America's physicians and surgeons are now facing a malignancy more severe than any epidemic. The outcome of the struggle against this pestilence certainly will determine the future of the medical profession and may help to determine the future of all of our free institutions.
In past issues of this Bulletin, we have discussed in some depth the conspiratorial drive to convert the United States into a totalitarian dictatorship. That goal cannot be reached, of course, until every institution and profession is brought under the rigidly authoritarian control of central planners in the federal government. Freedom of choice and enterprise must be excised totally from our society. And even the most intrinsically personal decisions must be left to the arbitrary control of federal bureaucrats.
The destruction of our independent system of health care is an essential element of this drive. For the Master Conspiracy cannot succeed in enslaving America until every physician has been made an employee of the government and every citizen made dependent upon the government for all medical care.
Without any doubt, the American medical profession, as presently constituted, has been one of the most impenetrable roadblocks in the path of the treacherous schemers working to sovietize America. Physicians, due to the very nature of their profession, are tremendously independent. And as a result of the high standards which they have set for themselves, and their role as relievers of suffering, they are highly respected and command a great following. In fact, opinion polls indicate that the physician is the most respected man in the community.
Doctors have played leading or important roles in most of the key events in our nation's history. From the winning of the revolution to the present time, medical men have helped to champion the cause of individual liberty. Even today, the membership of The John Birch Society is composed of a higher percentage of physicians than any other profession. A fact which certainly is exemplified by the COUNCIL of the Society.
Through the largely unrestricted efforts of our medical profession, Americans today enjoy the finest system of health care anywhere in the world. Many diseases which troubled mankind for centuries have been all but eradicated. And progress is being made in the struggle against other grievous maladies.
Undoubtedly the preeminent factor in the creation of our tremendous health care system has been freedom of choice. In our country, patients always have had the right to select their own physicians and even to choose between various methods of treatment. Doctors have selected the branch of medicine or field of research that they desired to practice as well as the size and location of their clientele, with their choice contingent only upon their own capability, or preference, or natural economic forces. If the current attack on our medical system succeeds, all of this will change drastically — and soon!
For the American people are being subjected to a well orchestrated propaganda campaign based upon trickery and outright deception to convince them that our private healthcare system is far too inefficient, expensive, and inequitable. Basing their arguments upon a completely fraudulent humanitarianism, Insiders of the Master Conspiracy and leftists in the medical profession, mass media, and Congress are calling for decisive government intervention in medical care. It is their intention to create a mandatory health system in the United States similar to the extremely dictatorial and grossly inefficient systems which exist in Great Britain, Soviet Russia, and other nations in Europe.
Concurrently with this propaganda blitz, an equally vicious campaign is being waged to condition the more than 330,000 physicians in America to accept ever increasing amounts of government regimentation of their private practices. Through regulations associated with various welfare programs, the federal government has begun instructing physicians as to whom they may treat, how they may treat them, the fees they may charge, and even what drugs they may prescribe. And federal bureaucrats are setting up professional review bodies to see that doctors toe the mark.
Although government regulation of medicine is new to the United States, it is one of the classic techniques for converting a nation into a dictatorship. In 1883 the chancellor of the German empire, Prince Otto von Bismarck, succeeded in having compulsory health insurance enacted. Sold to the German people as being absolutely necessary for their security, this program served as a springboard for the adoption of many other "humanitarian programs" — all of which served to increase governmental control over the people. And this same bellwether approach subsequently has been utilized for these same purposes in many other countries.
Using the Communist methodology of patient gradualism, promoters of nationalized medicine have been content to go after their goals in a piecemeal fashion. And having now achieved much of their program, they have intensified their efforts to have a comprehensive national health care and planning bill enacted. Before we examine any of these current proposals, however, let us first discuss the inroads that already have been made against our system of independent medical care.
A primary step, of course, in bringing any profession or industry under control of the federal government is to make that group dependent upon the state for financial remuneration for services rendered. The inauguration of the Medicare and Medicaid programs served that purpose very well indeed.
Medicare . . .
