“The more we do to you, the less you seem to believe we are doing it.”

                                                                                                 -Joseph Mengale

 Liberal economists and ethicists, clandestine in their efforts to influence the medical profession and the delivery of health care to all Americans, croon about the concept of distributive justice. Unfortunately, many in the heath care industry, including doctors and their representative medical societies, are singing along unmindful of where distributive justice can lead them. 

Among the more visible proponents of distributive justice in medicine is bioethicist Ezekiel Emanuel, MD, brother of the current White House Chief of staff Rahm Emanuel. In fact Dr. Emmanuel is currently serving as an advisor to the Obama administration on health care reform. He has cited the modern day father of distributive justice, philosopher John Rawls ( A Theory of Justice, 1972) in his writings. Rawls believed that resources should be available to all equally but, seemingly in contradistinction to that statement, that they be given to the greatest benefit of the least advantaged members of society. This would certainly be problematic in America where there is no caste system and people commonly go from less advantaged stations in life to more improved ones. Therefore, what criteria will be used to determine advantages and more importantly who will be making these decisions? In his book “The Ends of Human Life”, Dr. Emanuel evaluates the justice of the distribution of health services to the populace. In it he queries- “What considerations should determine the availability of services and patient selection for medical services?” The use of the word selection is disquieting. He goes on to state-“The quantity of social resources (read your money) devoted to medicine will influence the range of services that can be provided and how restrictive patient selection criteria must be.” Given the political leanings of Rawls and Emmanuel one can conjure up what selection portends. Aristotle believed in the concept of distributive justice in a different way. He too realized that allocation of scarce resources needed to be justly distributed but believed that merit not station be its constituent.

 The concept of distributive justice in medicine places the individual patient at greatest risk. Allowing it to be implemented would be to dispense with the Hippocratic Oath, a concept applauded by Dr. Emmanuel, and would break a physicians promise to do no harm. It will take us to a construct of medical minimalism where the least for the individual will be the best for society and the state. In such a system individual worth, and moreover, the worth of human life will diminish and the power of government will expand. Author Harold O. J. Brown writes about the threat to the individual patient in his book “The Sensate Culture”. He writes-“They become ciphers in the calculus of societal utility, like the animals in a veterinarians care, treated and healed when it is possible and economically feasible but painlessly disposed of when it is not.” The proxy for this in America is former Governor of Colorado and physician assisted suicide advocate Richard Lamm. A once powerful politician, he once stated that the elderly and terminally ill had “a duty to die and get out of the way”. Hilariously, in a New York Times article after that statement, he made an imbecilic attempt at an apology stating- “I was essentially raising a general statement about the human condition, not beating up on the elderly.” Once a Democrat, Mr. Lamm is now thankfully a member of the Reform Party and has therefore been politically neutered. Regrettably, there are those of his ilk in the seats of power today.

Almost sixty years ago in the New England Journal of Medicine an article by Leo Alexander M.D entitled “Medical Science Under Dictatorship” castigated the physicians and scientist who assisted the Nazis in purging the sick and frail in their pogrom against their own people and the people of the world. He noted the omnipresent “preparatory propaganda” that was “directed against the traditional compassionate nineteenth century attitudes toward the chronically ill”. And, “By 1936 extermination of the physically or socially unfit was so openly accepted that its practice was mentioned incidentally in an official German medical journal.” After Alexander poignantly cataloged Nazis atrocities perpetrated by doctors he left us with this: “Whatever proportions these crimes finally assumed, it became evident to all who investigated them that they had started from small beginnings. The beginnings at first were merely a subtle shift in emphasis in the basic attitudes of the physicians.”

Joseph Mengale was the most brutal Nazi physician at Auschwitz.

On May 20,2009, the New England Journal of Medicine published an article co-authored by two physicians with ties to Harvard, the bastion of liberal health policy academia. Dr. Elliot S. Fisher and Dr. Donald M. Berwick penned- “Achieving Health Care Reform ----How Physicians Can Help”. Without elaborating, because it contains the same liberal rhetoric we are all too familiar with, it basically just tells us to take one for the team. For guidance they refer to the Institute of Medicines landmark report Crossing the Quality Chiasm. This is merely a veiled attempt at guising government control as improved information systems blah, blah, blah. It sheepishly concludes- “ ….neither physicians nor anyone else on the front lines can improve care much on their own.” Thus, neither of them has any comprehension of what individual physicians accomplish each day in the aggregate.

