by Marilyn M. Singleton, MD, JD
Hoaxes and scams have been dominating the news lately. We have a marginally known actor faking a hate crimesupposedly to raise his Hollywood profile. His attempt to claw his way to the middle could have resulted in race riots, injury, and death. His punishment? All charges dropped.
The scandal about Hollywood and other elites buying their children’s way into top-rated universities really hit home. I remember when I had tutored some recent Vietnamese immigrants for a debate contest to win a scholarship for college. I could only hope that their hard work was rewarded and not wiped away by special favors bestowed on the “haves.”
Now we continue to have a slew of healthcare hoaxes: corporate stakeholders, legislators, and government agencies promise everything and have no accountability for their failure to keep their promises.
Take the large health systems’ claim that hospital consolidation and buying up physician practices would benefit consumers with cheaper prices from coordinated services and other unspecified savings. A major study of California hospital mergers found just the opposite. The analysis showed that the price of an average hospital admission went up as much as 54 percent. When the large hospital systems bought doctors’ groups, the prices rose even more. There was as much as a 70 percent increase in prices of medical services in geographic areas with minimal competition. This finding seems obvious to any of us who has the choice of shopping at Walmart or Target or Costco.
Logic aside, some legislators believe that having the government take over medical care would solve our access and cost problems. Single payer means no competition whatsoever. The single payer plans (H.R. 1384 and S. 1804) that abolish private insurance leave patients with an empty choice. Patients can contract with a physician to pay cash for government medical services covered by the government. But if the physician contracts for such services he cannot be part of the government program for any patient for 2 years. Realistically, these single payer bills make it financially unfeasible for physicians to privately contract with patients. Thus, only well-heeled patients, along with independently wealthy doctors, can buy their way out of the system.
There are variations on the theme of government involvement that allow buy-ins to Medicare, Medicaid, or iterations of the Affordable Care Act marketplaces. All of these all have the same defect: expanding the government healthcare monopoly.
The opioid crisis is an example of the unintended consequences of intervention by oversight agencies not directly involved in patient care. The Joint Commission on Accreditation of Healthcare Organizations (JCAHO), now the Joint Commission, a nonprofit organization that accredits more than 20,000 healthcare organizations and programs in the U.S, is for all practical purposes a government surrogate. In 2001, JCAHO declared that pain was the “5th vital sign” that had to be addressed or face consequences. The Federation of American Medical Boards told physicians that “in the course of treatment,” large doses of opioids were just fine. Moreover, Medicare has a hospital payment formula that relies on patient satisfaction surveys. If the patients are satisfied, including being so zoned out on opiates that they can’t taste the bad food, the hospital is paid more. The hospital is penalized for a bad rating.
And now to deal with the opiate issue, the government has issued guidelines that have been found to be harmful to some patients. One-size-fits-all restrictions have caused physicians to fear being flagged as over-prescribers by the medical board. Consequently, some physicians are tapering patients off opioids more quickly than they would ideally like. And in the public eye patients have been transformed from objects of compassion to criminal drug addicts.
Individualized medical care must not be reserved for the chosen few. Patients need physicians who are empathetic, thorough, and not married to a medical cookbook written by disinterested third parties. Perhaps this is why Mick Jagger of the Rolling Stones chose to have his heart surgery in the U.S. and not with his British homeland’s National Health Service.
Central control is not a good idea. Period. Do not believe the hoax perpetrated by the ruling class who will never have to live by their own rules. It is highly unlikely that Venezuela’s President Maduro is starving along with his people.
Bio: Dr. Singleton is a board-certified anesthesiologist. She is President of the Association of American Physicians and Surgeons (AAPS). She graduated from Stanford and earned her MD at UCSF Medical School. Dr. Singleton completed 2 years of Surgery residency at UCSF, then her Anesthesia residency at Harvard’s Beth Israel Hospital. While still working in the operating room, she attended UC Berkeley Law School, focusing on constitutional law and administrative law. She interned at the National Health Law Project and practiced insurance and health law. She teaches classes in the recognition of elder abuse and constitutional law for non-lawyers. She lives in Oakland, Ca.