: Part I — A recapitulation of liberty. Surg Neurol Int 2012;3:133. Available from: http://www.haciendapub.com/articles/america-guns-and-freedom-part-i-recapitulation-liberty [Last accessed on 2016 Jan 29].

5. Faria MA: America, guns and freedom: Part II — An international perspective. Surg Neurol Int 2012;3:135. Available from: http://www.haciendapub.com/articles/america-guns-and-freedom-part-ii-%E2%80%94-international-perspective [Last accessed on 2016 Jan 29].

6. Faria MA. Bioethics and why I hope to live beyond age 75 attaining wisdom!: A rebuttal to Dr. Ezekiel Emanuel’s 75 age limit. Surg Neurol Int 05-Mar-2015;6:35. Available from: http://surgicalneurologyint.com/surgicalint_articles/bioethics-and-why-i-hope-to-live-beyond-age-75-attaining-wisdom-a-rebuttal-to-dr-ezekiel-emanuels-75-age-limit/  [Last accessed on 2016 Jan 29].

7. Faria MA. Enhancing access via medical freedom — Call it MSA empowerment. Medical Sentinel 2000;5(4):123-127. Available from: http://haciendapub.com/medicalsentinel/enhancing-access-medical-freedom-call-it-msa-empowerment [Last accessed on 2016 Jan 29].

8. Faria MA. Enhancing medical care in the U.S. via health savings accounts (HSAs). Surgical Neurol, 2005 Sep;64(3):276-7. Available from: http://haciendapub.com/articles/enhancing-medical-care-us-health-savings-accounts-hsas [Last accessed on 2016 Jan 29].

9. Faria MA. Longevity and compression of morbidity from a neuroscience perspective: Do we have a duty to die by a certain age? Surg Neurol Int 2015;6:49. Available from: http://surgicalneurologyint.com/surgicalint_articles/longevity-and-compr… [Last accessed on 2016 Jan 29].

10. Faria MA. Medical liability tort reform: a neurosurgeon’s perspective. Surgical Neurology 2004;61(3):304-307. Available from: http://www.haciendapub.com/articles/medical-liability-tort-reform-neurosurgeons-perspective [Last accessed on 2016 Jan 29].

11. Faria MA. ObamaCare — Toward free market or socialized medicine? HaciendaPublishing.com, September 26, 2011. Available from: http://haciendapub.com/articles/faria-Obamacare-%E2%80%94-toward-free-market-or-socialized-medicine [Last accessed on 2016 Jan 29].  

12. Faria MA. ObamaCare — Another step toward corporate socialized medicine in the U.S. Surgical Neurology International 2012;3:71. Available from: http://surgicalneurologyint.com/surgicalint_articles/Obamacare-another-step-toward-corporate-socialized-medicine-in-the-us/ [Last accessed on 2016 Jan 29].

13. Faria MA. Rationing irrationality in anticipation of ObamaCare. HaciendaPublishing.com, October 4, 2013. Available from: http://haciendapub.com/articles/faria-rationing-irrationally-anticipation-Obamacare [Last accessed on 2016 Jan 29].

14. Faria MA. Religious morality (and secular humanism) in Western civilization as precursors to medical ethics: A historic perspective. Surg Neurol Int 16-Jun-2015;6:105. Available from:  http://surgicalneurologyint.com/surgicalint_articles/religious-morality-and-secular-humanism-in-western-civilization-as-precursors-to-medical-ethics-a-historic-perspective/ [Last accessed on 2016 Jan 29].

15.  Faria MA. The road being paved to neuroethics: A path leading to bioethics or to neuroscience medical ethics? Surg Neurol Int 2014;5(1):146. Available from: http://surgicalneurologyint.com/surgicalint_articles/the-road-being-paved-to-neuroethics-a-path-leading-to-bioethics-or-to-neuroscience-medical-ethics/ [Last accessed on 2016 Jan 29].

16. Faria MA. Vandals at the Gates of Medicine — Historic Perspectives on the Battle Over Health Care Reform. 1995. Macon, GA: Hacienda Publishing, Inc. Review available from: http://surgicalneurologyint.com/surgicalint_articles/a-critique-of-dr-miguel-farias-book-vandals-at-the-gates-of-medicine/ [Last accessed on 2016 Jan 29].  

17. Miller CF.  Why I am concerned about the future of medicine. Surgical Neurol Int 2014. Available from: http://surgicalneurologyint.com/surgicalint_articles/why-i-am-concerned-about-the-future-of-medicine/ [Last accessed on 2016 Jan 29].

18. Stolinsky, David C. Is our health-care system “broken”? HaciendaPublishing.com, November 1, 2015. Available from: http://www.haciendapublishing.com/articles/our-health-care-system-%E2%80%9Cbroken%E2%80%9D-david-c-stolinsky-md [Last accessed on 2016 Jan 29].

Written by Dr. Miguel Faria

Miguel A. Faria, Jr., M.D. is an Associate Editor in Chief and World Affairs Editor of Surgical Neurology International (SNI). He is Clinical Professor of Surgery (Neurosurgery, ret.) and Adjunct Professor of Medical History (ret.), Mercer University School of Medicine. Dr. Faria was a member of the Injury Research Grant Review Committee of the Centers for Disease Control and Prevention (CDC; 2002-05). He is the author of Vandals at the Gates of Medicine (1995); Medical Warrior: Fighting Corporate Socialized Medicine (1997); and Cuba in Revolution — Escape From a Lost Paradise (2002). His website is https://haciendapublishing.com

This article may be cited as: Faria MA. Free market or socialized medicine for the future of US health care? Surg Neurol Int 23-Jun-2016;7:68. Available from: https://haciendapublishing.com/free-market-or-socialized-medicine-for-the-future-of-us-health-care/

Copyright ©2016 Miguel A. Faria, Jr., M.D.


Bioethics — The Life and Death Issue

Since the time of Hippocrates (460-370 B.C.), the Father of Medicine, physicians have traditionally subscribed to doing no harm and prescribed what is in the best interest of their individual patients; in other words, putting their patients first. This concept is known as individual-based ethics.

The new bioethics movement, on the other hand, subscribes to population-based ethics, in which physicians become obligated to make decisions for their patients in concert with what is in the best interest of society or the state.

