Washington Witch Doctors
Incantations and force will not produce health care.
In primitive tribal societies, a witch doctor also functions as a medicine man. Acting as physician, magician, and priest, he derives his power and influence almost exclusively from this triple role.
Fundamental to the method of a witch doctor is a belief in spirits and magic. Bodily ills are not organic or psychosomatic, but the product of evil spirits. Evidence and experience based on scientific data are unknown to the tribal witch doctor. If he feels in his guts that it's right, it's got to be so.
There are striking similarities between the witch doctor of the tribal society and the modern-day politician and his ally, the social engineer. These witch doctors of Washington, in their handling of medicine in the last dozen years, have demonstrated a belief in medical black magic. And the results are correspondingly untoward. In a primitive society, treatment by the witch doctors results in a high mortality rate. We have seen the same fate befall American medicine since the Washington witch doctors began applying their political surgery to individual doctors in particular and to the private medical system in general.
In a tribal society, there are no individuals as such and thus no individual rights. The tribe—the collective or group—is paramount, and individuals make no decisions for themselves. In a phrase, it is the purest form of equality possible. And not even then does pure equality exist, for the tribal chief and the witch doctor make all the major decisions on behalf of the tribe. Holding the power of life and death, the chief enforces the decisions. And the witch doctor justifies the exercise of such lethal life-and-death power by his communication with the spirits.
Our political system today has more and more come to resemble the tribe. Most, if not all, programs proposed by presidents and passed by Congress are justified with the tribal premise of equality—on the premise of the greatest good for the greatest number—and if the individual gets hurt in the process, well, that's unfortunate but necessary. Nowhere in America has this premise been more consistently applied, with more appalling consequences, than in the field of medicine.
In 1972 Marvin Henry Edwards produced a book that should be read by everyone concerned with the state of American medicine. Titled Hazardous to Your Health (New Rochelle: Arlington House, 1972), it unmasks the proponents of government or tribal medicine in the name of humanitarianism. In one part of the work the author pinpoints the three tribal premises on which national health insurance rests. All three are of European origin, according to Edwards, and have never been fully accepted by the majority of the American public. Nevertheless, they are the mainstay of governmental policymaking.
Premise: All goods and services should be redistributed by the government according to each person's needs.
Premise: The individual exists to serve the needs of government.
Premise: Some individuals may presume the right to regulate others.
Illustrative of the employment of these three premises is, not surprisingly, one of the leading advocates of national health insurance: former HEW Secretary Wilbur Cohen. His career in government goes back to Franklin Roosevelt's New Deal. He was one of the original architects of the social security system and for almost a quarter of a century has been associated with its numerous modifications. Unknown to the average American and to most American doctors, Wilbur Cohen has been a powerful influence in the push for government takeover and nationalization of the private medical system in this country.
In 1971, after successfully engineering acceptance of the Medicare and Medicaid programs by the Johnson administration and Congress, Cohen revealed his witch doctor philosophy. Significantly, Walter Mondale, then U.S. Senator from Minnesota, inserted in the Congressional Record an article written by Cohen advocating a guaranteed annual income and national health insurance. Cohen maintained that such things are not a privilege, but a right, "a right grounded in human and community responsibility and not a handout or a gratuity or part of a policy of noblesse oblige."
So here revealed is the tribal philosophy of the major architect of socialized medicine in the United States. "National Health Insurance," wrote Dr. Cohen, "is a mechanism to focus our planning and our [our?] priorities for a more intelligent distribution of the miracles of science to millions of our [?] people.…Medical services are a scarce resource. The allocation of scarce resources to priority needs involves planning, judgments, administrative capacity and self restraints."
In his own words, we have Dr. Cohen's presumption that rights are conferred by the community or tribe via the mechanism of government—a revolution, he calls it. "Today the revolution in our ideas about rights and guarantees is fast crowding in on the long held concepts of differentiation between individual and community responsibility.
