By: Tamzin Rosenwasser, M.D.

Donald Berwick, in charge of Medicare and Medicaid, says “Too many Americans are being harmed by care that is supposed to help them.” I say “Too many Americans are being harmed by government that is supposed to follow the Constitution and does not.” We can improve medical care, on our own, if we can get their government bureaucracy to stop robbing us of our time. When Berwick says he messes up his children’s names all the time, I wish he would realize how he is also messing up our lives, and stop it.

Ezekiel Emanuel says, “Washington is never going to do a good job of making smart cuts to Medicare.” “Washington,” a shortcut for “bureaucracy,” is never going to do a good job of anything concerning medical care. The Medicare/government bureaucracy created the problem in medical care. Perverse incentives in Medicare/Medicaid for hospitals, patients, and physicians, have led to the explosion in Medicare/Medicaid costs. That is the direct fault of government interference in medical care. Nothing is more personal than medical care, and nothing is less conducive to having bureaucrats, whose only tool is force, in charge.

Emanuel writes that it is impossible for Medicare to write payment rules that cover all circumstances. It is impossible to devise rules, however complicated, that cover the even greater number and complexity of medical situations, but someone tried to do so, apparently thinking they had a God-like wisdom denied us. Leave the people of the United States alone to do what they have demonstrated many times that they know how to do: solve problems.

Nobody— not government, bureaucracy, Berwick, or Emanuel— nobody is wise enough to make medical decisions for 305 million people. Those people own their own lives. Government does not own them.

“To control Medicare spending and reduce the deficit, we need to stop paying for wasteful procedures, accelerate adoption of the Affordable Care Act reforms and empower doctors, nurses and hospitals to provide higher-quality and more efficient care,” Emanuel continues. Who pays? The taxpayers. But who is “we?” Emanuel, Sebelius, Berwick; those who claim superior wisdom. From Colonial times, right up until 1965, when Medicare went in, how did Americans manage without bureaucrats meddling? Yet Americans created and discovered without government direction, and we can solve every problem in medical care delivery if the government would just leave us alone to do it.

In 1998, the Deborah Heart and Lung hospital in New Jersey, was in trouble for charity care to Medicare patients. We can’t have that! Only the government can say who gets what. This 89-year-old charity hospital was fined $840,000.00 for their charity.

It is only since the government began meddling that we have had these problems. Government destroyed the market for medical insurance for everyone over 65. Government has all but destroyed medical charity. Government created this one-size-is-going-to-fit-all-like-it-or-not system. Despite the lag period, this result was entirely predictable.

In order to evade the responsibility of facing the terrible mess in medical care created by government interference, Emanuel now proposes a giant step forward in the destruction of freedom, in the guise of helping.

He writes, “The responsibility for ending unnecessary medical spending needs to be placed in the hands of doctors and hospitals. This can happen only if we change our fee-for-service payment system.” “We” means him and who else? Also, what about our patients? Are they just an afterthought? Are they lumps of clay there for Berwick and Emanuel to deal with as though they were not real human beings, with their own thoughts, feelings, and preferences, and their rights to liberty? The doctors and hospitals would be forced, of course, by the huge, bogus “health care” bill, to do just what the government says.

No, we do not need command and control from bureaucrats, or thousands of pages of mind-numbing rules. We do not need a government conducting more experiments with our patients and their lives. We need what is our birthright, freedom. Freedom for our patients, and freedom for us to take 7care of our patients, with them and their families being fully informed participants.

Author/Contributor:

Dr. Tamzin Rosenwasser earned her MD from Washington University in St Louis. She is board-certified in Internal Medicine and Dermatology and has practiced Emergency Medicine and Dermatology. Dr. Rosenwasser served as President of the Association of American Physicians and Surgeons (AAPS) in 2007-2008 and is currently on the Board of Directors. She also serves as the chair of the Research Advisory Committee of the Newfoundland Club of America. As a life-long dog lover and trainer, she realizes that her dogs have better access to medical care and more medical privacy than she has, and her veterinarians are paid more than physicians in the United States for exactly the same types of surgery.

From the Wall Street Journal:

A divided U.S. appeals court in Atlanta ruled Friday that a key provision of last year’s federal health-care overhaul is unconstitutional, siding with a group of 26 states that challenged the law.