The above distinction is how the ethics expert and renowned attorney Wesley J. Smith frames the controversial debate in his book, Culture of Death — The Assault on Medical Ethics in America (2000): “Medical ethics deals with the behavior of doctors in their professional lives vis-à-vis their patients. Bioethics, as it has developed over the last few decades, focuses on the relationship between medicine, health, and society. This last element allows bioethics to espouse values ‘higher’ than the well-being of the individual and to perform the philosophical equivalent of triage. Because of the almost imperialistic view of their mandate, many bioethicists presume a moral expertise of breathtaking ambition and hubris. Many view themselves, quite literally, as forgers of ‘the framework for moral judgment and decision making,’ those who will create ‘the moral principles’ that determine how ‘we are to live and act,’ fashioning a ‘wisdom’ they perceive as ‘specially appropriate to the medical sciences and medical arts’.” (Smith 2000, pp.4-5)

Bioethics and the “right to die” movement are bolstered by those in government and academia who believe that health care resources are finite and scarce and thus should be allocated properly and rationed among the population. The old and infirm should yield to the young and healthy.

Smith explains, “Put more simply, bioethics seeks to create a new morality of medicine that will define the meaning of health, determine when life loses its value, and forge the public policies that will promote a new medical and moral order.” (p. 5)

The Individual-Based Ethics of Hippocrates

A recapitulation of the traditional ethics and legacy of Hippocrates is in order to better understand the current trend toward bioethics.

The bedrock of medical ethics, 2500 years after its proclamation by Hippocrates and his followers in the School of Cos in the fourth and fifth centuries B.C., reads in part:

“…I will follow that method of treatment which, according to my ability and judgment, I consider for the benefit of my patients, and abstain from whatever is deleterious and mischievous. I will give no deadly medicine to anyone if asked, nor suggest any such counsel. Into whatever houses I enter I will go into them for the benefit of the sick and will abstain from every voluntary act of mischief and corruption…

“Whatever, in connection with my professional practice, or not in connection with it, I may see or hear in the lives of men which ought not to be spoken abroad I will not divulge, as reckoning that all such should be kept secret…”

As seen by the words of the Hippocratic Oath, active euthanasia was strictly proscribed by Hippocrates and his followers. The Oath of Hippocrates comprises the first set of precepts to formulate systematically a voluntary, self-imposed code of ethics — an edification of professional morality unsurpassed in history.

The oath also provides for ethical conduct in treating the ill and vulnerable and protects patient confidentiality, noble concepts heretofore unknown in any other profession, except the clergy.

Unfortunately, some of the newly compiled oaths of bioethics are not so faithful to the tradition of Hippocrates, and many medical schools have written or followed their own codes of ethics to “keep up with the times” so to speak. These modern codes almost universally have a tendency to subordinate individual autonomy to the collective, be it “the greater good of society” or the will of the state.

Not surprisingly,a controversy is raging regarding the direction that bioethicists have taken as it relates to medical ethics. Many medical ethicists believe that the ethics of the profession are being perverted and transmogrified through the trivialization and deliberate misinterpretation of the core principles of the Oath of Hippocrates. They also decry how his oath is being replaced with more up-to-date oaths that allow the applications of more flexible ethics (situational ethics and moral relativism) supposedly more attuned to the zeitgeist of the twenty-first century. This controversy corresponds with the switch from medical ethics to bioethics.

The medical editor Robert Lowes writing in The New Physician, the official journal of the American Medical Student Association, states: “Although reciting a pledge at graduation has become more widespread in recent years, the Hippocratic Oath isn’t necessarily hip among new docs anymore.” Dr. Robert M. Veatch, director and professor of medical ethics at the Kennedy Institute of Ethics at Georgetown University in Washington, D.C., affirms: “Another major flaw in the [Hippocratic] Oath is a narrow individualism that fails to balance the needs of society. As such, the Oath offers no guidance to today’s health-care reformers.” (Lowes 1995, p. 14)

Other more recent oaths have, therefore, been recited to assuage or circumvent “troublesome” passages in the Hippocratic Oath, like, for example, where the latter states, “I will prescribe regimen for the good of my patients according to my ability and my judgment and never do harm to anyone. To please no one will I prescribe a deadly drug, nor give advice which may cause his death.”

The Oath of Lasagna, written in 1964 by the clinical pharmacologist Louis Lasagna, dean of the Sackler School of Graduate Biomedical Sciences at Tufts University in Boston, reads in part: “If it is given me to save a life, all thanks. But it may also be within my power to take a life; this awesome responsibility must be faced with great humbleness and awareness of my own frailty. Above all, I must not play at God.” And, “I will remember that I remain a member of society….”

The trend toward bioethics and population-based ethics from individual-based medical ethics is obvious. Good intentions do not always lead to beneficence, but detrimentally to partisan politics as substantiated in Lowe’s article.

Bioethics and Population-Based Ethics

The recent revisions in the American Medical Association’s (AMA) code of medical ethics try to walk a tightrope balancing individual autonomy and the needs of society. The preamble to the AMA “Principles of Medical Ethics” states: “As a member of this profession, a physician must recognize responsibility not only to patient but also to society….” Furthermore, Principle 7 states: “A physician shall recognize a responsibility to participate in activities contributing to an improved community.” One might ask, “So, what’s wrong with that?”

Many physicians and medical ethicists such as Jane M. Orient, M.D., professor of medicine at the Oregon Institute of Science and Medicine, the eminent pulmonologist Jerome C. Arnett Jr., M.D., and Edward Annis, M.D., past president of the AMA, agree that the attitude of trying to compromise on what should be absolute moral principles lead to a perilous slippery slope in the transmutation of medical ethics. More pointedly, the problem with compromising ethics and subordinating the individually based patient-doctor relationship based on trust between the patient and his/her physician to the purported needs of society, the community, and/or the collective good is that it opens the door to the transmogrification and perversion of medical ethics, and the subjugation of the individual to the collective and the profession to the state.

In authoritarian societies, bioethics may lead to physicians becoming merely an instrument of political control “for the good of society.”

How, one might ask, does the present situation in America compare to that of Nazi Germany? How could civilized physicians be transformed into dark angels of death for the national socialist Nazis? In the highly civilized society of Germany, physicians participated in “direct medical killing and systematic genocide” because of lebensunwertes leben (“a life unworthy of life”) — an “ethical” concept carried out voluntarily by German physicians under the auspices of the state for the good of German society. Over 200,000 German citizens died in this fashion before the Holocaust. Joseph M. Scherzer, M.D., who was cited in Vandals at the Gates of Medicine, writes, “Physicians were no longer caretakers of an individual patient, but rather promoters of the general health of the German people. Physicians were servants of the state rather than independent [Hippocratic] practitioners.” (Faria 1995, p. 238)

The lessons of history sagaciously reveal wherever the government has sought to alter medical ethics and control medical care, the results have been as perverse as they have been disastrous. In the twentieth century, in the Soviet Union, in Nazi Germany, and in fascist Italy, medicine regressed and, after perverting the “ethics” of the medical profession, descended to unprecedented barbarism under the aegis of, or in partnership with, the state. German medicine’s dark descent into barbarism was a product of doctors willingly cooperating with the state at the expense of their individual patients.

