by Mark Lundgren, C4L
Mark Lundgren, College of Health Sciences, Biomedical Sciences, Barry University
Before I delve into the specifics of “Obamacare” and the impact of government managed health care in the American dental profession, I must explain a concept that is vital for understanding the dangers of the current health care bill- “Obamacare” is not about the health of the public, but of control of the public and the health industry. A government functions analogously to cancer. The cancer starts small and relatively harmless, but slowly the malignant cells replicate. Eventually, the malignant cells metastasize and infiltrate the other tissues of the body, draining the host of his resources until he succumbs to the cancer. Cancer is difficult to treat because the cancer cells somehow “trick” the body into accepting the malignant cells as normal, thereby preventing the body’s immune system from destroying them. This is the same mechanism a government uses to infiltrate parts of society. A government “tricks” the people into thinking that the government is needed (for protection, safety, health care, etc.) when in reality the societal organ operated much better without the cancerous government. A classic example of this mechanism, whether intentional or unintentional, is the recitation of “sob stories” in order to stir people’s emotions. “My mother/brother/friend desperately needed a [blank] treatment, but had no insurance and did not receive the treatment. If the government ran health care, then everyone would be treated.” These stories are effective not because they are rooted in fact, but because they appeal to people’s natural compassion. The natural goodness of people is then used deviously as justification for government intervention. (1)
Americans are very charitable and compassionate people, and as such the debate about health care reform naturally evokes strong passions, emotions, and opinions on both sides of the issue. But we must be careful to not let feelings interfere with our reason and logic. For example, advocates of the package of health insurance regulations managed to frame the issue as “reform versus the status quo.” (2) But reform (in the true sense of the word) was never the issue. Reform means improvement, and no rational person would argue against improving the current health care system. Therefore, the real debate is not “reform versus the status quo,” but how to best improve the system. (2)
Unfortunately, the PPACA legislation that was signed into law on March 23, 2010 will not improve our health care system, but will undermine the integrity of the medical profession. Fortunately, dentistry is still a remarkably autonomous profession, and is still relatively free of cancerous government interference, but the threat of a government take-over is looming. Dentistry and medicine are intimately related, so one can only assume that the dental profession is susceptible to the same problems that plague the medical profession. The backbone of medicine is the doctor-patient relationship. It is essential for the delivery of high-quality health care in the diagnosis and treatment of disease. The Patient Protection and Affordable Care Act, which gives the federal government significant control over the medical profession, is a profane violation of the doctor-patient relationship. Using present day examples of failed health care policies, I will show that government managed health care destroys the doctor-patient relationship by limiting physician (and dentist) autonomy, and that the “Obamacare” legislation is pushing America further down the slippery slope in which doctors are chattels of the state.
On March 23, 2010 President Obama signed the Patient Protection and Affordability Act into law, legislation that may permanently alter the medical profession in the United States of America. The act expands Medicaid eligibility, establishes health insurance exchanges, and creates numerous government agencies to oversee insurance regulations, health care payments, and medical research. The act did not explicitly give the government complete control over the entire health care sector, but it did give the federal government unprecedented control over the medical profession through health insurance. By controlling and regulating the health insurance industry, the government has solidified its role as an intermediary between the patient and the doctor.
From 1789 until 1933, medicine in the United States was practiced the same way as all other legitimate businesses- as a consensual contract between two free individuals, the doctor and the patient. There were no social welfare programs, publicly funded health care programs, or bureaucratic governing bodies dictating the decisions physicians could make. (3) The system was not perfect, and medicine was still in its infancy (and not very scientific by today’s standards), but this business model did not develop randomly. It was a natural consequence of John Locke’s idea of natural rights (or inalienable rights). The concept of natural rights, which can be understood as rights that are not contingent upon the laws, customs, or beliefs of a particular society, formed the basis of the Declaration of Independence and the U.S. Constitution. Accordingly, the most basic right granted to every human being is personal autonomy; every person has the power to control their own actions and the right to what he makes with his own hands. (4) In the context of medicine, under natural law, a doctor is free to make his own judgments and free to charge and profit whatever amount he sees fit. Likewise, the patient is equally as free to make his own decisions and is free spend as little or as much as he sees fit on his own health.
