For several decades, American bioethicists have been providing persuasive arguments for rationing medical care via the theory of the necessary "rational allocation of finite health care resources."(2) More recently, assisted by various sectors of organized medicine, they have developed multiple approaches to justify what they see as the necessary curtailment of services and specialized treatments deemed not medically necessary.
This is a great book. It shows how American medicine is being socialized to the detriment of patients.
Corporate Medicine: Then and Now
The physician should not dispose of his professional attainments or services to any hospital, by body, group or individual...under terms or conditions which permit exploitation of the services of the physician for the financial profit of the agency concerned.
(AMA, 1949, on medical ethics and the corporate practice of medicine)
Today, the socialized corporate practice of medicine is rampant. But there is hope on the horizon.
Your Doctor Is Not In was written by an internist in solo private practice who is also executive director of the Association of American Physicians and Surgeons. Dr. Jane M. Orient is a gifted writer and a prominent figure in the health care reform discussion, who here addresses many of the problems with our health care system and offers solutions.
Americans enjoy the best medical care in the history of the world, but our system is being destroyed by government regulation, by the socialist principles embodied in the Medicare and Medicaid systems, and by the liberal social policies our society has followed over the last half century: that is the theme of Code Blue: Health Care In Crisis, by Dr. Edward R. Annis, past president of both the American Medical Association (AMA) and the World Medical Association, and one of America's most distinguished physicians.
Written by two reporters, this book contains a wealth of information about the history and inner workings of the American Medical Association since its founding in 1847. It is divided into two parts. The first covers how the AMA is organized, the history of its development, its ongoing battle against compulsory health insurance, a description of its political action committee (AMPAC), and a discussion of its support for the business ethic. The second covers the AMA's response to health issues including alternative medicine, the tobacco problem, abortion, and the AIDS epidemic.
It will be of little avail ---- if the laws are so voluminous
that they can not be read or are so incoherent
that they can not be understood --- Or undergo
such incessant changes that no man who
knows the law today can guess what
it will be tomorrow.
The Federalist Papers.
Dr. Miguel A. Faria, Jr., who is a consultant neurosurgeon, Adjunct Professor of Medical History (1993-1996) at Mercer University School of Medicine, and editor-in-chief of the Medical Sentinel of the Association of American Physicians and Surgeons, has combined astute political insight with his encyclopedic knowledge of history to create this unique blend of historical perspective and political commentary, with its emphasis on the history of medicine and medical ethics.
It was apparent to both politicians and informed observers at the outset that Canada's compulsory socialized medicine scheme (now going on 42 years since the first tentative political steps were taken) would have enormous political appeal.
The Hippocratic Oath, Abortion, and the U.S. Supreme Court
We are witnessing today what could be described as the grandest expansion of the Nanny State (Socialism) in the history of America. And, I believe this expansion to be one of the most diabolical, intricate, and subversive schemes to plague the landscape of American public policy.
Kassebaum-Kennedy Law and Immunization Activities
An AAPS member has brought to our attention the fact that a portion of the Kassebaum-Kennedy law included in the administrative simplification provisions contained several sections having to do with immunization registries. The information was contained in Immunization News, a newsletter by the Pennsylvania Forum for Primary Health Care (PFPHC; Vol. 2, Issue 2, Summer 1997).
Cloning Humans and Harvesting Organs in the Brave New World
When Bill and Hillary Clinton moved into the White House arrogance took on a new dimension. At the very least, we have abject socialists in the highest office of the land: One elected; the other on the former's coattails. Here we have a husband and wife team who are champions of a political philosophy our country had fought against and defeated in two world wars and a cold war. Bill Clinton's closest friends during his developmental years appear to have been Fabian Socialists.
Grim Reaper Seeks Legal Status
AMA Membership Opposes "Leadership" on E&M Guidelines
AMA leadership is still pushing hard to get some form of the AMA/HCFA E&M guidelines implemented. But the AMA House of Delegates recently voted to oppose any documentation system that "requires quantitative formulas or assigns numeric values to elements in the medical record to qualify as clinically appropriate medical record keeping" ("House rejects checklist approach for E&M guidelines," AMNews, June 29, 1998).
More Government Tracking and Guidelines
In response to the corporatization of medicine in general and our local hospital administration trying to eliminate the contract with ER physicians in January 1997 in particular, the Medical Staff passed several Bylaws Amendments by greater than the two-thirds majority vote of active staff members in June 1997.
Slightly paraphrased for this article these Bylaws:
1) Add to the Existing Preamble to provide the professional and legal structure for Medical Staff operations and relations with the Board of Trustees, and are mutually binding.
Tie a Yellow Ribbon Round the Old Oak Tree
Returning home after being away at the AAPS meeting for several days always reminds me somewhat of the anxiety and apprehension disaster victims must experience on returning home after the hurricane - I always wonder if my practice is still going to be there when I get back. The annual AAPS meeting, of course, was well worth the trip, and the value of "recharging one's batteries" was self-evident in the increased attendance.
Thank you for your outstanding effort as editor of the Medical Sentinel, especially for your courage in tackling emotionally charged issues which our other "representative organizations" ignore. Unfortunately, our aversion to the feelings these issues engender, does not negate the need to deal with them. As new members of the AAPS, we have mixed emotions discovering that our unpleasant feelings are shared by so many colleagues.
A "Dear Colleague" letter signed by Alvin H. Moss, M.D., Project Director of the "West Virginia Initiative to Improve End-of-Life Care" informs West Virginia physicians:
In an effort to solve health care problems, we seem to accept the judgment of politicians as a substitute for the judgment of buyers and sellers in a free marketplace when determining what health insurance coverage we need for ourselves.
I, for one, would not select to pay insurance for a toupee, in vitro fertilization, sperm bank deposits, or mental health care on a parity with any physical illness. Yet, I pay for them anyway because politicians have made judgments for me by passing health care mandates.
Robbery: "It all depends how you define it"
Kudos to Dr. Camardese
Dr. Nino Camardese of Norwalk, Ohio was honored to be a guest speaker at the 27th annual national convention of the American Academy of Physician Assistants which took place in Atlanta, Georgia, May 29-June 3, 1999.
Conrad Meier's article on snake oil in health care policy (Medical Sentinel, May/June 1999) deftly calls attention to the adverse effects of state-mandated coverages in health insurance policies. Required inclusion of many paramedical services, routine checkups, and other ancillary items progressively boost premiums beyond an affordable range, with the predictable result that there are fewer people who take out insurance or continue existing policies.
In view of Dr. Faria's essay, "Is There a Right to Health Care?" in the July/August 1999 issue of the Medical Sentinel,(1) and an editorial which appeared last year in The New England Journal of Medicine,(2) which spoke of a "distributive ethic" akin to corporate socialized medicine, and the collectivist drive toward a right to medical care in America with new proposals for a 28th Amendment to the U.S.
Virginia Postrel's book, The Future and Its Enemies, is about the forces that create the future. The author makes some interesting points and brings unique insights that may be of interest to physicians who are attempting to understand and influence the changes occurring in our health care delivery system. However, the book has some flaws, including the author's seeming acceptance of corporate socialized medicine as the product of a normal free market.
Some of those agencies which fancy themselves as legitimate controllers of medical care have shot themselves in the foot. Vaccination authorities decided some time ago that the hepatitis B immunization series should begin in the newborn period, despite very low risk of hepatitis B during the pediatric years and uncertainty as to the residual protection when those infants enter the years of increased risk from medical occupations, IV drug abuse, and promiscuous sexual practices.