Michael Arnold Glueck, M.D., and Robert J. Cihak, M.D.
Tuesday, Sept. 9, 2003

Why do human beings cooperate in their own destruction?

The question has been asked many times, about many human disasters – from great republics whose citizens surrendered their liberties, to innocents who walked into gas chambers.

Many answers have been adduced: inability to resist, fatalism, the belief that some emergencies require stern but "temporary" measures. But perhaps the most common reason why people choose slavery is the belief that – despite all the evidence of history and all the force of logic and common sense – they're going to get something out of it: They'll benefit.

In the Aug. 13 issue of The Journal of the American Medical Association (JAMA), an article appeared that must rank as one of the great historical examples of how people talk themselves into subjugation and disaster. The "Proposal of the Physicians' Working Group for Single-Payer National Health Insurance" is so odious, so evil and so utterly illogical in so many ways that it's hard to know where to start dissecting it – or to conquer the queasiness sufficiently to get started.

These are the article's main points:

• "Access to comprehensive health care is a human right. It is the responsibility of society, through its government, to ensure this right. ..."

• "In a democracy, the public should set health policies and budgets. Personal medical decisions must be made by patients with their caregivers. ..."

• "A single public plan would cover every American for all medically-necessary services. ... Unnecessary or ineffective services ... would be excluded from coverage. ... The NHI [National Health Insurance] program would pay each hospital a monthly lump sum to cover all operating expenses. The hospital and the regional NMI office would negotiate the amount. ..." (Doctors could choose among payment "options.")

• "Only a single comprehensive program, covering rich and poor alike, can end disparities. ..."

Rhetoric and the United Nations notwithstanding, there is no enforceable American "right" to "comprehensive" medical care. Legally, such medical care would be an entitlement. Which means: You get what the government gives you.

The notion that an abstraction called "the public" will set policies and budgets is ludicrous; disclaimers notwithstanding, the government will. And those who set policies and budgets will determine who gets what, regardless of doctor/patient desires – especially when the government determines that something you desperately need is "unnecessary."

Equally ludicrous is the notion that the best way to provide medical care for the poor is to assume responsibility for everybody, including the vast majority who neither need nor desire state medicine. "Equality" in health care is impossible and pernicious; no two patients are alike.

Medical caregivers and the government will "negotiate" payments? Economically, "single payer" is a "monopsony," that is, one buyer controls the market.

If you want to see a monopsony in action, just ponder the so-called Military-Industrial Complex. How do the sellers respond to the ever-changing priorities and whims of the single buyer, in this case the Pentagon and the Congress? By endless duplicity and mendacity, by shady dealings and sweetheart relationships, by distortion and outright corruption and dreadful inefficiency.

And finally, if you don't like what you're getting, as a doctor or a patient, what is your recourse? Where else can you go?

Nowhere – unless you're wealthy enough to escape to a foreign country where you can buy services with your own money, as many Canadians and other foreigners already do.

But there's an additional problem, which the advocates of state medicine rarely bother to acknowledge. The American economy already groans under unsound government policies and regulations.

Social Security and Medicare cannot be sustained, let alone expanded, in their present forms. (These programs were based on the assumption that we'd breed fast and die young. Now we do the opposite). Our manufacturing and many sectors struggle under increasingly complex and increasingly wasteful regulations. The federal deficit is skyrocketing, thanks to our foreign adventures. Were America any other country, we'd be in receivership.

It can't go on. And handing the medical economy, already one-seventh of the GDP, over to the government will only hasten the reckoning.

In sum, those physicians who wish to spend their lives as government apparatchiks are welcome to do so; there are many opportunities, such as in the service of domestic and foreign governments. Many of these wannabe apparatchiks admire foreign medical systems – but not to the point of actually hiring on full-time.

But those physicians or patients who expect to benefit from hastening the inevitable day of economic reckoning – and those who would destroy medicine in the name of nonexistent rights and spurious equality – should have the honesty to call such slavery by its proper name.

Contact Drs. Glueck and Cihak by e-mail.

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