The Ethics of Corporate Socialized Medicine

It is the free mind and individual responsibility, the principles of the Renaissance that have brought us the wonders of modern health care through the free-market capitalist system and through the inventiveness of the free minds it has raised. It seems we are now going to harness the capitalist engine for rationing….

It seems that we in America are about to embark on an accelerated venture of harnessing the capitalist engine for the destruction of healing…. For instance, the terms managed competition we hear in all these proposals, by sleight of words say the opposite of what they mean. It is competition in management we should be speaking of…. It is the loss of philosophical concepts, the loss of the spirit of free will and individual responsibility represented in these schemes, together with conceptual muddle-headedness which are sounding the death knell to the philosophy of our civilization.(1)

Thomas A. Dorman, M.D.

As we further reflect on what transpired during the health care reform debate of 1993 and 1994, we must realize more than just changes in the U.S. health care delivery system were (and are still) at stake.  As you would remember, the government launched an all-out attack to seize control of the American health care industry, and with it, 15% of the GNP, in one giant scoop. The attack was successfully repulsed by the American public, who rejected the colossal state bureaucracy inherent to that scheme of socialized medicine.

But a clear and present danger still looms on the medical horizon, and that is, corporate socialized medicine in the form of managed care/managed competition. Where once the supreme medical ethic dictated that physicians place their individual patients’ interest above their own (and above that of the state) in the spirit of true altruism and charity, today’s ethics of corporate socialized medicine and managed competition propound that the physician place cost considerations and the interest of third-party payers above that of his or her patient. That is, they want physicians to practice what the Swiss philosopher, Professor Ernest Truffer, calls a veterinary ethic that rejects the traditional medical ethic requiring a physician to care for his/her patient according to the patient’s specific medical requirements, in favor of a new ethic which consists of caring for the patient as if he/she were a sick animal, not in accordance with its specific medical need, but according to the wishes of its master or owner—the person or entity responsible for paying the medical bills.(2)(6)

For the first time in the history of medicine, physicians are being coaxed or coerced, whatever the individual case might be, to ration health care by restricting their patient’s access to specialists or expensive treatments—that is, involuntary rationing for the sake of cost containment and as to make the HMOs, for which they work, more efficient and profitable.

Today, physicians are subject to so-called cost-effective analysis and economic credentialing. This is a methodology by which hospitals and health care networks (particularly HMOs) use utilization review data about physician medical practices (not to determine quality, but to monitor financial impact). Physicians who have not been cost-effective, that is, they have not been stringent in their restrictions (or who treat the sickest and most difficult cases and thereby incur the most costs in their communities), may have not only their bonuses withheld at the end of the year, but could also lose their membership status in hospitals or health care networks when they apply for new, additional, or renewal of clinical staff privileges.

Major health care networks are acting in collusion with government bureaucrats and policymakers to impose managed competition, and to change the time-honored ethics of the medical profession. Much about this cozy relationship between government bureaucrats and private health care mega-corporations has come to light, at both the state and national levels.

At the state level, we have the case of Minnesota where a private foundation, working hand in hand with members of the governmental Interagency Working Groups, has instituted a bureaucratic, “Clinton-Lite,” statewide health care system.(3)

At the national level, thanks to the lawsuit (AAPS v. Clinton) filed by the Association of American Physicians and Surgeons (AAPS) against the Health Care Task Force headed by Hillary Clinton and Ira Magaziner, we again have the case of corporate special interests seeking to change the American health care delivery system, to revamp it and make it more to their liking and directed towards their own financial benefit.(4,5) In both the state and national scenarios, big foundations and mega-corporations, with a vested financial interest in managed care (HMOs), militated behind closed doors under the auspices of the government to implement managed competition as the method of health care delivery for the entire nation. The concept of managed competition (or corporate socialized medicine), with managed care and gatekeepers as centerpieces and cost containments as its raison d’être, threatens the supremacy and the sanctity of the patient-doctor relationship and the ability of the physician to do ethically all he/she can for his/her patients.

