AAPS News October 2018 – Two Classes

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Volume 74, no. 10

On the eve of midterm elections, America is violently divided. There are “deplorables” (Hillary Clinton’s term) or “dregs” (Joe Biden’s term), who are supposedly the enemies and “haters” of an amalgamation of “oppressed” minorities. The supposed champions of the latter are the ones wearing masks, shouting slogans and obscenities, throwing rocks, obstructing police, vandalizing property, etc. Their political affiliation is Democrat, a party solidly united behind a “progressive” agenda and determined to obstruct anything the party elected by deplorables tries to do.

Preserving “healthcare”—or the Affordable Care Act (ACA) —is at the top of the political agenda, at least until it can be replaced by a Bernie Sanders or Alexandria Ocasio-Cortez style of socialized medicine—a term no longer being shunned.

Actor Jim Carrey, among the richest men in Hollywood, said, “We have to say yes to socialism—to the word and everything,” on HBO’s “Real Time with Bill Maher” show. “We have to stop apologizing.”

Venezuelan journalist Laureano Márquez responded that socialism is not the antithesis of selfishness. In Venezuela, “there is no equitable distribution of wealth; wealth is concentrated, as rarely before in our history, in very few hands.” Márquez explained that people in Venezuela are “at God’s mercy” and are fleeing the country “however way they can” as they do not have access to medication, food, or other basic needs (tinyurl.com/ydzxvaq9).

Instead of denying that Medicare is socialized medicine, health-policy experts say that “Medicare as it exists today—a government-run service for all elderly Americans—is the closest thing America has to socialized medicine” (Washington Post 9/10/18). The Post was criticizing Florida Governor Rick Scott’s tweet: “If you want to protect Medicare, vote Republican. If you want a socialist experiment with Medicare, by all means vote Democrat.”

Making the program more generous for all would only make it better, Democrats argue, but seniors are increasingly opposed to redistributing their benefits to all.

Then-Senator Hillary Clinton’s 2004 statement, “We’re going to take things away from you on behalf of the common good” (https://tinyurl.com/yc6ntlpn) does not appeal to the class on the from side of the redistribution.

 The Oppressors vs. the Oppressed

Setting groups against each other in identity politics is a great tactic for seizing power, but the ultimate two classes are the rulers and the rest. Leftist professors and civil rights defenders think that they will be the ones in power, but former KGB propagandist Yuri Bezmenov stated that would never happen. “Useful idiots” are “instrumental in the process of subversion, only to destabilize a nation.” After that they are no longer needed, and “they know too much” (https://tinyurl.com/ya5e29pa). They get shot.

Bezmenov’s Rules of Revolution are:

1 . Corrupt the young, get them interested in sex, take them away from religion. Make them superficial and enfeebled.

  1. Divide the people into hostile groups by constantly harping on controversial issues of no importance.
  2. Destroy people’s faith in their national leaders by holding the latter up for contempt, ridicule and disgrace.
  3. Always preach democracy, but seize power as fast and as ruthlessly as possible (https://tinyurl.com/jj6sokf).

The one false idea borrowed from communist or totalitarian government needed to destroy a free society is egalitarianism, he writes. The power of the state is needed to avoid squabbles between the givers and the takers in forced redistribution.

Slow Subversion

The Fabian Society still exists, operating as a globalist think tank. It was named after the Roman General Quintus Fabius Maximus, who famously used tactics of attrition and delay to defeat his enemies. Their articles and essays push the latest globalist propaganda from the erasure of national sovereignty to the promotion of gender politics and gender “fluidity.”  Key tactics are to control the narrative, co-opting or destroying dissenters, and to divide and distract the public (https://tinyurl.com/yaep3y3j).

Having escaped Communist tyranny in Hungry, in order to “speak freely, to live without the fear and obligatory debasement of paying lip service to evil,”  John Rigo writes that he is feeling a sense of déjà vu in Australia. He had tasted the “bitterness of ideological servility at workplaces in the old Soviet bloc: going through pitiful pretences to avoid victimization, mass meetings and marches where we had to cheer and celebrate the lies we were fed and knew we were being fed.” Now, “top managers in Australia are regularly issuing their enlightened edicts on ‘correct’ opinions,” he writes. And we have “universities of servility” (https://tinyurl.com/ydbae5n3).

