The Yellow Brick Road to OzbamaCare
By Richard Amerling, MD
May 2010 -- Contemplating how we got
brings to mind the Frank Capra classic Wizard of Oz. Both require the
complete suspension of disbelief in favor of magical thinking and the
bestowing of God-like abilities to mortals.
is as believable as a tin man getting a heart, a scarecrow a brain, and
a cowardly lion, courage.
The Yellow Brick Road to OzbamaCare
paved with empty promises, boldfaced lies, and.....price controls. The
people are promised access to high quality healthcare at little or no
added cost; the proverbial free lunch. All will be "covered" regardless
of pre-existing illness, and insurance premiums will actually go down!
The government will decide what policies will be offered, and
the price. Somehow, private insurance companies will survive.
The medical profession (well, some of us) go
along, naive as Dorothy, though most doctors dream of going home to
Kansas, where medicine is practiced between patient and physician,
without third party intrusions.
Price controls, administered by public and
private third party payers, have already gone a long way towards
destroying the world's best healthcare. Wage and price controls
instituted by FDR during World War II set the stage for tax-subsidized,
employer-sponsored health insurance. This tornado uprooted people from
individual control of healthcare and started us down the road.
Medicare and Medicaid, enacted by LBJ and
a Democrat-controlled Congress in 1965, gave the federal and state
governments huge toeholds into the health industry. Both programs have
grown exponentially, due in no small measure to heavy-handed price
controls. Choosing to pay physicians next-to-nothing for seeing
Medicaid patients led to ER abuse and skyrocketing costs, which are
bankrupting many states. Medicare price controls, especially on
doctors, have also fueled massive spending. Less money for office
visits leads directly to more spending on tests, consultants, and
hospitals, with lower quality care. Medicare is bankrupt and will
implode over the next ten years as baby boomers sign up, doctors opt
out or retire, and half a trillion dollars is cut from its budget.
The trip to Emerald
ends badly for most of the players. Brave Toto pulls down the screen
revealing the Great Oz to be a snake oil salesman. He gives the tin man
a cheap watch, the scarecrow a meaningless diploma, the lion a
brass-plated medal, then absconds in a hot air balloon.
Dorothy comes to understand she has
had the power to return home. We, too, have the ability to click our
ruby slippers, get out of third party arrangements, and return to the
unfettered practice of individualized, high quality medicine. But we
need the support of millions of patients who realize that all-powerful
wizards are a fiction and that only the free market can actually
deliver on promises.
Richard Amerling, MD,
is a nephrologist practicing in New York City. He is an Associate
Professor of 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
Hospital Queens and a nephrology fellowship at the Hospital of the
University of Pennsylvania. He has written and lectured
health care issues and is a Director of the Association of
Physicians and Surgeons. Dr. Amerling is the author of the Physicians'
Declaration of Independence (http://www.aapsonline.org/medicare/doi.htm).