Even with the comic relief of the endpage, as a reductio
It is not called the "Art of Medicine" for nothing. Sure, there is vast hierarchy of biological science which has finally begun to be understood on the molecular level; sure, there is truly impressive arsenal of diagnostic and pharmacological and surgical weapons that are available to physicians in the quest for the maintenance of human health. These tools are just that; the Art of medicine is the experienced and artful use of these tools. A physician trains as any artist trains by studying what has been done, by practice and many years of difficult training of mind, and by learning how to think within his art. There is no artificial intelligence program that can substitute for a good physician; there is no writable set of rules that a physician has to rely on or that can be an authority in the practice of the art of medicine; anything is better than a bad physician; unfortunately, they exist. It looks like their numbers will increase soon, dramatically.
Physicians, for centuries, have sworn, and they have been trusted to DO NO HARM. Yet one of the noblest and most difficult professions is now, quite literally, littered with: medical whores suborned by insurance companies; licensed MDs who have been trained in inferior foreign "medical schools" and who often know so little of the language of this country that they cannot communicate with their patients and who have now replaced properly educated and trained physicians because their inferiority makes them cheaper to hire; a large intersection of these two groups; increasingly forced reliance on HMOs for inferior, absent or downright negligent and harmful practice of medicine, or so it is called.
Who have good professional physicians and we their patients to blame for this? Basically, ourselves!
See the story of how we wound up with Racketeering HMOs and how Physicians Got Screwed.
See also the letter of resignation of a psychiatrist from the American Psychiatric Association for reasons intimately related to this essay.
We, the people of this country founded on principles of liberty and freedom, have delivered ourselves into the hands of an an insatiable monster that demands sacrifices of blood on a scale that would horrify the ancient cultures which first practiced this as a sacred ritual. I speak, of course, of the federal government of United States of America.
I am not propounding some mysterious conspiracy theory; if there is a conspiracy, other than the obvious one of transcendental supidity, which is highly dubious, I have not got a clue as to what its ends might be or who the "real" players are. There is simply no good end in sight, for anybody. This is simply putting together the proverbial 2 and 2, (just the facts ma'am) and coming up with 4; yes, mathematicians - I do really know better - that was a metaphor.
Before I go on - yes, there are actually a few people
in government who are far more ethical and far smarter
than the abysmally low norm;
they are silenced and rendered powerless in face of interlinking
corruptions and general stupidity about some very simple
things that are made objects of equally stupid debate.
I've actually known a few of these: Representative Weinberg,
Senators Feldman and Baer from The State of New Jersey;
if I had the time, energy and resources, I would actually
work for them; similarly the Senatorial candidate John Edwards
here in North Carolina.
The stupidity of government is nothing new; and, it is an escalating
real problem for our form of government as it has evolved.
I paraphrase Mark Twain in his decription of the congress as
"our national asylum for the mentally enfeebled";
were that false, it would not have the slightest humor.
Operative is a Genaralized Gresham's Law which in economics says
bad money drives out good; just leave out the money partl
it's still valid.
I've actually seen it in action, all too often.
No punches pulled here.
End of Minor Interruption.
To feed its boundless appetite for power and control (a minor example) of the people of the US, the federal government and now the governments of the States individually, continue to thieve the life blood, liberty, freedom and wealth of this country only to piss it down a toilet, the toilet of its own bureaucracy. The espoused purpose is always the public good, the public need, to save us from ourselves, to save this, to save that, or to prevent a disastrous occurrence of dubious probability, or even worse, to achieve a more equitable distribution of wealth. There was a time when anybody with an 8th grade education would recognize that last one as some kind of socialism, and be quite opposed to it, albeit, perhaps, for the wrong reasons. We cannot, however, have pure socialism in this country unless the federal government confiscates all private property so that it becomes the property of "the state"; what we can have and do have to an increasing degree is fascism wherein private property is allowed but, "the state" dictates what may and may not be done with it. Property is not then yours after all, and it can, of course, in the interest of the state be nationalized which is to say stolen from you at any time. Both A. Hitler and B. Mussolini thought this was a splendid idea. Though both were masters of sick techiques of emotional maipulation, neither of them were scholars of anything.
