Is there a doctor in the house? Not for long.

Doctors like me have to go. That much is clear. Even though we have done nothing wrong.

The problem is simple: I was trained to provide the best care possible, to everyone, all the time—regardless of race, ethnicity, sex, sexual orientation, wealth, power, position, politics, cost, cleanliness, friendliness, consciousness, or anything else.


Hippocrates Frustrated - ICD-10-Patient-Care-Impact-Frustration


A Simple Recipe for Care

Mine was a simple recipe. And it worked every time.

I was taught to consider only that person sitting in front of me needing my care. I was not burdened with considering the needs of society or the world. I was not charged with correcting past societal injustices by others—whether based upon race, ethnicity, religion, social status, sex, sexual orientation, or any other characteristic.

Health care, I was told, is too important an arena for mean-spirited revenge. As an ER physician, I have kept gravely injured murderers alive so that they can stand trial for their crimes against others, many of whom I pronounced deceased myself. I have even been called to testify in some of those trials. It is not, I was told, my place to judge. And so I did not judge—anyone. I had my opinions, but they never left my mind. Nor did they influence the care that I provided. It made my job easier. And it was more fair, because who is to say that my personal judgments would always be correct? Most certainly they are not. Of that, I am acutely aware.

I was not asked to make my treatment decisions based upon cost or in such a way as to save anyone money or make anyone money. Though I was aware that a lot of money was being spent and made by someone based upon the decisions that I made, that someone was not me, and it could not be me. Those were the rules. I was glad for those rules. They, too, made my job easier.

I was not expected to fret over whether what I wanted to give the patient was affordable in a societal sense. To the contrary, I was intentionally blinded to the money involved lest the independence of my medical decision-making be compromised. I liked it that way. I still do.

I was taught that it was not up to me to choose the winners and losers in the raffle of life. I was assured that if I just did my job, and fought my hardest, for every single patient, the rest would take care of itself. And until Obamacare came along, for the most part, it did.

In other words, I was taught to practice medicine like it says in the Hippocratic Oath that we traditionalists still take seriously.

For that I am grateful. It does, however, make me like a fish out of water in this brave new post-Obamacare America.


No Country for Old Doctors

Because of my training and resulting philosophy, there is no place for me in the post-Obamacare healthcare delivery system. You see, we traditional physicians are unwilling to ration care. We are unwilling to ration care, because we know better than to do so. We recognize the inherent cruelty, immorality, and self-defeatism in our being transformed from caregiver to executioner, if only through the passive withdrawal of care. Or at least most of us do.

I still feel that it is not my place to judge. And yet Obamacare will force me to do just that—to judge my fellow man not even according to my own guiding principles, but rather according to the impersonal, cruel yardstick of a federal government hundreds of miles away from where both me and my patient sit, and lie, and struggle.

And so we traditionalists must go. It’s either that or change—in big, oath-shattering ways. We must become controllable. We must forgo exercising the very judgment for which we are trained in favor of the ill-intended edicts of self-serving, non-medically trained government bureaucrats, politicians, and insurance industry and Wall Street fat cats.

Some of us will simply leave and never look back. Medicine is a funny discipline. Once we leave it, though we retain the knowledge and skills, we rarely return. To return is far too painful. And so we continue to sit it out.

Doctor's Back in Green Scrubs - Handcuffed

Many will claim to be retiring early. If pressed, they will talk of spending more time with the grandkids, gardening, or traveling around the country in that RV that has been parked in the backyard for years. That is a much easier conversation.

While they may end up enjoying their retirement years, that is not why they left. I can promise you that. They left because they are unwilling to change. They left because they are unwilling to do their government’s bidding, hurting their own patients in the process. They left because they are unwilling to work as government robots. They left because they are unwilling to work for free, and under constant threat of financial ruin, imprisonment, or both—which is what the government now demands.

Those who cannot or will not leave the profession will change. Many will become unrecognizable, though they will look the same on the outside.

That is bad for us physicians. It is even worse for you, our patients.

The Brave New World of Obamacare

In case you doubt me, consider these facts:

The Affordable Care Act specifically gives certain nurses the right to introduce themselves to patients as “Doctor.” Why would that be, except to confuse the healthcare consumer about who—and what—their provider really is?

