Volume 75, no. 5 May 2019
How many times have you heard, from organized medicine, that the “train has left the station,” and you need to be on board, or that the train of socialized medicine is unstoppable?
Fans of old Western movies know that trains were stopped in many ways. Recently, the 2010 action/thriller movie Unstoppable was inspired by the true story of the 2001 CSX 8888 or Crazy Eights incident of an unmanned runaway freight train with several cars carrying a highly toxic and combustible chemical.
I thought the film was an unintended metaphor for Medicare. The incident started with human error. At first there was denial of the seriousness of the problem: the train was called a “coaster,” but it was running at full throttle with plenty of fuel. Upper management declined to derail it while it was passing through farmland because they didn’t want to destroy valuable property while it could be stopped. Efforts to slow it from the front ended in disaster, and “777” hurtled at 70 mph toward a curve, in a densely populated city, that required slowing to 15 mph.
The movie featured two unlikely heroes: a veteran engineer (Denzel Washington) who was being forced into early retirement, and a young conductor (Chris Pine). The rookie was unhappy about working with someone from a “retirement home,” and started out by making a nearly fatal error of adding too many cars to the train. When the “777” situation became clearly desperate, the old guy, over objections and threats from management, decided to uncouple his locomotive and chase the runaway. They caught it, hooked onto the rear, and tried to slow 777 by accelerating in the opposite direction. The engineer then made a harrowing run along the top of the train to set handbrakes on individual cars. Ultimately, another unauthorized hero raced 777 in his car, and the conductor was able to jump into the cab and take control.
The “Third Rail”
With Medicare, the “third rail” of politics, the U.S. is still in a state of denial. Fueled by inexorable demographics, Medicare is destined to crash and burn as 777 would have if unstopped, and the eventual carnage increases with each delay in confronting reality. Incremental tweaks in benefits, tax increases, and covert rationing (DRGs, ACOs, MIPS, etc.) are not slowing runaway spending. Politicians, bureaucrats, and corporate middlemen not only resist genuine solutions, but threaten those who offer them.
Now the “democratic socialists” lining up to run for President want to add still more cars to 777, which is the leading edge of socialism in America. This makes sense for a Ponzi scheme—one delays the day of reckoning by attracting new “investors.”
It appears that the only hope is a rear-guard action—by older Americans who have experienced freedom, and younger people awakening to the destruction of the American dream. We need free-enterprise solutions to pull in the opposite direction and to use every possible braking mechanism. And we need a leader who is dedicated to stopping socialism to leap into the control cab. Destroying this prospect seems to be the obsessive preoccupation of the American Left and its allies.
Cutting Off the Fuel
Bernie Sanders, Alexandria Ocasio-Cortez, and other Democratic Socialists energize their base with visions of the paradise just around the treacherous bend, even though no socialist train has ever made it there. On his Facebook page, Bernie Sanders posts, under an upbeat video: “Take a look at what Finland, the happiest country in the world, is doing. If Finland can provide everyone with health care, send everyone to college for free and provide affordable child care, why can’t the US?”
In fact, Finland can’t do it either. Prime Minister Juha Sipilä and his cabinet members have resigned after failure of reforms said to be necessary to safeguard the medical system’s financial stability. Sipilä’s proposal, opposed by trade unions, would have given citizens vouchers to receive care from private clinics “if a patient cannot access services provided by a county-operated utility within the time frame laid out in the treatment guarantee.”
The report of his difficulty getting care for his feverish 6-year-old daughter in Finland “isn’t some nightmare vision of the NHS,” writes a man who recently moved from Britain to the country “normally lauded as the shining example of a successful welfare state.” He resorted to a private doctor, as many Finns do for timely or life-saving care (The Guardian).