In general , "leaders" do and say very stupid things, which is why people like B. Franklin and T. Jefferson invented and promulgated a federal repulic (NOT a democracy!) with its system of checks and balances as our to be adopted form of government. It's not perfect, as the state to which it has degenerated readily demonstrates; but, in principle, it's still the best idea in government that's come along and known within the past 6000 years or recorded history. Yet, if there is anything fundamentally out of control, it is the increasingly centralized federal government, which among other paternalistic agendas is trying desperately to push fascism/socialism down our already lubricated and prepared throats. Our federal government, which continues daily to destroy the best healthcare system the world has ever seen in the vestige of what remains of a free economy that it has also destroyed, desparately wants to control health care; now, we patients and physicians are in deep trouble. "A Managed National Health Care System" will kill us all, in its orgy of bureaycracy and statism. The evidence is already in as it is and has been on socialism for a long time. Why is your government doing this? It's no secret or conspiracy. It is a simple historical fact that any government, and all governments have only one pupose: to steal all you own and make you completely sibservient to it. You are nothing but an expendable cash cow, whoever you are.
But, what's so wrong with socialism/fascism?
Socialism necessarily imposes values on nonstatic (dynamic) goods and services which have a dynamics of their own irrespective of their valuations by fiat. Under socialism, economic corrections must be made ultimately by correcting the imposed valuations in order to maintain the desired distribution of wealth. The constant question is then what corrections to make? In order to answer this question one has to know what the "state of the economic system" actually is. That's easy, we work up a good set of economic indicator functions based on some parameters that we can measure. So we measure things like partitions of a gross national product, a couple ways of getting a handle on the value of the circulating wealth and we're ready to start figuring out what changes to make. Easy. A great system that will eliminate all "economic dislocations". Right? Wrong! The one little item that causes the entire system to be logically selfcontradictory and reasonably untenable is the same reason why it never works in practice:
When you measure, what you are measuring is exactly what you put there in valuations to begin with. Yes, you get numbers; but, the numbers are, relative to any sort of reality, meaningless. If you make economic decisions based on these numbers, that is no different from playing Russian Roulette, a phrase that can now be considered to have a double entendre.
Socialism is the system under which everybody loses and everything and everybody is reduced to the lowest common denominator. Is that what you physicians want to be? Is that what you patients want in your trusted physician?
Never, in all recorded history, has governmental interference with anything not caused more problems than it solved. What, on earth makes anybody accept that it can possibly ever do otherwise. Anybody who wants to see the modern results of governmental interference need only look at their own lives, their own bank accounts - if they have any; or, going back what now, I'm sure, seems eons can look at the utter collapse of the erstwhile USSR. These are the practical evidences of the previous theoretics.
Back to the consequences of this governmental confiscation
of wealth and what it has to do with the art of medicine.
When the system of buying and selling goods and services
has a leak and wealth is lost, the buyers and sellers
quite naturally try to keep whatever wealth they have.
One way to do this is for manufacturers cut corners;
I call this the "Chunky Manouvre" since I first recognized
it and understood as a child:
put out a product at a given price;
keep the price but start reducing the size or amount.
Remember when coffee was sold in pound tins instead of
the sneaky 13 Oz. or 11.5 Oz. tins?
Another way to do this, if you are rich enough, is to
lobby or buy outright, the votes of elected governmental
officials, say senators or representatives, governors, etc.
in order have legislation passed that essentially makes
you into a governmentally sanctioned thief with legal pedigree.
Insurance companies did this back in 1945 when they
which exempted insurance
companies, in part, from federal antitrust laws.
This Special Interest Group has
been buying legislation and judges ever since;
and, it may be the most powerful and pervasive special interest group
that has ever existed.
[See also the more subtle and insidious, yet legal method of
The McCarran-Ferguson Act, along with with the other federal and
state laws and judicial precedents that protect insurance
companies from completely justifiable litigation, can and
should be repealed and overridden.
That the States regulate insurance is part of the
McCarran-Ferguson Act provisions.
Should it be repealed,
don't expect that a switch to federal regulation
to make things any better.
They could be worse.
[See such consideration in links on the
insurance page .]
The latest ongoing destruction of everybody's constitutional
rights is the attempt by the Federal and State Governments to limit
(and surely, eventually, to prohibit entirely) your rights
to litigate against and reclaim damages, punitive and real
from an insurance company.
Your right to do this is one of the two essential rights that
give reason to suffer a government to exist.
Now, I wonder why they would do that?
This attempt euphemistically called "tort reform" that caps damages that jury may award, fortunately has been declared unconstitutional, as it indeed is, by several State Supreme Courts.
