Monday, October 20, 2008

A Great Editorial from ACEP News

October 2008
By David F. Baehren, MD

The United States has enjoyed the most successful and enduring form of elected government in the history of mankind. In spite of our political class being populated by some of the most unworthy scoundrels ever to run for office, our system of checks and balances has served our nation well, and we have prospered.

The genius of our founding fathers is evident in their deliberations over the writing of our Declaration of Independence and the Articles of the Constitution.

The signers of the Declaration were accomplished and serious men. Almost all were wealthy, and each had much to lose by signing his name. At the end of the document, they wrote, "We mutually pledge to each other our lives, our fortunes, and our sacred honor." They knew the dangers they faced. Many were hounded by the British and eventually lost family, fortune, and their lives. They died, however, with the thing they cherished most still intact: their sacred honor.

Fast forward to present day, when our politicians and candidates spend more time trying to get and stay elected than they do thinking about the preservation of the republic--a republic for which so many have risked and given their lives. Our current crop of public servants couldn't shine the boots of the likes of John Adams, Samuel Adams, Thomas Jefferson, and Ben Franklin.

An election year seems to bring out the worst in them. The dishonorable pandering that goes on is most vexing. There seems to be little talk about what's best for the country as a whole, and lots of talk about what can be done to please this or that interest group. The latest redistribution-of-wealth scheme disguised as a stimulus package is a very good example of this kind of nonsense.

The biggest prize of all in the pandering game is health care. Some are ready to give it away to all at the expense of the taxpayers. Assuming one believes that expanding the federal health care system would actually help people, it's easy to appeal to voters based on stories of individual hardship. How could anyone deny health care insurance to a working mother of three?

When the poster child approach is used, it becomes difficult to make an argument against a national health plan without sounding heartless. And those who are pushing for national health care are counting on this. A rational person might first ask what kind of coverage would be provided. Would it be like Medicaid, where access to care (except emergency care, of course) is quite limited, and the only guarantee is that nobody will try to collect money after the government pays 30 cents on the dollar?

Would everyone have Medicare, where money gushes like Niagara Falls? (Some of that money actually splashes at the feet of doctors on occasion.) Medicare pays for people who don't recognize a soul or know the year to get dialysis. Ambulances shuttle patients all over creation at $500 a ride--but Medicare won't pay a doctor a reasonable fee to make a house call. Amplify this kind of waste five times, and the budget deficit will soar. The money will dry up quickly, and then the rationing will begin. At first, it will be relatively easy, and we won't dialyze people who don't know what planet they inhabit. Later, choices will become more difficult, and people will wait months for bypass surgery or will be disapproved for hip replacements.

Will we allow people to purchase supplemental insurance and maintain a two-tiered system, or will everyone be forced to live under the same cash-strapped federal system? That's the way it is in Canada. Those with means choose to come to the United States and pay out of pocket when they are put on the waiting list for surgery or chemotherapy, because they are prohibited from buying private insurance.

Americans will demand choice in their health care coverage. Just as people with money abandoned city schools 40 years ago, people will flee the federal health care system. Access to good care will be diminished for those who are stuck in the federal system and will improve for those who can afford the private system. Our elected officials may feel better for having done something to "help" people, but everyone else will be the worse for their efforts. And the very people they set out to help will suffer the most. Just look at the failed public school system of every large city in the country to get a look into the future of health care.

There is more to this than guaranteeing health insurance for a mother of three. The larger debate should surround what's best for the survival of our republic. This is what our founding fathers pledged their honor to. They put the good of the nation ahead of their parochial interests.This is a rare discussion in Washington anymore. Remember, it is our elected representatives who have created the Social Security system but failed to put money aside to pay the tens of millions of people who are about to start collecting from it. These are the numbskulls who gave us EMTALA and demand our servitude (under threat of stiff penalty) without any promise of compensation for our efforts. This is the fiscally irresponsible lot that spends money on useless earmarks while our collective debt soars. I don't have high hopes that any of our candidates or elected representatives will look at the big picture and realize that our Constitution does not guarantee happiness. We have no right to it. We are free only to pursue it.

Our founding fathers did not believe that pursuing happiness involves sitting on the couch waiting for your federal insurance card. Thomas Jefferson said, "The democracy will cease to exist when you take away from those who are willing to work and give to those who would not." He would not be pleased with our current entitlement state and our punitive tax code. He might even look at our current government in the same way he saw his British oppressors and say that it is his right--it is his duty--to throw off such government, and to provide new guards for our future security. No doubt, today he would be branded as a crazy extremist. Every election provides our nation with a crossroads. For physicians, this is a particularly important one. I fear that the implementation of a national health care system will propel us further down the slippery slope we travel already.

When the majority sees fit to tax the wealthy minority to pay for something not promised in the Constitution, our republic creeps closer to collapsing into socialism. And then we will be a mere shadow of the great republic forged over 2 centuries past.

Dr. Baehren lives in Ottawa Hills, Ohio. He practices emergency medicine and is an assistant professor at the University of Toledo Medical Center. Your feedback is welcomed at


  1. This comment has been removed by the author.

  2. Sounds like this guy either reads our blog or he can envision what every other thinking, reasoning practicing private physician can (sorry 911, but it's probably the later).