The practice of medicine by natural law prevailed throughout the 19th and early 20th centuries in America. It wasn’t that no one during this time period thought of the concept of universal health care, as the implementation of Marxism was well underway in Europe and Asia, or that no one had proposed any bills in the United States (they had, for instance Dorothea Dix proposed the federally funded “Bill for the Benefit of the Indigent Insane” in 1854), it was just well known in the U.S. that the federal government was prohibited by the Constitution from mingling in the private affairs of citizens. (5) This changed around 1933, and the concept that health care and welfare as “rights” with government involvement in the lives of citizens became increasingly mainstream. The catalyst for this change was the rise of Franklin Roosevelt who, with the help of the Great Depression, managed to convince a large following that a federal social welfare program would be beneficial for nation. Consequently, Social Security legislation was signed into law, establishing the beginning of a welfare state in the U.S. Roosevelt attempted to directly add health care provisions to the Social Security legislation, but was unsuccessful due to the public and AMA backlash. (6) Roosevelt and his administration did, however, manage to change the tax code and laws so that the source of health care financing shifted from primarily the individual to primarily employment-based insurance programs. (2, 7) In the decades that followed the Great Depression, Medicaid, Medicare, ERISA, COBRA and numerous government agencies affiliated with the United States Department of Health and Human Services, such as the FDA, emerged and encroached themselves into the health care sector.
Health Care is not a “Right”
“The concept of medical care as the patient’s right is immoral because it denies the most fundamental of all rights, that of a man to his own life and the freedom of action to support it. Medical care is neither a right nor a privilege: it is a service that is provided by doctors and others to people who wish to purchase it. It is the provision of this service that a doctor depends upon for his livelihood, and is his means of supporting his own life. If the right to health care belongs to the patient, he starts out owning the services of a doctor without the necessity of either earning them or receiving them as a gift from the only man who has the right to give them: the doctor himself… American medicine is now at the point in the story where the state has proclaimed the non-existent “right” to medical care as a fact of public policy, and has begun to pass the laws to enforce it. The doctor finds himself less and less his own master and more and more controlled by forces outside of his own judgment.” (Robert Sade, MD 1971)
The idea that “health care is a right” is flawed and extremely detrimental to medical professionals and society as a whole. The “health care is a right” argument might seem compassionate superficially, but other people must pay for things like healthcare. Those people have bills to pay and families to support, just as everyone else. If there is a “right” to healthcare, the providers of those goods, or others, must be forced to serve the recipient. (9) It is also worthy to note that the “right” to health insurance is based on the same premise. Glenn Beck eloquently explained this concept with the analogy, “if you give “free” insurance to someone who can afford it, but chooses to spend their money on other things, you are essentially paying for those other things. I refuse to subsidize anyone’s Pussycat Dolls ringtone.” (10)
The Doctor-Patient Relationship
With the passing of “Obamacare,” the doctor-patient relationship in the United States was transformed into the doctor-government-patient relationship. Before practicing medicine, doctors take the Hippocratic Oath to always work for the good of the patient and to respect the patient’s freedoms and privacy. (11) In turn, patients could take comfort in knowing that the doctor was doing everything in his ability to protect his patient’s well-being. Trust is vital between the patient and the doctor. Now that the federal government has wedged itself in between the doctor and patient as the health care financier, this trust will erode way. Instead of a mutual agreement between the doctor and patient, the government will dictate the finances and resources available, and in turn, the actions of the physician. Instead of working for his patients, the doctor now works for the government. The dangers of this phenomenon are illustrated by a particularly sinister component of “Obamacare”- Pay for Performance. (12). As explained by David McKalip, M.D., Pay for Performance, or PFP, is a system that provides “incentive” payments for physicians and hospitals to comply with cost-cutting goals of government and insurance companies. Rather than being a reward for providing the best care for patients, PFP is better described as a system that punishes doctors for spending health care dollars on their patients. The doctor will have a choice: do the right thing and offer the most innovative and appropriate care to patients, or fail to even tell the patient about all the more costly care that is available to them. It will be difficult to trust your doctor in this new system. (12)