The “Right to Die” Becomes the “Duty to Die”

An article in the New Oxford Review illustrates how “a right to die” easily becomes “a duty to die” once society labels some lives as “not worth living (lebensunwertes leben). Two case histories were briefly outlined.

In one instance, Harold Cybulski, visited by his family while in his hospital bed in Ontario, Canada, woke up from a coma just as his physicians were about to “pull the plug and let him go.” As the grieving family filed in, Cybulski’s two-year-old grandson ran ahead crying, “Grandpa! Grandpa!” Cybulski opened his eyes, sat up in bed, and reached down for the little boy.”

In another instance, 83-year-old Marjorie Nightbert had suffered a stroke and, impaired of swallowing and possible aspiration, required a feeding tube. Her brother, who had durable power of attorney, instructed her doctors to withhold feedings. As Mrs. Nightbert starved, she began to request and a nurse gave her “a little milk.” For this offense, the nurse was reprimanded. After fourteen days without food and water, a pro-life activist heard of the affair and brought the case before the state protective system and the attention of a judge who ruled in favor of the patient. Unfortunately, at a final hearing a different circuit judge ruled that Mrs. Nightbert was “not competent to ask for food” and ruled in favor of her brother. Mrs. Nightbert, unlike Grandpa Cybulski, died after another torturing two weeks of starvation.

Despite mounting stories such as these, article after article in the medical literature has subtly and not-so-subtly extolled the virtues of utilitarian (collectivist) ethics in its various incarnations (e.g., population-based medicine, shared ethics, futility of care, and distributive ethics). All of these proposals seek to submerge the heretofore supremacy of the individual-based ethics of Hippocrates for a collectivist (authoritarian) ethic in which the physician is no longer beholden to his individual patients, but to the greater, collective “good of society.” This is necessary, medical professionals are told by the proponents of bioethics, because physicians must participate in the allocation of scarce and finite health resources (i.e., rationing). Traditional medical ethicists counter that if society has learned anything from recent history, particularly the closing days of the twentieth century, it is that death is the ultimate and most efficient form of rationing.

Increasingly physicians and hospitals in the United States, following the lead of countries with universal health care (socialized medicine), are being pressured to ration health care for the elderly and the seriously ill. And private insurers and managed care companies following the government lead are likewise participating in the “rational” allocation of resources.

Physicians serving on ethics committees in various specialties have been persuaded to legitimize medical care rationing under the concept of the “duty to die,” veiled in the more euphemistic terms such as “futile care” or “end-of-life” care initiatives, leading to the same ends. For example, the “shared ethics” espoused by British bioethicists in the Tavistock Group reflect a growing collectivist attitude in bioethics that many medical ethicists believe is destroying the medical profession piecemeal and embrace a collectivist morality in which individual rights take a back seat to the prerogative of society, government, and insurers.

Some bioethicists, such as Daniel Callahan, director of the Hastings Center and author of Setting Limits, Medical Goals in an Aging Society (1988), Peter Singer, bioethics professor at Stanford University, and particularly John Hardwick, of East Tennessee State University, have openly insisted that elderly patients who have lived a full life have a “duty to die” for the good of society and the proper utilization of societal health resources.

Traditional medical ethicists, on the other hand, insist that the ethics of Hippocrates state that the doctor must place the interest of individual patients first, above monetary considerations, the medical professional’s own self-interest or the interest of society. They maintain that the doctor must also reject utilitarian ethics; that he or she must place the interest of the individual patient above that of the collective, be that the third-party payer, the government, or the more lofty-sounding entities such as society or the “greater good.”

To do otherwise is the first step down a slippery slope of government-imposed rationing and active euthanasia.

Interestingly, Dr. Leo Alexander, an eminent psychiatrist and chief U.S. medical consultant at the Nuremberg War Crimes Trials described how German physicians became willing accomplices with the Nazis in Ktenology, “the science of killing.” This was done we learn for the good of German society and the improvement of “the health of the German nation.” And in this light Alexander addresses the critical question: “If only those whose treatment is worthwhile in terms of prognosis are to be treated, what about the other ones? The doubtful patients are the ones whose recovery appears unlikely, but frequently if treated energetically, they surprise the best prognosticators.” Once the “rational allocation of scarce and finite resources” enters the decision-making process in the doctor’s role as physician, the next logical step is: “Is it worthwhile to do this or that for this type of patient”

As cited in the Medical Sentinel article, “Euthanasia, medical science, and the road to genocide,” Dr. Alexander wrote “from small beginnings” the values of an entire society may be subverted, and “it is the first seemingly innocent step away from principle that frequently decides a life of crime. Corrosion begins in microscopic proportions.” (Faria 1998, p. 79)

Many scholars believe that the movement of bioethics to transmute the traditional, individual-based ethics of Hippocrates into the utilitarian ethics and the rational allocation of resources is the first step down the slippery slope of determining who lives and who dies — rationing by death.

References

1. Annis ER. Code Blue: Health Care in Crisis. Washington, DC, Regnery Publishing, 1993.

2. Arnett JC Jr. The “Tavistock Principles” of medical ethics. Medical Sentinel 2001;6(2):63-65.

3. Arnett JC Jr. Bad Ethics is not For the Patient’s Good. Medical Sentinel 1999;4(5):182-183.

4. Callahan D. Setting Limits, Medical Goals in an Aging Society. New York: Simon and Schuster, 1988.

5. Collison J. Just a human weed? Grandpa! Grandpa! New Oxford Review, April 1999, pp.23-25.

6. Faria MA Jr. Transformation of medical ethics through time. Parts I and II. Medical Sentinel 1998;3(1):19-21 and Medical Sentinal 1998;3(2):53-56.

7. Faria MA Jr. Euthanasia, medical science, and the road to genocide. Medical Sentinel 1998;3(3):79-83.

8. Faria MA Jr. Vandals at the Gates of Medicine — Historic Perspectives on the Battle Over Health Care Reform. Macon, GA, Hacienda Publishing, Inc., 1995.

9. Haydon S. Nazi eugenics disclosure sends Swedes into shock. The Washington Times, National Weekly edition, September 7, 1997, p. 24.

10. Humber JM, Almeder RF (eds). Is There a Duty to Die? Totwa, NJ, Humana Press, 2000.

11. Kim TF. Tavistock Group Proposal — ‘Shared ethics’ for all providers a Quixotic quest. Internal Medicine News, March 1, 1999, p. 5.

