All Commentary
Tuesday, February 1, 2000

Why Medicine Is Slowly Dying in America

Most Doctors and Patients Are Clamoring for Increased Rights Without Increased Responsibility

Michael Hurd ( is a psychologist in private practice in the Washington, D.C., area. He is the author of Effective Therapy (Dunhill, 1997) and Grow Up, America! (forthcoming). Dr. Hurd is the president of Living Resources, Inc., and publisher of “The Living Resources Newsletter.”

The American Medical Association recently voted to form a national union for physicians. It’s official. Doctors are now unionized—just like public school teachers, postal workers, and truck drivers.

In one sense, unionizing is a good step for doctors. Everybody asserts their health-care “rights” today except for physicians. We hear about patient rights and HMO rights and government rights. We never hear about the doctors’ rights. It’s time doctors stood up for themselves too—for their patients’ sake as well as their own. If they don’t, the quality of medical care will deteriorate (as we already see happening), and we’ll all suffer the consequences.

Why didn’t doctors need unions in the past while they do today? Turn back the clock to the 1960s when Medicare became law. Medicare, for all practical purposes, socialized medicine for the elderly. At first, it seemed like a good deal for everybody. The best health care imaginable—all for free! Who could argue with the goodies? Excellent reimbursement rates for physicians. High-quality care for elderly patients—with little or no cost. Low payroll tax rates—at least initially.

Then reality set in, slowly, as it usually does. By the 1980s, it was clear that medical costs were skyrocketing. It’s not hard to figure out why. Elderly patients no longer had to worry about costs. Doctors felt no competitive pressure to keep rates reasonable to stay in business. Guess what happened? Demand for health care skyrocketed. So too did cost.

The Law of Mandates

The extent to which the government mandates a product or service as free is the extent to which demand for it will rise. If the government suddenly legislated that all cars were free, then everybody would clamor to have three or four cars, rather than one or two. People who normally would be content not owning a car at all—perhaps because they lived in a city or relied on a close friend—would want a car because, what the heck, the government’s paying for most or all of it anyway. And people who used to be content with Chevrolets would want BMWs and Mercedes-Benzes.

With demand for Medicare shooting ever upward, the government had to do something. If not, we would all soon be paying 85 percent of our income in payroll taxes just to cover Medicare. In a strange sort of way, government and HMO bureaucrats have saved us from this fate. They started to make the cost-cutting decisions that we, as individual patients in the medical marketplace, righteously refused to face. When costs began to skyrocket, voters in effect told their politicians, “For heaven’s sake, do something. I don’t care what. Just something.”

And “do something” they did: in the form of ever-increasing controls. Somebody has to do it. If patients and doctors are not going to control costs—and it is most certainly not in their interest to do so under a free-lunch, socialized program like Medicare—then clearly the government will have to do it for them.

Ironically, as legislation has sought to remove capitalism from the medical sector, medicine has become more concerned with money than ever before. Prior to Medicare and government regulations, you did not hear horror stories of patients who were turned away from life-preserving surgery or medication because bean-counting bureaucrats were trying to save money. Now such tales are commonplace.

Yes, the sanctimonious Great Society “liberals” of the 1960s were successful at removing the “stench” of business from medicine. And look what they gave us in its place. The kindly family doctor has been replaced by the cool, terse HMO physician—whose primary incentive is to see as many patients as possible, as rarely as possible.

Medicine is slowly evolving into a war of all against all. Doctors find patients increasingly demanding and greedy in their use of medical services they do not have to pay for. Patients find doctors increasingly arrogant and uncaring because, after all, the doctors don’t really answer to them. Thanks to government regulations, doctors now answer to the third party who pays their bills and tells them how to do treatment. No wonder there’s a call for a “patient bill of rights” as well as a union for doctors.

Has the elimination of freedom and capitalism really been good for patient and doctor? Has our four-decade experiment with socialized medicine been a success? No, most would reply. Yet these same people cling to Medicare and government regulation with the tenacity of a child clinging to his teddy bear.

Spreading Control

In the 1990s government controls slowly spread from Medicare to what remained of the “private” sector. Non-elderly patients were, for the most part, shoved into HMOs and other managed-care programs. In 1993 the government tried to force everybody into managed care by decree. The infamous Clinton plan sought to equalize the mediocrity. The plan failed to pass, but for the most part medical care today is managed care. Government- inspired managed-care companies are running the show, much more than doctors and patients are. Instead of socialized medicine, we have fascist (superficially private) medicine.