So must the individual subordinate his traditional rights to the collective community. But Cohen clearly states that he and others, holding the lethal life-and-death power of the law, will tell us what are those rights. And we are not individuals with minds of our own, but scarce resources to be used by the government social engineers for the benefit of the tribe.
The totalitarian implications of these premises have not been recognized, much less challenged.
MEDICAL CARE AS A RIGHT
What is a right? In general, it is a moral principle. But it ceases to be a moral principle when the implementation of that right means that one individual can be treated as a natural or scarce resource, to be commanded by government even if it is against his or her will. And it certainly is not a right or a moral principle when individuals or groups of individuals are used and abused for the benefit of others. Yet this is precisely what has happened to individual doctors in particular and American doctors as a whole. Against their consent and even over their vigorous protest, physicians have been forced to live by coercive rules, regulations, and government-dictated programs. The consequence of such programs for physicians, patients, and medicine has been degradation and demoralization of the profession.
Dr. Robert M. Sade—in REASON, September 1972, in the New England Journal of Medicine, December 1971—confronted the issue of medical care as a right. "The concept of medical care as the patient's right is immoral," he wrote, "because it denies the most fundamental of all rights, that of a man to his own life and the freedom of action to support it. Medical care is neither a right nor a privilege; it is a service that is provided by doctors and others to people who wish to purchase it. It is the provision of this service that a doctor depends upon for his livelihood, and is his means of supporting his own life. If the right to health care belongs to the patient, he starts out by owning the services of a doctor without the necessity of either earning them or receiving them as a gift from the only man who has the right to give them: the doctor himself."
The idea that human beings and the products of their labor—that is, of their minds—are scarce, or even natural, resources is an idea that is totalitarian, with its roots deep in the dark pages of history.
Dr. Thomas S. Szasz, professor of psychiatry at the State University of New York at Syracuse, has pointed out (Freeman, June 1969) that as far back as the Middle Ages both the Church and the State sought to impose restrictions in the practice of medicine. The government of Nazi Germany, he notes, did likewise. Nor is it scare-mongering to bring up the Nazi case, for "no government or organization . . . can provide medical care, except to the degree that it has the power to control the education of physicians, their right to practice medicine, and the manner in which they dispose of their time and energies."
Thus behind the glittering slogans and humanitarian justifications for government-guaranteed medical care remains the naked force and power to command, with or without their consent, the services of physicians in the name of the tribe. Physicians' services are also commanded in the name of a right—thus confusing a right with a claim.
How is it that the Washington witch doctors have been so successful in selling the nation and many of its doctors what is clearly a sophisticated variety of serfdom? The answer can be found in the failure of individual doctors and organizations like the American Medical Association to expose the premises of the tribal philosophy. They have not challenged the premises of equality, of individuals existing to serve government, of the right of an elite to regulate the activities of other individuals, of medical care as a "right" rather than a service. And, importantly, they have failed to understand that such premises have been used to enslave individuals throughout history.
AN INFAMOUS TRADITION
Take, for example, the claim of the regulating elite that those who oppose the tribalization of medicine are living in the past. Socialized medicine is supposedly a new, 20th century idea. But "national health insurance plans are nothing new," wrote Marvin Edwards in Hazardous to Your Health; "they have been proposed, debated and tried—unsuccessfully—for nearly three hundred years."
In 1689 a plan similar to the one advanced by Senator Edward Kennedy was proposed; in 1769 the British county of Devon implemented a socialist health program, only to have it collapse because demand outstripped tax receipts! In 1854 Prussia enacted Europe's first large-scale compulsory health insurance, and in 1883 Bismarck did the same for all of Germany. And in the 50 years between 1883 and Bismarck and 1933 and the rise of Adolph Hitler, it was such socialist schemes on the installment plan that led the German people from Bismarck's welfare state to Hitler's police state.
