Under the present developing system of medical care — i.e., managed care and HMOs (corporate socialized medicine), physicians today (including neurosurgeons) are subject to cost-effective analysis or economic credentialing—the methodology by which hospitals and health care networks (particularly HMOs) use utilization review data about physician medical practices (not to determine quality as claimed, but more accurately, to monitor financial impact). Physicians who have not been cost-effective, that is, they have not been stringent enough in their restrictions (or who treat the sickest and most difficult cases and thereby incur the most costs in their communities), not only may have their bonuses withheld at the end of the year, but could even lose their membership status in hospitals or health care networks when they apply for new, additional, or for renewal of clinical staff privileges.
This is bad enough for doctors, but what patients also need to know and understand is that when their physicians get delisted by these networks, they lose their freedom to choose their physician; when their favorite hospital is not contracted by these networks, they lose their freedom to choose their place of treatment and even potentially, their treatment plan. This is not only unethical medical practice, but it is also unfair competition in a mislabeled “free-market.” It is tyranny played out on an uneven playing field.
If, we as physicians do not quickly become proactive during this transitory period, what we are all going to get—under the so-called incremental reforms—will be more of the same—more managed care to satiety, managed care ad nauseam and with it, covert rationing of medical care, quality sacrificed under the guise of cost controls, and in the not-too-distant future, government-sanctioned euthanasia for the elderly, not as acts of self-determination as proclaimed by leading non-physician ethicists, but surreptitiously, encouraged by the corporate state as the ultimate form of rationing.
But how did we end up in this state of affairs with American medicine headed exactly in the wrong direction after repulsing the government vandals battering the gates of medicine (i.e., the utter rejection of the Clinton health care plan of 1993 by an awakened American public)? To answer this question, we need to go back to the pages of history and look at the changes ushered in by the Great Society of President Lyndon B. Johnson in the mid-1960s.
A Modern Trojan Horse?
During that time many people thought that government could solve all of their’s and society’s problems. Physicians were no exception. So yes, many physicians succumbed to the allurement of Medicare and Medicaid in 1965. “After all,” they asked themselves, “why not accept government payments for medical services [formerly] provided pro bono publico to the indigent as charity?” With these questions answered in the affirmative, the physicians listened to the seductive songs of the sirens that weakened their natural defenses to government intrusion. So began the government onslaught that ultimately resulted in the breaching of the walls of the medical profession. This onslaught was launched in tandem with the concerted all-out assault upon the erstwhile institutions of American society that had served America, the land of opportunity, so well. Along with the government inroads into the medical profession, the 1960s saw major changes taking place in the criminal justice system, so that the rights of criminals came to supersede those of the victims. Crime began to pay for itself, and pay handsomely.
It was also at about this time that the ethics of the civil justice system (tort) underwent a serious transmogrification. After centuries of common law tradition, whereby lawsuits were filed only as a measure of last resort, now lawsuits were felt to be good for society, not only as a method of resolving legal disputes, but also as a powerful weapon to effect a more “equitable” wealth redistribution in society. In this egalitarian atmosphere, even contracts were no longer sacred and could be violated with impunity by activist jurists.
The inception of the welfare state of the Great Society, along with the debacle of the Vietnam War, heralded the beginning of the great American cultural decline. It was the beginning of the end of the Golden Age of Medicine and the beginning of the erosion of the patient-doctor relationship. It was also the beginning of the declivity of the erstwhile traditions and institutions of American Society.
On the economic front, the sweeping reforms ushered in the final devaluations of the currency so that after a series of monetary reforms beginning in the 1930s with the policies of the Federal Reserve System, U.S. paper money by 1968 and finally 1971 was no longer backed by gold or silver. The predictable, unrestrained printing of paper money or fiat currency by the Federal Reserve, without precious metal backing, allowed inflation to become a permanent fixture of the American economy. The implementation of wage and price controls in 1971 was then justified to fight the same inflation the government had created. For physicians, their share (19%) of the health care budget pie meant that with inflation, their real earnings, like everybody else, were eroding. So, it was not surprising Medicare and Medicaid, for some, promised a path to financial prosperity. Physicians made more money than ever before with government intervention, but it was at a heavy price, for it carried the hidden cost of our independence.
Progressive government intervention in every aspect of American society heralded the beginning of the decline of the truly individually-based, free enterprise system and the erosion of America’s sense of self-reliance and rugged individualism. And in my estimation, it also marked the beginning of the ebb of Western civilization and the American way of life.
