The Healthcare Debate

Sarah Palin doubles down on 'death panels'

By ANDY BARR | 8/13/09 7:05 AM EDT
Former Alaska GOP Gov. Sarah Palin defended her claim that the Democratic health care proposal would create “death panels” in a statement Wednesday night slamming President Barack Obama.

“Yesterday President Obama responded to my statement that Democratic health care proposals would lead to rationed care; that the sick, the elderly and the disabled would suffer the most under such rationing; and that under such a system, these ‘unproductive’ members of society could face the prospect of government bureaucrats determining whether they deserve health care,” Palin wrote in a note on her Facebook page.

“The provision that President Obama refers to is Section 1233 of HR 3200, entitled ‘Advance Care Planning Consultation.’ With all due respect, it’s misleading for the president to describe this section as an entirely voluntary provision that simply increases the information offered to Medicare recipients,” she continued.

“Section 1233 authorizes advanced care planning consultations for senior citizens on Medicare every five years, and more often ‘if there is a significant change in the health condition of the individual ... or upon admission to a skilled nursing facility, a long-term care facility... or a hospice program.’"

The White House and Democratic lawmakers have blasted Palin in recent days for suggesting that her own son, Trig, would have had to face a bureaucratic panel to get access to health care under the provision in the House health care proposal because he was born with Down syndrome.

“The America I know and love is not one in which my parents or my baby with Down syndrome will have to stand in front of Obama’s ‘death panel’ so his bureaucrats can decide, based on a subjective judgment of their ‘level of productivity in society,’ whether they are worthy of health care. Such a system is downright evil,” Palin wrote last week.

White House press secretary Robert Gibbs identified Palin on Wednesday as one of the GOP leaders he says is spreading “wrong” information about the health care debate.

Additionally, the Democratic Congressional Campaign Committee is using Palin’s “death panels” claim in a fundraising plea to supporters, calling the former governor’s statement “disgusting” and “outrageous.”

But Palin seemed undeterred in her latest statement, pointing to columns by The Washington Post’s Eugene Robinson and others to support her suggestion last week that the Democratic proposal is “Orwellian.”

“President Obama can try to gloss over the effects of government authorized end-of-life consultations, but the views of one of his top health care advisers are clear enough,” Palin wrote. “It’s all just more evidence that the Democratic legislative proposals will lead to health care rationing, and more evidence that the top-down plans of government bureaucrats will never result in real health care reform.”

SEC. 1233. ADVANCE CARE PLANNING CONSULTATION.

(a) Medicare-

(1) IN GENERAL- Section 1861 of the Social Security Act (42 U.S.C. 1395x) is amended--

(A) in subsection (s)(2)--

(i) by striking `and' at the end of subparagraph (DD);

(ii) by adding `and' at the end of subparagraph (EE); and

(iii) by adding at the end the following new subparagraph:

`(FF) advance care planning consultation (as defined in subsection (hhh)(1));'; and

(B) by adding at the end the following new subsection:

`Advance Care Planning Consultation

`(hhh)(1) Subject to paragraphs (3) and (4), the term `advance care planning consultation' means a consultation between the individual and a practitioner described in paragraph (2) regarding advance care planning, if, subject to paragraph (3), the individual involved has not had such a consultation within the last 5 years. Such consultation shall include the following:

`(A) An explanation by the practitioner of advance care planning, including key questions and considerations, important steps, and suggested people to talk to.

`(B) An explanation by the practitioner of advance directives, including living wills and durable powers of attorney, and their uses.

`(C) An explanation by the practitioner of the role and responsibilities of a health care proxy.

`(D) The provision by the practitioner of a list of national and State-specific resources to assist consumers and their families with advance care planning, including the national toll-free hotline, the advance care planning clearinghouses, and State legal service organizations (including those funded through the Older Americans Act of 1965).

`(E) An explanation by the practitioner of the continuum of end-of-life services and supports available, including palliative care and hospice, and benefits for such services and supports that are available under this title.