If you look at two of the authors of this perspective you will not be surprised to find that they belong to the socialist, globalist Institute of Medicine. Dr. Berwick not only belongs to the IOM but is a member of their Global Health Board which just recently finished their manifesto "The U.S. Commitment to Global Health: Recommendations for the Public and Private Sectors". These people are self avowed advocates of handing our nation's healthcare sovereignty over to the World Health Organization. The WHO states in its Commission on the Social Determinants of Health that it is our obligation to "Tackle the inequitable distribution of power, money and resources." And, "Address the inequities ...in the way society is organized." Most laughable is Dr. Fisher and Dr Berwick's feigned fealty to patient centered care. These people are distributive justice advocates and apostates to the Hippocratic Oath. Distributive justice takes away the rights of the individual and allocates them to the collective. Google search distributive justice + medicine and you will be appalled at how prevalent an idea this is among these IOM types, some of who are presently serving in the Obama White House. So as not to steer away from the playbook, the report also sites global warming, which is perpetrated on the poorer nations who bear no culpability in its creation (women, poor and children hit the hardest), as "possibly the largest health inequity of our time." They affirm that medical intellectual property and patents should be made vulnerable to less fortunate countries to the detriment of those that labored on them and invested in them. They would require that universities and other medical research institutions that take government and philanthropic funding be forced to "..adopt patent policies and licensing practices that enable and encourage the development of technologies to create products for which traditional market forces are not sufficient..". In essence, make products that you will lose money on. Given the example of the American banking system it would be ill advised to take funding at all lest your Constitutional right to private property be abridged. This applies to physicians as well since the IOM recommends that-"Congress should work with federal Executive Branch agencies and departments and U.S. universities to explore opportunities to leverage the U.S. workforce to contribute to solutions to partially address health workforce deficits in low income countries."

In its sycophantic coda dedicated to WHO the report states- "The committee finds that the United States has much to gain from supporting WHO and sees a unique opportunity for U.S leadership in strengthening this global body." With IOM zealots in the White House this comes as no surprise. President Obama wants to commit $63 billion to global health over the next six years.

This evidently is not near enough as, although we give more to WHO than any other country, we are drubbed by the report because we don't pay "our fair share." In goes on to foreshadow in frightening prose-"Given all these factors, WHO's financial struggle significantly hinders it's ability to promote institutional leadership against the pressures of state sovereignty and to advance the application of its legal powers.”

For Fisher and Berwick to moralize to any physician on how to assist these liberals in the destruction of our own livelihood unhinges my indignation.

California liberal state delegates, operating under a $42 billion budget deficit, wish to forge ahead with bill SB 810, their prescription for universal single payer health care, known as the California Healthcare System. Already inept at running public heath care and needing to scratch away $544 million of Medicaid services from the state budget this year, they remain undeterred in adopting an enormous expansion of their budget with this legislation proposal. This bill will misplace tremendous power over individual patient’s rights by consigning it into the hands of a very select few. This is always a recipe for a tyrannical governmental disaster.

The bill would create the California Healthcare Agency, charged with running this new system, and would be headed by an all powerful HealthCare Commissioner to oversee the new bureaucracy. This will be an appointed position by the California Governor and therefore this Commissioner would be unanswerable to the voters. It will give he or she oversight power over the unproved Office of Health Planning, Office of Patient Advocacy, Office of Healthcare Quality, Office of the Inspector General- a branch of the Attorney General’s office, the California Healthcare Premium Commission, the Healthcare Fund, the Public Advisory Committee, the Partnership for Health and head the authoritarian Healthcare Policy Board. The Commissioner will have the power to appoint the heads of all of these offices and to appoint and fix their compensation.  Health care already comprises thirty percent of California’s state budget. It is meretricious, at best, to suggest that this kind of government expansion will lead to a savings to the people of California.  Each regulatory clutch within this agency will expand and devour more of people’s money and personal property as it evolves. We know this by looking at the history of all of the current entitlements in California and elsewhere.