While U.S. voters support seemingly free care or universal coverage, and are two-to-one in favor of guaranteed issue/community rating, the proportion flips to two-to-one opposition if quality reduction results—whether through less access to tests, treatments, or top specialists or through long waits. As Michael Cannon points out, the Affordable Care Act (ACA) may have increased the number covered, but it has worsened coverage for the sick.
Also, according to the Kaiser Family Foundation, 60% of Americans oppose Medicare for All if it would raise taxes or eliminate private insurance, writes Stanley Feld, M.D.
We need to rupture the fuel line of delusions.
It is up to us. Physicians and patients must implement and support initiatives that pull medicine in the direction of freedom. They must apply brakes to socialist proposals at all levels, and spread the truth about socialist failures and dangers.
Medicare Called “Swiss Cheese Coverage”
Although Medicare was supposed to protect the elderly against catastrophic medical costs, catastrophic coverage is exactly what it lacks. The burden of medical spending (out-of-pocket expenses as a percentage of income) is much higher among the elderly than among those below age 65. Those in the lowest quintile of income spend nearly 42% of their income on direct medical expenses or insurance premiums. A near-poor family purchasing coverage on an ACA Exchange is guaranteed never to have to pay more than 15.5% of income on health care in a year. To make ObamaCare look budget neutral, lawmakers relied on diverting $1.3 trillion in resources intended for Medicare. The estimate of Medicare’s unfunded liabilities of $37 trillion over the next 75 years is grossly understated as it rests on a pyramid of highly unrealistic assumptions about how aggressively Medicare can reduce payments to doctors and hospitals (Chris Conover, Forbes).
What would happen to the elderly under Medicare for All?
Features of Bernie’s Utopia
In-Car Deliveries: Because the nearest maternity ward may be 125 miles away, Swedish parents-to-be are taught how to deliver a baby in a car, and some have had to do it. The number of hospital beds is declining.
Patient-Physician Relationships Gone: Swedes complain that they can’t see their own GP. Patients are being seen by temporary hires provided by outsourced staffing companies. Telemedicine has mushroomed. Physicians are complaining about the fragmentation of care, with little chance for follow-up (ibid.).
Games Doctors Play: To keep their earnings up, some Canadian physicians, like humans in any government-controlled health system with scarce resources, may engage in “time shuffling,” “upgrading,” “injury enlargement,” “ping-ponging,” “service splitting,” and more.
Overseers: “Canada’s once-free physicians soon realized their entire profession was going to be overseen…by medical police,” writes William Gairdner. “There would be strict state control and scrutiny of fees, fines for contraventions of the act, and queries from government inspectors about the ‘reasonableness’ of additional treatments or referrals to specialists. My own general practitioner (GP)…has remarked to me often, when I inquire about possibly being allowed a certain additional treatment, ‘Well, I don’t suppose that would be an abuse of the system’” (ibid.).
eSnooping: Any medical officer of the Canadian state has the right to review a citizen’s electronic health record (ibid.).
Disease: Socialist Venezuela is an “exploding supernova” of infectious disease because of a collapsed medical system and refusal to allow outside aid. Authorities under Maduro have concealed health information and retaliated against those who collect data or speak out about food and medicine shortages. Measles, diphtheria, and malaria rage. There are also leprosy, typhoid, tuberculosis, AIDS, Zika, dengue, chikingunya, and others previously long eradicated.
“We make men without chests and expect of them virtue and enterprise. We laugh at honor and are shocked to find traitors in our midst. We castrate and then bid the geldings to be fruitful.”
C.S. Lewis, The Abolition of Man
Canada’s Insatiable Pac Man: By 2017, Ontario’s costs for socialized medicine had reached 44% of government expenditures, and are projected to rise to 80% by 2030, eating up every other public service (Gairdner, op. cit.).
Medicare Spending Snowballs: Total Medicare spending is expecting to balloon to 5.9% of gross domestic product by 2038—up from its 2018 level of 3.7% of GDP, according to the latest Medicare board of trustees report. More than 10,000 Americans age into Medicare every day. By 2030, the percentage of Americans 65 years and older will outnumber those under the age of 18. The Hospital Insurance Trust Fund expenditures exceeded its income by $1.6 billion in 2018 alone.
