Governmental interference in the American medical marketplace (manifested by entities such as price and fee controls, mandates of coverage for insurance, mandated offering of managed care entities without simultaneous mandate for the offering of freedom-based insurance mechanisms, to name a few) has distorted the marketplace, raised overall costs, and lessened quality.

Nationalization of health care was attempted by President Clinton in 1993 through corporate-government partnerships, but fortunately, the plan was defeated by the realization health care costs would only escalate further and faster, and that heavy rationing would become inevitable. Had he succeeded, whatever remnant of freedom remained for physicians and their patients would have been lost.

Despite the evident adverse distortions that have occurred, and despite the overwhelming defeat of the Clinton Plan, Congress today is enacting his plan of socialization through piecemeal “incremental” reforms, disguising the legislation’s real intent in its public discussion of the meaning and content of these reforms.

As adverse complications have been suffered by patients secondary to the cost-conscious rationing of care via HMOs, government once again has interfered in the medical decision-making process by mandating treatments and lengths of stay for high-profile diseases whose sufferers have received the attention of the press. These mandates cause costs to rise, which will trigger more government interference, more loss of freedom, more damage to the physician-patient relationship. Many physicians, tiring of the fight to fulfill what had been a sacred oath, have given in to a system that constrains them professionally, or have retired early. Excellent, experienced physicians who have retired early have taken their unique expertise with them, and the quality of available health care is degraded as a result.

Those of us who knew the Golden Age of Medicine mourn its passing, and attempt to reinstate quality medical care and the supremacy of doing what is in the best interest of the patient. Essential to the reinstitution of this quality care is freedom of choice for the patient and the practicing of medicine according to the Hippocratic ethic by the physician. These two pillars have supported the patient-physician relationship, serving to protect patient autonomy, physician quality, and privacy for both, for over 2000 years.

How can these major cracks in the foundation of our health care system be repaired? Essential is the reinstitution of full freedom of choice for patients from choice of physician to insurance plans. The choice should be that of the consumer, or patient, not that of the employer. The tax law must be corrected so that the playing field is level and the individual receives the same deduction for the purchase of health insurance as does the employer. The plans that do not significantly benefit patients will decline in popularity; those that give the best protection and service for the least cost will prosper. Market forces will then be able to prevail. In such a system, patients should be able to search for protection from occurrence of severe illness, rather than being limited to spending primarily for the “maintenance of their current good health” which is when they are in the least need of the services of a physician.

In such a system in which the patient retains full choice of insurance products, the spate of recent laws issued by government (such as elimination of drive-through mastectomies and mandatory 48-hour financial support of hospitalizations for births) will become less necessary. Patients who feel a managed care entity best fits their needs (such as families with large numbers of children) will continue to select these entities. Others will seek insurance that is better suited to their personal needs. The option of Medical Savings Accounts (MSAs), in conjunction with catastrophic insurance, will offer yet another means of maintaining personal freedom of choice, privacy, and affordable protection against medical catastrophe.

Destructive cost-shifting is causing the private sector to progressively shrink. Failure to correct the tax code and enact urgently needed reforms of the current socialized programs (Medicare and Medicaid), will result in the continuing destruction and rapid decline of our formerly superb health care system. We must work to regain and preserve those characteristics with intensity and speed.

However, as we work to correct these elements of destruction caused in the past by the excessive meddling and distortion of government, the latter continues to wreak havoc in its now incremental bid to destroy private medicine, step-by-step, one reform bill at a time. The Kassebaum-Kennedy Bill, recently passed and signed into law by Clinton, contains many of the heinous provisions criminalizing both patients and physicians. These fraud and abuse provisions were found in the rejected Clinton Health Security Act of 1993. The potential for long jail terms and excessive fines for infractions that may be as minor as the use of an incorrect procedure code, now threaten both physicians and their patients. A therapeutic decision that a bureaucrat may deem as “medically unnecessary” may land any physician in jail. With this kind of intimidation and coercion, how many bright and capable students will want to subject themselves to the constant threat of fines and penalties in daily professional life after years of arduous study by becoming physicians? What quality will exist in the future in this system?