12. Lowes R. Swearing off the oath. The New Physician, April 1995, pp. 13-16.

13. Orient JM. Your Doctor Is Not In: Healthy Skepticism About National Health Care. New York: Crown Publishers, 1994.

14. Pellegrino ED, Thomasma DC. For the Patient’s Good — The Restoration of Beneficence in Health Care. New York: Oxford University Press, 1988.

15. Smith WJ. Forced Exit — The Slippery Slope from Assisted Suicide to Legalized Murder. New York: Times Books, 1997.

16. Smith WJ. Culture of Death — The Assault on Medical Ethics in America. San Francisco: Encounter Books, 2000.

Written by Dr. Miguel A. Faria, Jr.

This article was written in 2002 but was edited and published exclusively for HaciendaPublishing.com on October 29, 2012. The article can be cited as: Faria MA. Bioethics — The life and death issue. HaciendaPublishing.com, October 24, 2012. Available from: https://haciendapublishing.com/bioethics-the-life-and-death-issue/

Copyright ©2002 & 2012 Miguel A. Faria, Jr., M.D.


Betrayal: The Ruling on ObamaCare and the Federal Judiciary

The upholding of ObamaCare by the Supreme Court in an unexpected 5-4 political decision is a travesty of American constitutionality. It is a sad day in the country when a knowledgeable Chief Justice of the U.S. Supreme Court betrays the country and places himself and his legacy — not to mention the chants for “change” and “progress,” and his obvious desire for a favorable, epochal association with the first African-American president — ahead of the moral and economic well being of the nation. I say this because the burden of ObamaCare will be laid directly on the shoulders of the already overtaxed and overstretched small businesses, entrepreneurs, and the American middle class who sustain this nation.

Official portrait of John Roberts, 17th Chief Justice of the United States, 2005

The liberal justices voted as we expected, for man is a political animal. But the deciding vote by Chief Justice Roberts, I posit, was cast to assert and define his personal legacy as stated above, and to ride the wave of the times of statism and collectivism, not to mention the alleged inescapable legal positivism of history.

It is always amazing to me how liberals quickly extend sanctity and infallibility status to the Supreme Court whenever the Justices issue a ruling in their favor, even in 5-4 rulings, as if the other four justices were non-existent entities! The reality is the Court has been and remains a political animal, swayed by the politics of the moment (expediency), private considerations (personal legacies), and partisanship (ideology). It must carefully be watched and judged by Congress, the states, and the people — as we are still a federated republic.

Thomas Jefferson and many of the founders warned us about the unchecked power of the courts.  In 1821, in a letter to his friend Charles Hammond, Jefferson wrote:

“The germ of dissolution of our federal government is in the constitution of the federal judiciary: an irresponsible body, working like gravity by night and by day, gaining a little today and a little tomorrow, and advancing its noiseless step like a thief, over the field of jurisdiction until all shall be usurped from the States, and the government of all be consolidated into one. To this I am opposed; because, when all government, domestic and foreign, in little as in great things, shall be drawn to Washington as the centre of all it will render powerless the checks provided of one government on another and will become as venal and oppressive as the government from which we separated.”

Yes, Jefferson was annoyed by the power of the judiciary and the federal government at the expense of the States and individual liberty. I will not go as far as Jefferson in this condemnation, but it should make us ponder if our confidence in the Supreme Court should always be paramount.

And for those readers who will complain I am just a sore loser about this most recent court ruling, I ask where in the U.S. Constitution is Congress authorized to pass laws regarding education and health care, powers that the Court affirms as constitutional? For the likes of me, like James Madison on welfare, I cannot put my finger on either one of those elusive enumerated powers.

Simply stated, the upholding of ObamaCare by the Supreme Court, and its imminent consummation and consumption by the American people (most assuredly if President Obama is reelected with a suppliant congress) — will continue to bring forth the death knell of what remains of our Republic. The erstwhile prosperous land of the free, home of the brave, beacon of individual freedom and hope, will continue its descent and downward spiral toward more socialism — in the same mode and “fashion” as the morally and economically bankrupt social democracies of Europe. The fate of our nation hangs in the balance and will be determined this November!

Written by Dr. Miguel Faria

Miguel A. Faria, Jr., M.D. is the Author of Vandals at the Gates of Medicine (1995).

This article may be cited as: Faria MA. Betrayal: The Ruling on ObamaCare and the Federal Judiciary. HaciendaPublishing.com, July 2, 2012. Available from: https://haciendapublishing.com/betrayal-the-ruling-on-obamacare-and-the-federal-judiciary/.

Copyright ©2002 Miguel A. Faria, Jr., M.D.


ObamaCare — Another step toward corporate socialized medicine in the U.S.

The Patient Protection and Affordable Care Act (2010), more commonly referred to as ObamaCare, has become one of the most controversial pieces of legislation passed by the Democrat-controlled, 111th U.S. Congress during President Obama’s administration.

Figure 1: U.S. President Barack Obama at the White House, flanked by activist physicians, expounding on ObamaCare (expansion of corporate socialized medicine in the U.S.)

Despite significant political opposition and poll-after-poll evincing the American people’s strong dissatisfaction with a health care plan that was correctly seen as further socializing American medicine, ObamaCare [Figure 1] was passed by the two houses of the U.S. Congress and signed into law by the president on March 23, 2010.

One stated goal of the plan is ostensibly to “expand access to insurance for nearly 30 million Americans.” And to accomplish this ”reform,” the Obama administration has introduced the elements of compulsion — and more ominously, unconstitutional powers.

To increase access to insurance for 30 million uninsured Americans, ObamaCare forces insurance companies and managed care plans to extend coverage to people with pre-existing conditions; in effect, converting conventional rules of indemnity coverage (i.e., coverage for unforeseen medical illnesses and injuries) into prepayment for chronic medical care.

But perhaps the most egregious section of ObamaCare is to force uninsured Americans to purchase medical insurance. Noncompliance with this “reform” will trigger heavy fines imposed by the federal government as a penalty. This is referred to as the health insurance mandate, and it is quite different from National Health Insurance as in Canada (2,3,11), National Health Service as in Great Britain (6), or socialized medicine in France, Germany, and Japan.(12,16)  Thus, I make a relative distinction between the Obama administration’s plan for health care as corporate socialized medicine (i.e., public-private, corporativist partnerships) and the fully socialized medicine as in most European countries.(7-10)

The price of socialized medicine in every country in which it has been implemented is the usurpation of liberty, the erosion of individual autonomy, the gradual loss of the freedom to choose — working in parallel with the rationing of medical services and technology because the raison d’être of socialism is to control the population by depriving the people of freedom and keeping them subservient and dependent on the State.