We must remain vigilant and cognizant that under the guise of cost containment, the health care debate during the rest of this decade does not deteriorate into incremental reforms directed at covert rationing of medical care, and that quality and technology are not sacrificed on the altar of expediency and deceit. With managed care, Dr. Thomas Dorman, an AAPS physician member from California, asserts that the profitable incentives for cost containment are so irresistible as to constitute “competition in rationing.”1 In fact, it can be argued that the whole scheme of managed competition is the profit motive for the mega-corporations and competition in rationing for the rest of us.

The lessons of history sagaciously reveal wherever the government has sought to control medical care, medical practice, or physicians, 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 in the hands of the state. Physicians must not falter at this crucial moment. We should not allow neither the government nor the powers that be (or corporate socialized medicine and managed competition) to change the noble ethics of the House of Medicine or adulterate the sanctity and trust of the patient-doctor relationship.

There is a 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 medical care is ever fully implemented in America, patients can rest assured they will be greatly affected. They will find that their new physicians dare not advise them what is best for them, but will do as they are told by government bureaucrats and/or government-controlled, token, third-party networks. Gone will be the independent-minded physicians of yore who took medicine to its pinnacle, free of government intrusion and coercion, 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 will be patient and physician autonomy.

The reality is that the government-inspired false “ethics of caring,” is based on what is actually closer to Professor Truffer’s veterinary ethics, an ethic that forces physicians to act in the interest of the government or corporate entity as third-party payer, rather than in the interest of their patients; mandates coercive compassion; responds only to pressure by politically-powerful special interests; and insists on statism and collectivism to solve the world’s problems, rather than on the philosophical notion of free will and individual initiative.

For physicians, the impending change in the ethics of the medical profession, as it relates to the patient-doctor relationship, is of paramount importance. In fact, it is my profound belief that this transformation in the time-honored ethics of the patient-doctor relationship will be the defining issue for the rest of this decade. It will determine the physicians’ place in the general scheme of things, both in the professional realm of medical practice, as well as in their civic and social position in society. Will they remain committed to their patients in the tradition of Hippocratic medicine (and for others to the Oath of Maimonides), or will they succumb to veterinary ethics and the specious notion of doing what is “best for society” (and the managed care entity that employs them)? Before answering this question, let us remember both Socrates’ admonition, nosce te ipsum, “know thyself,” as it pertains to our role as healers and physicians, and Hippocrates’ counsel, primum non nocere, “first do no harm”—for the future of the profession and the health of our patients hang in the balance.

References

1. Dorman T. Managed care newsletter. San Luis Obispo, CA., February 1993.

2. Faria MA Jr. Vandals at the Gates of Medicine—Historic Perspectives on the Battle Over Health Care Reform. Hacienda Publishing, Inc., Macon, Georgia, 1995, pp. 240-242.

3. Hartsuch D. Beware of state health reform—inside Minnesota care. J Med Assoc Ga 1995;84(1):17-22.

4. Brown KM. Doctors fight government intervention with judicial activism. J Med Assoc Ga 1994;83(8):459-464.

5. Orient J. White House releases task force documents. J Med Assoc Ga 1994;83(12):711.

6. Goodman WE. Canadian Medicare: A Road to Serfdom. Presented at a AAPS  meeting in Toledo, Ohio, April 20, 1990. Dr. Goodman cites Swiss Professor Ernest Truffer and his medical philosophy of freedom in medicine.

Written by Dr. Miguel Faria

This article, which originally appeared in the April 1995 issue of the Journal of the Medical Association of Georgia as Dr. Faria’s “Editor’s Corner,” was subsequently updated and re-published as Chapter 22 in Medical Warrior: Fighting Corporate Socialized Medicine (1997). It has been posted here and is now accessible on this website for the benefit of our readers.