Down the chain of command from here will be the regional planning board members appointed by the regional director. They will also be eligible for 16 years of service. These deeply entrenched bureaucrats will have their tentacles in every aspect of health care funding and delivery within their arbitrarily assigned regions. Politics will surely enter into the creation of these regions and regional development districts are not specified within the bill. The potential for fraud and abuse is great and this is best evidenced by the provision in the bill which states that regional planning directors will be charged with the distribution of capital for investment in regional capital development projects which can include land acquisitions, property refurbishment, environmental impact costs etc. However, as stipulated in the language of the bill- “The regional planning directors shall make financial information available to the public when the system’s contribution to a capital project is greater than twenty-five million dollars (25,000,000).” Therefore, any project that the system spends $24,999,999 on is under the wire. Federal government funding involvement in a state project would be mutually exclusive.

The regional control of physician fee setting, program costs,  and price setting of durable medical goods will lead to local shortages of everything and bring down the quality of care to everyone in that region. You only need a rudimentary understanding of economics to understand this as goods will go where prices are best. Involvement of health care advocacy groups, practice guidelines and financial penalties for non-compliance will drive physicians out of California in a historic exodus. Most likely, as in Hawaii, simply trying to transition into this system will bankrupt it. If they are to do this let them do it quickly to provide the nation with its failed example lest we all become indistinguishable.

Connecticut is now in the health care spotlight as it unveils its plan for universal health care. In January of this year former community organizer Juan Figueroa, president of the Universal Health Care Foundation (UHCF), announced his organization’s plans for reforming Connecticut’s health care delivery. Not much is new or shiny about it as we have heard all the rhetoric before. In fact, it mirrors the Obama administration plan in an eerie way. What is interesting is the history and vocation of this organization.

In 1997 the Connecticut state attorney, state comptroller and some civic organizations, one of which was the very left leaning Citizens for Economic Opportunity (CEO), sued Anthem Insurance Company, a for- profit organization, for its merger with non-profit Blue Cross and Blue shield of Connecticut (BCBSC). The suit was supposedly intended to recover tax benefits that the non-profit BCBSC had received over decades of doing business in the state. The legal action dragged on until 1999 when State Attorney General Richard Blumenthal issued a press release that he, State Comptroller Nancy Wyman and CEO had settled the case out of court for 41 million dollars. One would assume, incorrectly, that the fruits of a law suit brought on by public officials would at least in part end up serving the people that the merger of the two insurance companies allegedly damaged. Instead, the money was used to create the Connecticut Health Advancement and Research Trust (CHART) whose intent, per Mr. Blumenthal, was to- ..serve the health needs of the citizens of Connecticut, particularly the indigent, uninsured and the underinsured.” CHART was to be funded by the Anthem Foundation of Connecticut, which was formed as a non-profit. However, per the Anthem Foundation's 2002 audited financial statements the organization was formed for a different purpose altogether. As it states: “The Foundation was organized to act as a catalyst for structural change by commissioning and directing studies regarding health care delivery, federal and state compliance issues and researching options for small employee health care insurance.”

You are not going to cure a lot of indigent sore throats with that.

In July 2004, the Anthem Foundation was changed to the UHCF with Mr. Figueroa as its president. What happened to CHART? It is the parent organization to UHCF and as it says on its website- “CHART is a research, development and education organization that hosts forums on various issues related to health care policies in Connecticut.” In 2006 UHCF had assets of 51 million dollars and disbursed 718,028 thousand dollars in grants. Who gets the money? Last year, representative of past years, the money went to municipal employees unions, teachers unions and community organizer groups including $120,000 to CEO, one of the schemes originators. On review of their website I could not ascertain that $1 went to the direct care or treatment of any individual whether they are indigent Black, White, Hispanic, male, female or otherwise. This is an organization dedicated to liberal policies and intends to further the role of government in every aspect of people’s health and well being. In essence, it seeks to become more powerful and has little to do with helping anyone.

