Jewish World Review Nov. 24, 2003 / 29 Mar-Cheshvan, 5764
Drs. Michael A. Glueck & Robert J. Cihak
The Caduceus Conspiracy: How the People Lost Medicine and How We Can Take It Back
In medicine it's always something! This week the column de
jour for many op-ed writers is the crisis of the drug prescription plan
before Congress. But let's look deeper.
In American politics, nothing matters unless it's defined as a
"crisis." That's one reason why we have the same crises, decade after
In medicine, however, "crisis" has a more specific meaning. It's
the moment when you either die or start to recover.
TODAY, AMERICAN HEALTH CARE IS IN BOTH KINDS OF CRISIS
It's been in crisis since the 1950s, when proponents of state
medicine suddenly discovered that the elderly weren't all that happy with
It's been in crisis since the 1960s, when LBJ, Congressman Wilbur
Mills (then chair of the House ways & Means Committee), and what is
euphemistically known within the Beltway as the "benefits community,"
created a Medicare they knew could not be sustained, long-term . . . and
threw in Medicaid for good measure.
It's been in crisis since the 1970s, when the HMO Act established a
"managed care" system in which the only way to make money was to sell group
coverage to employers, then withhold care.
It's been in crisis since the 1980s, when employers noticed that
the cost of insurance had gone bonkers, and reacted accordingly.
It's been in crisis since the 1990s, when Hillary tried to take
over one-seventh of the entire economy . . . and when the trial lawyers
conceived that medicine might be improved by a "Patient's Bill of
Rights"-generated mass infusions of lawsuits.
And it's in crisis today, as Congress and the administration
prepare to tack onto Medicare a prescription drug "benefit," offering as
partial justification the fact that, since Medicare will inevitably go
broke with or without it, why not just do it now and worry later?
But America's health care system is also in acute crisis. For this
is the moment when the system either dies or changes. Continue along the
present path, and within a few more years, we will have state medicine.
(And doubt not that this is the goal of those who, have willfully wrecked
the system to justify governmental takeover.) Or we can create, for the
first time, a genuinely free market in health care, based upon the
astonishing principle that the American people are capable of figuring out
what they need, and then finding it.
WHAT MIGHT A SYSTEM BASED ON FREEDOM LOOK LIKE
It would, first of all, restore the clear distinction between
insurance and payment for services. By definition, insurance is the pooling
of risk against infrequent but nonetheless predictable events. In medical
terms, this means hedging against physically and financially catastrophic
events. Payment for services means taking care of more routine, although
far from inexpensive matters.
Catastrophic health insurance should be available to all, whether
through employment, through groups formed for the purpose of purchase, or
through purchase from the federal or state government. As a matter of
decency and humanity (not of right), such insurance should be made
available at reduced rates, or simply given, to the poor.
AS FOR THE SERVICES HALF THREE PRINCIPLES APPLY
First, people should be free to purchase only what they need. Why
pay for other people's pregnancies or abortions if you're a man, or a woman
who won't be getting pregnant? (Imagine how wonderful if the cable company
sold only the channels you wanted, not the whole package).
Second, people should be free to form purchasing groups, and
organizations should be free to offer, specialized services. We're already
seeing specialized offerings, such as dental or optometric, coming out of
groups such as AARP. Cash also has its place. For example, a Seattle group,
SimpleCare, offers routine services at substantial discount a discount
made possible by the clinic's substantially reduced paperwork and
administrative costs. Barter might also find a place. And governments at
all levels, again as a matter of humanity and decency, should provide
routine services to the poor.
Finally, the government should encourage the creation of a
freedom-based system through expansion of tax-exempt or deferred medical
savings accounts and other tools.
All very fine . . . especially if you believe that the American
people are more than a bunch of lazy idiots who want everything handed to
them by the federales. But what reason is there to believe that this is the
moment of acute crisis?
The American economy is structurally unsound. The proliferation of
debt at all levels of government and the private sector; the ongoing
hemorrhage of jobs; the trillions now required for homeland defense and
foreign adventures; the aging of the workforce; a dozen reasons more might
be adduced. Wrecking one-seventh of the economy, turning it from private
profit to government liability, could well be the straw that does the deed.
For let us be honest the patient in crisis nowadays is America.
Editors Note: Michael Arnold Glueck wrote this week's column.
Michael Arnold Glueck, M.D., is a multiple award winning writer who comments
on medical-legal issues. Robert J. Cihak, M.D., is a Discovery Institute
Senior Fellow and a past president of the Association of American Physicians
and Surgeons. Both JWR contributors are Harvard trained diagnostic radiologists.
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