Comments by Lawrence Huntoon, MD, PhD on latest editorial in JAMA by Ezekiel Emanuel. JAMA Vol. 310 No. 4 pp. 374-375, July 24/31, 2013
Zeke bemoans the fact that physicians have not yet completely given up in defeat and joined his unsinkable ship, the SS Socialist (new and “improved” version of the Titanic).
Zeke says physicians are “in denial” – i.e. he says physicians are not willing to accept full blame for the spiraling cost of medical care.
Zeke, however, fails to address the major cause of increased costs of medical care – government intervention. Government intervened between the “seller” and the “buyer,” so that neither was concerned about costs because “someone else” (taxpayers) would foot the bill. When neither “seller” nor “buyer” care about costs, costs predictably increase.
Insurance companies, protected from antitrust actions by the McCarran Ferguson Act (1945), are allowed by government to function as monopolies. Monopolies always result in higher prices not lower ones. The insurer also acts as a “third party” between “seller” and “buyer” such that neither cares what it costs. Insurers also destroyed the concept of true insurance, and instead sell a very expensive version of prepaid healthcare (out of which the insurer takes a very handsome cut).
This disruption of the free market system IS the Cause of increased costs of medical care. And ObamaCare is making all of this worse. More government intervention is not the solution to a problem caused by and perpetuated by Big Government.
Zeke calls for more cost-containment.
Zeke calls for embracing “change”
1. Elimination of independent physicians in favor of so-called Accountable Care Organizations where the physician is accountable to the organization first, and patient last
2. Elimination of fee for service medicine in favor of bundled payments, where large hospital corporations as the main partner in Accountable Care Organizations will determine what the physician “serfs” will receive for their work (HMOs tried capitation in the 1990s, and not only did it not reduce costs but it was universally hated by physicians and patients alike – remember the movie “As Good as It Gets”?)
3. Substitution of “cheaper” PAs and NPs for physicians. Apparently, Zeke thinks that medical school, internship, residency, fellowship, and years of experiencing as a practicing physician are very over-rated or at least not affordable in the new “society-based” model of care where society comes first and individual patient comes last. Besides, PAs and NPs may be more amenable to being the agents for rationing care than physicians.
Zeke finds the physician survey results published in the July 24/31 issue of JAMA
to be very discouraging in terms of advancing a socialist agenda (“Change”).
In particular, he finds most depressing:
Failure of physicians to embrace loss of autonomy
Failure of physicians to embrace drastic cuts in income via a bundled payment ACO system (failure to embrace working harder and longer for less and less pay)
Failure to embrace limiting access to care for certain treatments in the interest of
preserving “society’s limited resources” – “society” should determine what people
receive and don’t receive in terms of medical care.
And, although Zeke pays lip service to physicians as “captain of the healthcare ship,” it
is clear that Zeke’s “all hands on deck” approach plans on demoting physicians to
ordinary “deckhands” who will swab the decks and do as they are told by their “superiors.”
It sounds like Zeke is counting on physicians developing the Stockholm Syndrome,
where beaten down hostages of an oppressive government/insurer third party system
develop positive feelings toward their oppressors and adopt the same views as
their oppressors. Zeke wonders why it is taking so long to break the backs of
Meanwhile, Zeke enjoys the secure salary of an academic working in, of all places, a Department of Medical Ethics. In writing the editorial, he discloses no conflicts of interest.
…and the IRS is a government agency focused on compassion run by a man who felt no obligation to pay his taxes.
L.R. Huntoon, M.D., Ph.D., F.A.A.N.
Journal of American Physicians and Surgeons
Lake View, NY