In Britain, beginning in 1909 and continuing until July 5, 1948, when the National Health Service was adopted, advocates advanced a series of arguments assuring the British public that government-run medicine is preferable to private and personal voluntary practice. Dr. Michael Saxon, in his study of the British National Health Service, concluded in 1970 that almost none of the promises made by the advocates of the system has been met. In fact, exactly the opposite results have been produced. He cites, for example, 22 specific areas where the British experiment has failed. "There is no doubt," Dr. Saxon concluded, that the National Health Service "is a bad medical, social, economic and political experiment and should be phased out to make way for individual physician innovations."
Two years later a former Minister of Health, J. Enoch Powell, conceded that the British system had failed, but he believes that it is impossible to abolish it—at least for now. He also contended that under a private system more care would be available than under the government system, less hospitals would be obsolete, and a better attitude of doctors toward patients would replace the bitter relationships that exist under the current system.
It is not necessary to spend any time on the chronic economic stagnation of socialist Britain, except to emphasize one neglected point. Britain's problems are generally attributed to the monopoly power of the trade unions. But behind that monopoly, and the crisis it has created, is a vast welfare-state network—similar to what post-World War I Germany had. And part of that British welfare-state network is the needlessly expensive National Health Service, similar to the one first put into position by Otto von Bismarck prior to the turn of the century. But the similarity does not end there. Germany collapsed into Hitler's dictatorship. And now for the first time, responsible British critics are suggesting that the English people might be headed for a dictatorship!
On a smaller scale, government medicine throughout the globe has suffered as in Britain. Marvin Edwards in his analysis of national health programs in Japan, Sweden, Germany, France, and the Soviet Union concludes they all have the same chronic problems: overcrowding in hospitals, long waiting lists for hospital admissions, inadequate facilities, doctor shortages, hurried consultations, irritating and harmful bureaucratic regulation, lack of privacy, and cut-rate medical care. "Experience has proven national health programs to be failures wherever they have been tried.…The fault is not in the planning, but in the concept. Neither bureaucrats nor legislators are equipped either by training or experience to make competent judgements in the field of medicine. Tax funds cannot provide enough beds or enough medical facilities to handle the flood tide of demand created by 'free' medical care."
Harry Schwartz of the New York Times made much the same observations in a 1972 book, The Case for American Medicine. In fact, it was he who coined the stabbing expression: "Don't Get Sick in Sweden. You have never had such impersonal care and such long waits in your life."
The major part of Schwartz's book in concentrated on dismantling and demolishing the myths, half-truths, and outright lies fostered by the advocates of government tribal medicine in America. "In their righteous wrath," he wrote, "many of today's critics seem to feel that the limits of truth, balance or plain common sense just don't apply to their holy cause."
It could only take the mentality of a witch doctor to evade the historical and contemporary evidence that state-sponsored medicine is a lethal poison for doctor, patient, and society. Yet for most of this century advocates of socialized medicine have, like primitives, prescribed a cure that has proven costly and has almost killed the patient.
Fifteen years ago Professor Leonard Peikoff of Brooklyn Polytechnic Institute in New York wrote an article titled "Doctors and the Police State." He described how labor unions and state and federal governments sought to pass laws that would, in effect, give politicians the powers of a police state over the nation's physicians. "It is not easy," he warned, "to convert a free country into a totalitarian dictatorship; those who attempt it know that they must move gradually, by a series of precedent-setting steps."
In the decade of the sixties, this is precisely what the advocates of socialized medicine did. In August 1965 Congress passed Medicare and Medicaid after a heated national debate. Actually, it was something less than a debate; the proponents accused the opponents of being in favor of greed at the expense of the poor and the aged. This emotional factor was then played upon by the advocates in the aftermath of the assassination of John F. Kennedy, since he had sought health care for the poor and aged. Those who suggested that Medicare and Medicaid would be costly, bureaucratic, and impossible to administer were either ignored or accused of putting the profit motive ahead of the poor.