Health Care Policy Failures: A Look at Socialized Medicine (and Dentistry)
The most misleading (and unfortunately, cited) literature today regarding health care reform are probably the WHO/U.N. health model studies. The content of the studies conducted by these agencies, their affiliates, and similar organizations are beyond the scope of this essay, but they are routinely discredited and shown to be politically biased towards socialized medicine. (8) For example, in all of the studies that evaluate the health care systems of various countries, the medical statistics are self-reported by the nations and their hospitals. Health care systems are then ranked by numbers in categories such as “infant mortality rate” and “life expectancy.” Certain studies have even resorted to quantifying unscientific categories such as “better health” and “responsiveness to people’s expectations in regard to non-health matters.” (10) The problem with these statistics is that they are subjective and are influenced by far more factors than can ever be accounted for in surveys. (8) For example, countries such as the United States count all infants born with even a hint of life as alive, while European countries selectively count infants based on weight and gestational development at the time of delivery and alter their statistics accordingly. (10) Here is an example of how the “life expectancy” category can be misleading… Location A has a life expectancy of 78.7 years and location B has an expectancy of 75.8 years. Does this mean that location A has a better health care system? (10) According to the Commonwealth Fund and the World Health Organization it does. (13, 14) In reality, location A refers to the life expectancy in Utah and location B refers to the life expectancy in Nevada, and these two states have nearly identical health care systems. (10)
I found two statistics that, in my opinion, clearly exemplify proof that America’s health care system, while not perfect, is the best system in the world. The first is that U.S. companies have developed half of all major medicines introduced worldwide over the last twenty years, despite having only five percent of the world’s population. (10) The second is that 33 of the last 55 winners of the Nobel Prize in Medicine went to Americans. (15). Regardless of access to care issues, America advances medicine at a faster rate than any other nation in the world. The explanation of this phenomenon is simple. In America, there is incentive to become a doctor. Medicine in America traditionally attracts the best and the brightest students to the profession, as doctors enjoy enormous respect in society and significant financial benefits for their hard work. Doctors also have (or had) the autonomy and freedom to be creative and innovative without having government bureaucrats dictating and making decisions for them. As Robert Sage, M.D. correctly states, “Progress requires freedom of action, and that is precisely what national health legislation aims at restricting.” (8) It is my belief that medicine throughout the world suffered a serious set-back with the signing of “Obamacare.” The socialized countries of the world have the advantage of benefiting from the medical innovations consistently introduced by the United States while still retaining their health care systems based on political ideologies. If the rate of medical progress by the United States slows, it seems logical to me that the socialized health care systems will suffer as well.
Currently, the most accurate model we have of the potential consequences of “Obamacare” is arguably the Massachusetts universal health care system, or “Romneycare.” The similarities are explained in the liberal blog Think Progress: “Both plans require people to purchase coverage, and both provide affordability credits to those who can’t afford insurance. Both create insurance exchanges, both establish minimum creditable coverage standards for insurers, and both require employers to contribute towards reform.” (16) Health reform advocates have touted Massachusetts as a model for health reform, but the system, only 3 years old, is already plagued with the same predictable problems that always accompany government intervention. Some of the problems include: over-packed ERs, long lines to see a physician, physician shortages, and that 200,000 residents still remain uninsured. The biggest problem in the Massachusetts system, though, is the out-of- control increases health care costs, which are even greater than the national average. (17) Eventually, the state will be forced to either abandon the system, which is unlikely (as governments never voluntarily decrease their own size) or drastically control costs by rationing. In my opinion, the high costs of the current Massachusetts system will be used as justification by the government to take even greater control over health care.
