Joseph Stalin and Adolph Hitler weren’t exactly friends, but ideologically they were on the same page about many issues, the right to health care and the right to due process, amongst them.  They were proponents of the former and obviously, not so much the latter.  Sound familiar?

What they were actually in favor of was control of the healthcare their citizens received.  Hitler and his National Socialist Democratic Party actually used this issue of the “right” to healthcare to politically destroy Otto von Bismarck, whose power was already tenuous given the economic devastation intentionally inflicted on the Germans after the First World War, a “crisis” economy that begged for a tyrant like Hitler. 

Control over healthcare gave the statists control over the very lives of their citizens, arming the state with the authority to decide who got healthcare and who did not, for many, who lived and who did not.  As all totalitarian regimes value individual citizens strictly as a function of their value to the state, and as the citizens began to believe the “we’re all in this together” sort of nationalistic chant, this grant of power over healthcare given to the state therefore had credibility and even seemed to be a necessity to many of the affected citizens.

While the Allied nations worked hard to publicly paint Hitler as the monster he was, these same nations quietly and privately embraced his economic fascism.  Frederick Hayek’s “Road to Serfdom,” an unintentional best-selling blockbuster in the United States, was written as a warning for the British people, a warning that the fascist corporate state so decried by the British government, had in fact, been embraced by the British government!   The proud British paid no attention and quickly adopted what we now know as the National Health Service, a system that is actively and admittedly euthanizing patients in these modern times to make bed space for those in the waiting room.

This could never happen in the United States could it?  Only the most naive wouldn’t recognize that we are on the same path as these failed and murderous states.  One very sinister activity that is escaping most people’s attention is the move by the federal government designed to promote the hospital employment of physicians.  This arrangement erodes the patient-doctor relationship and therefore disenfranchises the patient, as the doctor’s boss is the hospital, not his patient.  Physician employees are much easier for tyrants to control.  Hospital administrators controlling large groups of doctors and the government controlling a small group of hospital administrators-that is the goal.  Private practitioners, those with their patients’ best interest at heart, never mind what the state has to say, must be marginalized if not eliminated completely, for the complete takeover of medicine by the state to succeed.   This effort is well on its way.

This article in the Wall Street Journal provides a glimpse into how the productivity of hospital-employed physicians falls, but doesn’t go far enough to show the true devastating effects of this employment arrangement, I think.  While patients can appeal to their personal physician for help, their appeals to their employed doctors are more likely to fall on deaf ears, as these employed doctors must follow the old proverb, “whose bread I eat, his song I sing.”  These doctors must ultimately advocate for their boss, not their patient in the event their interests are not aligned.

Here are some examples of how the current system is rigged in favor of the physician-as-employee arrangement.  Medicare pays hospital-employed doctors 40% more for the same service as non-employees.  Physicians must buy prohibitively expensive electronic medical record systems (promoted in the name of “safety”) or face even lower payments from Medicare. Physicians who do not demonstrate “meaningful use” of their electronic medical record systems (if they can afford them at all) will face further cuts from Medicare.  “Meaningful use” includes transmission of confidential patient information to Uncle Sam, by the way, without the patient’s consent.  One part of Obamacare calls for bundled Medicare payments to hospitals, which then divvy up the money to the doctors, as they see fit.  One part of Obamacare prohibits the construction or expansion of physician-owned hospitals, institutions demonstrating better outcomes and lower prices consistently.  Recently, the federal government issued regulations providing for profitable administration of chemotherapy only to hospital-based oncology units, not the non-hospital private practitioners, who can only charge a price less than their cost for these drugs.  I could go on.

If your doctor isn’t working for you, he or she is working for someone else.  It is only a matter of time before this represents a conflict, your interests as a patient suffering as a result.  This is a necessary part of the national health care plan, where rationing from the central planners will be used to balance health care budgets. 

The response to shortages (invariably the result of state intervention) by the free market and its entrepreneurs, is to look for new and more efficient ways of providing the service, activities that lower prices and improve access for everyone.  Entrepreneurs see shortages as opportunities, while central planners, not only cause these shortages, but respond with the usual rationing and price controls. The Independent Payment Advisory Board (IPAB), an integral part of Obamacare will be the price control mechanism, the mission for which will be to price services below their actual market price, ensuring that little supply of these services is available and therefore balancing health budgets with this subtle, behind-the-veil rationing.

This is the compassion of the state, where central planners decide who gets what from a shrinking supply, whereas market players deliver more supply at lower prices.  Employed doctors will be much more easily controlled than independent ones when this system is fully operational.  Hitler and Stalin understood this.  The current regime in the United States does, as well.

G. Keith Smith, M.D.