Wednesday, June 17, 2009

Very Bad Medicine: a Surgeon’s Historical Perspective on Nationalized Healthcare

By Daria Anne DiGiovanni

When my Blog Talk Radio co-host Stephen Rhodes and I sat down to interview Dr. Alphonse J. DiGiovanni, M.D., General and Vascular Surgeon last week (yes, Dr. Al also happens to be my dad) about the Obama Administration’s forceful push to nationalize medicine, I already had a fairly accurate understanding of the points the good doctor would make in defense of the free market, and the best healthcare system in the world.

Among other troubling things, socialized medicine would jeopardize doctor-patient privilege by giving government bureaucrats the power to interfere with the proper course of treatment (e.g. usurping the doctor’s authority to recommend a particular procedure or operation deemed necessary for the patient’s health); potentially force mothers-to-be to abort pregnancies determined to have fetal abnormalities (and pay doctors more money to intimidate parents into choosing abortion); and deny elderly patients recommended care simply because the state decides it is not worth the time and money to preserve a life that’s nearly over anyway.

Dr. Al eloquently opined on all of the above, but he also offered a history lesson as to how it all began, having been in practice since 1965. And just to set the record straight, he is not some wealthy physician born with a silver spoon in his mouth, fighting for a doctor’s right to make a lot of cash. Contrary to what liberals want Americans to believe, not every doctor was once a child of privilege. My father was born to Italian immigrant parents who came to the USA well into their 30s, in order to create a better life for their children. His dad was a humble tailor with a third-grade education; his mother a seamstress who only made it as far as the sixth grade.

The third of only four surviving sons, Alphonse was a hard-working, gifted student and athlete with a dream of playing professional baseball. When a shoulder injury forever shattered that worthy goal, my father turned to his second love—medicine, maintaining excellent grades throughout high school, college and medical school while simultaneously managing three jobs to finance it all. So when he speaks of the horrors of socialized medicine, it is not because he hates poor people; indeed it is because he knows from experience that when the government encroaches upon any industry, the results are bad for everyone.

Doctor, can you give us a bit of history as to how this all began?

“Actually, the first intrusion of government into medicine was the Foran Bill in 1947, which came on the heels of England’s development of national healthcare when they regrettably rejected Winston Churchill. In retrospect, I am glad the Foran Bill did not pass; but at the time I was a real liberal. I’d gone to a public high school for gifted students—Central High School in Germantown, Philadelphia where the social sciences division was totally left. All I got was how bad the Republicans were, and how good the Democrats and FDR were. That was when I first heard the term trickle-down economics, long before that criticism was leveled at Ronald Reagan.

“In college, I participated in a debating session in which I had to argue in favor of the Foran Bill, but as I immersed myself in study, I began to realize what the cons were. I still thought it was good for the country but my attitudes really changed over time with Barry Goldwater, and Ronald Reagan’s impassioned speech on his behalf. That was very telling for me, and it absolutely changed my outlook.

“Then along came the first successful government intrusion into medicine in the form of the Medicare Act of 1969, which was President Johnson’s aim for his historical legacy. And they managed to pass it by throwing an incredible amount of money at hospitals, who were then allowed to triple and quadruple their fee structures. So not only hospitals, but physicians were very well paid, thus blunting all of the adversarial components, as people who were once opposed to it softened. That is how they were able to pass Medicare.

From 1969 to the present-day, there’s been a progressive reduction in fee structures. And from what little is known about Obama’s plan, he is not going to throw the money into it that Johnson did—his plan is cradle-to-grave, purely socialistic. And there won’t simply be rationing of care for the elderly and disabled, but for everyone.”

What about Obama’s plan most concerns you?

“Well, I can’t really discuss specifics, because there’s not a whole lot of information out there yet. All we know at this point is that it is a general scheme of nationalization. And by the way they are attempting to speed it up and get it out there by August. My feeling is that they must already have their objectives in place, since this is a monumental undertaking. In general, I view socialized medicine as a gigantic game of Monopoly in which the government prints out a lot of money and masks the socialistic component in a euphemistic term—a ‘one-payer’ system. I would caution all Americans to be on the lookout for that.”

Are there any medical groups protesting this passage of this potential bill?

“Although it’s been fairly quiet up to this point, I think the response is going to pick up steam and medical organizations will begin to exert their influence on their representatives in D.C. As for the AMA, they’ve been tilting left for many years and are thus worthless, in my opinion.

“I base that on my own experience as a physician in Pennsylvania. Back when malpractice laws were established, the state asked me to give money to capitalize the system, not the insurance itself. It was determined that as a specialist, I owed $2,168, simply to capitalize; that amount was not the insurance premium itself.

“Originally, they’d wanted every doctor in PA to contribute $500, but the problem was that general practitioners and pediatricians balked at paying that much. Therefore, they were permitted to give just $250, while specialists like surgeons were required to cough up $2,168 to make up the difference. Again, that figure does not represent the premiums, which were very high.