The Issue Is Not “Healthcare”

While Democrats and Republicans spar over ObamaCare, focusing on things like the “pre-existings” problem that affects a tiny proportion of Americans, both ignore the root of the problem and “there’s not a dime’s worth of difference between them,” writes Daniel Horowitz (https://tinyurl.com/y7ytwtx9).

If we cede the battle for freedom, the only issue is who is to be in the elite class that rules the rest of us. All else is pretext.


The Root of the Problem

ObamaCare destroyed the insurance market for the sake of a handful of people, most of whom already had access to state high-risk pools, writes Daniel Horowitz (op. cit.). “And remember, the entire problem of pre-existing conditions was born out of this very philosophy of giving insurance companies a monopoly over health care through the tax code, Medicare, and Medicaid, thereby eliminating price transparency, inflating the price of health care, creating monopolies, and destroying the concept of lifelong continuous renewal catastrophic insurance that is portable and held from day one of life.”

If one accepts the idea that the federal government should tax some people to pay other people’s medical bills, “for the amount of money we spend on Medicaid and the subsidies just to give people terrible access and create a monopoly for health care and hospital administrator conglomerates over private practice, we could take every uninsurable person and stick money in their HSAs to pay directly for their bills” (ibid.). Not a single Republican is proposing such a bold alternative.

The issue appears to be control of the money.


News Briefs from Utopia

  • Dehydration in the UK: Although euthanasia is illegal in the UK, hundreds of patients are reportedly dehydrated to death in the National Health Service each year if this is deemed to be in the “best interest” of a patient said to be dying, based on vague criteria such as loss of appetite or social withdrawal. Some patients reportedly begged for water or desperately sucked on sponges as they died of thirst (https://tinyurl.com/ybe22dej).
  • Hallway Care in Ontario: A patient waited in an ER hallway for 47 hours for surgery on multiple fractures and a lacerated kidney. One hospital in Toronto had a peak occupancy rate of 147% (https://tinyurl.com/yabpyh29).
  • French Hospitals Threatened: President Emmanuel Macron stated that “without changes, the hospital system will collapse.” Increased spending, more doctors for rural areas, and rethinking the system’s organization are promised (tinyurl.com/yb9ydjtp).
  • Private Care Surges in UK: As NHS rationing deepens, private companies have seen a 53% increase in the self-pay market for acute medical care over the past 4 years. The number of patients waiting for hip or cataract surgery has tripled over that period, to nearly 450,000. In Sussex, proposals say patients should suffer uncontrolled intense pain for 6 months before being referred for hip surgery. The cost of hip replacement is £9,000-£14,000, and a cataract operation costs up to £5,000. Inability to get timely operations based on clinical need, not one’s bank balance, threatens the idea of universal healthcare, free at the point of use. (https://tinyurl.com/y9l2wo3g)

“Socialism means equality of income or nothing, and…under Socialism you would not be allowed to be poor. You would be forcibly fed, clothed, lodged, taught, and employed whether you like it or not. If it were discovered that you had not character and industry enough to be worth all this trouble, you might possibly be executed in a kindly manner; but whilst you were permitted to live you would have to live well.” ~George Bernard Shaw, The Intelligent Woman’s Guide to Socialism and Capitalism, 1928


ACOs Must Take Financial Risk, Azar Says

Health and Human Services Alex Azar announced that the Centers for Medicare and Medicaid Services (CMS) would be launching “bold” new “value-based” models that would make physicians and hospitals into “accountable navigators of the health system.” Physicians need to have “real accountability for outcomes.” Otherwise, “the federal government would simply be giving bonuses on top of potentially excessive payments,” he said (https://tinyurl.com/yc2q6njj).

CMS Administrator Seema Verma said that after 6 years, the Accountable Care Organization (ACO) model has shown increases in net spending for CMS and taxpayers. Medicare cannot afford “weak incentives” that involve upside risk (no bonus if no savings) only (https://tinyurl.com/y7xdtsxu).