When the program went into effect in July 1966, a number of warnings were issued, but they largely went unheeded. Dr. Edward Henderson, then executive director of the American Geriatrics Society, commented a month before the program took effect that "there seems to be a lack of proper planning to implement the law. It has been perfectly obvious for the past ten years that we need more doctors, we need to graduate more medical students, we need more nurses and hospital beds. But very little has been done."
Perhaps the most succinct and prophetic comment was made by Ernest Laetz, an administrator at U.S. University Hospital in Ann Arbor, Michigan: "Medicare looms like an iceberg. We can see part of it. But what lies below the surface makes me apprehensive." It took only 15 months for the Great Society ship to strike the iceberg of Medicare and Medicaid. A national magazine reported: "The cost of Medicaid…is soaring beyond expectations. A majority in Congress appears convinced that Medicaid must be curbed before it gets completely out of hand.…Its scope has turned out to be much broader than most members of Congress anticipated."
It was not until two years after the program became law that evidence began to surface about the advocates of Medicaid having deliberately misled Congress. For example, the chief architect and advocate of the program—again, Professor Wilbur Cohen—had forecast when the Medicaid bill passed in August 1965 that it would probably be necessary to raise patient Medicaid fees. Yet he apparently was instrumental in Congress's receiving cost estimates that were inconsistent with that forecast. In March 1968 a former colleague of Cohen's in the Social Security Administration, Dr. Barkev Sanders, complained that HEW estimates, which Cohen controlled, were deliberately downgraded as a way of gaining acceptance by Congress and to undercut those who contended the program would be too costly. The figure given Congress was: $1.3 billion by 1970. By 1968 the program was running $4.1 billion. HEW officials, of course, expressed surprise.
Congressman Thomas Curtis, Republican from Missouri, contended not only that Sanders was correct but that the claim by HEW that "unexpected" costs were due to doctors' fees was downright wrong. On the House floor, Curtis agreed with Sanders on the point "that the costs should have been fully anticipated, and to give the impression they are due to increases in doctors' fees is an error, which covers over the more basic underlying actuarial errors permeating other aspects of the social security official estimates."
Yet the advocates of government medicine would not be budged by, the facts Their tenacity in the belief in magic is again illustrated by Wilbur Cohen. A month after the facts began to surface that the program he fostered was out of control financially and administratively, he told a New York audience that the time was at hand "for a new and comprehensive system of providing medical care for all the people of the United States."
By 1969, escalating costs had been joined by fraud and scandal from California to New York. A New York State commission found that in that state alone the program was being bilked of $60 million out of a total outlay of $1 billion.
In 1970 HEW officials were admitting that "it's organized insanity—no, it's disorganized insanity. Part of the turmoil certainly started under the Democrats," they acknowledged, "but we [Republicans] ought to accept a substantial part of the blame."
What did both Republicans and Democrats propose to do to cure the Medicare and Medicaid mess and scandal? Certainly not to end the politically lucrative program. No, their tactic was to shift the blame away from the Washington witch doctors and onto the physicians—a majority of whom opposed the program in the first place!
In fact, from 1967 until the present, the entire focus in the discussion of skyrocketing costs for medical care has been on doctors' fees, nursing homes, hospitals, and insurance companies—not on the program created by Congress.
AFL-CIO chief George Meany in October 1967 advocated government controls over doctors' charges to Medicaid and Medicare patients.
In 1969 the IRS was busy examining the tax returns of 10,000 physicians.
In 1970 Ralph Nader was castigating the booming nursing-home business that government had helped create through its programs. Insisting that nursing homes were unsafe and providing inadequate care, he proposed more government regulation as the solution. And his ally in the Senate, Senator Frank Moss of Utah, called for a corps of bureaucratic inspectors to police nursing homes.