Enacted in 1965, Medicare was the first major nationwide program of government-financed health care in the United States. With a program administered directly from Washington, Medicare was designed to provide federally funded medical treatment for the elderly. Prior to the passage of the Medicare legislation, however, there existed substantial data indicating that such a program was totally unnecessary. And as no grant of power had ever been given to the federal government to become involved in medical care, this legislation clearly was unconstitutional. But as most demagogues have learned, there is something almost irresistible about an impassioned plea in behalf of the elderly.
From the inception of the program, Medicare proponents had assured concerned taxpayers that annual costs for this program would not exceed five billion dollars. Like all other government programs, Medicare requires tremendous amounts of paperwork. Indeed, the time and expense involved in filling out Medicare forms for reimbursement for medical services was directly responsible for a more than sixteen percent escalation in hospital costs during Medicare's first year of operation. Similar cost increases were experienced by physicians in their private practice. Many private hospitals and individual doctors threatened refusal to treat Medicare patients because of the paperwork involved. And some followed through on their promises.
It is axiomatic, of course, that whenever a group of citizens believes they have a right to certain services or products at little or no expense to themselves, the demand for those goods and services will increase dramatically and unnaturally. Not only the truly ill but also the malingerers make more frequent demands upon the medical profession, completely upsetting the consumption balance established through personal economic considerations. And increased demand in a marketplace with an inflexible supply always causes an increase in prices.
Medicare and other government health care plans have severely strained the fiscal stability of many hospitals by allowing recipients of their programs ("clients") to accumulate millions of dollars in hospital bills, which the federal government has either underpaid or in some cases refused to pay at all. Conversely, when the government does reimburse hospitals and physicians, it does so on a "cost-plus" or customary charge basis. Because this money is coming from the seemingly endless coffers of the federal government, little compunction is shown about increasing costs and charges to obtain as much money as possible. As conservative columnist M. Stanton Evans has observed:
These prices have zoomed upward in direct proportion to the flow of cost-plus funds for Medicare and Medicaid to physicians and hospitals, in which medical providers are reimbursed according to their "customary" charges and costs of operation. The all-too-natural result of these arrangements is to make sure that customary charges and operational costs are rapidly increased to absorb the available money.
Medicare's cost-plus system of payment has precipitated directly an increase in hospital expenses. Because hospitals are paid a daily rate related to their own operational costs, administration can no longer deny demands for higher wages or more elaborate equipment on the basis that the money is lacking. They need only to increase their operational costs by spending more money for these items. The health care consumer who is not governmentally supported has had to pay these artificially inflated costs either directly or through increased insurance premiums. To say nothing about the hard-earned tax monies which support government medical programs in the first place.
Direct annual expenditures for Medicare, which were not to exceed five billion dollars, were costing taxpayers nearly double that amount by 1970. And Medicare costs currently are running at more than fourteen billion dollars per year, with estimates that the costs will hit twenty billion dollars in the next few years. It is no wonder that since 1972 the overall cost of health care has risen by more than twenty percent. The physician component of the Consumer Price Index has risen by more than seven percent annually while costs for hospital care have continued to increase by fourteen percent each year.
Seizing upon their constituents' natural concern over rising medical costs, many leftist politicians, led by Senator Edward Kennedy, have advocated more governmental intervention into medicine as a panacea. Unfortunately, some well-meaning citizens, not understanding that too much government is the root cause of virtually all of the problems extant in the health care field, have supported these proposals.
Medicaid . . .
After succeeding in having the Medicare program enacted, as the initial piece of the nationalized medicine mosaic, the Conspiracy directed its efforts towards the passage of a more far-reaching bill. Using the same phony humanitarian appeal, the Insiders and their Communist subordinates proposed the creation of a federal program to provide health care for the "needy." Their efforts led to the enactment of the Medicaid program. The administration of this program is left to the individual states, which pay part of the costs on a matched-fund basis. Naturally, the results have been disastrous.
Between 1968 and 1975, the number of Medicaid recipients increased from 8 million to 24.7 million, while federal and state outlays increased from 3.7 billion dollars annually to more than 12.6 billion dollars. Indeed, Medicaid nearly has bankrupted some state governments.