Verma acknowledges that beneficiaries may not know whether they are assigned to an ACO or how an ACO may change their providers’ incentives. (Beneficiaries do not share the savings.)

The National Association of ACOs (NAACOS) disputes CMS’s findings, which are used as the basis for requiring downside risk (repayment penalties for exceeding spending targets). According to NAACOS, the Medicare Shared Savings Program generated net savings of $541.7 million to the federal government for 2013-2015, while the CMS benchmarking methodology tabulated a  net loss of $344.2 million (tinyurl.com/y7asalp6).


Medicaid Expansion Increases Cost Shifting

One of the arguments that convinced Arizona lawmakers in 2013 to expand Medicaid was that employers and employees were paying a “hidden healthcare tax.”  According to this theory, when hospitals treat the uninsured, they pass along the unpaid treatment costs to private payers, leaving employers and employees with higher health insurance premiums, write Naomi Lopez Bauman, Angela Erickson, and Christina Sandefur of the Goldwater Institute (https://tinyurl.com/yblty7t9).

But Arizona’s Medicaid expansion actually made the “tax” worse. Before Medicaid was expanded, proponents in 2007 claimed that the cost shifting to private payers amounted to 14% more than hospitals’ costs. But in 2016, private payers paid 27% more than hospital costs—meaning that, three years into the Medicaid expansion, the proportion of cost shifting had actually increased. Urban hospitals were able to increase charges on private payers dramatically, reaping disproportionate financial benefits at the expense of their rural counterparts.

“The primary beneficiaries of Arizona’s Medicaid expansion are not the people, but the politically connected hospitals,” the Goldwater Institute concluded.


AAPS Calendar

Sep 18-21, 2019. 76th Annual Meeting, Redondo Beach, CA.


ACTION OF THE MONTH

Ask congressional incumbents or candidates to end the safe harbor for supply chain kickbacks driving up the cost of drugs and  supplies. See a template letter at http://bit.ly/nokickback.


A Constitution Minute: the ‘General Welfare’

“I found a constitutional loophole that many congressmen use as a blank check, as well as justification to control most aspects of our lives,” writes Walter Williams, “namely, the general welfare clause” (https://tinyurl.com/y8d5g45o). What did the Framers mean by “general welfare,” found in the preamble and Article 1, Section 8?  In 1817, Thomas Jefferson wrote, “Congress had not unlimited powers to provide for the general welfare, but were restrained to those specifically enumerated.” In 1854, President Franklin Pierce vetoed a bill to help the mentally ill, writing, “I can not find any authority in the Constitution for making the Federal Government the great almoner of public charity.” President Grover Cleveland, a Democrat, vetoed 584 acts of Congress, often because of they lacked a constitutional warrant.


Maryland Sues to Uphold Affordable Care Act

In a mirror to the lawsuit brought by Texas and other states (AAPS News, September 2018), Democrat Attorney General Brian E. Frosh of Maryland filed suit in a district where most judges were appointed by Barack Obama. The case argues that a tax of $0 is still a tax, and that in any event the penalty can be severed from the guaranteed issue/community rating  provisions that protect people with pre-existing conditions from paying more [and that guarantee unaffordability]. Frosh states that loss of ACA would  hurt the 150,000 Marylanders who bought ACA plans this year, the 300,000 who qualified for expanded Medicaid, the state’s healthcare system, and public finances (Wash Post 9/14/18).


Is SCOTUS the Final Word?

The doctrine of judicial supremacy, writes Daniel Horowitz, has led to a “dictatorship of the robes” (tinyurl.com/ybta9lha).

“It is clear that Democrats believe the courts are the final say on every constitutional question—no matter how absurd their ruling is. They further believe that once a court uses this phantom ‘veto’ power a single time on the progressive side of the question, even when that ruling is overturning 200 years of laws, political practices, customs, and prior court precedent, it is unassailable, … even by a subsequent court.” He notes that while Republicans believe that another court might overturn a precedent, they still hold that “a court opinion in an individual case can set broad precedent that is self-executing and universally binding as the law on everyone and out of reach of the other two branches.”

