The Changing Protocols of Medical Care

By Doug Magill

Karl Kraus once compared corruption to prostitution.  But, corruption was actually worse, he said, because it affects the morals of the country rather than just an individual.  In reviewing the melee surrounding the Patient Protection and Affordable Care Act, it is impossible not to be appalled at the incoherence, dishonesty, duplicity, bribery, and coercion that have diminished the United States Congress as a deliberative body.

Despite shrieks of “moral imperative” there was nothing moral, or edifying about it.

Imposed on the country in contradiction to promises of openness, transparency, discourse and bipartisanship, no other word than corruption could adequately describe what happened.  From the President’s insouciant disregard for rules, protocol, and the integrity of his office, to the Democratic Party’s disdain for its stated purpose, we have all been diminished by this public policy plan.

One doesn’t have to be an economist to realize that.  By expanding the number of people to be covered, eliminating caps, waiving preconditions, and disconnecting decisions about coverage from claims for services, we will have an increase in demand without an increase in supply.  There will also be a lot more waiting and enormous cost pressures that will land in the political realm for resolution.  Of particular note, the anti-life concerns on those oldest and youngest will be intense; the ability to invest in new technologies will be curtailed.

The concept of insurance has been mockingly transformed into a contradiction, as there is no insuring of anyone or anything.  Just ask companies that will exist for a while to act as transfer-payment agencies for the government until cost pressures put them out of business entirely.  And what is dictated in terms of coverage will undoubtedly lead to dictates of procedures, and availability, and longevity.

The cost basis for the entire act is beginning to unravel, with enormous consequences for fiscal sustainability down the road.  Health and Human Services Secretary Kathleen Sebelius has recently acknowledged to both the Senate Finance Committee and the House Ways and Means Committee that the CLASS (long term care) portion of the act is not sustainable (something that was also noted in President Obama’s deficit commission report).

By charging participants to pay for five years of premiums before providing any services, there was an illusion of a surplus that offset some of the rest of the costs of the act.  Once claims begin to be made costs will rapidly outstrip revenues leading to more political decisions about benefits, premiums, and screams for additional government bailouts.

The frightening reality is that Sebelius claims that she can redo the entire CLASS program without consulting Congress.  Clear indication that one of the effects of the act is to devolve decision making to bureaucrats – away from individuals, and even away from elected representatives.

Beyond macro concerns about what will likely be exploding costs and limited choices, we are already seeing some changes in the structure of medical care that will affect how treatment is provided.

Consolidation is already occurring among providers, and more physicians are giving up private practice to become employees of large chains.  That pressure will intensify in the next couple of years.  Associated with the reduction in the availability of private physicians will be the recognition of health care choices decided by the largest chains in collusion with government agencies.

Over 100,000 doctors were recently surveyed by the Physicians Foundation.  The results are crushing: Sixty percent of them believe they will have to serve fewer patients because of the recent health care act, and a significant number felt they would stop practicing rather than become employees and disconnected from patient care.

The recent political showdown in Wisconsin has highlighted another truly frightening aspect in the way that health care will be provided – and rationalized.  The fact that some physicians chose to hand out fake sick notes to protesting Wisconsin teachers  illustrates that their concerns for “social justice’ and their political choices override medical ethics, or what patient care truly means.

It is not unreasonable to entertain this fear: As more doctors become employees of giant chains who are held captive by government directive, more and more decisions will be made in relation to perceived societal good rather than in the patient’s best interest.

Much evil has been done in this world in the name of moral imperatives. Ultimately, the pain, suffering, and needless deaths that will result from this will be nothing less than evil.

C.S. Lewis wrote that “Of all tyrannies, a tyranny sincerely exercised for the good of its victims may be the most oppressive.”

America, be not proud.


Doug Magill is a former Chief Technology Officer and radio host who lives in Solon and works as a consultant, freelance writer, and voice-over talent



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