The free enterprise system in the United States has traditionally relied on free choice in a free market place, whether we are talking about buying a home, an automobile, computers — or medical care. Government compulsion and social engineering are not well received by free marketeers and individualists in our society.

Figure 2: Hillary Rodham Clinton during the health care debate of 1993

Small steps, incremental “reforms,” have taken place in American medicine via increased rules and regulations regarding utilization and rationing of services, coverage, and payments to physicians, etc. But further large-scale attempts to socialize American medicine have been repeatedly defeated since 1965, when Medicare (i.e., health care for the elderly) and Medicaid (i.e., health care for the indigent) were instituted.(4,5,9) A good example of this rejection of socialized medicine was the failed attempt by President Bill Clinton to revamp the U.S. health care system in 1993-1994. The Health Security Act of 1993 was a grandiose effort to further socialized American medicine in a corporativist direction,(8-10) and was dubbed “HillaryCare” because the effort was led by former First Lady Hillary Clinton [Figure 2], who serves today as President Obama’s Secretary of State.

If There Was So Much Opposition to ObamaCare, How Did It Get Through Congress?

The Patient Protection and Affordable Care Act was introduced in the U.S. Congress in September 2009 when the Democrat Party still had majorities in both Houses of the American Congress. Despite those majorities, the Republican Party (GOP; “Grand Old Party”) was able to introduce several amendments and mount significant opposition to the legislation.

ObamaCare passed in the House of Representatives on October 8, 2009. The Senate then took up consideration of the bill and passed it “with amendment” on December 24, 2009.

According to the U.S. Constitution, when a bill that has already been passed by one house of congress is altered or has amendments added to it by the other house, then the bill must return to the originating house to be re-voted on and passed again with those changes or amendments. Because the Senate version of the ObamaCare bill passed “with amendment,” the bill had to go back to the House of Representatives to be reconsidered and re-voted on.

Likewise, if the House made any further changes or added any new amendments, the bill would then bounce back to the Senate for a re-vote. This process may seem unnecessarily cumbersome to foreigners, but the American Founding Fathers in their wisdom devised this method so that thoughtful consideration could be given to the making and passage of laws, and thus, hopefully preserve our constitutional republic. 

However, the legislative shenanigans used by the Speaker of the House of Representatives, Nancy Pelosi (D-CA), and her counterpart in the U.S. Senate, Majority Leader Harry Reid (D-NV), to get the amended ObamaCare legislation finally through congress turned that process upside down. Even the Washington Post, not usually considered a “conservative” publication, astoundingly reported that Speaker Pelosi was willing to do anything to ram the bill through Congress in 2010.(13)

Figure 3: ObamaCare protestors in Washington, D.C.

Time was of the essence because 2010 was also a mid-term election year in the United States. Given the growing voter dissatisfaction with the Obama administration, the slow economic recovery, and the mounting opposition to this bill, the makeup of one or both houses of congress could potentially change in early 2011. This political consideration added great urgency to the need to get ObamaCare passed once and for all and signed into law before any of the newly elected congressional members were sworn in.

So, Here Is What Transpired:

In 1974, Congress created a special methodology for balancing the budget, whereby the U.S. Senate could reduce the escalating budget deficit with a simple majority vote (i.e., 51 votes), rather than requiring the usual 60 votes that are needed to stop a filibuster. Under this Senate rule, the expediting process was called “reconciliation,” but it was only to be used for balancing the budget.

Figure 4: ObamaCare legislation as passed by the U.S. House of Representatives

First, President Obama and his Democrat congressional leaders, Pelosi and Reid, attempted to change the rules to effect passage of this legislation at any price. They used budget “reconciliation” rules to bypass the planned GOP Senate filibuster that would normally have allowed the Republicans to defeat the legislation with 41 Senate votes. (The 41-vote possibility became a potential reality when Massachusetts elected a Republican, Scott Brown, to the U.S. Senate on January 19, 2010.)

Second, the Democrat congressional leaders invoked a convoluted concept of “procedural rules,” to make sure one way or the other President Obama could get this cherished piece of legislation through Congress (Figure 4).

The Washington Post article expounded the convoluted methodology as follows:

“Rather than passing the Senate bill and then passing the fixes, the House will pass the fixes under a rule that says the House “deems” the Senate bill passed after the House passes the fixes.

“The virtue of this, for Pelosi’s members, is that they don’t actually vote on the Senate bill. They only vote on the reconciliation package. But their vote on the reconciliation package functions as a vote on the Senate bill…the bottom line is this: When the House votes on the reconciliation fixes, the Senate bill is passed, even if the Senate hasn’t voted on the reconciliation fixes, and even though the House never specifically voted on the Senate bill.”(13)

And that convoluted way of thinking did not even include Speaker Pelosi’s “most revealing” comment expressed during an interview on Fox News on March 9, 2010: “We have to pass the health care bill so that you can find out what is in it.”(15)

Figure 5: U.S. President Barack Obama signing The Patient Protection and Affordable Care Act on March 23, 2010

So, to make the story brief, the socialist members in the U.S. Congress were willing to do anything to pass and have signed into law what Vladimir Lenin deemed “the keystone in the arch of socialism” — government control of medical care!

The ObamaCare legislation again passed in U.S. House of Representatives on March 21, 2010 by a tight vote of 219-212, with 34 Democrats and all 178 Republicans voting against the bill! President Obama signed it into law two days later (Figure 5).

The fact that the legislation was quickly repealed in a largely symbolic gesture by the newly elected House in a 245-189 vote that January 2011 tells how unpopular the law was and remains. President Obama was happy to take credit for ObamaCare when he thought the American people would approve of it with time; but in the intervening years that has not happened. Therefore, many of President Obama’s followers are now distancing themselves from the law they helped create!

Violating the U.S. Constitution to Justify ObamaCare

The U.S. Constitution, unlike the constitutions in other countries or other forms of government, limits the power of the federal government to specifically enumerated powers. Powers that are not specifically granted by the constitution are not authorized. Additionally, the first Ten Amendments to the U.S. Constitution, enshrined as the Bill of Rights, even forbid Congress from passing laws restricting individual freedom. For example, the First Amendment reads, “Congress shall make no law respecting an establishment of religion, or prohibiting the free exercise thereof; or abridging the freedom of speech, or of the press; or the right of the people peaceably to assemble, and to petition the Government for a redress of grievances.” The Second Amendment forbids the government from disarming law-abiding citizens, etc.