For instance, California's Medicaid program, known as Medi-Cal, had more than 2.4 million recipients by 1971 — some twelve percent of the state's population — and the costs for the program had doubled within four years. The San Francisco Examiner warned that "The system could bankrupt the state . . ." During the fiscal year of 1969-1970, there were 141 claims filed for every 100 persons enrolled in the program. By mid-1969, a little more than three years after the program had been put into operation, more than 66 million Medi-Cal claims had been processed. Incredibly, Medi-Cal allowed a much wider range of benefits than the average workingman could afford. Of course, the tax burden of the workingman was increased to pay for these government health benefits. The situation in California was an example of conditions throughout the nation.
Medicaid had been passed, however, in the face of evidence clearly demonstrating that it was not needed. At the time of its enactment, more than ninety percent of all Americans were covered by some form of private health insurance. In addition, statistics proved that before Medicaid and Medicare the "poor" had received adequate medical attention. As Dr. Robert M. Sade observed in an article for the excellent Private Practice magazine for October 1974:
A government survey during the years 1963-1964 correlated age-adjusted hospital admission rates with income levels. The survey disclosed that families with incomes under $2,000 a year had 124 hospital admissions per 1,000 people. In the families with a near poverty income of $2,000 - 4,000 a year there were 142 admissions per 1,000. These figures contrast with hospital ad missions in families with incomes over $10,000: there were 120 admissions per 1,000 in this group. Length of stay correlated negatively with income: the highest income group had fewer days in the hospital than the other groups.
Data from a later study indicated that more than 68 percent of the low-income group saw a physician as compared with 69 percent in the middle-income group and 70 percent in the high-income group. During the year when these statistics were obtained, the lower-income group visited a physician on an average of five times, while the middle group had four visits, and the high-income group visited a physician on an average of 3.7 times. All of which goes to show that there were absolutely no sound reasons for the creation of Medicaid.
The actual reasons for the creation of the Medicare and Medicaid programs have nothing to do with medical or economic necessity. The results of these government health programs, including increased medical costs, an expanded federal bureaucracy, government regulation of doctors and hospitals, and higher taxes, are not merely incidental to these programs — they are the primary goals for which the programs were created. Complete governmental control of medicine — that is, to have every physician a government employee and every citizen dependent upon the federal government for all medical needs — is the sole purpose of these programs. Medicine is being used as a stalking horse to bring about the conversion of our Republic into a totalitarian dictatorship. And as we shall see, Medicare and Medicaid already have laid the groundwork for even more lethal infusions of government regulation into medicine.
PSRO . . .
Now that a substantial number of physicians and surgeons had become accustomed to receiving compensation from the federal government for medical services rendered to certain classes of people, the next piece of the conspiratorial mosaic was put cunningly into place. This involved the creation of the Professional Standards Review Organizations (PSRO's) in 1972. Passed as an obscure amendment to a bill increasing Social Security benefits, this legislation established a nationwide system of PSRO's virtually to dictate procedures for all phases of medical practice to physicians receiving payments from the government under any federal health care plan. In essence, PSRO's place a federal medical bureaucrat appointed by the Department of Health, Education, and Welfare between doctor and patient, interfering with a heretofore sacrosanct relationship.
Under PSRO requirements, physicians must consult published standards to determine the medical regimen they can pursue. All of these standards are based upon normative situations, virtually eliminating any personal decision-making by either doctor or patient. Obviously, standardization of medical care can result only in mediocrity. It is no wonder that some physicians angrily have labeled these standards "a PSRO cook-book."
Writing in The Review Of The News for October 10, 1973, Constitutional scholar Dan Smoot discussed the control over physicians that has been given to PSRO.
The P.S.R.O. examiners can search through a doctor's files and records — not just business files, but also the traditionally privileged and confidential medical records on patients. And the P.S.R.O. examiner needs no search warrant, court order, or other authority to make such searches. He does not need to show probable cause to believe, or even to allege belief, that the doctor has done anything wrong. All the examiner needs is a desire to make the search, and an identification card.
In fact, the P.S.R.O. examiner can second-guess a doctor's professional decision about treating a patient, and can penalize him for having made the decision — penalize him by denying him payment for the services rendered, or by recovering payments if already made. A P.S.R.O. examiner can overrule a doctor's professional decision — order him not to perform an operation he had decided to perform; order him to change the medicines he had prescribed; order him to hospitalize, or not to hospitalize, a patient.