In formerly communist countries, and in socialist democracies such as Canada, France, and Great Britain, citizens are used to things being this way. They don’t even have HMOs. Instead, monolithic government agencies, similar to our Department of Health and Human Services, control medicine. It’s called “single-payer” insurance, which will become the next big push in the United States if people like Ted Kennedy and Hillary Clinton have their way.

Most Europeans and Canadians have no concept of genuine medical excellence because they’ve never experienced private medicine. Americans are different. We prefer to have more control over our lives than people do in other nations. We used to have private medicine here, and to a limited degree we still do. We liked—and still like—the results of private medicine, which include dignity and respect for both doctor and patient.

Yet most of us have accepted a lethal contradiction. We have endorsed the idea that trading value for value—in the form of dollars—is somehow tasteless or wrong in the medical arena. So we call on government to handle the dirty economic business for us. Observe the results.

In a sense, medical care is less valued by today’s patient, because it’s cheap and looked on as a “right.” Such a mentality is a breeding ground for mediocrity. Look at how the public school system has evolved into mediocrity (and even violence). Kids have a right to “free” education, run by the government and unionized teachers—but how much of a value is it?

The same is starting to happen in health care. We’re in the earlier stages of the same kind of breakdown currently becoming more obvious in the public school system. How long before some crazy patient shows up in a doctor’s office with a gun, frustrated by the lack of service his $5 copayment is buying him? (Indeed, indignant that he has to pay the $5 at all.) It happened to public education. Why will it be any different with public medicine? Consider Medicare.

People cling to Medicare just as they do to the public schools. They seem to think it’s some kind of mystical oracle that can make something out of nothing—when in fact (as even its government overseers admit) it’s a fiscally bankrupt actuarial disaster that destroys the rights and responsibilities of doctors and patients.

Watching pressure-group representatives shriek on the evening news that “Our Medicare must be preserved!” is like watching grown, educated adults cry, “The tree that grows money must not be cut down! How dare anybody think of cutting it down!” It’s absolute madness.

Today, most doctors and patients clamor for increased rights without increased responsibility. Yet if they are going to support government programs like Medicare and the many state and federal regulations that increasingly grant a “right” to this or that form of medical care on demand (or, at most, for a small copayment), they have to live with the consequences of such legislation.

The consequences include losing control over who your doctor will be and over medical decisions that affect you. Neither doctors nor patients like those consequences, but they continue to push for more government regulations and mandates anyway.

If you want less government control (including indirect government control, such as HMOs and managed care), you need to support privatization of the medical care system. This will require all patients to shop more carefully and rationally for services, the same way they now shop carefully for cars, computers, and groceries.

Privatization will also require doctors and insurance companies, competing in the marketplace, to keep costs reasonable in order to meet the demands of the patient-consumers. If Dr. Jones charges too much for foot surgery, Dr. Smith can open a clinic across the street and charge less. In a free market, where rates are not uniformly imposed by the Health Care Financing Administration or some HMO board of directors, Dr. Smith will have every incentive to do so.

The new government policy must be: “Take responsibility for your own health care—and we’ll lift the legal and tax burdens off your shoulders immediately.” Young and middle-aged people must be put on notice that Medicare’s days are numbered, and they must start saving and investing on their own.

If you don’t want all this added responsibility, then just leave things the way they are now. Don’t pressure your representatives to privatize health care. The government will just keep taking more and more control, which means: taking more and more control over your bodies and your lives.

Then in another few years everything will probably be run by the state or federal Department of Health and Human Services. (They will call this “streamlining.”)You’ll have lengthy waits for surgery, just like they have in Britain and Canada. Doctors will already be unionized, making them more defensive, arrogant, and adversarial than ever. Lawsuits will increase, driving medical costs still higher. Medicine, for everyone except the highest government officials, will work like the post office—only the stakes are much higher than the delivery of your mail! The waits will probably be longer too.

Today, most Americans righteously expect the best health care in the world. Government and intellectual elites have convinced them that they have a right to it on demand, whether they want to pay for it or not. But sooner or later reality always asserts itself. He who picks up the tab eventually runs the show—indeed, has to run the show. Patients and doctors are getting what they voted for and demanded. In the end, the politicians are simply following the voters’ orders.

At the dawn of the 21st century we enjoy a window of opportunity. A strong economy makes ending government programs such as Medicare more feasible than ever. It may be our last chance to privatize medicine without even more painful results. We had better move quickly.