    I wish we could trade Jeffersonian lawyers for trial lawyers (p.s. those are the guys who build the REAL mansions by "helping people").

  3. I mentioned your blog in my last post:

  4. "Would it be like Medicaid, where access to care (except emergency care, of course) is quite limited, and the only guarantee is that nobody will try to collect money after the government pays 30 cents on the dollar?

    Would everyone have Medicare, where money gushes like Niagara Falls? (Some of that money actually splashes at the feet of doctors on occasion.) Medicare pays for people who don't recognize a soul or know the year to get dialysis. Ambulances shuttle patients all over creation at $500 a ride--but Medicare won't pay a doctor a reasonable fee to make a house call."

    To understand the health care issue requires understanding of these sentences. "Insurance" does not equal real access. Would you rather have "free" medicaid-like coverage (many physicians won't accept it, and your wait will be long) or would you rather pay for reasonable insurance you can use? The reasonable solution is to make individual insurance expenses deductible and to allow the vast majority to pick their own plan. Tying coverage to employment is an archaic practice.

  5. Good government is just as important as good health care for all. So that we may all benefit from better government, I hereby vote that all government officials of any/every stripe be prohibited from making more or receiving more benefits than an entry-level ER nurse or resident physician and have to work the same hours.

    Free government for all!

  6. Some dood came to my door and was trying to get me to vote for Obama. I'm like "no, I am not voting for someone who is a redistributionist even if I would theoretically benefit in the short term."

    He looked at me with the most clueless stare ever when I said that.

  7. I attended the University of Toledo my fresh and soph years.. What a coincidence

  8. Strange coincidence I posted almost the same comments this AM regarding educational changes and healthcare changes...good blogging OD MD

  9. hi guys,
    I'm from Ontario (its in that big country to the north) and while I would be the first to admit our system is not perfect, it is redistributionist. I would also say that its a helluva lot better then what you all have going on there. Sure your hospitals are of better quality yadda yadda yadda and thats great if you happen to be upper middle-class, or at leas well offish. But guys! What would Hippocrates say about the fact that people with less money are treated as second class citizens in hospitals. (In a country which prides itself by the way on being classless in terms of the law, and by extension the government)

  10. hi laura from ontario!

    you are simply wrong. the point is that EVERYONE who shows up in an ER here, regardless of what crime they committed, what country they jumped off the boat from, or whether they have insurance/money or not, will get their grade two astrocytoma resected within a week or two as compared with your fine system. you must have watched that dillhole michael moore's 'movie'. if you are curious and not just throwing stones you can search the blog for EMTALA and find out why the jewel of the world's health care systems is on the verge of collapse and, to quote pj o'rourke, "if you think health care is expensive now, wait until it's free".

    and by the way, we do not pride ourselves on 'being classless' (whether you meant the double entendre or not), we pride ourselves on equality of OPPORTUNITY and therefore ease of movement between classes.

    love your beer by the way.

  11. Howdy Laura from the Icy North,

    I don't know who told you that you have to be "upper middle class" to get health care in this country, but that's simply baloney.

    Estimates are that about 46 million Americans are without health insurance. Many of these are eligible for forms of government assistance already available.

    There is work to be done in this area, no one questions that. But what we don't want is a government takeover of health care with it's inevitable rationing of goods and services and bureaucratic red tape.

    Trust me, I see American medicine every day and there's no truth to your assertion that only the wealthy or nearly wealthy receive care.

  12. dear 9 and gang,
    no one could pride themselves more on classlessness than you guys!

    let me get this straight-you bitch on the one hand because you're keeping people who don't know the year alive. You bitch on the other that they'll make you ration care. make up your fuckin mind, people! Also, I hope nobody here is a geriatrician. They're the worst for doing all kinds of shit for no reason to old people.

    There is no true equality of opportunity in this country (or any other, really). Enjoyed the remarks (other thread) about why don't I get upset about actors or sports figures who are only successful by virtue of "natural abilities or luck, blah blah....", yet your own is due to exactly that.

    I haven't read why or for what you are leaving your current job, but can I suggest a concierge sort of practice? This would be an ideal situation, based on your conviction that your current patients are all boat jumpers and criminals. Perhaps if the patient were of a more lucrative class you could order all the tests and treatments you want, regardless of THEIR drug/alcohol abuse, smoking, obesity, depression, self centeredness, or any other previously unacceptable habit.

    Your repeated assertions of how glad I would be to have you when I am dying (no doubt through some bone headed action on my part), are not necessary, don't bother. I usually receive excellent medical care by non psycho physicians.

    It's true. Mean people really do suck! :-)

  13. Uh, Sleepless, what happened to lurking and laughing? We'd be better off not hearing your random nonsensical ranting. Also, the psycho inference from you is a bit of the pot calling the kettle black. I seriously think you have some mental pathology happening. Maybe you should have that checked out by your non-psycho physician.

  14. I can think of no greater affirmation than having YOU think that I'm a psycho.


  15. dear sleepless,
    did you just see the polls jump towards mccain? it was you! God love 'ya and i have no doubt that you have a whole bunch of physicians. best of luck.