The Clouded Utopian Vision for Healthcare Ignores Reality
Mar 19, 2012
By Richard Amerling, MD,
In his latest book Ameritopia, Mark Levin discusses utopian “masterminds” who make promises of “heaven on earth” that are never possible to deliver. Attempting to create utopia leads to disruptions in the status quo, always making it worse. In order to pursue their agenda, utopians must ignore history, current realities on the ground, facts, science, and human nature. They must also turn a blind eye to the human suffering their efforts cause. They must lie and misinform on a massive scale to convince citizens they live in misery and should give up their liberty for false promises. In medicine we have terms to describe such thought processes—delusional, sociopathic, and schizophrenic!
Look at the current administration’s energy policy, such as it is. It is based on the absurd ideology that considers carbon dioxide, a gas we all exhale and which feeds plants, a pollutant. Thus, carbon-based energy sources are to be shunned and billions of taxpayer subsidies thrown at so-called green technologies that cannot make it in the marketplace. Rounded to the nearest whole number, the total contribution to world energy made by wind power is zero. We are blocked from developing national sources of oil and gas, and allowing a pipeline to be built from Canada. Coal-fired electricity plants are being closed, and energy prices are climbing. This affects us all, and ultimately makes us poorer. But the utopians are impatient to implement their policies now, ignoring the obvious fact that we are dependent on fossil fuels and will be for the foreseeable future.
Government Run Healthcare is the ultimate utopian delusion. As Levin points out, control of medicine has been a key element of utopian schemes dating back to Plato’s Republic. Government Healthcare depends on an unconstitutional mandate for all individuals to purchase health insurance, for the “greater good” of universal health care. This ignores the obvious fact that for young and healthy people what is called insurance is a really bad deal. These folks will be forced to subsidize care for others who may be better off than they are themselves. The utopians claim the free-market system has failed. Actually, it is government policies and mandates that drove costs through the roof.
Government Healthcare “invests” heavily in preventive care with little evidence such measures actually work. Funds for this come largely from half a trillion dollars cut from Medicare, that is, from care for the elderly and disabled. This is not to defend Medicare, which is a bankrupt bureaucratic nightmare. But current beneficiaries have paid into the system and will not benefit from “preventive care”; they already have all the diseases associated with aging. Never mind. Their care will be strictly rationed by the Independent Payment Advisory Board, an unelected and unaccountable group of “experts” who will decide what services will and won’t be paid for.
Fee-for-service practice, which is all that currently assures promptness of care, will be phased out in favor of the managed care du jour, the Accountable Care Organization (ACO). In this utopian fantasy doctors and administrators will receive a fixed sum for each enrolled patient and will then work harmoniously to provide high quality care, keeping whatever money is left over. There is absolutely no chance that ACOs will work, unless they severely restrict care and/or cherry pick their members.
ACOs and all physicians will be coerced into following “practice guidelines,” issued by “expert panels.” This one-size-fits-all approach to medicine will inflict incalculable harm on patients. The notion that a handful of elites can tell doctors working in the trenches how to treat their patients is pure utopianism.
Ah, but they will be armed with the ultimate utopian tool: the electronic health record. Your brand new, government-certified, “meaningful use-capable,” EHR will give the feds access to all your confidential patient encounters and information. The EHR, through embedded algorithms, will “guide” your decision-making along approved, cost effective paths. The potential to inflict harm across such a platform is greatly magnified.
The utopian conceit that a small group of elites can effectively manage something as complex as the practice of medicine will lead to failure, dislocations, and suffering on a massive scale. It must be turned back.
Richard Amerling, MD is a nephrologist practicing in New York City. He is an Associate Professor of clinical medicine at Albert Einstein College of Medicine in New York, and the Director of Outpatient Dialysis at the Beth Israel Medical Center. Dr. Amerling studied medicine at the Catholic University of Louvain in Belgium, graduating cum laude in 1981. He completed a medical residency at the New York Hospital Queens and a nephrology fellowship at the Hospital of the University of Pennsylvania. He has written and lectured extensively on health care issues and is a Director of the Association of American Physicians and Surgeons. Dr. Amerling is the author of the Physicians' Declaration of Independence.