100% Wealth Tax Not Enough: As Chris Conover demonstrates in a three-part series, the unfunded liabilities of Social Security and Medicare alone exceed total U.S. household net worth (tinyurl.com/yygox2qc). This projection assumed payment rates so low that half of all hospitals would have negative margins; more realistic projections show the gap is much worse. Every year’s delay in addressing the problems makes needed adjustments more severe. Considering all spending by federal, state, and local governments, the fiscal gap in 2017 was a quarter of a quadrillion dollars, nearly 2.5 times all household wealth.
Can Venezuela Recover?
Economic miracles happen, writes Lawrence Reed of the Foundation for Economic Education (FEE), citing postwar Germany and Hong Kong. “How does a nation brought low by socialism recover? Answer: Liberty!” The blueprint for recovery must begin by learning the lessons from the past 20 years:
(1) “Socialism neither is nor has any theory of wealth creation.” (2) “Socialism concentrates power in the hands of a few.” (3) “Socialists are demagogues. They divide society into classes and set them up to wage war against each other….” (4) “Socialism is a disaster in both spiritual and material terms. It’s fueled by perpetual anger and victimology.”
A new government of Venezuela must have respect for the rule of law, an independent judiciary, freedoms of speech, press and assembly, a sound currency, secure property rights, and a choice-based education system. It must not only remove corrupt officials but also close the door to the granting of special favors by government.
With such reforms, the U.S. could also experience a new golden age instead of continuing into the vortex of socialism.
May 4. Missouri chapter meeting, Kansas City, MO.
Sep 18-21, 2019. 76th Annual Meeting, Redondo Beach, CA.
Sep 30-Oct 3, 2020. 77th Annual Meeting, San Antonio, TX
Judge Upholds MMR Mandate in NYC
Brooklyn Judge Lawrence Knipel dismissed a lawsuit brought by five parents who complained that the city had overstepped its authority in overruling religious exemptions and imposing hefty $1,000 fines on both adults and children who declined MMR during a measles outbreak (AAPS News, April 2019). “A fireman need not obtain the informed consent of the owner before extinguishing a house fire,” Knipel wrote. “Vaccination is known to extinguish the fire of contagion.” Three civil summonses have been issued to parents who failed to comply with the mandate; if they fail to appear, they could be fined $2,000. The purpose of the fines, said Health Commissioner Oxiris Barbot, is “to enlist as many people as possible spreading the message that these vaccines are safe and effective.”
According to attorney Mary Holland, the Dept of Health, on the eve of the hearing, issued a new resolution removing all criminal sanctions and the implied threat of forced vaccination.
Millions Paid to Two Autistic Children
The U.S. government has not admitted that vaccines can cause autism. However, the Vaccine Injury Compensation Program (“Vaccine Court”) has just ordered multimillion dollar awards to two children for “encephalopathy,” a Vaccine Table Injury. The autism spectrum disorders they developed might not be the result of the severe damage they suffered. Both cases were filed in 2003, and the families have been fighting for compensation ever since. Most records are sealed; only limited information is available. One child’s mother said: “It’s a constant fight when you have a vaccine-injured child. It’s not just the disability, it’s the ignorance. The hatred from the medical community towards families like ours is intense.”
ND Protects Docs from MOC Discrimination
North Dakota passed a law limiting hospitals’ ability to deny staff privileges based on nonparticipation in Maintenance of Certification (MOC®). It also provides that insurers may not exclude physicians based solely on a physician’s decision to not participate in MOC, including basing a physician’s network participation on any form of MOC participation or status, nor may it “discriminate with respect to reimbursement levels based solely on a physician’s decision to not participate in any form of [MOC].” AAPS tracks laws related to MOC® here: bit.ly/mocbills.