Copyright ©1992-2021 Miguel A. Faria, Jr., MD

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1 thought on “The Ethics of Corporate Socialized Medicine”

  1. Hi Russell and Miguel,
    I talked with the Editor of the CANS July Newsletter and he gave me a lot of excuses why they could not publish the paper. It was too long, and would take 10 of the 20 pages of a month. He would rather publish the histories of the medical centers in California. He thought it was well written and thorough. He did not know about the Covid information we wrote, He thought the Legislature’s new regulations suppressing Speech were just about Covid! He did not know about Ron Johnson’s Senate findings; This is the most pressing issue physicians face, but he just wanted to edit a newsletter. That should tell you what he represents. Unfortunately, the more I read the more I encounter this same type of attitude. Total denial and fear of taking a stand. People just do not look at what is happening, connect the dots, and understand the implications of what is happening. We are the early reactors. Those who want to treat a disease before it becomes incurable. I think things will have to get much worse before there is a chance they will be improved. Not enough people understand what is happening.

    Basically as I have known him for years, he is politically correct, avoids controversy, and wants to be friends with everyone. I learned in school that a strong man has enemies; the weak have none. I accepted Russell’s revisions which I thought are excellent.
    I made some modifications. I will put it aside for a bit while I return to other things I need to finish first. I Appreciate your help. — Jose
    —–
    Dear Jose,
    Your comments about the CANS Newspaper editor “Unfortunately, the more I read the more I encounter this same type of attitude. Total denial and fear of taking a stand… as I have known him for years, he is politically correct, avoids controversy, and wants to be friends with everyone.” That reminded me of something momentous said by the greatest neuropathologist, the Spaniard genius who traced the neuroanatomy of CNS with his silver staining and other methods, Santiago Ramón y Cajal (1852-1934), who back in the 19th and early 20th centuries admonished us about the same people we face today in medicine’s leadership, as you can read in the introduction to a speech I gave, later turned into a Chapter in my book, Medical Warrior.

    Retrieving the quotation for my files I found the context in which I used Ramón y Cajal ‘s affirmation and — PRESTO! it was in context of my resignation to the Editorship of the Medical Association of Georgia, which is attached — “Censorship and editorial lynching in the deep south”! We are the three musketeers, Jose, Russell, and I, and we have all encountered the monster within the belly of the medical censorship: herd mentality, cowardice, apathy and above all complaisance (Aristotle’s description of the attitude of the slave) — and, as Ramón y Cajal stated, those cowards who are willing to lie and accept lies!

    Incidentally I called Dr. Al. Ma. a coward to his face at a meeting of our county society in Macon, a joint meeting with the auxiliary (doctors’ wives). You should had seen their faces. Dr. Ma. only bowed his head at the head of the meeting after my resignation! The hypocrites sent me an award a few weeks later (attached)! My dear friends and medical warriors, I’m attaching my resignation speech without further comment. That was 1995!— Miguel. P/S. I know you guys have plenty to read and read this years ago, but I thought it was very apropos! — Miguel A. Faria, M.D., is Associate Editor in Chief in neuropsychiatry; history of medicine; and socioeconomics, politics, and world affairs of Surgical Neurology International (SNI)
    —–
    Dear Miguel,
    Your comments about the MAG are exactly what was happening and is happening today. Every day Carol and I are disgusted with that attitude we see everywhere. Biden who is not running the country because he is incapable of doing that mentally and has been even before inauguration. He is the puppet of Obama. We are living in the third Obama term. It is the only way to explain everything that is happening. Obama’s goal is to intentionally destroy the USA. It is plain as anyone could see but most are living in Denial. Same as in the MAG. I understand why you were angry with them and your comment about the President at that time as a ” coward” was accurate. No one wanted say that or hear it. But that was the truth. Same with the CANS editor. I see this attitude throughout Medicine. Doctors are brainwashed into submission by propaganda they do not understand. They are supposedly smart but are actually dumb. We call that vertical intelligence. Give me that average person any day. They’ll have common sense.