Last week the UHCF held public forums regarding its rollout of the proposed Sustinet public health insurance plan. Learning nothing from Massachusetts, Hawaii or the Soviet Union I am sure they intend to plow ahead with it. The plan is important because it is a minute version of the Obama plan in almost every respect. It resolves to put an end to private health insurance by having them compete with government. Unlike government, private businesses can not indefinitely deficit spend and then print more money when the money is gone. This will exterminate the industry by attrition. Connecticut will launch Sustinet in the face of a state budget deficit of 8.7 billion dollars. They are counting on 800 million federal (yours and mine) dollars over five years in their plan. Yesterday, in the Connecticut Post, a story on the Connecticut Office of Fiscal Analysis’ evaluation of the Sustinet proposal appeared. It stated that the cost of the program could not be known because the standard benefits have not even been decided on. Yet, the Sustinet proponents claim that it will save individuals 900 dollars a year that they would have spent on health insurance. This is chicanery of the worst kind.

I think the Obama administration has a fretful eye on this little state. We should have a vigilant one.

In the last two months, two articles in the medical literature have provided affirmation that opposition to government take over of our health care system is constructive. The articles reveal the possibilities of unintended consequence brought on by the well intentioned liberal policy of centralized control of American medicine.

The Institute of Medicine, a liberal science and health policy organization, proposed the development of medical treatment and diagnostic guidelines to standardize health care delivery. This idea was well received by those in medicine ambitious to wrest control from doctors and patients regarding independent decisions relative to the patients well being. In the February 25, 2009 edition of the Journal of the American Medical Association (JAMA), an article titled “Scientific Evidence Underlying the American College of Cardiology (ACC)/ American Heart Association (AHA) Clinical Practice Guidelines” stated that “..clinical practice guidelines are largely developed from lower levels of evidence or expert opinion. The proportion of recommendations for which there is no conclusive evidence is also growing.” It also stated that recommendations with high quality evidence comprised only 19% of available guidelines. This study applied to clinical guidelines among these entities only, however, the ACC and AHA are two of the largest and well financed health care organizations in the country and extrapolation of these results to other guidelines is hardly a stretch of the imagination. What is unimaginable is that any central government institution can use comparative effectiveness research and produce superior outcomes yet this is the mechanism that they propose to implement. This research will lead to more guidelines which will be firmly entrenched in our health care policy. In the aforementioned study it was stated that updates to guidelines could take a mean of 4.6 to 8.2 years. The potential for our health being subject to inferior science for indeterminate amounts of time is self evident.

The second article of interest comes from the March 1, 2009 Family Practice News periodical. This article demonstrated the ostensible implications of forcing doctors to practice under medical guidelines. The Centers for Medicare and Medicaid Services (CMS) developed guidelines for treating community acquired pneumonia (CAP). It then made hospitals responsible for reporting  to CMS on compliance with these guidelines. An Internet survey conducted at five medical centers in North Carolina revealed that to comply with CAP guidelines 55% of emergency physicians at those centers had given antibiotics to patients that they did not believe had pneumonia. Specifically, one of the CAP guidelines required the administration of antibiotics, not always benign drugs, to patients with pneumonia within 4 hours after their arrival to the ER. At times, not able to examine, test and diagnose patients within that time frame, the physicians opted to give antibiotics on their best guess rather than incur the consequences of non-adherence to CMS guidelines. This represents a disturbing although natural trend for some people to abandon principle over policy. It also presents a reprehensible example for medical students and residency trainees exposed to such an ethical disregard.   

The suggestion of scientifically well founded guidelines to assist doctors in caring for patients is not inherently bad. It is the autocracy that accompanies it which needs to be resisted. Human beings can’t be expected to act infallibly and some will succumb to authority despite knowing the difference between right and wrong. This makes centralizing health care a precarious affair.

In 2007 the Robert Graham Center for Policy Studies in Family Medicine and Primary Care, a research unit of the American Academy of Family Physicians, issued an opinion piece on the governments truncheon for change- the Patient Centered Medical Home (PCMH).  In here it betrays that-“ The PCMH may be a political construct but it is also an important evolutionary model derived from extensive evidence for its components.”Moreover, speaking to the nature of its good intentions-“As a political construct, there is a real risk that the medical home principles will be turned to the specific task of cost containment threatening the intent and potential to improve the experience each person has in the course of their care.” Do these people know absolutely nothing about history and human nature?