“In 1965 when I went into practice, several values of liability coverage were available to suit an individual doctor’s needs. But all of that changed, and eventually it became mandatory that you had to purchase at least $1 million in coverage. Now at first, that didn’t seem so unreasonable, but by 1995 I’d already paid my annual $40,000 premium when they announced in October of that same year that I owed a supplementary charge of $16,000. By 1996 I’d had enough and decided to shut down my surgery practice.”

If you look at Great Britain, the doctors ration in the form of quota. And once that quota is satisfied, they are free to go on vacation. Can you elaborate on that?

“Sure, the British government assigns monetary priorities on healthcare; therefore so much allocated for certain services. And when that fund is used up, that’s it: the doctors have the prerogative to walk away and say ‘I am not going do this procedure again until next year,’ regardless of what is in the best interest of the patient. It’s not very good for anyone, the doctors or the patients.
“It also varies, what services you may get, depending upon surpluses. In Germany for example, their colonoscopy fund was used up in August. So if you needed a colonoscopy, you had to wait until the New Year to get one. You were basically put back at the end of the line, with no consideration of the urgency of your particular medical situation.

“And another thing they do in Great Britain is make patients wait to be seen by a doctor in ambulances in the parking lot, if they are unable to be looked at within four hours. Can you imagine leaving a patient out in the parking lot like that? It’s deplorable. The other negative aspect I hate to admit on the part of my profession is that this system also creates lazy doctors. The free market by nature rewards those who work hard and produce quality work, and this is also true in a free-market-based healthcare system: take away incentives and quality suffers. Again, that is ultimately bad for both patients and doctors.”

What about the effects on would-be doctors considering a career in medicine?

“When you get into these excessive costs, salaries will become stagnant. Over time, the pay scale will be reduced. One of the saddest byproducts of this is that I have many, many colleagues who have discouraged their own children from going into medicine because of the looming disaster, should Obama get his way. Most of the doctors I know are really devoted people who care about doing the very best job they can—not simply based on monetary rewards but because in a free system, they have the motivation do so.”

Do we really have a healthcare crisis?

“You know, one of my biggest problems with this whole debate is this notion that poor people are denied healthcare. This is simply untrue; no one that presents themselves to an emergency room is ever denied care because of their inability to pay. What it should be rightly termed as is a crisis in health insurance, which is due to many factors, including the overly litigious society we are living in and the negative influence of trial lawyers; the inability of consumers to cross state lines when purchasing the plan that best meets their needs; and of course, the growing number of illegal immigrants that overburden hospitals, especially in border states—an issue our government repeatedly refuses to address.

“Further that ‘47 million uninsured’ is a bogus figure I’ve been hearing about for the last twenty years. It does not include young people who choose not to purchase insurance, people who are in-between jobs and thus transitioning into new plans; and the inflationary impact of Medicare, which has made insurance unaffordable for many. There again, far from being a solution, government interference has only created an even bigger problem.”

Doctor, what are some of the moral implications of nationalized healthcare, aside from the rationing of services?

“Well as you know from Daria, I have a son with Down syndrome who is an absolutely beautiful, beautiful person. At the time of his birth in 1959, we didn’t have the diagnostic tests to determine abnormalities like Down’s ahead of time, but even if we had, we never would’ve terminated my wife’s pregnancy. Over thirteen years ago, my daughter Carolyn had a scare with her firstborn son when it was determined he was at a high risk of being a Down syndrome baby, but as it turned out, my grandson Christopher was born perfectly healthy.

“What I fear the most with a nationalized system is that doctors will be pressured to talk patients into having abortions when such diagnostic tests determine the presence of some sort of abnormality, whether it be Down syndrome or anything else. Further, the government could resort to actually paying doctors more money to perform abortions in these situations. Then at the opposite end of life, there’s a high probability that we as a nation could start engaging in euthanasia, based on someone else’s subjective idea of ‘quality of life.’ So it is very troubling from a moral perspective. Who among us is God? Who among us is perfect and empowered to decide who lives or dies? That sounds very much like Josef Stalin or Adolf Hitler to me.”

Finally doctor, what can the average person do to fight this trend?

“I would encourage all Americans to make an effort to get educated, to really understand the dire implications of a nationalized system. Just look at Canada and other places, where even heads of state choose to come to America when they need major surgery. Everyday citizens from Canada regularly cross the border when they’re told they have to wait six months just to have a test.

“There’s a reason why we have the best healthcare system in the world. So get the facts and don’t just blindly accept the media spin. Then lobby your representatives in Washington. On the flip side, I believe it is now imperative for all doctors to inform their patients about the realities facing all of us should this horrendous bill pass. They have got to get over their fears of what their patients might think, and start speaking out. All of us have so much to lose if we don’t.”



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