Free enterprise is one of the utmost benefits of democratic republic; and that form of government is what our founding fathers established. Consumer driven free enterprise may even be, not just the greatest stimulus to the maintaining of a democratic society but also, the means by which we preserve the reasonable health of a nation‘s economy. As individuals taste the freedom that comes from our democratic system, they are inclined to feel free to start their own businesses; they become entrepreneurs. Throughout the 232 years since our founders broke away from the suppressive control of the British monarchy and established, as Lincoln said at Gettysburg, “a new nation, conceived in liberty,” free enterprise, especially deriving from the small business community, has been the mainstay of the wealthiest nation on earth; the United States of America.
Beginning in 1965 the nation’s healthcare system began an insidious and persistent slide away from the economic principle of free enterprise; a decline that has brought it to its present state of subservience to the business community (namely HMOs established by insurance companies) and the state and federal governments. 1965 was a time when President Lyndon B. Johnson signed Medicare into law, congress having been contemplating the legislation since the 1961 letter that President John F. Kennedy had sent to them recommending health insurance for the elderly under the Social Security Act. The alleged purpose of handing the reins of the practice of medicine over to the federal government was to enable all senior citizens to obtain affordable healthcare. As with most collectivist, liberal ideas, it has had the opposite effect of that which was promised.
When the Medicare program was inaugurated in 1965, the federal government projected that Part A—the segment of Medicare that pays for hospitalization—would cost $9 billion by the year 1990. The program’s actual cost that year was $66 billion. Thus we find that, after inflation, the cost of Medicare was 165 percent higher than the government had predicted it would be. Is anyone surprised by that? When the figures had come in, a sane person would have immediately seen the failure of the government controlled health care system and turned the health and welfare of the senior citizens back to where it had been in 1965; the hands and brains of private physicians. But then, insanity is defined repeating the same errors while fully expecting a different result.
When I entered the practice of internal medicine in 1967, health insurance companies (Such as Blue Cross and Blue Shield), and the government controlled Medicare plan, each required that a patient had to be admitted to a hospital before they would pay for certain radiological testing; upper gastrointestinal X-rays and barium enema examinations for example. We physicians thought that the restrictions were both inane and unnecessarily expensive. It meant that the cost of a patient’s X-ray would also have to include at least one night’s stay in the hospital, paying for room and food, as well as a minimum amount of laboratory work that an admission to a hospital required. Furthermore it necessitated payments to nurses, orderlies, nurse’s aids, dietary personnel, lab technicians, administrative personnel and housekeeping workers, not to mention the doctor’s fee for making at least one hospital visit and performing a complete physical examination. All of those costs could have been avoided if someone in the world of business and politics, had simply taken the sage advice from those of us who really new how to run a healthcare system. That is just one example of the unnecessary, financial waste that one finds in a bureaucratic system of big business and government.
Despite the failures in the Medicare system, the new “control freak” on the block would be the brainchild of the Nixon administration in 1971 and what would become known as managed healthcare. The plan would see to it that planning grants would be issued to HMOs (health maintenance organizations) such that by 1980, 90% of the US citizens would be enrolled in an HMO. In fact, by 1996 there were 600 HMOs in the country and only 25% of our citizens (65 million at the time) were enrolled. Once again the impetus for the plan was to control the cost of healthcare. However, as everyone knows who pays a healthcare premium or is aware of what their employer pays on their behalf, the Nixon plan has been as dismal a failure as the Watergate break-in that brought Nixon to an infamous, embarrassed retreat from the world’s most powerful position.
The question thus arises, can we do anything to put an end to the upward spiraling healthcare costs and if so what are the alternatives? The answer is a resounding “Yes. “ Over the next several weeks of this newspaper’s Sunday edition I will attempt to explain to the reader why we have to pay so much for healthcare and that viable and reasonable solutions to the exorbitant rise in healthcare costs do exist. The answer is not to be found in a national healthcare program, as some who are running for the offices in our executive and legislative branches of the federal government would have you believe. The solution is found in that which has motivated both the success, as well as the cost control, of businesses of every stripe in this great nation. The solution is found in a consumer driven medical economy of free enterprise, a system that puts the patient in charge of what we are willing to pay and our ability to find the best doctor for the best dollar cost. It works in the world of commerce and it will also work in the world of affordable healthcare as well. I know that because I practiced medicine for a few of my early years in a world of free enterprise. While health care is a privilege and not a right under our constitution, affordable healthcare is something we should all strive for in this nation where each citizen has been “endowed by our Creator with” other “inalienable rights of life liberty and the pursuit of happiness.” It is high time that the controlling reins in the art and science of medicine should be handed back to those who really know how to run the medical system; physicians. The bureaucrats have failed us miserably.
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