Book Review of Vandals at the Gates of Medicine: Historic Perspectives on the Battle Over Health Care Reform. Reviewed by Jane H. Ingraham

A Physician’s Diagnosis

Here is an unusual book; half is a history of Western civilization and half a powerful exhortation against government control of the delivery of health care. Far from being disconnected, these two subjects are thoughtfully woven together by Dr. Miguel Faria, eminent neurosurgeon at Mercer University School of Medicine in Macon, Georgia.

Dr. Faria’s thesis is that a knowledge and appreciation of the hard-won lessons of history, especially the development of medical science and medical ethics over the past three millennia, are essential to solving the health care debate in which we are all embroiled today.

The scope of Vandals at the Gates of Medicine is enormous, taking the reader from the earliest civilizations in Mesopotamia and Egypt through ancient Greece, the Roman Republic, the Roman Empire, the Dark Ages and the Middle Ages to the remarkable breakthroughs of the Renaissance that started us on the road to modern medicine.

The reader emerges with a feeling of awe and gratitude for the brilliance and courage of medical pioneers who often risked (and sometimes lost) their very lives by steadfastly pursuing scientific truth in the face of ecclesiastical superstition and political prohibition.

Faria also confronts his reader with the appalling realization that the tragically short lifespans (often due to childbirth), the horrifying plagues that swept through Europe wiping out huge portions of the population, the suffering, the deaths, and the broken families resulting from ordinary diseases and wounds of war could have been mastered centuries earlier than they were if both man and markets had been free. After reading Vandals at the Gates of Medicine, one ought to be left with a consuming desire to fight to preserve and protect America’s superb medical care, the product of thousands of years of slow, heroic upward struggle.

Dr. Faria is certainly fired up. Something of a Renaissance man himself, he not only practices one of the most demanding medical specialties, but also is profoundly learned in history. In addition he is a prolific writer, holding the position of editor of the Journal of the Medical Association of Georgia, to which he often contributes articles. Perhaps most important, and the reason why he has written this book, Dr. Faria is an articulate, informed leader in the fight against the looming threat of government takeover of the health care industry. Born in Cuba, Dr. Faria, unlike the multitude that takes our extraordinary health care for granted, has a special understanding of what he calls the “mortal danger” facing all of us as a handful of politicians prepares to assume power over the quality and availability of medical care in the name of a bogus compassion.

There is so much of historical interest in this volume that it would be an injustice to single out Dr. Faria’s presentation of any particular age to comment upon. Readers already familiar with the periods covered will be delighted with this new interpretation while those breaking new ground will expand their knowledge. Although Dr. Faria is highly competent in this area, he is at his best when pleading the case for free market principles in general and health care in particular as against government socialist intervention. Many of his pages seem seared with the intensity of his dedication to freedom as the sine qua non of humanity’s welfare.

Rush Toward Destruction

Holding the decline and fall of the Roman Empire as an example of how a government can bring about its own destruction and even an end to a civilization, Dr. Faria sees America rushing down the same paths. He points out that government intervention, not the free market, has caused skyrocketing health care costs which, in turn, are being used as justification for more government intervention. Although the public generally believes that U.S. medicine is based on free market principles, Dr. Faria says that nothing could be further from the truth. Mountains of ever increasing, often obscure, bureaucratic regulations are eating up 25 percent of doctors’ time; a government mandate system determines doctors’ pay; procedures, drugs, and hospital stays are regulated by review boards.

The government’s “free” health program (Medicare) has caused an explosion from 6.5 percent of gross domestic product for health care to 14 percent (and rapidly rising), for the simple reason that the “beneficiaries have no incentive to control costs, but every incentive to demand more services.”

With almost all health costs now paid by either government or insurance, this third-party intervention between doctor and patient has caused patients to lose all sense of spending their own money, as was once the case before we ever heard of a health “crisis.” With market forces thus lacking, the result is that costs continue to escalate. Dr. Faria sees the role of government as making possible tax-free medical savings accounts, which he sees as the basic solution.

Government is also the culprit behind the “litigation juggernaut” which has contributed mightily to escalating health care costs. Those who haven’t already realized the iniquity, inequity, and widespread costs of this explosion of lawsuits will learn of them here. Faria sees socialist-minded judges, predisposed against private medicine and feeding the juggernaut with preposterously high settlements, as a sort of modern-day Inquisition, aided by the legal profession and jurists. Today, blighted careers, early retirement, and an atmosphere of fear are substitutes for the stake.