The 2-1 ruling marks the Obama administration’s biggest defeat to date in the multifront legal battle over the health-care law.

The U.S. Court of Appeals for the 11th Circuit ruled that Congress exceeded its constitutional powers when it required individuals to purchase health insurance or pay a penalty.

The decision affirmed part of a January ruling by U.S. District Judge Roger Vinson of Florida, who ruled the health-insurance mandate unconstitutional.

The appeals court, however, overturned the portion of Judge Vinson’s decision that voided the entire health-care law. The court said the unconstitutional insurance mandate could be severed from the rest of the law, with other provisions remaining “legally operative.”

Read full story at:
http://online.wsj.com/article/SB10001424053111904006104576504383685080762.html

Read decision at:
http://www.scribd.com/doc/62177323/Florida-et-al-v-Dept-Of-Health-Human-Services-et-al

Keith Smith, MD, founder of the Surgery Center of Oklahoma City, now has a blog focusing on free market solutions that increase quality, decrease cost, and empower patients.  The Surgey Center of OK provides price transparency for by posting inclusive prices for procedures on its website.   The blog can be found at http://blog.surgerycenterok.com/.

By: Tamzin Rosenwasser, M.D.

We hear much talk about preventive care, but nobody has defined it. From the content of the discussions, I deduce that what the health bureaucrats actually refer to would be better characterized as “early detection.” Early detection is what occurs when a physician finds a disease in its early stages that might have been prevented by earlier measures. But who can take those measures? Not the physician, only the patient. There is only one person living the patient’s life; it is the patient. I cannot live his life for him.

Let’s consider obesity, and intake of harmful substances. If I have a dog, I can control the dog’s life so that it takes in only whatever food I give it, and is protected from harmful substances. But as a physician, do I portion out my patients’ food daily? Of course not. Am I in charge of restricting their lives so they cannot have access to cigarettes, or too much booze? No.

Prevention lies entirely in the patient’s realm. All the physician can do is advise. Not even the most conscientious patient can prevent all disease and injury, and the physician can do nothing to prevent medical problems unless the patient is reduced to the equivalent of livestock or a ward of the state. Physicians do warn of problems that may arise if the patient does not take action to avert them. In my experience, very few of the patients who are counseled about the risks of smoking, excess alcohol, sun and tanning beds, sedentary lifestyle, unhealthy diets, and harmful drug use act on the advice. Some state that they will not do so, and many can be observed not to do so.

When I advise patients with melanoma, a skin cancer that can kill the patient, to use clothing as protection against UV radiation from sun, I have heard these responses: “I’ve only had one.” “We have a boat.” “Do you know how hard it is to wear long sleeves?”

I have seen college students step into the street without a glance in either direction, relying on the posted 5 mile-per-hour speed limit. The message they get is that someone else is responsible for their safety as pedestrians. Surely, every motorist should take utmost care to avoid injuring someone, but that job becomes more difficult if the other party abdicates responsibility for his or her own safety.

When government usurps responsibility, I suspect that people are more likely to abdicate. That has happened with Medicare and Medicaid. The taxpayers are stuck with paying for the medical care of strangers. People who don’t have to worry about the bills may be more willing to take the chance of getting skin cancer out on the golf course, or hepatitis C from IV drug abuse, or lung cancer from smoking, instead of using sunscreen and clothing, not abusing drugs, or quitting the smoking. Pride and shame leach out of their souls and they are quite comfortable with spending someone else’s money to care for problems they could have prevented with their own efforts.

One young smoker, whom I advised to quit, remarked: “By the time I get cancer, they’ll have a cure for it.” How nice that the universal “they” are working on this person’s behalf, while he lifts not a finger to help himself. People are developing a predatory dependency, like the ungainly cowbird, which lays its eggs in a warbler’s nest after kicking the warbler’s eggs out. The warbler ends up raising the young cowbirds, which tower over her like a six-foot man over a petite woman.

This dependency is part of the unconcern with preventive care if it takes any personal effort by the patient. Much of life is maintenance, including maintenance of one’s own health. Should the physician, and strangers, care more about someone than he is willing to care about himself? Where would this burden end?