`(F)(i) Subject to clause (ii), an explanation of orders regarding life sustaining treatment or similar orders, which shall include--

`(I) the reasons why the development of such an order is beneficial to the individual and the individual's family and the reasons why such an order should be updated periodically as the health of the individual changes;

`(II) the information needed for an individual or legal surrogate to make informed decisions regarding the completion of such an order; and

`(III) the identification of resources that an individual may use to determine the requirements of the State in which such individual resides so that the treatment wishes of that individual will be carried out if the individual is unable to communicate those wishes, including requirements regarding the designation of a surrogate decisionmaker (also known as a health care proxy).

`(ii) The Secretary shall limit the requirement for explanations under clause (i) to consultations furnished in a State--

`(I) in which all legal barriers have been addressed for enabling orders for life sustaining treatment to constitute a set of medical orders respected across all care settings; and

`(II) that has in effect a program for orders for life sustaining treatment described in clause (iii).

`(iii) A program for orders for life sustaining treatment for a States described in this clause is a program that--

`(I) ensures such orders are standardized and uniquely identifiable throughout the State;

`(II) distributes or makes accessible such orders to physicians and other health professionals that (acting within the scope of the professional's authority under State law) may sign orders for life sustaining treatment;

`(III) provides training for health care professionals across the continuum of care about the goals and use of orders for life sustaining treatment; and

`(IV) is guided by a coalition of stakeholders includes representatives from emergency medical services, emergency department physicians or nurses, state long-term care association, state medical association, state surveyors, agency responsible for senior services, state department of health, state hospital association, home health association, state bar association, and state hospice association.

`(2) A practitioner described in this paragraph is--

`(A) a physician (as defined in subsection (r)(1)); and

`(B) a nurse practitioner or physician's assistant who has the authority under State law to sign orders for life sustaining treatments.

`(3)(A) An initial preventive physical examination under subsection (WW), including any related discussion during such examination, shall not be considered an advance care planning consultation for purposes of applying the 5-year limitation under paragraph (1).

`(B) An advance care planning consultation with respect to an individual may be conducted more frequently than provided under paragraph (1) if there is a significant change in the health condition of the individual, including diagnosis of a chronic, progressive, life-limiting disease, a life-threatening or terminal diagnosis or life-threatening injury, or upon admission to a skilled nursing facility, a long-term care facility (as defined by the Secretary), or a hospice program.

`(4) A consultation under this subsection may include the formulation of an order regarding life sustaining treatment or a similar order.

`(5)(A) For purposes of this section, the term `order regarding life sustaining treatment' means, with respect to an individual, an actionable medical order relating to the treatment of that individual that--

`(i) is signed and dated by a physician (as defined in subsection (r)(1)) or another health care professional (as specified by the Secretary and who is acting within the scope of the professional's authority under State law in signing such an order, including a nurse practitioner or physician assistant) and is in a form that permits it to stay with the individual and be followed by health care professionals and providers across the continuum of care;

`(ii) effectively communicates the individual's preferences regarding life sustaining treatment, including an indication of the treatment and care desired by the individual;

`(iii) is uniquely identifiable and standardized within a given locality, region, or State (as identified by the Secretary); and

`(iv) may incorporate any advance directive (as defined in section 1866(f)(3)) if executed by the individual.

`(B) The level of treatment indicated under subparagraph (A)(ii) may range from an indication for full treatment to an indication to limit some or all or specified interventions. Such indicated levels of treatment may include indications respecting, among other items--

`(i) the intensity of medical intervention if the patient is pulse less, apneic, or has serious cardiac or pulmonary problems;

`(ii) the individual's desire regarding transfer to a hospital or remaining at the current care setting;

`(iii) the use of antibiotics; and

`(iv) the use of artificially administered nutrition and hydration.'.

(2) PAYMENT- Section 1848(j)(3) of such Act (42 U.S.C. 1395w-4(j)(3)) is amended by inserting `(2)(FF),' after `(2)(EE),'.

(3) FREQUENCY LIMITATION- Section 1862(a) of such Act (42 U.S.C. 1395y(a)) is amended--

(A) in paragraph (1)--

(i) in subparagraph (N), by striking `and' at the end;

(ii) in subparagraph (O) by striking the semicolon at the end and inserting `, and'; and

(iii) by adding at the end the following new subparagraph:

`(P) in the case of advance care planning consultations (as defined in section 1861(hhh)(1)), which are performed more frequently than is covered under such section;'; and

(B) in paragraph (7), by striking `or (K)' and inserting `(K), or (P)'.