Senator Abraham Ribicoff, meanwhile, was demanding that the government investigate private medical insurance companies to "help the consumers determine what they are buying." Why he and Senator Moss had not made the same demands when they voted for Medicaid and Medicare programs in 1965 remains a mystery. But then again, that is part of the mentality of the political witch doctors.
Look at all the available evidence! Little doubt remains that many who supported and advocated Medicaid and Medicare 12 years ago knew at the time that it was only the first step to nationalization of the health industry. The chaos and corruption from the program in the last decade has provided an excuse to offer as a cure for the patient more of the same poison.
A USELESS "CURE"
On the fourth anniversary of the program, for example, a group of politicians, labor leaders, and men and women of the medical profession itself advocated a national health insurance program to replace Medicaid and Medicare! The group, headed by United Auto Workers official Leonard Woodcock, conceded that the government had spent in excess of $9.2 billion. And, under its plan it would cost only $8.8 billion—but, another $6 billion would have to be raised in taxes to cover all citizens under national health insurance. "The insecurity created by the health crisis in America," asserted Woodcock, "stems from the lack of a nationwide system for providing and financing comprehensive health care."
It was this blindness and bigotry, if not downright dishonesty and misrepresentation, that spurred New York Times editor Harry Schwartz to begin work on his brilliant and lucid work, The Case for American Medicine: A Realistic Look at Our Health Care System (New York: David McKay, 1972).
Schwartz is justifiably critical of many of his colleagues in the media for their outright misrepresentation of the real cause for the medical crisis in America while ignoring the virtues and accomplishments of the private practice of medicine. In a Saturday Review article in August 1971 he wrote: "In an era of increasing and justified disenchantment with big government, it is astonishing that so many well-meaning and intelligent reformers essentially want to nationalize and bureaucratize American medicine, either explicitly as in Britain or implicitly as in some of the legislation before Congress. One would have thought that the postal system and public schools would have taught them long ago that nationalization does not mean efficiency, and that the telephone system would have taught them that even a private integrated system can develop serious flaws. Based on the record of the past we have every reason to suspect that if the revolutionary proposals for transforming American medicine are adopted and implemented, medical care in this country will cost more while providing less satisfaction and poorer treatment for millions."
In the five years since publication of Schwartz's book in 1972, the nation and the private medical profession have been subjected to a relentless propaganda campaign—in books, magazine articles, newspapers, radio, television—that blackens the profession while ignoring its considerable superiority and value compared to government-imposed and government-dictated medicine. Senator Edward Kennedy and others in Congress have every year since 1972 advocated a national health insurance plan. Yet there is evidence to challenge the wisdom of that proposal.
In 1973 HEW admitted that its major health programs are in a shambles and wanted the American Medical Association to help them straighten things out.
In 1974 the Rand Corporation predicted that any national health insurance program would swamp doctors' offices and out-patient clinics but have little impact on hospitalizations.
In 1975, the tenth anniversary of Medicaid and Medicare, U.S. News and World Report noted that for all practical purposes private medicine had lost much of its prized independence, that the profession itself had given up. "The fact is," stated the magazine, "that health is one of the most heavily subsidized industries in the country, and with money comes control."
In 1976 there was the malpractice insurance crisis. Ralph Nader's campaign encouraging litigation against doctors had been effective indeed. In the midst of the crisis, Nader's director of health research urged more of the same: "People sue because they are disenchanted with their lousy health care. I would encourage more malpractice suits. Then maybe the physicians in this country would start pulling themselves into shape."
Patricia Coyne, the Washington correspondent of Private Practice magazine, cited the Nader campaign and the general attack on private medicine as the prelude to its total takeover by government. The malpractice insurance proposals advanced in Congress, she pointed out, were one more way of gaining control of the private medical profession under the smokescreen of reform. "The malpractice crisis is just one of many instances in which the liberal mentality has tended to create chaos in an institution which it has decided is in need of guidance and control. These are tactics men have always used when they seek to vest themselves with power and influence over others."