Faria also condemns the “myths and misconceptions” pedaled by media and government socialists intent upon arousing envy and resentment in order to turn the public against private practice. Here is the genesis of “doctor bashing” — the perception of “greedy” doctors “profiting” from the misfortunes of others. Faria urges physicians to stop making excuses for their income; they earn every penny by their lengthy training, hard work, long hours, individual acts of charity, great responsibilities, and above all, by the value society places upon their services. In ancient Athens, where the Hippocratic school made the profound advance of divorcing medicine from the supernatural with attendant results, physicians were rewarded with prestige and wealth commensurate with their enormous value to society.

Descent Into Barbarism

As Dr. Faria describes the historical consequences of politicized medicine, we understand that if we have been worrying only about “choosing our own doctor,” we had better look a little deeper. Looking at recent history in light of the Hippocratic Oath of “do no harm,” Faria recites horrifying examples of the lethal combination of medicine and government. In the Soviet Union, Nazi Germany, Cuba and Nicaragua, physicians were (or still are) merely another useful state tool, manipulated for “the good of society,” resulting in unspeakable cruelty and untold millions of deaths. In Nazi Germany, physicians “committed nefarious acts for the participating in direct medical killings and systematic genocide because they accepted the “ethical” concept of the state (their employer) of “a life unworthy of life” (i.e., Jews, gypsies, elderly, handicapped, homosexuals, and political opponents).

Of this philosophy Faria states, “This dark descent into barbarism, a product of doctors cooperating with a brutal, socialist state, must never be allowed to happen here.” But already a historic parallel has appeared in the manifesto of the Arizona Affordable Health Care Coalition, a group of citizens and corporations including Cigna, Intergroup, and Blue Cross/Blue Shield, that is designing Arizona’s “managed care” plan. One of the coalition’s policy declarations comes uncomfortably close to the Nazi principle of “the good of society” by calling for “a necessary change of ethical focus” to a “biosocial model that considers not only the health needs of individuals but also the health needs of populations.” These Arizona planners probably have no idea what philosophy they are flirting with. Alas! This is the classic genesis of brutalities.

Dr. Faria chills us even more by showing that a Hitler isn’t necessary for state-controlled doctors to start killing. In the socialist Netherlands today, under Dutch euthanasia statutes, from 10,000 to 12,000 persons are put to death annually — most of them, we are assured, with their own consent. Unless the Dutch government has found a way to change human nature, this is hard to swallow. Even so, what about those who admittedly did not consent? About 80 percent of Dutch family doctors participate in euthanasia — or government “health care” rationing by death. Under socialized medicine it becomes imperative to do away with the most costly: the terminally ill, the elderly, the handicapped, etc.

Dr. Faria is at a loss to understand why physicians haven’t jumped into the fight to save the freedom of their own profession. He points out that our nation’s 653,000 doctors are perfectly placed to do this, but that they seem unaware of their tremendous assets. He urges them to attend regional health care discussions to explain the intent of terms such as managed competition (an oxymoron if there ever was one), employer mandates, global budgets (price fixing), and national health insurance, which is unadulterated socialized medicine. With about three million Americans entering doctors’ offices daily, doctors should be making literature available to patients, should stock their waiting rooms with magazines explaining what is really at stake, and should explain personally to patients what “free, cradle-to-grave health care” is really all about.

Physicians, writes Dr. Faria, “need to awaken to the reality that there is a social, political, and cultural war being fought right now for the heart and soul of America. The battle for the socialization of the health care delivery system is part of that war and must be seen from that perspective.”

Ultimate Consequences

Dr. Faria wonders what will happen to the rights of individuals in the “socialist utopia” to be fashioned by the new world order. “The ramifications,” he says, “are frightening…control of the medical profession by any government is ominous, not just for physicians but even more so for the uninformed public who are the consumers of health care and have the most to lose. Patients are poised to suffer greatly…. When they have the misfortune of failing seriously ill, only then will they be confronted with the tragic realities of socialized medicine: medical shortages, substandard care, medical rationing, and ultimately outright denial of care and government-sanctioned euthanasia.”

One wonders what more potent lesson about socialism Americans need to have than the spectacle of thousands of Cubans rafting across 90 miles of shark-infested waters for the chance of reaching America’s shore. When the dark night of socialism closes around us, where will we raft to? How can we explain the incredible fact that the people of this great nation, with few exceptions, are sitting still and allowing this pernicious thing to happen?

Reading Dr. Faria’s passionate plea is guaranteed to galvanize you into action. Loan the book to all the doctors you know. We, the people, can stop this tragedy from happening. We must not let the gates of medicine fall to the Vandals.

Reviewed by Jane H. Ingraham
Originally published in The New American, October 3, 1994