Though some of the Founders feared that judicial review would grow into judicial exclusivity, nobody ever thought the courts would be the final say, especially if they concocted revolutionary adulterations of the Constitution and the contours of fundamental rights. No one believed that redefining marriage, life, human sexuality, and national borders is in the Constitution.

Judicial supremacists are heirs to the Dred Scott legacy—of  the insidious plot to maintain slavery, Horowitz writes. Lincoln argued against it in the Lincoln-Douglas debates. In his view, res judicata—finality in judgment—applies only to the parties in a case and only serves as precedent within the judicial branch of government. “The notion of the Supreme Court as a categorical veto of law and policy for the purposes of the other branches is likely the most dangerous legal fiction in American history.”

!Tip of the Month: “Going Bare” on professional liability insurance is an option for those who do not need hospital privileges. Insurance is an expensive form of asset protection. Most states do not require physicians to carry professional liability insurance, which attracts frivolous lawsuits by contingency attorneys. Only seven states require physicians to carry insurance: Colorado, Connecticut, Kansas, Massachusetts, New Jersey, Rhode Island, and Wisconsin. In eleven additional states physicians do not qualify for tort reform unless they have insurance. Florida requires that physicians who “go bare” post a notice in their office and obtain a line of credit. New York requires that physicians monitored by its medical board carry liability insurance. Check the laws in your state if considering this option.


Did Congress Implicitly Repeal ACA?

In the only amicus brief filed for plaintiffs in Texas v. United States, William J. Olson, Herbert Titus, et al. argued that the Tax Cuts and Jobs Act of 2017 (TJA) effectively repealed all of ACA. Although there a general rule against implicit repealer, unless earlier and later statutes are irreconcilable, TJA “repealed the constitutional predicate for Congress to enact [ACA], thus rendering it unconstitutional.” To be valid under the taxing authority, a statute must raise some revenue. “A zero tax is no tax at all.” The late Justice Antonin Scalia argued in his dissent from NFIB that the individual mandate was inseverable from each major provision of ACA (https://tinyurl.com/ya5n2uu7).


On Equality

From To Build a Castle (1978) by Vladimir Bukovsky:

“This dream of absolute, universal equality is amazing, terrifying, and inhuman. And the moment it captures people’s minds, the result is mountains of corpses and rivers of blood, accompanied by attempts to straighten the stooped and shorten the tall.

“I remember that one part of the psychiatric examination was a test for idiocy. The patient was given the following problem to solve: ‘Imagine a train crash. It is well known that the part of the train that suffers the most damage in such crashes is the carriage at the rear. How can you prevent that damage from taking place?’ The idiot’s usual reply is expected to be: ‘Uncouple the last carriage.’ That strikes us as amusing, but just think, are the theory and practice of socialism much better?

“Society, say the socialists, contains both the rich and the poor. The rich are getting richer and the poor poorer. What is to be done? Uncouple the last carriage, liquidate the rich, take away their wealth and distribute it among the poor…. But there is always one carriage at the back, there are always richer and poorer, for society is like a magnet: there are always two poles. But does this discourage a true socialist? The main thing is to realize his dream; so the richest section of society is liquidated first, and everyone rejoices because everyone gains from the share-out.

“But the spoils are soon spent, and people start to notice inequality again…. So they uncouple the next carriage, and then the next, without end, because absolute equality has still not been achieved…. Is it really surprising that whenever you get striving for equality and fraternity, the guillotine appears on the scene?

“… Men who are impetuous and sincere…are the first to start chopping heads off and, eventually, to have their own chopped off.”


Correspondence

Behind the “Guidelines.” Articles in the most prestigious medical journals such as NEJM and Lancet may fail to disclose authors’ lucrative corporate ties, as shown in a New York Times expose on cancer researcher José Baselga, who is chief medical officer at Sloan Kettering (https://tinyurl.com/yb4go587). He portrays his failure to report financial interests as a simple lapse. Anyone could simply forget receiving $3.5 million, right? “Dr. Baselga’s extensive corporate relationships—and his frequent failure to disclose them—illustrate how permeable the boundaries remain between academic research and industry, and how weakly reporting requirements are enforced,” writes the NYT.