Another example of a health care system that is commonly cited by health care reform advocates is the universal health care system in the U.K. Just like the current situation in Massachusetts, the wait times in ER clinics in the U.K. system were unacceptably long, so the government created a target mandating that patients be seen in less than four hours. The four-hour target could not be met, so now hospitals resort to “patient stacking,” a system of holding patients in the ambulance for hours in order to bypass the four-hour clock, which starts when the patients walk through the hospital doors. (10) The dental insurance plan in the U.K. is poor that almost half of dentists won’t accept patients using government health care. This led to 1 in 5 people deciding against getting any dental care because the cost is so high. The U.K. government dental plan actually made public access to dental care worse. (10) When I searched U.K. news outlets, I found numerous stories in the U.K. news about children having multiple teeth pulled in hospitals because of dentist access issues. (18, 19) In my opinion, though, the worst aspect of the U.K. universal health care system is NICE, or the National Institute for Health and Clinical Excellence, which is in charge of developing a standard method of rationing. This government agency actually assigned a monetary value to a person’s life when they determined that the allowable monthly treatment cost is 3,792 dollars per month. I was unable to find any information about the value of a human life according to the state of Massachusetts as a comparison.
A third health care system that is viewed as a “reform model” by some American health care advocates, such as Michael Moore, is Cuba. In actuality, Cuba is a perfect model of a worse-case scenario for the American health care system. Cuba exemplifies the danger of government involvement in health care. Superficially, Cuba appears to have an excellent health care system. Tourists, film-makers, and high-ranking government officials apparently receive high quality medical care. The problem is that Cuban citizens are prohibited from using those hospitals, instead being forced to use horrid public hospitals. The Cuban government simply lies about their hospital statistics to rest of the world. Based on personal testimony I’ve heard from Cuban immigrants now residing in America, the poor quality of care in the Cuban health care system should never be compared to heath care in the United States.
I interviewed a former dentist who lived and worked in Cuba under the Castro regime. He explained that after he graduated from Cuban dental school, government officials sent him to practice dentistry on the opposite of the Cuban island. When the officials recognized his dental and organizational skills, they recruited him to become a government official with a duty of managing other dentists. When he refused, the government transferred him, as punishment, to work as a dentist in one of the prisons. He described the dental care in Cuba as being of very poor quality, and noted that dental work consisted primarily of teeth extractions. He explained that in the 1990’s, a dentist working for the Cuban government’s universal health care system made six dollars a month. It was a higher wage than many other occupations, but it was still barely enough for survival. If you ask anyone who has lived in Cuba, they will explain that the average Cuban survives by stealing from the government and/or secretly bartering with others. The dentist half-joked, “You can’t steal anything useful for your family as a dentist. What are you going to take, the tools?” This is the life of a dentist in Cuba. The dental profession in the United States is, fortunately, still not directly threatened by an oppressive government take-over, but, considering the current legislation, the possibility is always real. We must never forget that before the Castro regime, life in Cuba was very similar to the United States. Cuba is the ultimate lesson for Americans about the potential consequences of government managed health care. Claims of sincere intentions and “benefits for the greater good of society” are only a ruse, and governments should never be trusted.
A Solution that Works
Some might argue that “America has the best health care system, but only for those who can afford it and too many cannot.” This is partially true. However, the solution to increasing access to health care is not more government control over medicine, the problem with our health care system is that there is too much government involvement. There will always be a disparity between the health care the wealthy receive compared to the health care the poor receive in any system. This might seem unfair to some at first glance, but the “access to health care” issue needs to be thought of in terms of relativity. A poorer person today might not be able to receive the latest and greatest medical care today, but in a few years, when the price of the medical innovation decreases because of increases in supply, that same person will eventually benefit. In the meantime, there are probably effective alternative treatments that are cheaper that the poorer person can afford. It is important for one to realize that a poorer person in the United States today still receives significantly better medical care today than a wealthy person living in the U.S. only a few decades ago.