It has been stated that the “Welfare Clause” in the Preamble to the U.S. Constitution authorizes Congress to distribute entitlements and to redistribute wealth in the form of socialism. But in discussing this clause, Thomas Jefferson wrote, “a distinct substantive power, to do any act which might tend to the general welfare, is to render all the enumerations [of their specific constitutional powers] useless, and to make their power unlimited.”

And James Madison, the “Father of the U.S. Constitution,” in a letter to fellow patriot Edmund Pendleton dated January 21, 1792, wrote: “[If] Congress can do whatever in their discretion can be done by money, and will promote the General Welfare, the Government is no longer a limited one, possessing enumerated powers, but an indefinite one, subject to particular exceptions.” In other words, there is no authorization in the U.S. Constitution for the implementation of socialism in America.

Likewise, our constitution does not authorize the federal government to take over the U.S. health care system. To legally justify the implementation of ObamaCare, particularly the section that forces American citizens to buy health care coverage, congressional democrats and the president have used the (interstate) commerce clause of the constitution (that empowers congress to regulate the interstate commerce among the individual states of the nation).

Again, this “broad construction” (interpretation) of the constitution is tantamount to a usurpation of power that would erase the limits of authority set for the federal government by the framers of our constitution. Nor have specific contravening amendments been passed to legally alter those constitutional limits.

Figure 6: U.S. Supreme Court building in Washington, D.C., where nine Supreme Court Justices will hear debate over the constitutionality of ObamaCare

The limits have been exceeded only by the judicial activism of court rulings, based on the two aforementioned broad interpretations of the “General Welfare” and “Commerce” clauses. The intention of the Founders was never for congress or a complicit activist Supreme Court to use commerce and trade between the states to wantonly approve unconstitutional federal legislation.

As a result, a majority of the states acting individually, as well as numerous civic and professional organizations, have filed lawsuits in federal court challenging the constitutionality of ObamaCare.(1) The U.S. Supreme Court (Figure 6) has agreed to review the lawsuits in March 2012 “as part of the three days of public oral arguments scheduled for March 26-28. There, lawyers for the Obama administration and a coalition of 26 states and private groups will separately plead their case on the health care law’s legal limits.”(14)

Let’s hope reason and constitutionality prevail, and that at least part, if not all, of the most egregious sections of ObamaCare are declared unconstitutional and repealed by the U.S. Supreme Court.

References

1. Association of American Physicians and Surgeons (AAPS). Medicaid Expansion, Individual Mandate, & Entire PPACA Unconstitutional, Doctors Tell Supreme Court. January 23, 2012.

2. Aubrey, ME. Canada’s Fatal Error — Health Care as a Right (Part I). Medical Sentinel 2001;6(1):26-28.

3. Aubrey, ME. Canada’s Fatal Error — Health Care as a Right (Part II). Medical Sentinel 2001;6(2):57-60.

4. Blaylock, R. National Health Insurance (Part I): The Socialist Nightmare. August 19, 2009. HaciendaPublishing.com.

5. Blaylock, R. National Health Insurance (Part II): Any Social Utility in the Elderly? September 26, 2009. HaciendaPublishing.com.

6. Butler, E. The National Health Service in the United Kingdom: Model for the United States? J Med Assoc Ga 1993;82(12):643-645.

7. Faria, M. ObamaCare — Toward Free Market or Socialized Medicine. GOPUSA.com, September 26, 2011.

8. Faria, M. Medical Warrior: Fighting Corporate Socialized Medicine. Macon, Ga., Hacienda Publishing, 1997.

9. Faria, M. Vandals at the Gates of Medicine — Historic Perspectives on the Battle Over Health Care Reform. Macon, Ga., Hacienda Publishing, 1995.

10. Faria, M. Corporate Socialized Medicine Threatens Medical Profession. Human Events, August 15, 1997, p 12-13.

11. Goodman, WE. Re-privatizing Medicine in Canada — By the Back Door. Medical Sentinel 1997;2(1):16-18.

12. Henderson, JW. Liberty, Equality, Fraternity and the Delivery of Health Care in France. J Med Assoc Ga 1993;82(12):651-655.

13. Klein, E. Strategy for Passing Health-Care Reform. Washington Post, March 15, 2010.  http://voices.washingtonpost.com/ezra-klein/2010/03/nancy_pelosis_strate…

14. Mears, B. All Nine Justices Will Vote on Health Care. Jan. 23, 2012.  http://www.news8000.com/news/politics/All-nine-justices-will-vote-on-hea….

15. Pelosi, N. Fox News, March 9, 2010. http://www.youtube.com/watch?v=KoE1R-xH5To

16. Schlitt, M. Health Care Systems in Japan and Germany Provide Facts, Not Theories. J Med Assoc Ga 1993;82(12):651-655.

Article written by: Dr. Miguel Faria

Dr. Miguel A. Faria is a former Clinical Professor of Surgery (Neurosurgery, ret.) and Adjunct Professor of Medical History (ret.) Mercer University School of Medicine; Member Editorial Board of Surgical Neurology International (2011-present); Recipient of the Americanism Medal from the Nathaniel Macon Chapter of the Daughters of the American Revolution (DAR) 1998; Ex member of the Injury Research Grant Review Committee of the Centers for Disease Control and Prevention (CDC) 2002-05; Founder and Editor-in-Chief of the Medical Sentinel (1996-2002); Editor Emeritus, the Association of American Physicians and Surgeons (AAPS); Author, Vandals at the Gates of Medicine (1995), Medical Warrior: Fighting Corporate Socialized Medicine (1997), and Cuba in Revolution: Escape From a Lost Paradise (2002).

This article may be cited as: Faria MA. ObamaCare — Another step toward corporate socialized medicine in the U.S. Surgical Neurology International 2012 3(1):71-71. Available from: http://surgicalneurologyint.com/surgicalint_articles/obamacare-another-s…

An edited version of this article was published in GOPUSA.com on March 20, 2012.

Copyright © 2012 Miguel A. Faria, Jr., MD


Faria: ObamaCare — Politics and Constitutionality

The Patient Protection and Affordable Care Act (2010), more commonly referred to as ObamaCare, has become one of the most controversial pieces of legislation passed by the Democrat-controlled, 111th U.S. Congress during President Obama’s administration.

Despite significant political opposition and poll-after-poll evincing the American people’s strong dissatisfaction with a health care plan that was correctly seen as further socializing American medicine, ObamaCare was passed by the two houses of the U.S. Congress and signed into law by the president on March 23, 2010.

One stated goal of the plan is ostensibly to “expand access to insurance for nearly 30 million Americans.” And to accomplish this ”reform,” the Obama administration has introduced the elements of compulsion — and more ominously, unconstitutional powers.