(4) EFFECTIVE DATE- The amendments made by this subsection shall apply to consultations furnished on or after January 1, 2011.

(b) Expansion of Physician Quality Reporting Initiative for End of Life Care-

(1) Physician'S QUALITY REPORTING INITIATIVE- Section 1848(k)(2) of the Social Security Act (42 U.S.C. 1395w-4(k)(2)) is amended by adding at the end the following new paragraphs:

`(3) Physician'S QUALITY REPORTING INITIATIVE-

`(A) IN GENERAL- For purposes of reporting data on quality measures for covered professional services furnished during 2011 and any subsequent year, to the extent that measures are available, the Secretary shall include quality measures on end of life care and advanced care planning that have been adopted or endorsed by a consensus-based organization, if appropriate. Such measures shall measure both the creation of and adherence to orders for life-sustaining treatment.

`(B) PROPOSED SET OF MEASURES- The Secretary shall publish in the Federal Register proposed quality measures on end of life care and advanced care planning that the Secretary determines are described in subparagraph (A) and would be appropriate for eligible professionals to use to submit data to the Secretary. The Secretary shall provide for a period of public comment on such set of measures before finalizing such proposed measures.'.

(c) Inclusion of Information in Medicare & You Handbook-

(1) MEDICARE & YOU HANDBOOK-

(A) IN GENERAL- Not later than 1 year after the date of the enactment of this Act, the Secretary of Health and Human Services shall update the online version of the Medicare & You Handbook to include the following:

(i) An explanation of advance care planning and advance directives, including--

(I) living wills;

(II) durable power of attorney;

(III) orders of life-sustaining treatment; and

(IV) health care proxies.

(ii) A description of Federal and State resources available to assist individuals and their families with advance care planning and advance directives, including--

(I) available State legal service organizations to assist individuals with advance care planning, including those organizations that receive funding pursuant to the Older Americans Act of 1965 (42 U.S.C. 93001 et seq.);

(II) website links or addresses for State-specific advance directive forms; and

(III) any additional information, as determined by the Secretary.

(B) UPDATE OF PAPER AND SUBSEQUENT VERSIONS- The Secretary shall include the information described in subparagraph (A) in all paper and electronic versions of the Medicare & You Handbook that are published on or after the date that is 1 year after the date of the enactment of this Act.

The Senate Finance Committee will drop a controversial provision on consultations for end-of-life care from its proposed healthcare bill, its top Republican member said Thursday.

The committee, which has worked on putting together a bipartisan healthcare reform bill, will drop the controversial provision after it was derided by conservatives as "death panels" to encourage euthanasia.

"On the Finance Committee, we are working very hard to avoid unintended consequences by methodically working through the complexities of all of these issues and policy options," Sen. Chuck Grassley (R-Iowa) said in a statement. "We dropped end-of-life provisions from consideration entirely because of the way they could be misinterpreted and implemented incorrectly."

NextJen wrote:For starters (not that this has any relevance other than to put you in your place a little) "Kapish" is spelled "capisci" and it's Italian, not yiddish.

Now to the meat of your "argument."

You are concerned about the spending related to the government healthcare plan, so let me address that (and let me know you can capisci it).

For starters, there is already a whole lot of government money going into a healthcare plan that is broken and desperately in need of reform. I know a lot of people like to yell, "if it aint broke, don't fix it" but it IS broken.

I am fortunate to have one of the best healthcare plans available in this country. With the exception of small copays (and not even on annual doctor's appointment) I pay nothing beyond the premiums and EVERYTHING is covered. So why would I want anything different? Why would I want change? Why am I for this SO-CALLED socialized medicine?

I'm glad you asked.

Because every year, my insurance premiums are going up MORE than my family's cost-of-living raises. Each year, we find ourselves bringing home less money. This is a problem and its entirely due to a bigger problem: uninsured Americans.

I can hear you thinking... "But that makes no sense!" So let me explain. People without insurance don't go to doctors unless it's a dire emergency. Whether it be injuries sustained due to an accident, or a heart attack or complications from cancer that have spread out of control due to lack of an earlier diagnosis. Take your pick. Since these are people without a primary care doctor, they are nearly always seen in emergency rooms, which, as you might know, is far more expensive. Hospitals cannot turn them away and they are treated and then billed. The hospital bills will nearly always send these people into bankruptcy and they therefore go unpaid. To make up for these financial losses, hospitals need to charge higher fees for everything else. This results in higher costs to the insurance companies who then pass the higher costs on to you.