An article which appeared in The Boston Globe on January 12, 1976, discussed another aspect of the PSRO program. This Globe piece pointed out that the Bay State PSRO, acting upon federal instructions and pursuant to a 3.2 million dollar federal contract, had just finished collecting data that "would reveal for the first time, and in vast detail, patterns of actual doctor and hospital behavior in treating Medicare and Medicaid patients."
These data include statistics concerning the drug prescription and medical treatment habits of individual physicians. Indeed, virtually every aspect of medical care and even areas classified by the Bay State PSRO as mistreatment — unnecessary surgery or hospitalization — were examined. And the chairman of the PSRO committee on data and research had informed the Globe that it probably would be necessary to disclose data identifying the individual doctors and hospitals as vital "to satisfy the legitimate rights of consumers to know what kind of service they are buying."
From the statements above, it can be seen clearly that PSRO is in keeping with the classic pattern for establishing federal control over any portion of the private sector. In PSRO, the federal government has followed up its financing of medical care with stringent regulation of the physicians and hospitals providing treatment. And through PSRO it has established the mechanism for reviewing the actions of doctors and hospitals to see that they comply with governmental guidelines. Threatened publication of statistics indicating noncompliance, although such noncompliance might well be the result of a physician providing superior medical care, undoubtedly is intended to be used as a coercive tool to eliminate any vestigial independence on the part of physicians.
National Health Insurance . . .
The next step sequentially in nationalizing medicine is to extend coverage of federal health programs from the "poor" and "aged" to everyone else. Not unexpectedly, the major legislative proposals to accomplish that very goal have come from Senator Edward Kennedy. One Kennedy bill, first introduced in 1970 and still being promoted vigorously, is entitled the Health Security Act. Actually written by the Committee for National Health Insurance, which was headed by Communist Walter Reuther, this legislation is supported by some of the most notorious radicals in the nation. Included in this group are Ralph Abernathy, John Kenneth Galbraith, Arthur Goldberg, Clark Kerr, Mrs. Martin Luther King, Carl Stokes, and others of the same revolutionary stripe.
Compulsory for all Americans, the Kennedy bill would eliminate private insurance plans. Its comprehensive health benefits would provide unlimited coverage for physicians' visits and care, including surgery, and for hospital treatment. Within certain very generous limits, nursing home care and hospital psychiatric treatment would be covered. Also, proposed benefits include payment to physicians for psychiatric care and for up to twenty visits to a doctor for each illness. And most of the cost for eye glasses, medical ambulance services, physiotherapy, and home health care would be paid by the government.
It is no wonder that conservative estimates of the initial annual cost of implementing the Kennedy plan run as high as eighty billion dollars. The program would be financed from general revenues, employee contributions, and payroll taxes. It is only fair to point out, however, that the actual cost for every other government health program has been grossly underestimated.
Kennedy and his fellow collaborators are pushing for enactment of this financially disastrous legislation at a time when the federal budget is floating towards four hundred billion dollars, with enormous annual deficits. And government, a completely unproductive parasite capable only of appropriating wealth, is now taking nearly forty-four percent of our total personal income and absorbing thirty-seven percent of our Gross National Product — to say nothing of the effects of the hidden tax of inflation. Kennedy's National Health Insurance plan would push the share of the GNP consumed by government from thirty-seven to more than forty-five percent all by itself.
An analysis of Kennedy's health bill done by the Social Security Administration more than three years ago estimated the cost of this program for a family of four at $1,271 per annum. Congressman Philip M. Crane, commenting in retrospect on the exorbitant cost, declared:
At that time, the average family in the United States was paying $550 per year for its medical care including insurance premiums. Today, 90% of our population is covered with health insurance. And that figure has been increasing.
Senator Kennedy's concern is not economic, however, but rather for the centralization of control over the entire medical profession in the hands of the federal government. Anxious not to be outdone by a Kennedy, other politicians have jumped on the socialized medicine bandwagon with programs of their own.
Richard Nixon outlined his official plan for a National Health Insurance Partnership (NHIP) in a Presidential message to the Congress on February 18, 1971. More limited in scope than Kennedy's proposal, but just as compulsory, the Nixon plan would have cost taxpayers more than forty billion dollars annually, while establishing extensive new regulations over physicians, hospitals, and patients.