In his farewell address to the nation President George Washington warned of human nature and its disposition to “ love of power and proneness to abuse it.” Similarly, Thomas Jefferson said “..experience hath shown, that even under the best forms [of government], those entrusted with power have, in time, and by slow operations, perverted it into tyranny…” These are absolutes. The rights of the individual, the cornerstone of our freedom, should not be abdicated to government at any level.  This includes our inestimable rights when it comes to health care.

I went to visit a patient of mine who has been in a nursing home since suffering a stroke a few years ago. At his bedside were several members of his family who wanted to be there at my appointment. My patient enjoys these gatherings and the attention it brings even though he is in pain from being bedridden, speaks poorly due to his stroke and needs help with all activities of daily living. His family helps out dutifully when they can and his life and comfort bring them great joy. Who is to be the judge of this man’s quality of life? Heaven, remit that power from the government.

Without the benefit of any debate in Congress, President Obama’s stimulus bill funds the creation of the Federal Coordinating Council of Comparative Research. This new beaurocracy will be charged with deciding which treatments are worthwhile for you by comparing them to alternative treatments and the differences in their outcomes. Of course, the formula created to achieve this task has at its crux the cost of the remedy in question. What is frightening is that cost will be closely tied to another formula which will function as a determinate of whether you are worth the trouble to treat or not.

The concept of a measuring tool to evaluate a person’s worth vaulted out of the minds of economists several decades ago. The Quality Adjusted Life Years (QALY) brain wave arose to assist in the rationing of care to individuals based on several arbitrary characteristics of their current health status. In the most common system, the EuroQol- ED-50 (ED-50), it is a number assigned on five elements of a patient’s health. (1) Patient mobility, ability to ambulate. (2) Ability for self care (3) Usual activities (e.g. work, leisure activities, reading etc.) (4) Pain (5) Psychological status, depression, anxiety. Each category is rated on a scale of 1 to 3 where 1 represents no problems, 2 represents some problems and 3 represents major problems. This 5 digit code is then linked to a number on a table from 0 (death) to 1 (perfect health). One can think of it more pragmatically as percentage.The QALY score, let us say for example .75 or 75%, is then used to calculate whether there is any gain to the system with regards to available resources in treating you with a particular treatment. This figure does not calculate the variable of the inherent value of a human being’s life to himself/herself or to their family. Using this capricious equation one can even be assigned a negative value and I assume that would lead to the interpretation that you are better off dead and likely soon will be.

I took the liberty of calculating the QALY of my patient mentioned at the beginning of this piece. It was -0.429. Try telling that to his family.

We are constantly deluged by the media regarding the sorry state of affairs in our health system. A typical statement of our woeful condition usually echoes the 2000 World Health Organization’s “Assessment of the World’s Health Systems” opening sentence: “The U.S. health system spends a higher portion of its gross domestic product than any other country but ranks 37 out of 191 countries according to its performance, the report finds.”   At first glance, I am wondering how this could possibly be true given that most citizens of the world are trying to get in this country and one reason is our health care system. I only had to investigate the parsing of the word performance to arrive at the truth. 

A very telling statement in the report follows: “In designing the framework for health system performance, WHO broke new methodological ground, employing a technique not previously used for health systems.” This alone should render supposition to this report. The criteria for assessing a health care system included 5 indicators. Overall level of health- based on life expectancy; health inequalities within the population; overall level of health system responsiveness-a combination of patient satisfaction and how well the system acts; distribution of responsiveness; and the distribution of the health system’s financial burden within the population. Let us look at responsiveness. Responsiveness was further defined as including respect for patient’s dignity, confidentiality and autonomy of individuals and families to decide about their own health. This is the exact opposite direction that the liberals in Congress intend on taking us. Moreover, responsiveness also included giving patients: “prompt attention, access to social support networks during care, quality of basic amenities and provider choice.”  This is an arbitrary measure, created by WHO, to basically judge the only thing that ultimately matters in delivering any service: Is the product good and are customers satisfied? In this, according to this report, the USA was number one in the world. Number one! The only criteria that I would agree that we do not do well on is distributing the financial burden as most of who work hard pay an unjust amount for those who do not. My summation, not theirs