With Obama's plan, approximately 1/3 of the cost is money that's already being put into a broken healthcare system; 1/3 of the costs will come out of taxes on the wealthiest 1% that will merely go back to pre-Bush amounts (wahh wahh, don't worry, they will still be rich) and the other 1/3 will be covered by the savings that will result as people see their primary care doctors and receive preventive care which will then keep their later healthcare costs down.

The Swiss Menace

By PAUL KRUGMAN
Published: August 16, 2009

It was the blooper heard round the world. In an editorial denouncing Democratic health reform plans, Investor’s Business Daily tried to frighten its readers by declaring that in Britain, where the government runs health care, the handicapped physicist Stephen Hawking “wouldn’t have a chance,” because the National Health Service would consider his life “essentially worthless.”

Professor Hawking, who was born in Britain, has lived there all his life, and has been well cared for by the National Health Service, was not amused.

Besides being vile and stupid, however, the editorial was beside the point. Investor’s Business Daily would like you to believe that Obamacare would turn America into Britain — or, rather, a dystopian fantasy version of Britain. The screamers on talk radio and Fox News would have you believe that the plan is to turn America into the Soviet Union. But the truth is that the plans on the table would, roughly speaking, turn America into Switzerland — which may be occupied by lederhosen-wearing holey-cheese eaters, but wasn’t a socialist hellhole the last time I looked.

Let’s talk about health care around the advanced world.

Every wealthy country other than the United States guarantees essential care to all its citizens. There are, however, wide variations in the specifics, with three main approaches taken.

In Britain, the government itself runs the hospitals and employs the doctors. We’ve all heard scare stories about how that works in practice; these stories are false. Like every system, the National Health Service has problems, but over all it appears to provide quite good care while spending only about 40 percent as much per person as we do. By the way, our own Veterans Health Administration, which is run somewhat like the British health service, also manages to combine quality care with low costs.

The second route to universal coverage leaves the actual delivery of health care in private hands, but the government pays most of the bills. That’s how Canada and, in a more complex fashion, France do it. It’s also a system familiar to most Americans, since even those of us not yet on Medicare have parents and relatives who are.

Again, you hear a lot of horror stories about such systems, most of them false. French health care is excellent. Canadians with chronic conditions are more satisfied with their system than their U.S. counterparts. And Medicare is highly popular, as evidenced by the tendency of town-hall protesters to demand that the government keep its hands off the program.

Finally, the third route to universal coverage relies on private insurance companies, using a combination of regulation and subsidies to ensure that everyone is covered. Switzerland offers the clearest example: everyone is required to buy insurance, insurers can’t discriminate based on medical history or pre-existing conditions, and lower-income citizens get government help in paying for their policies.

In this country, the Massachusetts health reform more or less follows the Swiss model; costs are running higher than expected, but the reform has greatly reduced the number of uninsured. And the most common form of health insurance in America, employment-based coverage, actually has some “Swiss” aspects: to avoid making benefits taxable, employers have to follow rules that effectively rule out discrimination based on medical history and subsidize care for lower-wage workers.

So where does Obamacare fit into all this? Basically, it’s a plan to Swissify America, using regulation and subsidies to ensure universal coverage.

If we were starting from scratch we probably wouldn’t have chosen this route. True “socialized medicine” would undoubtedly cost less, and a straightforward extension of Medicare-type coverage to all Americans would probably be cheaper than a Swiss-style system. That’s why I and others believe that a true public option competing with private insurers is extremely important: otherwise, rising costs could all too easily undermine the whole effort.

But a Swiss-style system of universal coverage would be a vast improvement on what we have now. And we already know that such systems work.

So we can do this. At this point, all that stands in the way of universal health care in America are the greed of the medical-industrial complex, the lies of the right-wing propaganda machine, and the gullibility of voters who believe those lies.

•

Correction: In Friday’s column I mistakenly asserted that Senator Johnny Isakson was responsible for a provision in a House bill that would allow Medicare to pay for end-of-life counseling. In fact, he is responsible for a provision in a Senate bill that would allow a different, newly created government program to pay for such counseling.