And lest you think this will be the exception rather than the rule, consider this:

According to a new study, the healthcare workers anticipating the greatest job growth over the next decade are not physicians or nurses. They are not therapists or any other trained medical professionals. Rather, the three healthcare job categories anticipating the greatest growth over the next decade (by quite a large margin) are:

(1) with 555,000 new jobs and 38.1% ten-year job growth: home health aides, who make an average of less than $22,000 per year and who have no formal education or training;

(2) with over 458,000 new jobs and 26% ten-year job growth: personal care aides, who make an average of $20,000 per year and who have no formal education or training; and

(3) with 599,000 new jobs and 17.6% ten-year job growth, nursing assistants, who make an average of less than $26,000 per year and who are required to obtain only a postsecondary nondegree.

Hmmm . . . All of the high-growth healthcare jobs are as untrained aides and assistants. Go figure.

Why is this concerning? Because once this anticipated job growth takes off, and once they all don white coats and introduce themselves to you as “Doctor,” you will not know the difference, that’s why.

And there is a difference. That is not being elitist. It is a fact.

As an emergency physician with literally decades of education and training behind me, I am trained to save your life in the event of an emergency. It is what I do. It is what I love doing. With all due respect to the wonderful job that they do under my supervision, a home health aide, personal care aide, or nursing assistant can do little more than call 911—even from iElder Care - Holding Hands - end-of-life-800 - RESIZEDnside the hospital. That is neither a criticism of them nor an exaggeration of my skills. It is a fact.

Even so, in a few years’ time (if not sooner), you will have no way of telling me from them. In fact, if things stay on their current course, I will not be around. And so you will be left with them. Unsupervised. Good luck with that.

Don’t get me wrong: They will smile sweetly, hold and stroke your hand gently, and hug you warmly. They will make you feel both valued and appreciated. They may even bring you your medications and take your vital signs. Will they save your life? No. Will they cure, or even provide you with a concrete way to manage, your disease? Not likely. Are they me? Absolutely not. And yet you will be left in their unsupervised, if kind, care. And that is a dangerous place to be.

A New Breed of Doctor

Of course, lots of folks will still be walking the halls of hospitals and clinics wearing long white coats and introducing themselves as “Doctor.” Some will be nurses and nurse’s aides, and some will be other ancillary staff.

Some will be actual physicians—with MDs and everything. The difference is that they will be educated in a way that is completely foreign to me. Those who are already practicing but unwilling to retire early will be “re-educated” along with them. That process has already begun.

Together they will be taught to consider medicine as not a personal, but rather a societal endeavor. They will be taught to practice “population-based medicine.” They will be charged with practicing “outcomes-based medicine” (which will function to exclude the sick and the elderly from receiving care, because their “outcomes” are less likely to be good despite exemplary care). They will be expected to address—and remedy—”health disparities” by making it easier for some (the historically disenfranchised) to access care, while preventing others (the historically favored) from doing so. In that way, they will be taught to deliver “medical justice” through the care that they deliver to real human beings, all of whom are innocent of any of the historic wrongdoing ostensibly being rectified.

They will be taught to practice medicine that is judgmental rather than accepting, that is punitive rather than comforting, and that is redistributive rather than fair.

In fact, this is already being done behind the closed doors of the nation’s predominantly liberal progressive institutions of medical higher education.

Don’t believe me? Consider this:

A New Breed of Medical School

The Affordable Care Act explicitly provides for the establishment and federal funding of government-run medical schools, ostensibly to meet anticipated “physician shortages” caused by the passage of the law itself. The statute furthermore explicitly provides that government-run medical schools will emphasize affirmative action in their admissions and advancement policies.

Loyola Stritch - Dreamers to Doctors - Promotional Ad 01 - D2D-Screening-Flyer-Web-2

To make matters worse, there is already a movement afoot throughout the existing medical school community advocating for unrestrained affirmative action that will ensure that the country’s euphemistically labeled “Dreamers”—meaning the children of illegal immigrants who are themselves in the United States illegally—are allowed to attend and graduate from the American medical school of their choice regardless of accomplishment and promise—and, apparently, citizenship. No doubt, they will also do so for free. Unlike your kids and mine.