Observe that in the same year in which such controls were being advocated, HEW was mounting a swine flu inoculation program that turned into a fiasco. The New York County Medical Association made this pertinent but largely ignored observation: "The swine flu inoculation scheme is a classic example of what happens when politicians play around with the delivery of health care."
MORE BLACK MAGIC
Now here it is 1977, and what do we find? President Carter has proposed using the police power of the State to enforce a nine percent price ceiling on hospital charges and is considering a ceiling on physicians' fees as well. Some in the medical profession will go along with this, naively assuming that they can live with such measures or believing that they would control costs. In reality, the Carter proposals would bring us a step closer to nationalization. The administration is now setting up in HEW a Health Care Financing Administration. This will be the bureaucratic mechanism to handle a national health insurance program that Carter is hoping to railroad through Congress. The high outside cost for this Carter plan is estimated to be $130 billion annually.
And who has Mr. Carter appointed to head HEW? Why, the architect of the Great Society programs of the 1960's, Joseph Califano. And assisting him in planning national health insurance is none other than Dr. Wilbur Cohen.
So if at the start you were somewhat hesitant to accept my claim that what we have in Washington is political witch doctors who believe that medicine can be made by black magic, I trust the volume of evidence I have presented has persuaded you that the label is kind, if not understated.
Take as two final pieces of evidence the remarks of the outgoing head of the Council on Wages and Price Stability, William Lilley, III. It is his conviction, after looking at the evidence, that increasing government regulation of the health sector has its origins in the Medicaid and Medicare programs. Such programs require excessive hospitalization, medication, and other services. Government, he contends, "is a major part of the problem, not part of the solution. Its regulation has added enormous costs; it's questionable whether they've improved the quality of care that much." In a similar vein, the U.S. Public Health Service concluded last year that "further expansion of the nation's health system is likely to produce only a marginal increase in the overall health status of the American people."
Thus, what the private medical profession is facing is nothing short of enslavement. And this enslavement is being justified by men and women who have demonstrated that power over others is more important to them than actual performance and the administration of sound medicine. Will the private physician in this nation evade the evidence on this proposed enslavement, as the outgoing president of the American Medical Association did in 1966 when Medicare and Medicaid went into effect? "We are not stepping off into a bottomless pit of professional destruction and despair," asserted Dr. Charles Hudson. "If we make the most of this program, doctors may prevent its extension toward a national health service."
A REGIMENTED PROFESSION
The practice of medicine calls for perhaps the most personal relationship of any profession in the nation. Yet we now have a president who has brought back to power a group of political witch doctors who are preparing to regulate and control that very personal relationship. For the safety of the profession and of patients, physicians throughout the nation must stand up to these Washington witch doctors, must counter the con game for political power. If they don't, what they eventually get is what they will deserve.
Seven years ago Dr. Robert M. Sade put the entire issue in perspective with these thoughts: "When politicians say that the health system must be forced into a mold of their own design, they are admitting their inability to persuade doctors and patients to use the plan voluntarily; they are proclaiming the supremacy of the state's logic over the judgment of the individual minds of all concerned with health care. Statists throughout history have never learned that compulsion and reason are contradictory, that a forced mind cannot think effectively and, by extension, that a regimented profession will eventually choke and stagnate from its own lack of freedom. In the face of the raw power that lies behind government programs, nonparticipation is the only way in which personal values can be maintained."
The Washington witch doctors are gaining control, and medical black magic is the poison they are proposing. It remains for doctors and patients in America to make their declaration of independence.
Jeffrey St. John is a syndicated columnist for Panax Newspapers; a Washington, D.C., TV commentator; and a radio commentator on the Mutual Broadcasting System. He is a recipient of an Emmy award for a TV public affairs program and is the author of Jimmy Carter's Betrayal of the South.
This article originally appeared in print under the headline "Washington Witch Doctors".