In 2017, the AMA rejected a resolution to develop model state legislation that would bar hospitals, healthcare insurers, and the state medical licensing board from using nonparticipation in MOC programs as an exclusionary criterion for credentialing. Instead, AMA will profit from getting its programs accepted to meet some MOC requirements.
Tip of the Month: Physicians have a First Amendment right to post their own prices on their own website, as long as the prices are not set in collusion or agreement with anyone else. Antitrust laws in this context prohibit only price-fixing, which are unlawful agreements among multiple businesses to set prices. If any medical board regulation is to the contrary, please let us know and we will consider challenging it by asserting your constitutional rights.
Judge Blocks Association Plans
One of Trump’s initiatives to permit more Americans to buy affordable health insurance has been derailed by Judge John D. Bates of the Federal District Court for the District of Columbia, who called it an “end run” around ACA. The Trump rule allowed small employers and self-employed persons to take advantage of the same relief from ACA rules that is enjoyed by large employers under the Employee Retirement Income Security Act of 1974 (ERISA). President Trump said the rule would allow small businesses to save massive amounts of money and have better medical care. New York and ten other states sued in NY v. U.S. Dept. of Labor (NY Times 3/28/19).
AAPS Files Amicus to Defend Jury Verdict
After 20 years of litigation, Terrence Babb, M.D., finally won a jury verdict awarding $5.5 million in damages against Geisinger Clinic for wrongful termination. Geisinger appealed to overturn the verdict. It also argued against paying prejudgment interest, arguing that Dr. Babb was able to partially mitigate the harm—by doing often-unattractive locum tenems work and even relocating to Alaska. AAPS writes: “Patients are far better off when physicians can practice with the basic security that there will be legal accountability for wrongful actions taken against them.”
Courts Enjoin Title X Changes
Two federal district court judges in Washington and Oregon have ordered a temporary nationwide ban on Trump Administration restrictions on Title X funding to clinics that do not separate abortion services from family planning and other health services, or that refer patients for abortion (see AAPS News, April 2019). This was in response to a lawsuit filed by the AMA and Planned Parenthood.
OD Deaths Ruled to Be Second-degree Murder
In July 2012, Dr. Hsiu Ying Lisa Tseng, who operated a general medical practice with her husband in Rowland Heights, Calif., was arrested and charged with three counts of second-degree murder in the deaths of three patients for whom she had prescribed controlled drugs. She had treated one patient for 3 years, one for several weeks, and one had made just one visit. In one patient, she prescribed methadone at his request to treat his OxyContin addiction. Because Dr. Tseng was not a licensed addiction specialist, this was called “an extreme departure from the standard of care.” In another patient, Dr. Tseng told investigators that her goal had been to wean him from opioids and that she had reduced the doses of the drugs he had been taking by 80%. Prosecutors stated that such a drastic reduction would lead to withdrawal and that her prescriptions likely increased his potential for overdose because she failed to verify the doses of the earlier prescriptions from other physicians. On appeal, the doctor argued that though she acted with negligence sufficient to support convictions for involuntary manslaughter, there was no evidence she acted with “conscious disregard” for her patients’ lives. The Los Angeles-based Court of Appeal upheld the convictions based on the doctrine of “implied malice.”
MSSNY Is Aboard. In its latest issue of eNews, the Medical Society of the State of New York writes: “MSSNY reaffirmed its opposition to the concept of single payer. MSSNY will continue to consider the feasibility of other payment methodologies including single payer and will also continue to work collaboratively with physicians who both support and oppose such proposals in order to assess the strengths and weaknesses of such proposals. MSSNY will continue to advocate that physicians are ensured direct input and ongoing involvement on all aspects of any single payer system or other system that may be considered by the New York State Legislature or United States Congress.”