The Legacy of the Great Society
On the social front, despite spending $4.5 trillion dollars, the War on Poverty by all estimations has been an utter failure. In fact, it has worsened the lot of those it had intended to benefit. The traditional family is disintegrating as families are headed not by fathers, but by the faceless bureaucrats of the nanny state; illiteracy is rampant; teenage pregnancy and illegitimacy has doubled, tripled, and is still climbing. In some inner cities, the rate of illegitimacy now exceeds 80%, providing a plethora of grist to the welfare mills.
Likewise, a “generation gap” was created that alienated children from their parents; students from teachers. Not surprisingly, respect for elders and civility were lost. Absolute and universal truths gave way to moral relativism and situational ethics. Immediate gratification and “follow your bliss” philosophy was substituted for hard work, honest living, and deferred gratification. A wall of separation was erected between church and state, and prayer was prohibited in public schools.
On the political front, it was the beginning of the politics of envy to justify the taking of the fruits of the labors of working individuals (via taxation or otherwise) to give to others, not so predisposed. It was and continues to be redistribution of wealth via institutionalized, legal plunder on a grand scale. In the meantime, wealth creation (for some who are not as equal as others) became immoral. Yet, all this time, the government was (and continues to be) getting bigger and more intrusive at the expense of productive citizens. With this legacy, it is no wonder that the bloated bureaucrats are not only consolidating and perpetuating their positions of power and control, but also are dividing and conquering, in Machiavellian fashion, while “inhaling” and imbibing heavily on the divisive and destructive politics of envy.
In every major historic era, the diligent student of history will find epochal events and eerily familiar historic parallels. This is not because history is necessarily cyclical as many learned people believe, but because human nature itself has not changed in the last 6000 years. Human nature and actions, particularly those of strong personalities, are responsible for many of the crucial human events recorded on the pages of history.
Much can be learned from history and frequently, dramatic parallels can be drawn that deserve more than the ignorant neglect or the cursory explanation relegated them by many liberal historians. With this in mind, let us travel back in time to the 3rd century after Christ.
In the years A.D. 244-249, the Roman Emperor Philip, “the Arab,” planned a spectacular series of gladiatorial games and circuses galore to celebrate the 1000th anniversary of the founding of the Eternal City of Rome. He had proclaimed a “New Age.” But this new age was not the New World Order that he envisioned, for the sun had begun to set on the declining Empire.
In fact, the Empire was being assailed by hordes of barbarians from outside her gates and plagued by domestic insurrections and civil wars from within. Rome suffered from decadence, anguish, and unremitting despair. The moral foundations on which Rome was founded had been greatly eroded. And as the scholar Michael Grant had proclaimed, it was a veritable “Age of Crisis.” Emperors were murdered with impunity by their own rebellious troops or by treacherous imperial bodyguards. The Praetorian Guard seemed to possess the power to make or brake emperors at will. For the first time in history, Roman emperors were killed or captured on the field of battle by the foreign invaders. The unthinkable was actually happening: Rome, the former mistress of the Mediterranean, was on the verge of total collapse.
Once again, as history has so often shown, in an instance of impending catastrophe, a great opportunity arouse in the year A.D. 284, when a strong man, the captain of the Praetorian Guard, Diocletian, rose to the occasion and was appointed Emperor. A powerful personality, Emperor Diocletian did not wait for historic cycles, but proceeded to make history himself. And while his military genius is historically evident and indisputable, his political and economic policies were utter failures. Once he had secured the Empire and reestablished law and order, he could have reinstituted the venerated institutions that had served the Roman Republic so well, and for so many centuries.
Instead, Emperor Diocletian abolished the last vestiges of republican rule and established an autocratic system run by a gigantic bureaucracy to administer his new and visionary welfare state. And to pay for it, the currency was devaluated and coins were minted in great numbers. Inflation, predictably, went unchecked. Not surprisingly, stringent wage and price controls were instituted in a futile attempt to check the same government-created inflation and runaway prices. To get their fair share of government subsidies, farmers left their land and hurried to the crowded cities. Fields went unplowed. Common goods became scarce and had to be rationed. Prices soared. Black markets flourished. Riots broke out.
