Whoa! We are so eager to let government take over more of our lives. Instead of Government Option Healthcare which may sound benign enough to some, would you buy government option fast food or football?

We have government option mortgage, Fannie Mae and Freddie Mac, which created the housing bubble by buying every mortgage product Wall Street created. We blame Wall Street, but wouldn’t you make as many widgets as possible if government option widgets bought everything you made? How about government option boarder security … 15 – 20 million illegal aliens in this country? There is a long list of government option enterprises: Banking - the Central Bank, Education – public schools, Energy – total foreign dependence, Governing – Congress, Safety net – bankrupt Social Security; and the list is insanely long.

We’ve had Government Option Healthcare for a long time; it is called Medicare and Medicaid. Being the market maker by setting prices for medical services, Medicare/Medicaid has been a bonanza to doctors and hospitals but at the price of destroying the market. There is an indisputable cause and effect between Medicare/Medicaid and the cost of medical care just like Fannie Mae and Freddie Mac and the housing bubble.

The unintended consequence of more Government Option Healthcare is mind boggling. ‘Anytime you create a situation where the sheep must negotiate with the wolf you’ve got a problem.’

Having struggled with Government Option Healthcare for years, I would choose government option fast food and football first.

Ron Law, MD

Cancer kills.

One of the most remarkable phenomena of the human body … for that matter all living things … is control. Without control our tongue will keep growing till it suffocates us or our heart muscle will grow thicker and thicker till there no room for blood to flow. None of this happens in the healthy state because of remote or local controls on growing cells. A tumor is a condition when cells have escaped the normal controls and formed a collection of abnormal tissue. A cancer is a condition when cells have gone crazy and grow out of control … here, there and everywhere. Eventually the cancer takes over and drains more and more life giving energy from the host and death becomes imminent.

Biology teaches us many lessons beyond living things.

A healthy living society consists of many societal organs in which balance and control are paramount. We were once a child in need of growth and development. Then we emerged as a splendid young adult. What a spectacle! Then we suffered illnesses, which we have overcome. And now we reach a stage in life at risk for cancer.

Is there an organ in our society that has escaped its control and has grown larger and larger? And has this organ gone crazy growing out of control … here, there and everywhere sapping us of more and more life giving energy? And at what point will this society die?

Each individual must answer this question for himself/herself. He or she will ponder the reasons for such out of control growth. Can a grand purpose justify this irrational expansion?

Biology provides another insight. A cancer cell escaping the control of the body can be viewed as its means of achieving immortality. Is there a grander but totally futile purpose than that?

Ron Law, MD

Mr. John Smith has a neck operation scheduled for Friday. His pre-op EKG was read by the computer as abnormal … “consider old heart attack.’ His operation is canceled; he sees a cardiologist in one week; heart doctor orders a stress heart scan; the test is normal; he gets his surgery 3 weeks later; all goes well. But it really went badly for all parties.

Why?

The operation was canceled because doctors are risk adverse. EKG’s are often abnormal; the heart doctor orders a test he knows will be normal, but he has to satisfy the surgeon and the anesthesiologist whom he has no control over. The stress test costs hundreds of dollars and entails the radiation of 200 or more chest X-Rays. The patient wasted weeks in consultations, tests and delays.

Community Standard

The doctors in this case are not so worried about being sued than following a community standard that arose from malpractice fears …so called defensive medicine. You need to know doctors are not making decisions case-by-case shaking in their boots about Mr. Malpractice Lawyer knocking on their doors. But over time, community standards develop out of malpractice fears and run up costs unspeakably in all areas of medicine: medical practice, rehab, nursing homes, big Pharma, medical device companies and so on. My guess: $200 billion is a low number.

That the present healthcare reform bill contains no tort reform speaks to the insincerity, even corruption, of the parties. Your health is not foremost in their minds. Tort reform will pay for all the reforms necessary.

If I Were King:

Make real tort reform a priority. This is too complicated for me to comment further. But there are lots of changes in many states removing lawyers from our lives.

Let me try another approach: a consumer product with a low failure rate is affordable. The same consumer product with no failure rate is not affordable. Doctors know failure is unavoidable, so they act to be blameless.

It is that simple.

Ron Law, MD

Ron Law, MD

This is what the government on both sides is proposing for 1/7th of the US economy. Surely this is the MAD POLITICIAN SYNDROME.

If I Were King:

I would propose an 8-year plan to ensure myself of 2 terms ... self serving but understandable.

I would propose one major change A YEAR after prioritizing what is most important, then second, then third and so on.

I would discuss with industry leaders, legislators, doctors and citizens over each year how to tackle that major change. There is so much material out there if we only bothered to look.

I would monitor my progress and report to the people.

I would call it Health Care Security - to mimic FDR's Social Security.

As King, my priority would be:

1. Increase access and competition among insurance carriers.

2. Health care for the uninsured.

3. Tort reform.

4. Cut waste and fraud in Medicare and Medicaid.

5. Electronic Health Records.

6. Transition from private practice to hospital employment model ... like Kaiser.

7. Public Health.

8. Research for targeted diseases.

As a doctor there is an unspoken doctrine, 'above all do no harm.'

Write to your Congressmen and Senators to stop this MADNESS and begin Staged Reform ... a step-by-step plan.

Ron Law, MD

§         Regulation lowers quality and increases costs … this is experiential.

§         Governmental regulation lowers quality and increases cost A LOT …

the Medicare and Medicaid Systems.

Ergo, healthcare reform needs more competition, not governmental regulation by any stretch of the imagination.

Health is the first of all liberties; and the Declaration of Independence places Life before Liberty and Pursuit of Happiness. As such, why are we so eager to give up the most important investment in our lives … our health?