Other plans, differing only slightly in nature, aimed at the same ultimate goal, have been introduced with regularity by radical members of Congress such as Senators Jacob Javits and Claiborne Pell. With consummate hypocrisy, the promoters of nationalized medicine have vociferously acclaimed Britain's National Health Service as a paradigm to be emulated by all civilized countries.
Instead of opposing these nefarious programs, opportunistic leaders of the American Medical Association, throwing integrity to the wind and in so doing sounding a possible death knell for the medical profession, actually have authored their own "compromise" health care plan. Arguing that their bill is voluntary and limited, the AMA obviously was not concerned with either the additional expense of their program or the increased regulation of their profession.
The AMA had followed a similar pattern in dealing with the Medicare and Medicaid legislation. After some initial opposition to these dangerous acts, the AMA reversed course and supported the bills. AMA leaders did claim, after enactment, that Congress had gone further than it said it would. Another major setback for the medical profession occurred in 1974 when the AMA opposed repeal of the PSRO's. In the face of a powerful and relentless enemy, the AMA clearly has abdicated its responsibilities.
Responding to its cowardice and compromise, physicians have been dropping out of the AMA at a rapid rate. The last time dues were increased, more than twelve thousand members refused to maintain their membership. In 1974, four thousand members dropped out, leaving less than half of the nation's physicians as AMA members. Attendance at the 1975 AMA Annual Convention was off nearly eighty percent from just a decade ago. And all of these statistics are indicative of the fact that America's physicians want strong, bold leaders who will accept no substitute for victory in the fight to preserve an independent medical profession.
The most recent piecemeal approach to national health insurance was proposed on January 19, 1976, by President Gerald Ford in his State of the Union Address. He called for health insurance to cover "catastrophic" illnesses for the elderly. If Ford's program is adopted, we certainly can expect that there soon will be a demand for an extension of coverage to everyone else.
British Health Service . . .
Because media and political promoters of nationalized medicine have waxed rhapsodic over the National Health Service in Great Britain, we can be certain that it is a system very similar to the one which they intend to impose in the United States. But a close examination of the National Health Service reveals that it is a fraud and disaster of monumental proportions. It has succeeded only in making every physician an overworked and underpaid employee of the government.
In 1975, a party of American doctors and Congressmen made a fact-finding visit to England to study NHS firsthand. Their findings were reported in the September, 1975 issue of Private Practice magazine. Some of what they learned has been incorporated into the following paragraphs.
Established in 1948, pursuant to the National Health Service Act of 1946, the initial NHS budget was 148 million pounds. Today costs exceed 4.5 billion pounds, and the Labor government has promised to increase the budget at the rate of ten percent each year. By some official estimates, salaries and administrative expenses of the government bureaucrats who run the NHS absorb nearly thirty percent of its budget.
Over-utilization precipitated by the fact that there is no charge to the patients using the NHS has created huge waiting lists (over seven hundred thousand persons on these lists last fall) for virtually all needed surgery. The fact that services are free also encourages patients to remain in the hospital much longer than necessary, thus further exacerbating the problem of over-utilization.
Many persons desperately needing treatment for malignancies or other pressing medical problems have expired before receiving lifesaving measures. In some cases, these individuals already had waited months for their turn for the "free" medical treatment being paid for by their taxes. The NHS Ombudsman reported on the case of a woman who had waited months for open-heart surgery. After finally being called into the hospital, she was discharged without surgery due to crowding of the surgical schedule. Four and a half months later, she was readmitted, only to be discharged again four days later. Scheduled to enter the hospital for a third time several months after the second incident, her surgery was again canceled. She died two days after this third cancellation. This particular case is very typical of the NHS.
One orthopedic surgeon reported that any older person needing a hip replacement will probably die before getting to the top of the list. It takes an average of nine months just to get an appointment with an orthopedist. Other specialties are not much better off, with waiting lists for hospital admissions ranging from one to two weeks for acute cases to two to three years for hernias and other non-life-threatening problems.