The Kassebaum-Kennedy law is another incremental building block toward the total socialization of American medicine. Moreover, it provides the instructions to assign each American a unique identification code which will be used to transmit formerly confidential past, present, and future health data to a national computer data base which will make medical privacy an issue of the past.

As Adolf Hitler wrote in explaining the moral philosophy of Nazism:

It is thus necessary that the individual should finally come to realize that his own ego is of no importance in comparison with the existence of his nation; that the position of the individual ego is conditioned solely by the interests of the nation as a whole...that above all the unity of a nation’s spirit and will are worth far more than the freedom of the spirit and will of an individual...

This state of mind, which subordinates the interests of the ego to the conservation of the community, is really the first premise for every truly human culture...the basic attitude from which such activity arises, we call — to distinguish it from egoism and selfishness — idealism. By this we understand only the individual’s capacity to make sacrifices, for the community, for his fellow man. ...The people form a true organization, a living unity, whose cells are individual persons. In reality, there is no such thing as an isolated individual, or an autonomous man.

Indeed, to help the state classify these individual cells, the Hollerith machine was used by the Nazi’s to collate a wide variety of information about the German population, including detailed genealogical, personal, and health data to accomplish policy objectives. The Hollerith machine functioned utilizing holes punched on a card, resulting in extremely efficient collation of data about individuals, data which contributed later to the connections between such data collected by government bureaucrats and the efficient implementation of mass murder after l939.

I quote the Purpose of Subtitle F — Administrative Simplification of Kassebaum-Kennedy:

It is the purpose of this subtitle to improve the Medicare program under Title XVIII of the Social Security Act, the Medicaid program under Title XIX of such Act, and the efficiency and effectiveness of the health care system, by encouraging the development of a health information system through the establishment of standards and requirements for the electronic transmission of certain health information...Health information means any information, whether oral or recorded in any form or medium that is created or received by a health care provider, health plan, public health authority, employer, life insurer, school or university, or health care clearinghouse and relates to the past, present or future physical or mental health or condition of an individual.

Compare this to the statement of Willy Heidinger of DEHOMAG, the manufacturers of the Hollerith machines:

We are recording the individual characteristics of every single member of the nation on a little card...We are proud that we can contribute to such a task, a task that provides the physician of our German body politic with the material (he needs) for his examination, so that our physician can determine whether, from the standpoint of the nation’s health, the data thus arrived at correlate in a harmonious, that is healthy relationship — or whether diseased conditions must be cured by corrective intervention....

The corrective intervention of the Hitler regime of mass murder was greatly facilitated through the use of these cards in facilitating localization of the victims.

How very much easier and faster such actions will be through the use of computerized information obtained through the administrative simplification provisions of the Kassebaum-Kennedy law.

I attended the December 1996 Physicians Council meeting of The Heritage Foundation in Washington, DC at which Representative Bill Thomas (R-CA), Ways and Means health subcommittee Chairman, spoke and told us of the then current debate in his committee about the plan to eliminate from the medical system certain elements of the elderly ill and the very young ill, such as “crack babies, who will never amount to anything.” The Kassebaum-Kennedy law is another building block toward the total socialization of American medicine.

Yes, it may well be happening here. We are seeing the rekindling of Platonism while we observe the simultaneous quenching of the Aristotelian primacy of the individual. As Plato wrote, “the first and highest form of the State and of government and of the law is a condition in which the private and individual is altogether banished from life...”

It is vitally important to the quality of our (and our children’s) lives here in this nation that we stop this incremental destruction of our private health care system, and that we fight to regain our individualism, our personal rights, and our freedoms. We must each and every one take action, not in the future but now, to reinstate the precious heritage of freedom and individualism that blessed and made this nation great.

Dr. Copeland, a past president of the AAPS, practices internal medicine in Hillsdale, New Jersey, and serves on the Steering Committee of the Physician’s Council at The Heritage Foundation. This editorial is based in part on her speech this past Spring to the Libertarian Party of Pennsylvania. Her address is 47 Central Ave., Hillsdale, NJ 07842.

Originally published in the Medical Sentinel 1997;2(4):138-140. Copyright © 1997 Association of American Physicians and Surgeons (AAPS).