I take the helm of the good ship AAPS in turbulent weather and uncharted waters. A storm has been brewing in this country for the past 100 years, but recent events have created conditions for a “perfect storm.”
A frontal system with very low pressure blowing in from the Midwest has installed a radical leftist ruling cabal in the White House. This junta is increasingly totalitarian, and has infiltrated all parts of the Executive Branch, including the Department of Justice, the Internal Revenue Service, the Environmental Protection Agency (which was already a hotbed of Marxism), and increasingly, the Judicial Branch. This cabal has intentionally set out to destroy the U.S. Treasury through outrageous deficit spending, massive redistribution of wealth, punitive taxation, unhindered expansion of the regulatory state, nationalization of industries, and finally, the passage of a leviathan entitlement known as “ObamaCare.” The President, acting more like the late Hugo Chavez every day, ignores Congress and the will of the people. He fails to enforce laws he doesn’t like, rewrites laws to suit his political fancy, and creates new
laws with executive orders and memoranda.
The ship of state is taking on water at a scary rate. Even more alarming is the failure of our bulkheads to contain the disaster. Congress has refused to effectively exercise its power of the purse, despite Republicans having taken control of the Senate and having increased their majority in the House. Within a day of the stunning midterm election, Sen. Mitch McConnell (R, Ky.) stated in response to a question that they would not shut down the government and default on the debt (as though the two were related; they are not). Congressional Republican leadership quickly surrendered its considerable power to the dictator-in-chief. Given such cowardice, impeachment, the other congressional remedy for a lawless president, is off the table. These are indeed uncharted waters—a rogue president, with two long years left, pursuing an anti-American agenda, and a feckless Congress unwilling to stop him. The American people are simply unrepresented in the nation’s capital.
Converging from the south with this fearsome socialist nor’easter is a tropical depression known as crony capitalism. Special interests, including the “medical- industrial complex,” “Big Labor,” “Big Information,” AARP, and AMA, have gained enormous power within Congress and the Executive Branch, and are pushing independent medical practitioners into a vanishingly small corner.
Consider that in fewer than 10 years the proportion of physicians in private practice has dwindled from two- thirds to one-third. Independent doctors are being price- controlled and mandated out of existence by Medicare, “Big Insurance,” “Big Information,” and into the open arms of “Big Hospital.” Since medical services typically cost twice as much when delivered in the hospital setting, total spending will increase. And doctors, once ensconced in salaried positions, are likely to become less productive. This will exacerbate the doctor shortage and worsen patient access to good physicians.
Doctors will be constrained by hospital contracts, such as the Accountable Care Organization model, and will be under pressure to limit spending. The stated goal of central planners, and many academics, is the elimination of fee- for-service payment for medical services. Erroneously blamed for cost inflation, fee-for-service practice is all that assures timely care. Its elimination will certainly lead to long waiting times for medical care. It will also spell the end of private medical practice.
“Big Pharma” will also get its piece of the action. More patients will have access to prescription drugs through Accountable Care Act third-party contracts, again involving overpaid middlemen called “pharmacy benefit managers.” And doctors will be pushed into over-prescribing these drugs to mostly healthy people by practice guidelines that will be built into the electronic health record.
“Big Information” is rewarded as EHR use becomes mandatory. The main purpose of the EHR is to furnish clinical information (“meaningful use”) to the government and to other third-party payers. There is zero chance that this information will remain confidential.
“Big Labor” also benefits from expansion of Medicaid. Most of the billions of Medicaid dollars flow to hospitals, whose employees are often under SEIU/1199. Remember that Andy Stern, the Communist president of SEIU (Service Employees International Union), was the most frequent White House visitor during Obama’s first term. I fear that hospital physicians will be squeezed by management and forced into SEIU contracts.
And so the Perfect Storm (with apologies to Sebastian Junger) has arrived. Totalitarian central government, supported by moneyed industrial and labor interests, combine to destroy the private, independent physician. AAPS is an old but well-built and seaworthy ship, manned by a competent and courageous crew. We are guided by the pole star of “Omnia pro aegroto,” or, all for the patient. We will weather the storm, and chart a course back toward the safe harbor of constitutional government, where the rights of individuals to choose their physicians and their medical care are safeguarded as sacred.