Private Practice quoted a prominent British physician concerning the effects of this crowding:
Dr. Charles Loehry, chairman of the medical staffs at Poole Hospital and Royal Victoria Hospital, both in Bournemouth, said that crowding has led to patients who might otherwise have lived dying at home before they can be admitted; patients dying in the emergency rooms after waiting hours for a bed; cancer patients waiting up to six weeks for treatment while their tumors spread; and emergency cases smuggled into beds of patients being operated on, so when they return from surgery there is no room for them. Doctors call this "musical beds."
It is not at all surprising that more than two million residents of Britain have subscribed to private health insurance, a practice still allowed — although under heavy fire from socialists who want to remove all vestiges of private medicine. The waiting lists for the few private beds in NHS hospitals are much shorter and are made up of people willing to pay to obtain quality health care. Even several of the most vociferous opponents of private hospital beds have resorted to using names other than their own to get private beds for themselves or members of their families.
Conditions under NHS, however, are no better for the doctor than for the patient. Indeed, over half of the physicians in many British hospitals are foreign-trained. This is due to the large number of British doctors emigrating annually. Each year, two examinations are given to qualify British doctors for medical practice in the United States. In 1972, 404 doctors took the test; in 1973, 828; in 1974, 1019. And 2517 doctors took this examination during January of 1975, the last examination for which we have figures. But their flight will be in vain if the American medical profession is nationalized.
The reasons for so many skilled physicians wanting to leave Britain are not hard to understand. Not only are the British hospitals overcrowded, but many were built in the nineteenth century as workhouses and later converted into hospitals. They are squalid and dirty, lack minimal fire protection, and much of their equipment is terribly outdated. A London Daily Mirror story on NHS told of patients holding cockroach races in filthy corridors. Government bureaucracy has seen to it that it takes generations to build a new hospital. Far more hospital beds were provided in the twenty-seven years preceding NHS than in the twenty-seven years since 1948.
With the atrocious food and pathetic ancillary services in most British hospitals, it is no wonder that so many dedicated healers are desperate about the quality of care received by their patients. Combining long hours, low pay, and bureaucratic harassment and paper work, the NHS is a torturous experience for its medical practitioners.
Indeed, top specialists at hospitals reach the highest pay grade of 12,000 pounds ($25,000) after fifteen years. General practitioners, who are not allowed to see their patients while they are in the hospital, get no set salaries. They are paid instead the equivalent of about $3.46 per year per patient. The average GP nets about $10,500 per year. To do so, however, he must have over three thousand patients on his list with whom he contracts for unlimited services. Of course, no physician can adequately treat three thousand individuals. But physicians are being paid for quantity, not quality.
Every American physician should consider carefully the medical situation in Great Britain. For unless all of them take strong and immediate steps, the NHS could be the shape of things to come for the American medical profession.
Because many enemies of a free and independent medical profession are participants in a Master Conspiracy, their interest is not in medicine but in total power. They will not limit their battle plans, therefore, to merely pushing for national health insurance. They will use every real and manufactured problem as justification for additional government regulation of the medical profession.
For instance, the present dramatic increase in medical malpractice insurance rates already is being used as a pretext for calling for ameliorative legislation by the federal government. Such legislation can only increase government's size and cost, while expanding its control over the medical profession. And federal legislation will affect every doctor in the land. Furthermore, there will be no opportunity for a physician to cast a retrospective vote against an enactment of this kind by changing the location of his practice. It is incumbent upon every medical practitioner to guard zealously against any governmental encroachments upon his rights as a free man or his responsibilities as a physician.
The battle to preserve America's tremendous private medical system is a vital component of the overall freedom fight. It is a campaign that will be won or lost in the United States. Victory can only be achieved, however, if every concerned physician joins the battle and exercises his personal influence.
The John Birch Society has been engaged in the fight for America for more than seventeen years. During that time, we have achieved a number of important victories. But we need the help of many more truly good men and women. As we have pointed out above, the prestige and following of our nation's doctors provide them with tremendous potential for playing a vital role in stopping the conspiratorial forces which are working to destroy our free society and to enslave us all.
We are exceedingly proud of the courageous physicians who are members of The John Birch Society. And we earnestly and respectfully invite all other like-minded men of medicine to join us in this crucial struggle.