With the economic situation worsening, Emperor Diocletian passed draconian decrees making occupations, trades, and professions hereditary. A man was bound to his trade or occupation for life and so were his children. Failure to abide by these decrees were punishable by death. At the same time, the largest and most ferocious persecution in history was carried out against Christians in an attempt to eradicate Christianity, once and for all. You see, Emperor Diocletian (like most autocrats and dictators) was also in need of distractions and convenient scapegoats.
There were no recognized basic rights to life, liberty, property, or to the pursuit of one’s occupation. Swarms of officers and government agents travelled the countryside harassing the citizenry and enforcing authoritarian imperial decrees. The land was rife with informers (and whistle-blowers) spying on the citizenry and on each other. But these were necessary, “shared sacrifices” for the good of Emperor Diocletian’s new socio-economic order.
Physicians, like everybody else, became part of a trade, and were no longer bound to their revered Graeco-Roman medical ethics, but to the new “ethics” decreed by the state. For physicians, mere survival had become the order of the day. They no longer answered a calling. They practiced a trade highly regulated by the state bureaucracy. Their ethics were now dictated by the government. Medicine declined steadily and centuries later, when the West was in the throes of the Dark Ages, medicine sank to its nadir. Ethical medicine, as had been practiced centuries earlier under the great physicians, Hippocrates and Galen, was only a semblance of its former self.
What Led to this Decadence?
All of the ingredients for the destruction of a civilization had, if fact, been added to the fatal brew. And less than two centuries later, the Eternal City of Rome (although by now christianized) was sacked by the Visigoths in A.D.410, the Vandals in A.D.455, and finally completely overran by sundry Germanic tribes in A.D.476. The Dark Ages followed.
The lessons of history sagaciously reveal wherever the government has sought to control medical care, medical practice and physicians (whether directly or indirectly), the results have been as perverse as they have been disastrous. In our own century, in the Soviet Union and Nazi Germany, medicine regressed and descended to unprecedented barbarism under the direction of the state.
There is a renewed threat of a modern dark age looming on the medical horizon. It is the impending dark age of corporate socialized medicine, and if this form of authoritarian industrial policy for health care is ever fully implemented in America, physicians and their patients can rest assured that they will be greatly affected. Physicians will find that they will be bound to obey new masters—the impersonal, profit-seeking bureaucrats of the managed care megacorporations working under monopolistic government protection. Patients will find that their new physicians dare not advise them what is best for them, but will do as they are told by bureaucrats of the third party networks. Gone will be the independent-minded physicians of yore who took medicine to its pinnacle, who treated their patients as individuals and who placed their patients’ interest above their own, in the spirit of true altruism, philanthropy, and humanitarianism, and within the sanctity of the patient-doctor relationship. Lost forever will be patient and physician autonomy.
For vigilant and informed neurosurgeons, there is no longer room on the sidelines. If we are not successful in our efforts, our fate will be the catastrophic stumble and inevitable plunge down the bottomless pit of corporate socialized medicine, and the enslavement of the medical profession (and neurosurgery) under the yoke of managed care. This plunge would signify the commencement of a New Dark Age of medical care regression, health care rationing, and perhaps, in the not-too-distant future, a brave new world of government or corporate-imposed, active euthanasia—rationing by death—as the ultimate and most efficient form of cost control. You can be sure the brunt of this cataclysm will be borne out, and the responsibility placed, on the shoulders of physicians. The biggest losers will be our patients. Yes, this conflict represents a moral, ethical, and political struggle that we can not afford to lose.
Written by Dr. Miguel Faria
Miguel A. Faria, Jr., M.D. is a consultant neurosurgeon, Editor-in-Chief of the Medical Sentinel, the official, peer-reviewed journal of the Association of American Physicians and Surgeons (AAPS), author of Vandals at the Gates of Medicine: Historic Perspectives on the Battle Over Health Care Reform (1995) and Medical Warrior: Fighting Corporate Socialized Medicine (1997).
This article is based in part on a speech delivered to the member of the Georgia Neurosurgical Society on May 27, 1995, and in part excerpted from Dr. Faria’s book, Medical Warrior: Fighting Corporate Socialized Medicine.
This article may be cited as: Faria MA. Medical Warriors: Fighting Corporate Socialized Medicine in America. HaciendaPublishing.com, May 1, 1999. Available from: https://haciendapublishing.com/medical-warriors-fighting-corporate-socialized-medicine-in-america/.
Copyright ©1997 Hacienda Publishing, Inc.