In Health Care, Freedom Is The Biggest Shortage
Americans cannot make their own medical decisions or decide how to spend their health-care dollars — bureaucrats do that.
By Deane Waldman – March 17, 2023
5 MIN READ
The news is filled with stories about a U.S. health care system “plagued with shortages” of money for care, access to care, and doctor time. What they do not mention is the shortage of freedom.
Americans are not free to select their preferred physician or choose the medicines they take into their bodies. Government bureaucrats, not physicians on the scene, triage critically ill patients based on “crisis standards of care”: non-physicians applying a checklist to decide who will live and who will die. Patients cannot choose who will operate on them, where, when, or even if. And of course, Americans cannot decide how to spend their health-care dollars — nameless, faceless bureaucrats do that. This is medical tyranny.
Doctors are equally un-free. Your assigned physician (assuming there is one) does not choose your medications, a pharmacy benefits management (PBM) program does. Operations are performed where the health plan instructs, and by whom they choose. Providers for Medicare and Medicaid patients must simply accept the federal payment (“reimbursement”) schedule.
Supporters of Biden’s Anti-Inflation Act of 2022 proudly announced the act empowered Medicare to “negotiate” drug prices. This brings to mind a soldier (provider) with a handgun negotiating with an M-1 battle tank (federal government as Centers for Medicare and Medicaid Service, CMS.) CMS dictates the payments, telling providers to take it or leave it. As providers are bound ethically to care for their patients, they must simply accept whatever payment schedule Medicare and Medicaid announce.
Both patients and providers live under medical tyranny. For providers, this creates an intolerable ethical conundrum. Medical ethics require a physician to provide the best possible care for the patient. Patients believe (wrongly) the provider has the authority commensurate with their responsibility. This is not reality. Doctors can only prescribe drugs the PBM allows. Surgery is done in the cheapest hospital, not the one with the best results.
Death by Queue
Single-payer health-care systems, the acme of government medical tyranny, are in danger of collapse in the United Kingdom, Australia, and Spain. Some experts warn of a similar breakdown here.
Health-care systems exist to make and keep people healthy, and to save lives through timely medical care. The best demonstration of system failure is death by queue: dying waiting in line for technically possible care that is not provided in time, measured by wait times.
Before the Affordable Care Act (ACA) was passed, the average maximum wait time to see a primary care doctor was 99 days. After the ACA, wait time had increased to 122 days.
This author’s wife waited seven months to see her primary doctor for chronic abdominal pain. It was inoperable pancreatic cancer. She died 22 months after diagnosis. Might things have been different if she had received timely care?
An internal Veterans Affairs audit concluded “47,000 veterans may have died” waiting in line for medical care. In Illinois in 2016, 752 Medicaid enrollees died waiting for treatment.
Despite having the most advanced technology and many of the best-trained physicians and nurses, U.S. health care fails to deliver care in time.
Three Reasons for Inaccessible Medical Care
There are three reasons for inaccessible medical care, attributable to federal medical tyranny.
First is the lack of providers. There are too few physicians for too many patients. Physicians are increasingly unwilling to accept low Medicaid or Medicare payment schedules, or tolerate the administrative hassle. Nationally, 31 percent of physicians refuse Medicaid patients. In Texas, more than 50 percent do. The increasing number of doctors retiring early exacerbates this problem.
There is an increasing number of patients demanding care, especially those with no-charge (“free”), government-supplied Medicaid coverage. In 2000, 15.6 percent of the U.S. population was enrolled in Medicaid. In 2022, the percentage had nearly doubled to 25.7 percent: 91,342,256 Americans. The conjunction of more patients with fewer doctors increases death by queue.
Second, providers’ time is consumed by the regulatory burden. Doctors spend so much time filling out forms — hospital privileges, insurance renewals, medical scorecards, billing requirements, compliance, and security, to name but a few — they have no time to talk with, much less think about, a patient. The most common complaint patients have when they finally get to the doctor’s inner sanctum is how little attention the doctor pays to them.
The third reason Americans are dying by queue is bureaucratic financial diversion. The U.S. spent $4.1 trillion on “health care” in 2022. Nearly half of that outlay produced no care! Instead of paying providers, hospitals, and pharmacies to provide care, that money paid for bureaucracy, administration, rules, regulations, compliance, and oversight.
The physician shortage, the regulatory burden, and bureaucratic diversion are attributable to Washington’s medical tyranny.
The proper response to Washington’s medical tyranny is both simple and politically anathema: The federal government must relinquish power to we the patients.
Reclaim our medical autonomy — our constitutionally guaranteed freedom. Patients should be free to make all medical decisions and choose how to expend their health-care dollars. Reconnect patients directly with their doctors — no third parties in between. Build state-based medical safety nets for the impoverished.
Such a patient-controlled, Washington-free system is not only possible, but it is also more accessible and less expensive than what exists now.
Deane Waldman, M.D., MBA, is professor emeritus of pediatrics, pathology, and decision science at the University of New Mexico. He is the former director of the Center for Healthcare Policy at Texas Public Policy Foundation and author of the award-winning book “Curing the Cancer in U.S. Healthcare: StatesCare and Market-Based Medicine.”