Another contention of those prone to denigrate their country at any opportunity is America’s poor achievement on the rate of infant mortality compared to other countries.Who beats us one on this issue? Singapore. Singapore, a country of roughly 4 million people, has an infant mortality rate of 3.2 per thousand births. The USA rate is 6.78 per thousand. How can this be? One reason is that mothers in Singapore are generally younger, married and unlikely to deliver crack addicted children as the penalties for drug related offences in that country vary from long prison terms to death. Maternity leave in that country is from 8 to 12 weeks but you have to be married to receive the benefit. Therefore, health care outcomes are likely to be affected by social behavior as well as the systems in place to provide care. Liberals want to relieve you of your liberty with regard to the former and ignorantly maraud the latter simultaneously.

We have a good health care system in the United States, not a perfect one. We are a great and diverse society, also not perfect. Let’s not demolish our health care in the pursuit of perfection which is unattainable.

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The Stimulus Bill of 2009 passed into existence this week with its revisions for America’s health system largely unscathed.   Congressional Democrats cowardly slipped provisions for health reform into this bill attentive to the fact that a public debate on the issue would shred their aspirations to tatters.

A newly created bureaucracy will be brought forth under the dictum of this legislation that has the potential to strike at patient’s and doctor’s rights in a very pernicious way. The Health Care Comparative Effectiveness Research Institute (HCCERI) will be created and controlled by a 21 member Board of Governors composed of, as stated in the Comparative Effectiveness Research (CER) Act, the Secretary of Human Health Services (HHS), the director of the National Institutes of Health (NIH), and the Director of the Agency for Health Research and Quality and 18 bureaucrats to be named later. Its funding will be 5 million dollars in the first year and expand to 300 million per year in five years. The undertaking of the HCCERI will be to evaluate research on competing treatments and diagnostic methods and then decide which ones are the most effective. Sounds like a good idea. The problem is that the NIH, with a 30  billion dollar budget, already does this and has been doing so for years. The information from their comparative effectiveness research is widely available to doctors so why do we need the HCCERI?  This new bureaucracy is there to tell doctors and patients what treatments they can and can’t have i.e. rationing care. Doctors, too stupid from years of training, can’t be trusted to stay current with the medical literature and therefore must be guided to the appropriate care for their patients by the government. The potential for the abuse of power under such a system is staggering.

The NIH helped fund the 100 million dollar Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT) in 1994. One of the many things it evaluated over 8 years was the difference between three types of blood pressure medications. Diuretics (fluid pills), ACE inhibitors and a calcium channel blocker were compared to each other. This study found that diuretics were 2mm (2 points) better than the expensive ACE inhibitor lisinopril. An example would be the difference between 160/80 and158/80.  Cost was one of the issues being studied as the researchers noted that diuretic use was declining due to newer more expensive medicines entering the market place. Had we had the HCCERI in place would we all then be prescribing diuretics to everyone? Fast forward to 2006 and enter Wal-Mart. Lisinopril is now $4 a month which is the same price as a diuretic. What would it take to turn the bureaucratic boat around on this versus doctors and the free market deciding what we should do?

History is always a great pedagogue. We only have to look at centrally planned heath systems in other countries to learn that this level of government interference always leads to rationing of care and senior citizens are always hardest hit. In 1997 J. Grimley Evans, a British professor of clinical gerontology, wrote the following  in the prestigious British Medical Journal about the British National Health Service: “Older people are discriminated against in the NHS. This is best documented in substandard treatment in myocardial infarction and other forms of heart disease, where it leads to premature deaths and unnecessary disability. The care for older people with cancer is also poorer than that provided for younger people.”