Historically, before the days of widespread government welfare, doctors, like lawyers, routinely worked pro bono in order to serve their community. Even today, despite all of the government restrictions, regulations, taxes, and welfare programs, many doctors still generously donate their time and skills to serve the needy. This is a fantastic testament to the nobleness of the American medical profession. I have no doubt that if the restrictions on physicians were lifted, the amount of time physicians donated to charity would greatly increase, thereby increasing access to care for the needy. However, under the current “Obamacare” legislation, the government is essentially forcing doctors to donate their time to charity. Forcing anyone, regardless of their profession, to work against their will, even under the notion of “for the greater good,” is immoral. Doctors and other Americans do not need to be forced into being charitable. In fact, Americans donate significantly more money to charity than any other country in the world. (20) As such, the solution to improving access to health care is through private charities. The private sector is not perfect, and people do not always use their free will for the good of humanity, but it is the best, most efficient, and the most moral means of practicing medicine.
I believe it is the duty of every dentist to fight government encroachment into the dental field for the sake of the patients, the sake of fellow dentists, and for the sake of the future of dental medicine.
- 1. Lundgren, Mark (2010). Cerebral Libitis and the Fluoride Flavored Water. (A work in progress as of April 24, 2010)
- 2. Richman, Sheldon (2010, March 30). Wishful Thinking on Health Care. Retrieved April 24, 2010, from the Campaign For Liberty Web site: http://www.campaignforliberty.com/article.php?view=727
- 3. Igel, Lee (2008, June) The History of Health Care as a Political Issue. Retrieved April 24, 2010, from the Web site:http://net.acpe.org/MembersOnly/pejournal/2008/MayJun/Igel.pdf
- 4. Locke, John (1689) Two Treatises of Government. Retrieved April 25, 2010, from the Web site:http://sonsoflocke.blogspot.com/2005/03/purpose-of-state.html
- 5. Pierce, Franklin (1854, May 3) Veto Message. Retrieved April 24, 2010, from the Web site:http://www.lonang.com/exlibris/misc/1854-pvm.htm
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- 8. Sade RM. (1971, December 2) “Medical care as a right: a refutation.” N Engl J Med. ;285(23):1288-92. PMID 5113728. Retrieved April 23, 2010 from the Web site: http://www.aapsonline.org/brochures/sademcr.htm
- 9. Paul, Ron (2009, July 21) Healthcare Is a Good, Not a Right. Retrieved April 21, 2010, from the Campaign for Liberty Web site:http://www.campaignforliberty.com/article.php?view=144
- 10. Beck, Glenn (2009) Arguing With Idiots. Mercury Radio Arts, Inc. Pages 235-265.
- 11. Lasagna, Louis (1964) The Hippocratic Oath: Modern Version. Retrieved April 24, 2010, from the PBS NOVA Web site:http://www.pbs.org/wgbh/nova/doctors/oath_modern.html
- 12. McKalip, David (2010, March 23) Pay for Performance: An Early Target for Revolutionary Repeal of Obamacare. Retrieved April 25, 2010, from the Campaign for Liberty Web site: http://www.campaignforliberty.com/article.php?view=712
- 13. The Commonweath Fund (2007) Annual Report.
- 14. The World Health Organization (2008) The World Health Report 2008
- 15. http://en.wikipedia.org/wiki/List_of_Nobel_Laureates_by_country
- 16. Hunter, Jack (2010, March 29). Romneycare = Obamacare. Retrieved April 24, 2010, from the Campaign For Liberty Web site:http://www.campaignforliberty.com/article.php?view=728
- 17. Tanner, Michael (2009, June 9) What the failure of the “Massachusetts model” Tells Us about Health Care Reform. Retrieved April 27, from the Web site: http://www.cato.org/pubs/bp/bp112.pdf
- 18. Rawstorne, Tom (2009, April 13) NHS scandal: ‘I couldn’t find a dentist… Now, aged 21, I’ve had all my teeth removed’. Retrieved April 19, from the Web site: http://www.dailymail.co.uk/health/article-1169764/NHS-scandal-I-dentist–Now-aged-21-Ive-teeth-removed.html#
- 19. Cannon, Michael F. (2007, March 12). Saving Dentistry From the Jaws of Defeat. Retrieved April 13, 2010, from The Cato Institute Web site: http://www.cato.org/pub_display.php?pub_id=812
- 20. http://en.wikipedia.org/wiki/List_of_most_charitable_countries