A quadruple scam of thievery by insurance companies and the federal government results from the current legal sanctioning of insurance companies' thievery: by not abiding by their written word and by adopting corporate policies of denial of claims and terminations, denials and delays in payments, insurance companies can and do reduce their policy holders to a state of destitution, and diability. Either the policy holder dies as a result or the tab for continued existence is picked up by the federal government in the forms of SSI and medicaid. The government is given a break (by law) in medicaid payments, and eveb when the protrated litigation is won against the insurance company, the company needs only to pay the reduced medical bills back to Medicaid. Repeat this hundreds of of thousands of times and the insurance industry as "saved" (actually stolen) millions of dollars from the tax payers or the US. Worse than that, this enhances and bloats the social services bureaucracies fantastically and effectively removes otherwise tax paying citizens from thae tax roles turning them into permanently disabled persons. So, taxpayers are paying for: the bureaucracies, the disabled persons, the value stolen by insurance companies, the decrease in federal revenue resulting from the removal of the diabled persons from the tax role; and, also being deprived of the substantive material contributions that could have been made by the disabled, were they not made permanently disabled by the insurance companies. This is unadulterated evil that should not be tolerated. A major weapon wielded by insurance companies and delivered to them, uncontrolled, by your government is the IME, allegedly an acronym for "Independent Medical Examination". The above link on this site tells the truth about it's alleged independence.
Simply from a economic viewpoint, leaving questions of justice and the meaning of law aside, this is a situation that can end only in disaster. Since there is no hope of this monumental corruption being reversed; let the collapse come as soon as it can be forced. Then be prepared with guns and ammunition.
The collection of insurance companies is not the only special interest group, but it is certainly, along with the federal government itself the most destructive force that has ever been literally aimed at the medical profession. Since the medical profession is my subject here, I will leave, for some other time, the subject of other special interest groups and the importuning and suborning of government to engage in further meddling and interference to "solve problems" that it has itself created.
Rather than be explicitly tedious about the ways in which the medical profession is given the proverbial purple shaft by the insurance industry and how its insidious and destructive presence is found everywhere inescapably, I'll just list key words and leave the details of each as known:
Malpractice insurance Personal injury Elective medical coverage Health Plans HMO Medicare MedicaidRemember that there is not only some de facto or de jura theft from physicians being committed here in each item, there is also the matter of endless paperwork, rules, code numbers, laws and statutes governing this and that. In most cases, a physician cannot deal with all this and still have time to see patients and remain current with the rapidly growing body of medical knowledge. He has two options: quit the medical profession, and a good number of good physicians have, or hire someone full time to deal with the mess. It is a fact of life that physicians may have to submit forms to insurance companies several times before being paid (Oh - I can't find them. Are you sure you submitted them? Could you tell me when you submitted them. Oh, those are old forms; you'll have to submit on our new forms. No, I'm sorry, we don't have any of the new forms left - the printer didn't deliver. Don't be snotty; of course we paid the printer! - [click), or that payment will simply be denied. (We had this dishonest physician once ....) It is also a fact of life that insurance companies make money on the money that you are owed but not paid on time. This trick is routine to them and they make a lot of money doing it.
Here in North Carolina, John Edwards who was running for State Senator was "besmirched" in television advertisements prior to the primary election by his opposition with the horrible news that not only was he an attorney, but represented clients regularly in personal injury cases against insurance companies. The poor baby had the audacity to earn money from this, and should therefore be considered an terrible person. Mr. Edwards won the primary. What the insurance industry has done and is doing to the legal profession, especially those practicing tort law is another matter for another time; but, the bottom line is simply that it is doing it to YOU too, whoever you are. I know the legal profession has a bad rep; most of them take with fairly good humor, and think lawyer jokes are funny. Sure, there are sleazy, stupid and inept lawyers; I've had the misfortune to know a few personally. However, it is good to remember that these are the guys that have to keep up with the rapidly evolving madhouse of laws that either thieve from you or make you a criminal by fiat that has been enacted, without your permission, by your government. As far as insurance companies and your government go, you are the enemy. They both want what you have. Destroy the tort law attorneys and you are dead.
Recently, Medicare/Medicaid has adopted a "Managed Health Care" approach to the art of medicine. The lambs (physicians and patients all) are being lined up for the slaughter. You know that HMO is another word for charnel house, and that your federal government desperately wants you to submit to a National Healthcare System (one neck, one leash) controlled by insurance companies and employing inferior foreign trained "doctors" who will not speak English, but will be cheap. There will be no good physicians left anyhow. MBAs know best how a physician should practice his art.
And then, if there are any musicians that happen to survive this newest and greatest destruction, there is the matter of managing symphony orchestras and music itself ....