Lawrence R. Huntoon, M.D., Ph.D., Lake View, NY

Cause of Burnout and Suicide? Moral injury was first described in soldiers, related to their actions in war. It can also result from financial incentives that corrupt the morality of  workers—for example ACO-HMO cartel gatekeepers who get paid more if they order less care. “Value care” means value to profiteering “payers” (the managed-care industry and government), and the “incentives” are bribes. CMS administrator Seema Verma now plans to fire all ACOs that refuse to take “downside” population underwriting risk—82% of the 561 accountable care organizations in the Shared Savings Program take “upside risk” only. Since these have been financial failures, “downside risk” is to be mandated. An immoral enforced bribe system will systematically corrupt the workforce’s moral integrity and ability to perform.

Robert W. Geist, M.D., North Oaks, MN

Hospital Mergers: the Obama Trap. In 2010, there were 66 hospital mergers in the U.S. Since ACA went into effect, the rate of hospital consolidation has increased by 70% percent. The government’s pretext for encouraging consolidation was to increase efficiency and decrease costs. In fact, when hospitals gobble up independent practices and form regional monopolies, prices increase, usually by more than 20%. The real goal is to increase control and to drive the system toward single payer.

Stanley Feld, M.D., https://tinyurl.com/yd7wewfq

Why Insurers Press for Home Visits. A physician friend who has a Medicare Advantage plan reports that at the start of every year, he is harassed with phone calls trying to set up a home visit by a nurse practitioner under the guise of a wellness visit. It turns out that the insurer can then collect the Medicare payment for the annual wellness visit, and the patient’s physician cannot.

Kimberly Legg Corba, D.O., Allentown, PA

Socialist Equality. The socialism I experienced growing up in Romania offered us equal misery, equal exploitation, and equal jail time if we did not obey the Communist Party rulers.  In practice, nobody shared anything under communism except misery and poverty. Although communism is described in textbooks as having no classes, there were actually two: the proletariat (the majority) and the ruling elite (Communist Party members). There was no “universal health care,” but instead the rationing of it. Hospital personnel, from orderlies to nurses to doctors, had to be bribed in order to properly care for patients. Patients who had no family caring for them lingered in a metal frame bed unattended for weeks until they got better on their own or died.  The state determined how many calories people could consume; how much electricity, water, and heat they could use; and how much personal property they could amass. The economic police knocked on doors and confiscated anything they deemed excessive.

In 1934, H.G. Wells told Stalin that profound reorganization was taking place in the U.S., the creation of a “planned, that is, socialist, economy.” Today, “small doses” of socialism have grown ever larger, promoted by politicians,  media, and academia.

Knowing how many people have died trying to escape oppressive socialist countries, I am shocked at how many “useful idiots” today are clamoring for this political and economic system that has killed millions who naively believed the Marxists.

Ileana Johnson, https://tinyurl.com/y92g9c9z

Transparency. Patients rarely ask or are told their “provider’s” schedule of financial recompense (how and how much they are paid) for providing (or not providing) care. Surely they ought to know how their doctor views them—as a cost or a benefit to the practice or hiring organization. Intelligent clients routinely ask how their stockbroker, banker, or wealth manager is paid.

Lee Beecher, M.D., Maple Grove, MN

Socialized Medicine by Stealth. Socialized Medicine is “any of various systems to provide the entire population with complete medical care through government subsidization and regularization of medical and health services.” Insurance is “coverage by contract whereby one party undertakes to indemnify or guarantee another against loss by a specified contingency or peril.” Under ACA reinsurance programs, taxpayers indemnify health plans from the financial risk of high-cost individuals! In short, taxpayers become “insurers.” Health plans become well-paid government contractors, managing dollars, tracking data and controlling doctors. Enrollees don’t know their medical data is shared with the  government to secure its payment for their care.

Twila Brase, R.N., https://tinyurl.com/yd3d3kg7

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