I had an interesting conversation with Mr. Jim Dau last Wednesday. Mr. Dau is a national media representative at the AARP. I brought the issue of the HCCERI up with him. According to Mr. Dau, and to AARP President Bill Novelli in his official AARP statement, critics of CER are using “scare tactics” to block health reform. I hope the 40 million members of AARP are paying attention. Apparently, AARP is on board with this and all of the health care changes contained in the stimulus bill. Essentially, Mr. Novelli has all of his members looking at the undercarriage of the bus. The AARP describes itself as non-partisan because they don’t contribute money to politicians or political action committees. It does not take much of an inquiry to see that they are in lockstep with the Democrat party. With 40 million angry voters, Democrats and Mr. Novelli may need to give greater consideration to the truth

In April of this year I will blessed to have lived in the greatest country in the world for 50 years. On February 10^th, I received a membership card from the AARP. I am sending it back without the $12.50.

I have always wondered why physicians in positions of influence in our profession act to undermine it under the guise of reform. I’m not saying that some reform in medicine is not needed; however, to affirm the cataclysmic paradigm shift advocated by the Presidents of the American Medical Association, the American Academy of Family Physicians and the American Osteopathic Association is an enigma. Their socialistic approach to reform would eventually abrogate the power of self-determination to the government over the individual’s will to make choices regarding their own health and well-being. (See the Oregon health system.) How do physicians, incipiently devoted to people, become fervid chattel to policy? It starts early.

Buried beneath the surface in many medical schools with leftist leanings, (for our purposes we will look at Harvard Medical School) are Departments of Social Medicine. These are brazen liberal indoctrination centers ensconced within these particular schools of medicine. They are political instruments of the left designed to inculcate the minds of medical students to their way of thinking. Herein lies the underpinnings of the transformation of healthcare as these people, soused by the liberal medical faculty, convulse into the real world with their quixotic tendencies to cure that which is not indisposed. They would serve as amusement if they were not serious.

President Obama’s healthcare transformation team is replete with disciples of the Harvard Department of Social Re-thinking. Dr. Dora Hughes, an Obama health policy advisor since 2005, received a Masters degree in public health from Harvard in 2000. Although she received her medical degree from Vanderbilt she most certainly was inseminated by the Harvard culture during her tenure there. With the recent remotion of tax bilk Tom Daschle, she is well-positioned to become a big power player in our healthcare system. From 2000 to 2003, as a senior officer at the liberal Commonwealth Fund, an extremely well funded healthcare policy foundation, she cut her teeth on the instrumentation of hijacking the US health industry. From there, she went to work for the disreputable Sen. Ted Kennedy as Deputy Staff Director for Health until 2005. Are there any more well established bona fides for a socialist? Well, maybe.

Enter Dr. David Blumenthal, Harvard trained physician, Executive Director of the Commonwealth Fund Task Force on Academic Centers, and a high level member of President Obama’s healthcare transformation team. Dr. Blumenthal is the founding director of the leftist Institute for Health Policy which makes the Commonwealth Fund look like the Heritage Foundation. He lives in Massachusetts, a state which has mandated that all residents of that state have health insurance. Not withstanding that this mandate has collapsed access to care in that state, Dr. Blumenthal says: “Indeed, as the Massachusetts experiences illustrates, non-compliance with mandates is a large problem, absent harsh sanctions.” Additionally he states: “Mandates alone, without strong incentives to comply and harsh punishments for violations, will have little impact on the number of uninsured Americans.”   Would you want this man to be your doctor?

What is frightening about these people and their like-minded minions is not their thought process but rather their new found power to apply it. These are authoritarian visionaries who are willing to strike at your liberty in the advancement of their agenda. They, not you, are to be in control of the dearest of your freedoms, your health. The sophistication of the academic assembly line that gives birth to this tyranny is repellent. Only the disinclined naiveté that gave ascendancy to the Obama administration could allot power to such autocrats. Let us not be so insensate as to let them rob us of our sovereignty over our own health.

Politicians are much akin to advertising executives when it applies to hustling their vendible goods. Both parties like to attach key catchphrases and slogans to the products they wish to sell. Sadly, with politicians and government there is almost always a disconnect between vendible and valuable.

