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.”

By: Jane M. Orient, M.D.

Politicians love to boast of the benefits they shower on favored   constituents with their right hand. But as with the amazing feats performed by magicians, the unwary audience is watching the wrong hand.

It may seem   that in government the right hand often doesn’t know what the left is doing.   However, it is surely obvious that the goodies in the right hand did not materialize out of thin air. They had to be taken from   somewhere.

Usually that somewhere is taxes. Even doctors know that. For  example, while bemoaning the coming cuts in their pay from Medicaid, some  ventured to say out loud, at a medical society meeting, that there is an  answer to the problem: we just need to raise taxes.

The very same  left-leaning doctors had just finished agreeing that many Medicaid patients   come to the doctor only because they are lonely or bored. They add that this   is all right with them because they get paid even though the visit was   unnecessary.

With healthcare reform (“ObamaCare”) there are some frank  tax increases. But even the Democrats in the 2008 Congress probably wouldn’t  have passed a recognizable tax increase large enough to fund the enormously   expensive bill. Instead, they gave us an insurance mandate. They insisted this   wasn’t a tax, although the Obama Administration insists that it is a tax after   all—if that’s what it takes to get a court to find it   constitutional.

In 2014, assuming this law survives, we’ll have a clever sleight of hand that casts the redistributionist,   now-you-see-it-now-you-don’t tax/nontax, as a subsidy. If you, by their   criteria, can’t afford the high premiums on the comprehensive policy that is   required, you get a subsidy to buy it—a negative tax. Otherwise, you have to   pay the full cost yourself. So, is the absence of a subsidy a tax, or the   functional equivalent of a tax? Aren’t subsidies and taxes mirror images, like left and right hands?

Say that the court finds that it isn’t a tax, for purposes of invoking the taxing powers of Congress, but is instead a way of   regulating interstate commerce, the alternate constitutional justification.   Wouldn’t it be unprecedented for Congress to penalize inaction under the  Commerce Clause?

One advocate for ObamaCare wrote to the Wall   Street Journal that “countless” types of personal inaction violate the law.   Most of these, however, are “if…then” situations, contingent on a previous   action. “Failure to put out your campfire” assumes that you lit a fire.   “Failure to wear clothes when out in public” assumes that you decided to go   out; you are not required to wear clothes in the bath. “Failure to file a tax  return” assumes that you have taxable income—and that one took a  Constitutional amendment. The only thing close to “If you are alive, then you   must buy a certain specified type of health insurance” is “If you are a male   who has reached the age of 18, then you must register for the draft.” Is the   insurance mandate a form of conscription? It forces us all to pay for care   that we might not want to buy, or be willing to provide, without third-party payment.

The left-handed logic used by the Administration in court is:   “If you are alive, you will get sick or have accidents, and use medical care, and the rest of us might get stuck paying for it.”

Why not an individual responsibility mandate? Rather like a mandate that if you have   children, you must feed them. And if you take food from the grocery store, you   must pay for it. Why do people get to stick “the rest of us” with their   medical bills?

With medical care, we have seemingly accepted the  concept of collective responsibility—and entitlement. Under this concept, any   person who is sick or injured is entitled to be taken care of. If others do not provide the care voluntarily—that’s called charity—then the government   must force someone to pay.

The method might be a straight tax. Or it   might be a mandate to force everyone to prepay into a collective pot called insurance. Both require force.

We see the benefits that the politicians   and magicians want us to see. What their left hand does is invisible and   deceptive. How much it takes, how much it wastes, how much it corrupts, how   much it restricts freedom, and how much harm it does—all this has been hidden  in smoke and mirrors.

Americans must demand a look behind the curtain.

Jane M. Orient, M.D., On Air contributor speaking on Healthcare Reform. Dr. Orient has appeared on some of the largest TV and Radio Networks in the country and her op-eds have been printed in hundreds of local and national newspapers, magazines, internet, followed on major blogs and covered in the Wall Street Journal and The New York Times.

Doctor Orient is the Executive Director of Association of American Physicians and Surgeons and has been in solo practice of general internal medicine since 1981. She is a clinical lecturer in medicine at the University Of Arizona College Of Medicine. She received her undergraduate degrees in chemistry and mathematics from the University of Arizona, and her M.D. from Columbia University College of Physicians and Surgeons. She is the author of Sapira’s Art and Science of Bedside Diagnosis; the fourth edition has just been published by Lippincott, Williams & Wilkins. She also authored YOUR Doctor Is Not In: Healthy Skepticism about National Health Care, published by Crown. She is the executive director of the Association of American Physicians and Surgeons, a voice for patients’ and physicians’ independence since 1943.

AAPS California Chapter Coordinator, Wayne Iverson, MD

Last year President Obama signed the Patient Protection and Affordable Care Act (PPACA), also known as ObamaCare, amongst a flurry of protests and concerns about the burdensome costs and impossibilities of complying with the regulations. Within months, large corporations demanded waivers while small business are left scrambling to meeting compliance under the new federal healthcare reform law. Individuals have seen their insurance premiums automatically increase 15-20% in 2010. The insurance companies claim they have to start charging more now because in years to come they will have more costs under the new law. So onerous and disruptive to the American way of life, over half of the states in America filed lawsuits challenging PPACA. Judge Vinson issued his final ruling on the lawsuit in Florida, agreeing with the attorneys representing 26 states and declared ObamaCare to be unconstitutional.

Accountable Care Organizations (ACO) are new entities spawned under ObamaCare that provide for any hospital inpatient service to be paid as a single lump sum to an administrative body. This entity will then in turn pass a portion of the money on to the hospital, doctors and ancillary healthcare providers rendering services during an individual’s hospitalization. Dr. Wayne Iverson, who has hospital attending staff privileges, holds an MBA and is an expert in healthplan development, says, “The new law establishes an expensive new administrative body that has all the functions and operating costs of an HMO without the safeguards HMOs have under state and federal law. With payments to hospitals and doctors already at very low insolvency levels, this additional drain will precipitate a financial crisis in the medical community.”

In San Diego County every major hospital system, except for the University of California San Diego (UCSD) Medical Center, is in the process setting up an ACO for their medical centers. One such multi-hospital system tried to establish an analogous administrative body over 10 years ago just to meet competition in the market place. In doing so, they spent millions of dollars in development which were completely wasted when the project closed down and the chief executive officer (CEO) was fired from his position. Dr. Iverson recently attended a medical staff meeting where plans for setting up an ACO were detailed. Dr Iverson said, “It was like having deja vu. The ACO promoters have a lucrative new project they can bring to the medical center, but it is not financially sustainable, and it ignores the fact that the ObamaCare has been declared unconstitutional.”

During the past two years the country has suffered from the poor US economy and measures passed by the last US Congress and signed by the President. With ACO development well underway the medical community is wasting millions of dollars on regulations that will be squashed. Whether it is a major medical center gearing up to have an ACO or individuals paying higher insurance premiums, it is hard to believe that our legal system allows an unconstitutional healthcare reform law to continue to drain the money from people in the United States.

The US Congress is currently struggling with reducing the historic budget deficit. Dr. Iverson concluded, “Our nation’s leaders and particularly our nation’s legal system should focus on saving the medical community and the community at large from wasting any more money chasing regulations promulgated under the decidedly unconstitutional ObamaCare.”