America's Socialized Health Care
By Lawrence Wilson, M.D.
Published 08/17/09

Health-care systems in most developed nations are in financial trouble. Health benefits are being cut back because of exploding costs. Degenerative illnesses such as diabetes and cancer are at epidemic levels in spite of new drugs and treatments. While doctors, politicians, and insurers blame each other, they rarely mention the real problem.

Skyrocketing costs are due to the structure of health care in all these nations. All are mainly socialized, including America's. This means they operate as top-down bureaucracies, out of touch with people's real needs. Almost no market forces are allowed to operate for rational decision-making and cost control.

The results are predictable. In 2002, America spent $1.6 trillion on health care, up 9.3 percent from 2001. Drug costs increased 15.3 percent while hospital costs increased 9.5 percent. Out-of-pocket costs, the most market-related, declined.

A graph plotting the percentage of government payment for health care with the total cost of health care would turn almost vertical after the passage of Medicare and Medicaid in 1967.

America really has three health-care sectors. The socialized part or government sector comprises about 65-70 percent and includes Medicare, Medicaid, and the Indian Health Service. It also include the Department of Veteran Affairs, the Public Health Service, programs such as KidCare, and the bulk of medical research. The latter includes the National Institutes of Health, National Cancer Institute, National Heart Institute, and about 30 other government institutes. The "donors" for research in these institutes have little say over what or how wisely their health-research dollars are spent.

All the above are funded from taxes confiscated from the people at the point of a gun, making this a less-than-compassionate system. All are insulated from the health-care marketplace and thus from rational decision-making. All are run as huge bureaucracies, with their inherent problems of fraud and high administrative overhead. Medicare rules alone are 133,000 pages in length. This makes the 10,000-page income-tax code look like a model of simplicity.

The war on cancer

An example of the dismal failure of the government sector in America is the "war on cancer," which is administered by the National Cancer Institute. It has cost taxpayers some $30 billion over a 35-year period. After adjusting for a longer life span, between 1950 and 1989 the incidence of cancer rose by about 44 percent. Breast cancer and colon cancer in men have risen about 50 percent, while some others have risen 100 percent. A recent article in the Journal of the AMA was entitled "Are Increasing Five-Year Survival Rates Evidence of Success against Cancer?" The answer was "No."

The news mostly announces new cures and new drugs, but nothing about the waste of money in federal cancer research. A recent news broadcast said some cancer had declined "due to lifestyle changes." For this the taxpayers paid $30 billion. However, this waste is predictable because national research laboratories are not primarily interested in a cancer cure, no matter what they claim. They are interested foremost in keeping their jobs and second in getting more money next year from Congress. This is the nature of all bureaucracies.

The regulated sector

The so-called private sector of American health care is better termed the regulated sector. It includes insurance companies, HMOs, and licensed pharmacists and physicians. To receive any government reimbursement they must "play by the rules" imposed by the socialized sector. As a result, this sector is mainly an extension of the socialized sector.

Insurance companies are burdened with a thousand state and federal mandates regarding what services they must supply. HMOs are also heavily regulated and are in fact creations of the U.S. Congress by virtue of the HMO Act of 1973.

Medical schools also receive government subsidies and grants. This means that what is taught is influenced if not dictated by these funding sources. Physicians are regulated by state licensing boards and, of course, must abide by Medicare and HMO regulations if they choose to work in those settings. To call any of these aspects of the health-care system "private" is a joke.

The free-market sector

Perhaps 2 percent of the health-care system is private or free-market. It is composed of the unregulated, non-mainstream holistic and alternative healing schools and practitioners. People pay cash for their services and products. Practitioners and suppliers must respond to people's needs to stay in business.

I have a medical degree but have worked as an unlicensed nutrition consultant (not a dietitian) for 23 years. My attention is focused 100 percent on what clients need, not on getting grants or subsidies, receiving insurance reimbursement, or paying lobbyists to plead my case in Washington. In the free-market sector, costs for vitamins, for example, have decreased.

Sad to say, many alternative practitioners who are shut out of mainstream medicine have lobbied for licenses. There is no real need except they can charge more, keep out the competition, and perhaps force insurers or the government to reimburse their services. These include chiropractors, some naturopaths, acupuncturists, and physical therapists.

