What Does “Free Market” Mean in Orwellian Newspeak?

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By: G. Keith Smith, M.D., http://www.aapsonline.org/

We are accustomed to Newspeak from the federal government, in which words have the opposite of their traditional meaning. For example, there’s what I call UCA, the (Un)affordable Care Act.

But now the problem is metastasizing to supposedly conservative publications and nominally free-market think tanks. In an article in The Weekly Standard, Eli Lehrer, president of R Street, writes that the primary reason that medical care costs so much is high wages and salaries for physicians and others in “health care.”

He writes: “The American Hospital Association estimates that two thirds of all medical costs are attributable to wages and benefits.” Along with doctors—whose pay takes up only about 10 percent of the healthcare dollar—he includes nurses, dental hygienists, and even janitors in medical facilities as among the overpaid. But he doesn’t mention million-dollar hospital administrators.

He writes that a one-year medical wage freeze would have the same cost-containment effect as confiscating all insurance company revenue beyond medical expenses and operating costs. The freezes and cuts in Medicare fees seem to have escaped his notice.

We might ask Lehrer and his fellow “free marketeers” what the compensation of physicians in the U.S. should be. As the free market has been thwarted in many ways in U.S. medicine, it is hard to know what a market-clearing price for physician services or any other health care should be. One hint that pay may be too low rather than too high is that physicians are fleeing the field. It is said that shortages of both physicians and nurses are reaching a critical level, with 500,000 unfilled positions in nursing. In 2010, there were only 60 applications for 120 available positions for training in heart surgery.

Market “disturbances” have benefited and continue to benefit the organizations with which Mr. Lehrer is associated or those that support his work.

I suspect that Mr. Lehrer doesn’t really believe that U.S. physicians make too much and that this is the problem with the high cost of care. To say this is, however, in the best interest of giant companies like HCA and Unisys. Writings that indict physician compensation as the primary culprit provide a smokescreen for these true cost culprits.

Our physician-owned surgery center (www.surgerycenterok.com) is profitable charging amounts one-tenth (10 percent) of those charged by our “not show a profit” hospital friends across town. Our price includes physicians’ fees and all personnel costs. Most insurance companies won’t even talk to us. Why should an intelligent person like Lehrer not be asking where the 90 percent of the healthcare dollar goes?

While most can understand that the vast majority of the politicians in Congress are bought and paid for and can be counted on to operate in a manner consistent with the best interests of their benefactors, fewer people question the influences that may be motivating commentators like Lehrer.

For starters, Lehrer was a speech writer for former Senator Bill Frist, who was “honored” in 2005 and 2006 as “one of the most corrupt members of Congress” by Citizens for Responsibility and Ethics in Washington. Lehrer’s old boss was the heir and major stockholder for the healthcare giant HCA, one of the largest hospital chains in the world. As such it should come as no surprise that Frist recently stated that had he still been in office, he would have supported UCA (ObamaCare), which benefits HCA. This brazen conflict of interest when he was a senator is apparent in his voting record.

After Lehrer’s stint with Frist, he landed a position as a manager at Unisys. If you guessed that Unisys was a health information technology company that profits immensely from UCA, you go to the head of the class.

The giant insurance lobby was delighted about the formation of “R Street,” and promoted it in articles and blogs. “R Street” formed when the Heartland Institute split up over the global warming controversy.

When asking “Cui bono?” (“Who benefits?”), let’s not forget about the corporate sponsors.

“Free market” in Newspeak means “crony capitalism.”


Dr. G. Keith Smith is a board certified anesthesiologist in private practice since 1990. In 1997, he co-founded The Surgery Center of Oklahoma, an outpatient surgery center in Oklahoma City, Oklahoma, owned by 40 of the top physicians and surgeons in central Oklahoma. Dr. Smith serves as the medical director, CEO and managing partner while maintaining an active anesthesia practice.

In 2009, Dr. Smith launched a website displaying all-inclusive pricing for various surgical procedures, a move that has gained him and the facility, national and even international attention. Many Canadians and uninsured Americans have been treated at his facility, taking advantage of the low and transparent pricing available.

Operation of this free market medical practice, arguably the only one of its kind in the U.S., has gained the endorsement of policymakers and legislators nationally. More and more self-funded insurance plans are taking advantage of Dr. Smith’s pricing model, resulting in significant savings to their employee health plans. His hope is for as many facilities as possible to adopt a transparent pricing model, a move he believes will lower costs for all and improve quality of care.

Dr. Smith resides in Oklahoma City, Oklahoma.

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