To increase access to insurance for 30 million uninsured Americans, ObamaCare forces insurance companies and managed care plans to extend coverage to people with pre-existing conditions; in effect, converting conventional rules of indemnity coverage (i.e., coverage for unforeseen medical illnesses and injuries) into prepayment for chronic medical care.

But perhaps the most egregious section of ObamaCare is to force uninsured Americans to purchase medical insurance. Noncompliance with this “reform” will trigger heavy fines imposed by the federal government as a penalty. This is referred to as the health insurance mandate, and it is quite different from National Health Insurance as in Canada (2,3,11), National Health Service as in Great Britain (6), or socialized medicine in France, Germany, and Japan.(12,16)  Thus, I make a relative distinction between the Obama administration’s plan for health care as corporate socialized medicine (i.e., public-private, corporativist partnerships) and the fully socialized medicine as in most European countries.(7-10)

The price of socialized medicine in every country in which it has been implemented is the usurpation of liberty, the erosion of individual autonomy, the gradual loss of the freedom to choose — working in parallel with the rationing of medical services and technology because the raison d’être of socialism is to control the population by depriving the people of freedom and keeping them subservient and dependent on the State.

The free enterprise system in the United States has traditionally relied on free choice in a free market place, whether we are talking about buying a home, an automobile, computers — or medical care. Government compulsion and social engineering are not well received by free marketeers and individualists in our society.

Small steps, incremental “reforms,” have taken place in American medicine via increased rules and regulations regarding utilization and rationing of services, coverage, and payments to physicians, etc. But further large-scale attempts to socialize American medicine have been repeatedly defeated since 1965, when Medicare (i.e., health care for the elderly) and Medicaid (i.e., health care for the indigent) were instituted.(4,5,9) A good example of this rejection of socialized medicine was the failed attempt by President Bill Clinton to revamp the U.S. health care system in 1993-1994. The Health Security Act of 1993 was a grandiose effort to further socialized American medicine in a corporativist direction,(8-10) and was dubbed “HillaryCare” because the effort was led by former First Lady Hillary Clinton, who serves today as President Obama’s Secretary of State.

If there was so much opposition to ObamaCare, how did it get through Congress?

The Patient Protection and Affordable Care Act was introduced in the U.S. Congress in September 2009 when the Democrat Party still had majorities in both Houses of the American Congress. Despite those majorities, the Republican Party (GOP; “Grand Old Party”) was able to introduce several amendments and mount significant opposition to the legislation.

ObamaCare passed in the House of Representatives on October 8, 2009. The Senate then took up consideration of the bill and passed it “with amendment” on December 24, 2009.

According to the U.S. Constitution, when a bill that has already been passed by one house of congress is altered or has amendments added to it by the other house, then the bill must return to the originating house to be re-voted on and passed again with those changes or amendments. Because the Senate version of the ObamaCare bill passed “with amendment,” the bill had to go back to the House of Representatives to be reconsidered and re-voted on.

Likewise, if the House made any further changes or added any new amendments, the bill would then bounce back to the Senate for a re-vote. This process may seem unnecessarily cumbersome to foreigners, but the American Founding Fathers in their wisdom devised this method so that thoughtful consideration could be given to the making and passage of laws, and thus, hopefully preserve our constitutional republic. 

However, the legislative shenanigans used by the Speaker of the House of Representatives, Nancy Pelosi (D-CA), and her counterpart in the U.S. Senate, Majority Leader Harry Reid (D-NV), to get the amended ObamaCare legislation finally through congress turned that process upside down. Even the Washington Post, not usually considered a “conservative” publication, astoundingly reported that Speaker Pelosi was willing to do anything to ram the bill through Congress in 2010.(13)

Time was of the essence because 2010 was also a mid-term election year in the United States. Given the growing voter dissatisfaction with the Obama administration, the slow economic recovery, and the mounting opposition to this bill, the makeup of one or both houses of congress could potentially change in early 2011. This political consideration added great urgency to the need to get ObamaCare passed once and for all and signed into law before any of the newly elected congressional members were sworn in.

So, here is what transpired:

In 1974, Congress created a special methodology for balancing the budget, whereby the U.S. Senate could reduce the escalating budget deficit with a simple majority vote (i.e., 51 votes), rather than requiring the usual 60 votes that are needed to stop a filibuster. Under this Senate rule, the expediting process was called “reconciliation,” but it was only to be used for balancing the budget.

First, President Obama and his Democrat congressional leaders, Pelosi and Reid, attempted to change the rules to effect passage of this legislation at any price. They used budget “reconciliation” rules to bypass the planned GOP Senate filibuster that would normally have allowed the Republicans to defeat the legislation with 41 Senate votes. (The 41-vote possibility became a potential reality when Massachusetts elected a Republican, Scott Brown, to the U.S. Senate on January 19, 2010.)

Photos of the Speaker of the House of Representatives, Nancy Pelosi (D-CA; left), U.S. President Barack Obama (center) and U.S. Senate Majority Leader Harry Reid (D-NV; right)

Second, the Democrat congressional leaders invoked a convoluted concept of “procedural rules,” to make sure one way or the other President Obama could get this cherished piece of legislation through Congress.

The Washington Post article expounded the convoluted methodology as follows:

“Rather than passing the Senate bill and then passing the fixes, the House will pass the fixes under a rule that says the House “deems” the Senate bill passed after the House passes the fixes.

“The virtue of this, for Pelosi’s members, is that they don’t actually vote on the Senate bill. They only vote on the reconciliation package. But their vote on the reconciliation package functions as a vote on the Senate bill…the bottom line is this: When the House votes on the reconciliation fixes, the Senate bill is passed, even if the Senate hasn’t voted on the reconciliation fixes, and even though the House never specifically voted on the Senate bill.”(13)

And that convoluted way of thinking did not even include Speaker Pelosi’s “most revealing” comment expressed during an interview on Fox News on March 9, 2010: “We have to pass the health care bill so that you can find out what is in it.”(15)

So, to make the story brief, the socialist members in the U.S. Congress were willing to do anything to pass and have signed into law what Vladimir Lenin deemed “the keystone in the arch of socialism” — government control of medical care!

President Obama signing The Patient Protection and Affordable Care Act into law on March 23, 2010

The ObamaCare legislation again passed in U.S. House of Representatives on March 21, 2010 by a tight vote of 219-212, with 34 Democrats and all 178 Republicans voting against the bill! President Obama signed it into law two days later.

The fact that the legislation was quickly repealed in a largely symbolic gesture by the newly elected House in a 245-189 vote that January 2011 tells how unpopular the law was and remains. President Obama was happy to take credit for ObamaCare when he thought the American people would approve of it with time; but in the intervening years that has not happened. Therefore, many of President Obama’s followers are now distancing themselves from the law they helped create!