The Founders of our nation constructed a Constitution, which is permanent because it takes into account an unchanging verity: human nature is immutable. The moral corruption that accompanies allowing one person to sponge off another is mirrored in biology. If a person is treated long enough with high enough doses of prednisone, his adrenal glands will stop making the equivalent steroid, and if the prednisone is stopped suddenly, the patient may die of adrenal crisis because the adrenal glands will not start working again quickly enough.

No society can be healthy when citizens refuse to take the steps necessary to keep themselves healthy. Physicians are doing what they can to detect disease early, but we cannot do the patients’ job of preventing problems arising from behavior such as smoking, excess drinking, dangerous drug use, violence, carelessness, sedentary lifestyle, poor diet, sexual promiscuity, and ultraviolet exposure.

If patients refuse to do the job of prevention, we can let them suffer the consequences themselves. Or we can force the entire society to suffer the consequence of total loss of liberty at the hands of a tyrannical government nanny. That is a price I am not willing to pay.

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Dr. Tamzin Rosenwasser earned her MD from Washington University in St Louis. She is board-certified in Internal Medicine and Dermatology and has practiced Emergency Medicine and Dermatology. Dr. Rosenwasser served as President of the Association of American Physicians and Surgeons (AAPS) in 2007-2008 and is currently on the Board of Directors. She also serves as the chair of the Research Advisory Committee of the Newfoundland Club of America. As a life-long dog lover and trainer, she realizes that her dogs have better access to medical care and more medical privacy than she has, and her veterinarians are paid more than physicians in the United States for exactly the same types of surgery.

On Apr 28, Gov. Jan Brewer of Arizona shot down the basic cornerstone of state-based efforts to replace “ObamaCare” with free-market approaches to lowering costs and improving quality. She vetoed a bill (S.B. 1593) allowing small businesses and individuals to buy medical insurance across state lines, just as most larger companies already do under the federal Employee Retirement Security Act, ERISA.

About 60% to 70% of employers have more than 100 employees and thus fall under ERISA. Freed of state mandates, they can buy their insurance in any state that gives the best price and the best packages of benefits.  The rest of us–individuals and small businesses—are chained to the insurance companies and mandates in our respective states of residence, and tied to whatever deals that these companies cut with the state government.

The governor was under intense pressure to veto the bill from special-interest groups, including insurance cartels and the Arizona Medical Association. The bill was amended on behalf of insurers to allow them to drop coverage for mandated services if companies from other states that don’t have the mandates come into Arizona to compete. This amendment was opposed by advocacy groups ranging from parents of autistic children to patients with diabetes, and by providers who lobbied to require insurers to cover their services.

Just 12 of the most common mandates increase premiums by as much as 30 percent. It is estimated that one in four uninsured Americans has been priced out of the market by mandates.

Brewer’s veto shows that she favors insurance companies over the 1.3 million uninsured Arizonans, stated Phoenix orthopaedic surgeon Eric Novack, M.D., founder of the U.S. HealthFreedom Coalition. He noted that Brewer’s health-policy adviser most recently worked for Blue Cross/Blue Shield and her chief of staff was chief operating officer for Arizona Physicians IPA for United Healthcare. He suggested they have influenced the governor to favor insurance companies.

Brewer also vetoed the interstate health care compact bill, which would free states from federal controls over their Medicaid program, with funding through federal block grants. Georgia is the first state to enact the compact into law.

These actions are “a blow to free-market choice and consumer freedom,” states Elizabeth Lee Vliet, M.D., a director of the Association of American Physicians and Surgeons (AAPS). “Allowing purchase of insurance across state lines simply allows small businesses and individuals to have the same choices as large businesses.”

The governor who came to national attention for standing firm on border security has failed Arizona citizens on the issue of securing medical freedom and control of our costs. “The voices of millions of consumers, small business owners, and grassroots activists were overridden by the powerful insurance lobbies.” Vliet states.

Dr. Vliet also said, “Collusion between government at all levels and big business interests is the enemy to overcome in restoring control of medicine and the medical dollar to ordinary Americans.  Healthcare reform is about money and control. The complicity of both Republicans and Democrats in the public-private cartel-like deals that create more government control and less individual freedom will continue to energize the Tea Party.  We must restore the focus on patient-physician relationship and individual liberty in healthcare decisions and options.”