The medical cartel

Another factor driving up costs and contributing to poor quality care is the medical cartel. A cartel exists when one group works together to set prices and control all steps in the production and distribution of a commodity or service. Through licensing and other laws enacted in the early part of the 20th century, one group, the American Medical Association, controls how many medical schools exist, how many students enroll, what is taught in the schools, the availability of hospital residencies, and, indirectly through licensing laws, who will get jobs in medicine. It would be difficult to find an industry in America that is more tightly controlled by one group or union.

Alternative therapies and practitioners have been ruthlessly suppressed, their proponents often being run out of the country. Thousands of Americans flee each year to Mexico and Europe to obtain products and therapies banned in the United States but in use for as many as 50 years elsewhere.

The kingpin of the cartel is the restrictive state-medical licensing laws, passed in the early part of the 20th century. Previously, there were no licenses and the health-care system worked well. However, one group of physicians, the allopaths or drug doctors, felt they were not making enough money. The AMA, formed in 1847, was quite candid about its intentions. It sought vigorously to reduce the supply of doctors by eliminating the competition and controlling the number of medical graduates. With backing from the Carnegie Foundation and the Rockefeller Institute for Medical Research, the AMA was quite successful. Because of its efforts, the number of healing schools fell from 140 in 1900 to 77 in 1940.

The purpose of a cartel is to improve the income of its members. From this perspective, American health care is a resounding success. John C. Goodman and Gerald L. Musgrave, in their excellent book Patient Power, explain that "the AMA endorsed the idea of a medical cartel and made participation in it ethically mandatory."

In his book Price Discrimination in Medicine, Reuben Kessel states,

The delegation by the state legislatures to the AMA of the power to regulate the medical industry in the public interest is on a par with giving the American Iron and Steel Institute the power to determine the output of steel.

The FDA

The large drug companies became part of the medical cartel through their agent, the federal Food and Drug Administration. Anyone who believes the FDA is an impartial or even helpful agency needs to read The History of a Crime; How Could It Happen, by Harvey Wiley, M.D., the first director of the FDA. In the book, he meticulously details how the FDA became infiltrated by food and drug companies and how its mission became completely subverted. As a physician, I believe no other domestic agency has caused more deaths than the FDA.

Physicians are the legal drug pushers in our society. Those who step out of line and prefer to prescribe vitamins, herbs, or non-patentable drugs often lose their licenses, though they do no harm. Only one state, Arizona, has a second medical homeopathic board that allows medical doctors to escape from under the thumb of the state board of medical examiners and practice as they see fit. In the past two years, a few states enacted laws to protect physicians from losing their licenses just because they use methods unapproved by their medical board.

Through physician licensing and hundreds of other rules, only those who practice drug medicine hold licenses, work in hospitals and HMOs, and direct government research institutes. This effectively blocks change. Most alternative-health practitioners who practice a far less expensive type of healing are shut out of the mainstream.

Special-interest laboratory laws also abound. In America one cannot walk into a laboratory and request a cholesterol test. One must first go to a doctor to obtain permission. Results may not be sent to the patient, only back to the doctor. This means another doctor visit. Thanks to these rules, a $10 test may cost $100 or more. The extra cost discourages people from caring for their health. Instead, they wait until a crisis occurs, which further raises the cost of health care. In Mexico, by contrast, one just walks into a laboratory, orders the test, and receives the results.

Deregulating health care

Whenever an industry becomes mired in special-interest rules, deregulation is the answer. It is a healing process that many industries periodically need. America "deregulated" trucking, airlines, the phone system, and power generation. In every case, dire predictions of chaos did not come true and the public benefited greatly. Power deregulation has also been very successful. What failed in California was not deregulation but simply another form of regulation.

Private regulation of health care is not new. For her first 120 years, America had a true free-market health-care system free of government interference. Herbalists, hydrotherapists, nature-cure practitioners, allopaths or drug doctors, homeopaths, Native American healers, religious healers, osteopaths, and others offered services and competed with one another. Each had its own schools, clinics, and hospitals. I was born in a formerly homeopathic hospital in New York City. There were few licensing laws, so no group had a legal advantage. Whoever helped people the most prospered. Competition between many kinds of practitioners kept prices low -- people paid for exactly what they wanted. Our health statistics ranked first in the world. Today America's worldwide rank in many health-care areas ranges from 19 to 22.

