What Happened to American Medicine?
America once had the best healthcare system around, but no longer. We still have the best doctors and nurses, but they are stymied and frustrated by a system that hampers rather than helps them when they try to care for us. Why?
Healthcare developed cancer, and the cancer devoured what American medicine needs: Fiduciary Service Partnership.
Fiduciary means that someone, like a patient, gives his freedom to act to another person, viz., a doctor, to be used for the benefit of the patient. If you need chemotherapy, you are asking the oncologist to poison you, please! When you ask the surgeon to operate, you literally give him or her control over your body and your future. What you are asking would be called attempted murder if done by someone other than the doctor!
Over the ages, there have been various formal codes of ethics for doctors, but they all say the same thing. We healers will use the power the patient gives us for the patient’s welfare, not our own. The fiduciary “bottom line” in healthcare is patient welfare.
Service also seems to be vanishing. Service literally means helping or doing work for another. A doctor serves a patient, though not as servant. Service is an act of free will involving commercial exchange. The doctor voluntarily provides his/her professional services to a patient in exchange for the patient’s money.
If health care – personal service given by one individual to another – were declared a basic human right, would that not mean that a patient could demand his “right” and the doctor could not refuse? Would not such a right then take away the doctor’s freedom?
Someone entitled cannot be a partner
If you are entitled to something, someone else is responsible to provide it. If you are entitled to health care, then someone else is responsible for your health, not you. The one who is responsible is the one who is in control.
Who told you that you were entitled? Answer: the federal government. For decades, we have been living in a “Father Knows Best” society. You know who Father is. He promises to take care of you. He will give you everything “you deserve.” (Of course, Father decides what you deserve, not you.) Father promises to provide everything, including free health care. You need not be responsible. Father will be. After all, “you are entitled.”
Entitlement and dependency are antonyms for personal responsibility and independence, aka freedom.
Good health involves a partnership between patient and provider. Neither is entitled -- each is responsible. Partnership is a two-way street with both partners being active. Good health is not “delivered.” Patient and doctor must collaborate as partners to achieve it.
How did we lose Fiduciary, Service, and Partnership?
We lost Fiduciary, Service, and Partnership for three reasons.
Third-party payment system
Third party payer systems destroy the connection between buyer and seller that is necessary to have a free market.
In every market except healthcare, the one who buys is the one who pays. In healthcare, a third party pays, not the patient though the patient consumes. The doctor is a seller who cannot set his or her price. The third party, aka government, does that. The free market connections between buyer (patient) and seller (provider) are disrupted by the third-party payer system.
In a controlled (non-free) market, the buyer has no incentive to economize. The payer has no incentive to pay for medical care. In fact, payers have a powerful incentive to delay, defer, or deny our medical care -- that is how they make money (private insurance) or “cut costs” (government).
Americans have been led to believe that health insurance should pay for their health care. Not so. The cancer has intentionally misled us about the function of health insurance, in order to increase our dependence on government.
What is insurance? It is a betting pool where the winner is the one who doesn’t collect. If you buy fire insurance and collect on your policy, that means your house burned down. Wouldn’t you rather have your house and not collect? If you buy health insurance and “collect” on your policy, that means you are sick. Is that what you really want?
Health insurance does not protect you against illness. It protects you against financial catastrophe in the event of a major, i.e., very expensive, illness or injury. You may be in a car crash and end up in the ICU, but with proper health insurance, you won’t end up in bankruptcy court.
Insurance should not cover reroofing your house, replacing worn tires on your car, or paying general medical bills. That is not what insurance is for.
Suppression of personal responsibility
It is a sad truth that suppression of individual responsibility is a highly successful political ploy. If we reject responsibility, we turn over control to the nanny state. We become dependent on them and their false promises. And apparently, we don’t learn.
In 1928, it was “a chicken in every pot and a car in every garage.” Ten months later, the great Depression began. Both pots as well as garages were empty. In 2011 it was, “If you like your insurance, you can keep your insurance.” What about upwards of seven million Americans who lost their health insurance due to ACA? Washington keeps us in line by promising to deliver entitlements, which never materialize. Sadly, we keep Hoping things will Change.
As a nation, we seem to be returning to pre-revolutionary America. In the 18th century, a hereditary aristocratic ruling class owned everything and controlled everyone. The government took our livelihoods and our lives. In 1776, we said “No!” and became an independent nation of self-controlling persons who eagerly embraced individual freedom and accepted the personal responsibility that comes with it.
Today, we are again under the thumb of a ruling class, this time called professional politicians. They behave as though we exist to serve them, not the other way around. They say government is responsible. Therefore, they are in control. We must do what they mandate.
The vast majority of Americans want: term limits; tax simplification; release of the free market so all Americans can get rich; the Keystone pipeline; the healthiest and best-educated populace on earth; a balanced budget; and energy independence. Yet those who claim to have our best interests at heart, ignore what we want and provide only for themselves.
Servant has become cruel master
The root cause of healthcare’s problem is cancer. When a healthy part of the body develops cancer, it ceases to do what the body needs, begins growing without limit, and steals the resources that all the other body parts need, ultimately killing the patient. Healthcare has cancer … of the federal bureaucracy.
Instead of serving us, the bureaucracy serves itself at our expense. It lives to expand, consuming our livelihoods, even our lives.
Servant has become cruel master.
The cancer of bureaucracy is anti-Fiduciary. The cancer of bureaucracy demands Service but does not provide service. The cancer of bureaucracy smugly rejects even the thought of a partnership.
The cancer’s bureaucratic diversion is the primary reason for our “unsustainable healthcare spending curve” (President Obama). To bend it down and save ourselves, we must regain control over the federal bureaucracy. We must kill the cancer cells but leave the healthy ones.
Affordable Care Act (ACA)
I am the last person to defend the ACA. However, honesty compels me to write that the federal bureaucracy developed cancer long before March 23, 2010. With that disclaimer, ACA is the acme of the cancer’s expansion: six whole new federal agencies; 10,512 pages in the Federal Register; tens of thousands of new government employees; and over $2 trillion of spending on new BARRC -- bureaucracy, administration, rules, regulations, and compliance.
What happened to American medicine? It lost Fiduciary, Service, and Partnership because our federal bureaucracy became malignant.
Can we bring them back? Most certainly we can, by doing the following:
(1) Reconnect consumer with supplier, by restoring control of one’s own spending;
(2) Use insurance solely for its true purpose;
(3) Embrace freedom and the personal responsibility that comes with it;
(4) Make a partnership with our health care providers;
(5) Rein in the cancerous federal bureaucracy by requiring both proof-of-effect and long-term cost/benefit analysis before Congress enacts legislation or the White House issues Executive Orders. We need to remind both: they work for us.
Dr. Deane Waldman, MD MBA, is author of The Cancer In Healthcare, Adjunct Scholar for Rio Grande Foundation, and former Emeritus Professor of Pediatrics, Pathology and Decision Science. Though he is a member of the Board of Directors of the New Mexico Health Insurance Exchange, the views expressed here are his alone and do not necessarily reflect opinions of the Board.