    When Carol and I were in China many times, we saw the effects of the one child policy. They are raising Self Centered children. At the time we wondered what the world would be like when these people assume control. We are seeing it right now. Interestingly at the same time in the USA was the Boomer revolution, which rejected all history. “Do not believe anything anyone over 30 tells you” was the mantra. So we have two sets of young people growing up all over the world, one in the West and the other in China both of whom are self consumed and pampered. That leads to an economics of “I want what I want now”. No delayed gratification as in a child. With that comes unbelievable debt explained by the ‘Modern Monetary Theory’ which says it does not matter what you spend because you print the money. So, there is no real debt. That is what they believe. The only saving grace here is that we are headed into a major Depression worse than. Worse than the 1930s. That will be a wake up call, if its not too late. The one factor that moderates all of this is that there is no Excellence in the world today except likely in Israel. Every country is in Debt and has the goal corruption I have outlined. Maybe not India. I am not sure about that. So everyone will be suffering at the same time. It is the opening for a dictator and the Promise of Utopia.

    We also remember seeing a TV report on the young, who were 18-24 about 25-30 years ago, being asked about ethics and Right vs. Wrong. The answer is, there was no right or wrong. ” it is OK if you can get away with it” Lying, cheating, stealing. Murder? The answer was I have to think about that! 40% of the people that age agreed with that philosophy. No ethics, no morals, no character! That is also what we are seeing today. Is that all fixable? Long after I am gone, maybe. So thanks for the history note. It is present history also. — Dr Jose Gausman, California
    ——
    Hi Miguel,
    I remember those times, although since I had not yet been introduced to you, I was not aware of the ugly details of your betrayal at JMAG as they were happening. I only found out about them later, as you unfailingly refused to sweep under the rug the cowardice and collusion of your spineless “friends” in MAG. Your observations about human nature are right on the mark. Our colleagues are generally weak and compliant. They would rather live with knowing they betrayed a colleague and their own morals, than to actually stand up against injustice. I wonder if you use their wall plaque for target practice. Roxanne and I are doing well despite our orthopedic challenges. We are learning how to care for a diabetic cat! Life in California grows crazier as Warden Newsom throws a legislative temper tantrum, pushing a bunch of new restrictions on concealed carry and junior shooting programs, including Olympic junior shooting (we’ve been through that one before). I believe a litmus test for our next GOP presidential candidate should be whether he will deploy federal forces to ensure compliance of rogue governors defying the SCOTUS decision in NYSRPA v Bruen. There is precedent in our lifetime, when Eisenhower nationalized the National Guard and sent the 101st Airborne to Arkansas after Gov. Orval Faubus blocked nine black students from entering their high school in Little Rock. This was in defiance of Brown v Board of Education. Don’t be a #Faubus! Below is my pinned tweet. —My best to you and Helen, as always, Tim. PS—The name of Ramón y Cajal and silver staining of nerve tissue is very familiar to me. I remember the name from my pathology studies. What I didn’t know is that he was not a typical academic shrinking violet.
    —–
    Dear Miguel,
    I went through much the same thing with the State Medical Society, County Medical Society and the staff of my hospital in High Point, NC–most were yellow cowards. I eventually left and moved to MIssissippi only to find much the same here. I fought the HMO effort tooth and nail, with only a handfull of us fighting the fight. I left North Carolina in disgust. As you know, everything I told them would happen indeed happened and one of my chief opponents asked me to write something in their defense–you published my response on your website. All three of us have faced the storm and our families suffered right along with us–but held firm. I find the medical profession an embarrassment and have divested myself from all. They are happily regimented and controlled by elites–so to hell with them. Bless you both for continuing the fight.—Russell. Russell L. Blaylock, M.D., Theoretical Neuroscience Research, LLC, Associate Editor-in-Chief; Neuroinflammation Section, Surgical Neurology International

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