Deregulation in health care would have to be a two-part affair of (1) eliminating government regulation and government involvement; and (2) eliminating the control of the medical cartel. Obviously, this would not be easy to accomplish because (1) the welfare-state concept, which Americans embraced in the 20th century, entails a government "safety net"; and (2) the medical cartel has been in charge for more than 100 years and most people are unaware of the way it controls the system.

Personal responsibility

The biggest problem with the drug-medicine cartel is that drugs and surgery do not prevent disease, do not address deep causes of disease, and do not make people healthy. They mainly suppress symptoms. According to the American Public Health Association, 48 percent of the determinants of disease are now due to "behavioral lifestyle," 25 percent are due to genetic constitution, 16 percent to the environment, and only 11 percent are due to lack of access to medical care. Often drugs make people sicker, which only adds to the cost. Malpractice lawsuits due to harm from the system add even more cost.

According to a recent article in the Journal of the AMA, modern medicine is the fourth leading cause of death in America, just behind cancer, heart disease, and strokes. This study only included deaths that occurred in hospitals. The Nutrition Institute of America just completed the first broad survey of the side effects of drug medicine.

It found that adverse drug effects and medical errors account for some 669,000 deaths, making drug medicine the leading cause of death in America. (See www.nutritioninstituteofamerica.org.) Instead of giving poisons, other healing systems balance body chemistry, correct spinal abnormalities, detoxify the body, or alter subtle electrical or vibrational imbalances in the body.

A new paradigm

An entirely different model of health care is possible. Instead of focusing on diagnosis and treatment of disease entities, it focuses on supplying missing factors of health. The new model is a true science of preventive medicine. There is no reason to wait to supply the factors of health. Prevention is hundreds of times less expensive than treating a condition when it has fully developed.

The new model uses more-sensitive assessment methods that detect imbalances long before a disease occurs. Whether by checking one's spine, hair tissue mineral analysis, or acupuncture pulses, small problems can be detected and corrected before they become serious ones. It is the only way to control health-care costs and really improve people's health.

The new model stresses participation and presumes the patient is responsible for his health. Changes in diet and lifestyle can only be recommended. Self-discipline and a desire to be well are required. An adult-adult or client-consultant relationship with the doctor replaces the parent-child relationship that currently exists between doctors and adults. Patients need to ask a lot of questions. Taking responsibility is healing in itself. It is empowering, replacing the futile and energy-wasting attitudes of fear, denial, and self-pity. Natural products can help restore balance and remove toxins from the body. Drugs and surgery would still be used but only as a last resort, as they are far more costly and dangerous.

The new model redefines health. It is not just an absence of cancer or heart disease. It is the state of relating harmoniously with one's physical, emotional, intellectual, and social environment. Health is never a commodity that can be bought and sold, doled out to the poor or guaranteed by a government agency. All such thinking is incorrect. Health is an outcome of understanding one's self and perfecting one's relationship with one's surroundings.

Adopting the new model

The health-care cost crisis offers an opportunity to view health care like any other industry. There is no market failure. How can there be market failure when there is almost no health-care market in the sense of free agents who willingly buy and sell on the basis of free access to information?

Deregulating health care would have to be part of dismantling the welfare state, as the two are closely related. Medical licenses are not only the basis for the cartel's control. They are meal tickets for any doctor who wants to participate in the welfare state.

Replacing licensing with private certification would break the power of the cartel and help restore a free market. No physician would be prosecuted and jailed for doing his best. Many people, brainwashed by 100 years of life under the cartel, would object, as they have objected to all the other deregulation efforts. But the American people would be much better off.

Instead of the FDA, several competing consumer rating groups would do far more to protect the American people than the current system. Lest this seem impossible, it was the system used successfully in America for more than 120 years. Several organizations tested new medicines and medical devices and decided which merited their seal of approval.

Though we may not wish to admit it, American health care is only slightly less socialized than the single-payer systems of Europe and Canada. No wonder costs are out of control. Deregulating health care would benefit all Americans and restore a crippled system to sanity. Health care does not have to be costly or dangerous.