Violating the U.S. Constitution to Justify ObamaCare

The U.S. Constitution, unlike the constitutions in other countries or other forms of government, limits the power of the federal government to specifically enumerated powers. Powers that are not specifically granted by the constitution are not authorized. Additionally, the first Ten Amendments to the U.S. Constitution, enshrined as the Bill of Rights, even forbid Congress from passing laws restricting individual freedom. For example, the First Amendment reads, “Congress shall make no law respecting an establishment of religion, or prohibiting the free exercise thereof; or abridging the freedom of speech, or of the press; or the right of the people peaceably to assemble, and to petition the Government for a redress of grievances.” The Second Amendment forbids the government from disarming law-abiding citizens, etc.

It has been stated that the “Welfare Clause” in the Preamble to the U.S. Constitution authorizes Congress to distribute entitlements and to redistribute wealth in the form of socialism. But in discussing this clause, Thomas Jefferson wrote, “a distinct substantive power, to do any act which might tend to the general welfare, is to render all the enumerations [of their specific constitutional powers] useless, and to make their power unlimited.”

And James Madison, the “Father of the U.S. Constitution,” in a letter to fellow patriot Edmund Pendleton dated January 21, 1792, wrote: “[If] Congress can do whatever in their discretion can be done by money, and will promote the General Welfare, the Government is no longer a limited one, possessing enumerated powers, but an indefinite one, subject to particular exceptions.” In other words, there is no authorization in the U.S. Constitution for the implementation of socialism in America.

Likewise, our constitution does not authorize the federal government to take over the U.S. health care system. To legally justify the implementation of ObamaCare, particularly the section that forces American citizens to buy health care coverage, congressional democrats and the president have used the (interstate) commerce clause of the constitution (that empowers congress to regulate the interstate commerce among the individual states of the nation).

Again, this “broad construction” (interpretation) of the constitution is tantamount to a usurpation of power that would erase the limits of authority set for the federal government by the framers of our constitution. Nor have specific contravening amendments been passed to legally alter those constitutional limits.

The limits have been exceeded only by the judicial activism of court rulings, based on the two aforementioned broad interpretations of the “General Welfare” and “Commerce” clauses. The intention of the Founders was never for congress or a complicit activist Supreme Court to use commerce and trade between the states to wantonly approve unconstitutional federal legislation.

As a result, a majority of the states acting individually, as well as numerous civic and professional organizations, have filed lawsuits in federal court challenging the constitutionality of ObamaCare.(1) The U.S. Supreme Court has agreed to review the lawsuits in March 2012 “as part of the three days of public oral arguments scheduled for March 26-28. There, lawyers for the Obama administration and a coalition of 26 states and private groups will separately plead their case on the health care law’s legal limits.”(14)

Let’s hope reason and constitutionality prevail, and that at least part, if not all, of the most egregious sections of ObamaCare are declared unconstitutional and repealed by the U.S. Supreme Court.

References

1. Association of American Physicians and Surgeons (AAPS). Medicaid Expansion, Individual Mandate, & Entire PPACA Unconstitutional, Doctors Tell Supreme Court. January 23, 2012.

2. Aubrey, ME. Canada’s Fatal Error — Health Care as a Right (Part I). Medical Sentinel 2001;6(1):26-28.

3. Aubrey, ME. Canada’s Fatal Error — Health Care as a Right (Part II). Medical Sentinel 2001;6(2):57-60.

4. Blaylock, R. National Health Insurance (Part I): The Socialist Nightmare. August 19, 2009. HaciendaPublishing.com.

5. Blaylock, R. National Health Insurance (Part II): Any Social Utility in the Elderly? September 26, 2009. HaciendaPublishing.com.

6. Butler, E. The National Health Service in the United Kingdom: Model for the United States? J Med Assoc Ga 1993;82(12):643-645.

7. Faria, M. ObamaCare — Toward Free Market or Socialized Medicine. GOPUSA.com, September 26, 2011.

8. Faria, M. Medical Warrior: Fighting Corporate Socialized Medicine. Macon, Ga., Hacienda Publishing, 1997.

9. Faria, M. Vandals at the Gates of Medicine: Historic Perspectives on the Battle Over Health Care Reform. Macon, Ga., Hacienda Publishing, 1995.

10. Faria, M. Corporate Socialized Medicine Threatens Medical Profession. Human Events, August 15, 1997, p 12-13.

11. Goodman, WE. Re-privatizing Medicine in Canada — By the Back Door. Medical Sentinel 1997;2(1):16-18.

12. Henderson, JW. Liberty, Equality, Fraternity and the Delivery of Health Care in France. J Med Assoc Ga 1993;82(12):651-655.

13. Klein, E. Strategy for Passing Health-Care Reform. Washington Post, March 15, 2010.  http://voices.washingtonpost.com/ezra-klein/2010/03/nancy_pelosis_strate…

14. Mears, B. All Nine Justices Will Vote on Health Care. Jan. 23, 2012.  http://www.news8000.com/news/politics/All-nine-justices-will-vote-on-hea….

15. Pelosi, N. Fox News, March 9, 2010. http://www.youtube.com/watch?v=KoE1R-xH5To

16. Schlitt, M. Health Care Systems in Japan and Germany Provide Facts, Not Theories. J Med Assoc Ga 1993;82(12):651-655.

Written by: Dr. Miguel Faria

Miguel A. Faria, M.D. is a former Clinical Professor of Surgery (Neurosurgery, ret.) and Adjunct Professor of Medical History (ret.) Mercer University School of Medicine; Member Editorial Board of Surgical Neurology International (2011-present); Recipient of the Americanism Medal from the Nathaniel Macon Chapter of the Daughters of the American Revolution (DAR) 1998; Ex member of the Injury Research Grant Review Committee of the Centers for Disease Control and Prevention (CDC) 2002-05; Founder and Editor-in-Chief of the Medical Sentinel (1996-2002); Editor Emeritus, the Association of American Physicians and Surgeons (AAPS); Author, Vandals at the Gates of Medicine (1995), Medical Warrior: Fighting Corporate Socialized Medicine (1997), and Cuba in Revolution: Escape From a Lost Paradise (2002).

This article may be cited as: Faria MA. Faria: ObamaCare — Politics and Constitutionality. HaciendaPublishing.com, March 27, 2012. Available from: https://haciendapublishing.com/faria-obamacare–politics-and-constitutionality/.

An edited version of this article was published in GOPUSA.com on March 20, 2012.

Copyright © 2012 Miguel A. Faria, Jr., MD