If extreme straddling were a sport, MSSNY would be an Olympic champion. They oppose single payer but will still consider it, and if we are going to have single-payer totalitarian medical care system, they want a “seat at the table” to provide input. This is lunch debating how they will be eaten.
Lawrence R. Huntoon, M.D., Ph.D., Lake View, NY
Vaccine Safety. People often miss the distinction between appreciating the value of vaccines, in general, and the fact that there is currently no oversight in the safety and efficacy of vaccines. Vaccines are a $60 billion/year business, so I suggest that blindly accepting their safety is contrary to everything we know about how pharma operates. Vaccines have adjuvants, such as aluminum, which are included solely to stimulate an immune response to enhance vaccine effects. Therefore, a vaccine by design produces an inflammatory response, the magnitude of which varies across individuals. A recent pilot study (tinyurl.com/y33cgtyh) compared the health of vaccinated vs. unvaccinated U.S. children. One criticism is that it was based on parental recall rather than on actual medical records, but if memory failed, it should’ve randomly failed equally for both groups. Mawson et al. found that while vaccinated children have less chickenpox and pertussis, overall they have much poorer health, including a three-fold higher incidence of neurodevelopment disorders (p < .001).
David Diamond, Ph.D., Tampa, FL
Media Quashing Disease Reports. Information on illegal aliens bringing in disease is actively suppressed. Fox News has banned the National Association of Former Border Patrol Officers from appearing. The Mexican newspaper El Imparcial reports 25,000 cases of tuberculosis in Mexico City, where it is the leading cause of death. Outbreaks in Somalis in Minnesota and acute flaccid myelitis in Colorado in 2014 are particularly hard to cover up.
Zack Taylor, NAFBPO, Rio Rico, AZ
Compulsory Vaccination Violates Rights. Mandatory medical treatment such as vaccination violates the Charter of Fundamental Rights of the European Union (tinyurl.com/367mr2), articles 1, 3, 4, 6, 10, 11, 12, 20, 21, 24, 41, 42, 51, 52, 53, 54. Web giants that are announcing plans to “curb anti-vaccine propaganda” are breaking the same articles.
It is in theory possible for measles vaccine virus to cause a measles epidemic, especially since an “epidemic” can now mean more than two cases. Reverse transcriptase polymerase chain reaction (RT-PCR) can distinguish the wild type from the vaccine strain. The problem is that the authorities will not want to confirm the theory because that would upset the population.
A case of brother-to-sister transmission of apparent measles after an MMR injection was described in The Lancet 2/4/89, with the suggestion to use caution when vaccinating children who have an immunocompromised sibling.
Björn Hammarskjöld, Ph.D., Mora, Sweden
Collusion. The “sudden” infatuation of the West with socialism/communism has been developed over decades. The Kremlin’s powerful links to and influence over Western political parties, media, and prominent individuals, as revealed in Vladimir Bukovsky’s Judgment in Moscow have prevented prosecution of the extreme human rights abuses over decades of Soviet rule. Many Americans have even made a cult hero out of former bartender Alexandria Ocasio-Cortez. Remember, Maduro was a taxi driver before he became president and destroyed Venezuela.
Maximizing Medicare Dollars. Some hospitals target every Medicare patient admitted to the ICU, pushing palliative and hospice care, regardless of prognosis. Patient legal paperwork is scrutinized for errors, so if family members disagree with the hospital’s medical plan, the right to make medical decisions for their loved one can be snatched away.
The “Ultimate Right”? Former NEJM editor-in-chief Marcia Angell, M.D., called physician-assisted suicide the ultimate right (NEJM 1/2/97). Embedded in ACA, as a way to reduce Medicare spending by hundreds of billions of dollars over the next decade, are care guidelines based on utilitarian socialist bioethics. This ethic has taken over professional societies. We have entered the macabre age of systematic killing for the collective: malignant misanthropic totalitarianism.
John Dale Dunn, M.D., J.D., Brownwood, TX