In our present medical system, doctors (particularly specialists) work independently within different hospital systems with only trace accountability to and communication with one another. As a result, hospital systems cannot control the quality and costs of their product lines (cardiovascular diseases, gastroenterology, pulmonary medicine, critical care, neurology, psychiatry, general and thoracic surgery, obstetrics and gynecology and so on). And doctors compete only on the basis of availability and quality to referring doctors and physician organizations.

Imagine the same scenario in business.

Say you have a high tech business: if your product development staff, sales people and managers are also working for your competitors having only their own self-interest in mind, how could your company compete in the free market system? You cannot and you will fail.

Now look at medicine today. Medicare and Medicaid regulate reimbursement (price fixing is illegal except when it is done by government) and regulate quality willy-nilly because the delivery of medical care is a very complicated business. Doctors provide quality care with little regard for the total cost because they are not responsible for the entire book of business. Hospital systems have little control of the quality and costs of their product lines because doctors largely control patient care. And the regulation to ensure quality is illusory at best. It is destined to fail.

The Kaiser Permanente behemoth is the quintessential practice model today in which doctors, nurses, ancillary staff, outpatient clinics, diagnostic centers, inpatient hospitals and insurer are fully integrated horizontally and vertically. And they are wiping out the competition. Hmmm, maybe there is a lesson to be learned here.

If hospital system A, hospital system B and hospital system C become Kaiser-like and hire subspecialists such as cardiologists, cardiothoracic surgeons, pulmonologists, nephrologists, surgeons, orthopedists, radiologists, and so on, they would be in a better position to develop and manage these product lines to compete among each other. An insurer would be able to decide if hospital system A with a price of $10,000 (quality B-) and hospital system B with a price of $11,000 (quality A+) or hospital system C with a price of $9,000 (quality C+) would be best in treating Congestive Heart Failure for their insured. Bear in mind that physician’s salaries make up as little as 10% of the total cost of inpatient and outpatient care … so an employed model is a powerful competitive weapon.

In this scenario, hospital systems A, B and C can compete for business from the various insurers for elective and semi-elective work. This analysis does not address outpatient primary care because the costs are largest in emergent, critical care and end of life care for which physician and hospital alignment is paramount. No doubt emergency conditions have to be attended to without delay. But the model exists today for Kaiser for whom patients are transferred back to Kaiser upon initial treatment and stabilization.

Once upon a time, doctors enjoyed the independence of private practice and the financial rewards of their entrepreneurship and quality of care. But those days are long gone with the imposition of regulations, audits and diminishing reimbursement from Medicare and Medicaid. In response to crushing reimbursement reductions, there is a strong movement afoot for hospital systems to employ doctors en masse in each subspecialty to control costs and the quality of their product lines. And with decreasing regulated reimbursement, doctors are more than happy to be employed. As this process runs it course, many Kaiser-like systems will emerge and competition will intensify.

The system can heal itself if given the chance.

Medicare and Medicaid have long dominated the medical business and controlled reimbursement. This Medicare and Medicaid cartel would be illegal if it were anything but the creation of the US government. Admittedly, there was a period when Medicare and even Medicaid created a bonanza for medical practitioners and the ancillary business; but in the process, these government entities’ perverted the practice of medicine and gave rise to the inefficiencies that powered the meteoric rise in the cost of medicine. We, the practitioners of medicine walk to the tune of the piper … two Government Sponsored Entities (GSE’s), Medicare and Medicaid.

Remember how the real GSE’s (Fannie Mae and Freddie Mac) fared? Fannie and Freddie fueled the implosion of the entire financial system costing the US taxpayers hundreds of billions of dollars with secondary effects throughout the world. Only the government can fail with such aplomb … blaming greed in the free market system. “To blame greed for the collapse of the financial markets is to blame gravity for the airplane crashing.” (Thomas Woods)

For any or all of the government’s good intentions, the yesteryear’s Midas Touch has turned to the Midas Curse. “A government big enough to give you everything you want is strong enough to take away everything you have.” (Thomas Jefferson)

Now they want to expand the program! Do they think we are really that stupid?

Countries that began with a government program (Canada) learned the hard way. In fact predictably, they learned that private enterprise cannot compete in a field in which the competition is not only a player, but also the umpire. To think this governmental insurance program will compete to keep private enterprise (and themselves) honest is the sales pitch that only the most arrogant among us can peddle. I admire them for their gall … but, once again, do they think we’re stupid?

There are countless ways to create competition. I have just offered one of many scenarios to show that competitive options are numerous. But the road to success runs quite opposite to the road of governmental regulation and a larger governmental insurance program. U.S. medical care is second to none. Why destroy it?

Cost of care is the area that needs reform. Competition to lower costs and increase quality can be attained when many little Kaisers compete. Greater competition will succeed swimmingly if the government will simply get out of the way. But this means less governmental intrusion in our lives, and the ability to stop labeling health care reform/competition as “republican” and instead label it as “common sense for the greater good.” If we are truly worried about the uninsured --and as a doctor, I am -- the academic and city hospital and clinic systems would be more than happy to oblige if they are sufficiently reimbursed … I hear $30 billion should do it. Let me be clear: competition does not negate the desire and need to provide for the under or uninsured. As a matter of fact, lower costs as a result of competition would make it easier to do just that.

So, what is the real impetus behind the current push and rush to reform healthcare? The answer lies in the primal need for politicians to increase the control and size of government, and in turn, boost their egos. To take control of our first liberty would be a coup d’état for generations to remember. Think about it, however. Future generations will remember this coup because they’ll constant reminder of paying for it. Do we want this to be our legacy?

Ron Law, MD