The medical home and patient centered care are two phrases that are nauseatingly referred to in the primary care medical lexicon these days.  You can’t read any literature regarding health care reform without these terms being referenced.  What exactly do they mean? I have asked many of my colleagues, some who profess to be well versed in the reform of medical practice and they can only offer a subjective analysis.  A medical home sounds pleasing. Let’s look at its definition as interpreted by the experts.

According to the American Academy of Family Physicians, a medical home is “ ..the focal point through which all individuals-regardless of age, sex, race or socioeconomic status- receive acute, chronic, and preventative medical services.”  Sounds nice. In fact, it describes what already goes on in just about every primary care office I am aware of. So why do we need this as part of reform?  The answer is we don’t.  As with any shill you have to be vigilant or you will become another dupe.

The medical home is the vehicle for nothing less than the destruction  of all that is good about medical care as it is currently delivered.  It is a practice model developed by a group of consultants for a project known as The Future of Family Medicine Project (FFMP). The model proposed by the FFMP smacks more of social engineering than  the delivery of care. Its main believed abstraction involves altering the role of everyone’s primary physician from care provider to information manager. The physician will be required to be accountable for case managing patient's care with a financial incentive to redirect them to community services, health coaches and group visits in an effort to keep them out of the fee for service face to face visit.

Significant “investment” will be required by practices to implement this when it is eventually mandated by the government.  The Deloitte Center for Health Solutions, a health care consulting firm, estimates the cost to each practice for infrastructure at about $120,000 and an additional cost per provider of $115,000.  The medical home will be accountable through performance measures as adopted by the government which, to monitor it, will require an enormous expansion of the Federal bureaucracy. This bureaucratic expenditure is not cited or assumed in any of the literature I have researched on the subject.

The most important piece of this scheme is its requirement that each medical home implements electronic medical health records for patients and necessitates that they interface with other medical homes, hospitals and payors i.e. government.  This is the Trojan horse that physicians, whose lives are already tormented by government, will let in the door to destroy not only their patient's privacy but their own livelihoods as well. Government will be allowed to make sure patients are treated along, what they will be told, will be scientific guidelines. For the most part, doctors not patients will be held fully accountable for patient’s behavioral adherence to these mandates. Every doctor knows that the least controllable variant in patient management is the patient and to tie your reimbursement to it would be financial suicide. Look to managed care if you don’t believe it.  In fact, under the medical home model part of the physician role is defined as gatekeeper. Ah, memories.

Proponents of the medical home will argue that in the long run ( and no one knows how long ) this will lead to significant savings to the nation by reducing overall cost.  However, this is only an assumption based on statistical models and, as I said, do not factor in the bureaucratic costs. There are some government sponsored pilot programs underway but that data will not  be available for years to come.  Democratic congressman Max Baucus, chairman of the Senate Finance Committee, has published his Call to Action manifesto, sure to be used as a blueprint for national health care, which has as its centerpiece the medical home and patient centered care. There is a problem however.  Recent data evaluated by the National Demonstration Project ( NDP ), a private pilot program developed to test the medical home concept and published in June 2008, shows that this approach is inherently flawed. The program is described as “..rife with unexpected setbacks. Staff turnover, embezzlement, death or illness in the family, financial worries, personal and personnel problems,  inconsistent technology, and the bureaucratic systems moving at a glacial pace..” . Is this what we want? There’s more. There is no proof it saves money. Not one dime.  NDP states: “ However, the data which have emerged will simply not permit analysis of the financial implications of implementing either the components of or the total { medical home } model.”  Furthermore, the side that declares patients need a physician’s office to be seen as a medical home need to hear this from the NDP: “ However, the data also suggest that this characteristic was largely in place in these practices at baseline.”  Astonishing.  They are, of course, continuing to evaluate their data. As Benjamin Disraeli once said: “ There are three kinds of lies: lies, damned lies and statistics.”

The Left is now in power in this country and they are eager to reform our health care system. That should scare the hell out of you.  If you are a doctor, especially specialists as you have more to lose, talk about this with your colleagues.  I can assure you many of us do not see this coming.  It is the siren-like pleasing phraseology of the medical home and patient centered care that will dash us on the rocks if  we do nothing.