A managed care company president was given a ticket for a performance of Schubert's "Unfinished Symphony." Since he was unable to go, he passed the invitation to one of his managed care reviewers. The next morning, the president asked the reviewer how he had enjoyed it, and he was handed a memorandum, which read as follows: MEMORANDUM 1. For a considerable period, the oboe players had nothing to do. Their number should be reduced, and their work spread over the whole orchestra, thus avoiding peaks of inactivity. 2. All twelve violins were playing identical notes. This seems unnecessary duplication, and the staff in this section should be drastically cut. If a large volume of sound is required, this could be obtained through use of an amplifier. 3. Much effort was involved in playing the 16th notes. This seems an excessive refinement, and it is recommended that all notes should be rounded up to the nearest 8th note. If this were done, it would be possible to use paraprofessionals instead of experienced musicians. 4. No useful purpose is served by repeating with horns the passage that has already been handled by the strings. If all such redundant passages were eliminated, the concert could be reduced from two hours to twenty minutes. 5. This symphony has two movements. If Schubert did not achieve his musical goals by the end of the first movement, then he should have stopped there. The second movement is unnecessary and should be cut. In light of the above, one can only conclude that had Schubert given attention to these matters, his symphony would probably have been finished by now. National Healthcare: medicine with postal efficiency & IRS compassion
Canada has national health care; when Canadians want or need REAL medical care they come to the US. If our paternalistic and meddlesome government has its way, they might as well stay home: they will get the same crap here as they do at home.
In deadly seriousness, why are you not complaining? Rebelling? Refusing to work? Refusing to pay for nothing but extortion? Just what is that overblown sanctimonious white elephant, that is at least 10 years behind scientific knowledge called the AMA (I don't mean American Motorcycle Association) doing? Physicians - Your life, your integrity, the existence of the medical profession is at stake and there is no roar of outrage at this cancerous and unmitigated evil? The AMA itself is clearly in collusion, if only by its silent or "confused" position of acquiescence, with the insurance industry; one could guess that this position might have been actively bought.
Thirty pieces of silver?
The insurance industry did not buy the McCarren-Fergusson legislation. MF was just another foolish attempt by our dimwitted Congress to accomplish a moral goal in its usual corrupt and collectively inept way. At the time it was passed, insurance companies had already become a collection of criminals. The companies were, however, smaller and if not pribately owned, privately controlled by a small number of people who were the directors and CEOs. Their scam d'annee was sell a large number of policies, collecting the premiums. The money would be milked from the company, often through "bad investments" in cousin Elmer's snakeoil plant and the company would then declare bankrupcy, leaving the policyholders with no effective policy.
Since this fraudulent device had become rampant enough, the Congress passed MF, whose actual purpose was to give powers to the States to regulate insurance companies in ways that would insure their solvency, thus preventing policy holders from routinely having worthless policies. In the protections granted insurance companies, MF did make it explicit and clear that none of the protections were there to protect them from from the consequences of criminal acts.
The interesting question (probably answerable through research) that remains is why our Congress, in this particular case, abdicated it constitutionally mandated authority over interstate matters specified in the interstate commerce clause of the Constitution by delegating regulation of insurance companies to the States. The insurance industry has made its preference of State regulation known. The conjecture is obvious, but where is the proof?
The only other important abdication of its constitutionally mandated responsibilities is in the coining of money, which is in the hands of the Federal Reserve Band, which paradoxically has no connection with and is not part of the Federal Government, but completely independent from it. [Cf. Law Page] for the history of the non governmental and very, one might legitimately say, all too private Federal Reserve Bank, that regulates our Nation's currency.
Try as I may, I can see no clause in the Constitution that gives to Congress the power, right or authority to abdicate the very responsibilities, rights and powers that are given to it by the Constitution itself. The Constitution (not the abberant Bill of Rights) is the statement of what Congress may and will do; any power or right given by the people to the Federal Government that is not explicitly stated in the Constitution is by its clear logic, expressly forbidden.
So now they, the insurance companies, seem to be able to hide behind MF and commit fraud combined with extortion and racketeering in new ways, so that crime and collusion with the federal government pays once again.
Since this was first written, the US Supreme Court has torn the perceived veil of protection from racketerring by insurance companies in the unanimous Humana v. Forsyth decision, on January 20, 1999.
Just look at this butthole Lott that is a United States Senator, and hasn't the integrity and honor even of Richard M. Nixon. This is not a pleasant lesson in the history of the US.