I ask you: Do you want your surgeon to be a product of affirmative action—much less an illegal immigrant who is also the product of affirmative action? Call me crazy; but I’m guessing not. And yet he or she will be. And you will never be told the truth.

And the defendant is . . . no one.

If, Heaven forbid, you were to die on the table, your family will simply be told that nothing could be done. Only it could have, in the right hands. But they won’t know that. No doubt, your family will be told the tragic news by a sincere, tearful nurse’s aide who will actually believe the script that she has dutifully memorized. After all, she has neither the education nor the training to know better. And so her conscience is clear as your family breaks down before her.

Your distraught family may not even be told that much if—as the federal government tends to do—it does away with the ability of patients to sue those who provide care once those who provide care are all government bureaucrats rather than private folks like me. Ever wonder why the VA Health System can get away with providing such notoriously substandard care? That’s why—because no one can sue them. Because they are the federal government. Get my drift? It will be no different with Obamacare. Mark my words.

And how can you sue an ilGavel on White Background 01 - judicial-reformslegal immigrant? Do they even fall under the jurisdiction of the United States courts? What’s to keep them from fleeing back to wherever they came from? Again, you get my drift. Again, mark my words: This is not the last you have heard of this.

In fact, there is already serious talk among state and federal politicians and the medical elite regarding the establishment of a taxpayer- and physician-funded “funds” from which patients injured in the course of medical treatment are automatically reimbursed according to government tables and charts and projections. Whoopee!, the American people are told. No more lengthy, expensive, and exhausting trials! No need to prove your case! Just get in line for the cash that Uncle Sam is ready to dispense! After all, if you say you’re hurt, we can assume that your doctor screwed up, can’t we?

Are we all together on this?

I certainly hope not.

Think of such funds as strict liability for doctors like me. If you treat patients, you will pay them for their bad outcomes, regardless of the quality of your care.

While such a model benefits those who suffer minor injuries (or are not actually injured at all), it discriminates against those gravely injured by provider misconduct, who necessarily lose their right to sue in exchange for a pittance payment too small to cover their future medical bills. In the process, it deprives both patients and physicians of that most sacrosanct right, the right to a trial before a jury of their peers.

Finally and most importantly, it directly incentivizes hospitals and physicians not to provide serious care to old and gravely ill Americans, whose outcomes are notoriously bad despite quality care—precisely because they are elderly and ill, with depleted reserves. In a system of strict liability for bad outcomes, those folks represent too much risk. In fact, resulting payouts are a given. And so they must be let go. And they will—be let go, that is.

The worst part? No one will be the wiser.

It is the perfect plan for the perfect scam. It is also the recipe for government-sanctioned murder.

Kaiser to the Rescue: The Medical School of the Future

As we learned this spring, there is yet another wrinkle in the re-education of America’s physicians. And it’s a doozy.

It seems that the medical schools of the future will also be run by the very insurance and health administration fat cats who dutifully climbed into bed with the Obama administration and helped shove Obamacare further down your throats.

Kiaser Permanente Sign 01 - la-fi-kaiser-permanente-20151204

Indeed, the first such medical school will be run by none other than the health insurance and healthcare delivery giant Kaiser Permanente. The new school, which will be located in Pasadena, California, will enroll its first students in 2019. Look it up.

So . . . the medical schools of the future will be run by the federal government and administered by the same corporate giants that already control the health insurance, healthcare administration, and healthcare delivery markets—in other words, the fattest of the Wall Street fat cats. And now they will control medical education as well. Even though they are the very individuals who stand to gain the most—and it’s a lot—from the denial of your care.

It is the ultimate self-serving, inside-dealing, corrupt monopoly. And it will kill us all if we let it.

Pretty Words for Ugly Actions

Yesterday, I published a blog post entitled, “Bad Influence: The 100 Most Influential People in Healthcare.” In that post, I decry the fact that that annual list is full of politicians and Wall Street fat cats and contains not one—not one, in a list of 100—practicing physician.

In the number 2 position, right under Barack Obama, is Bernard Tyson, Chairman and CEO of Kaiser Permanente and longtime Obama—and Obamacare—supporter.

Kaiser Permanente Sign 02 - KaiserPermanente05102012 - RESIZED

Upon announcing its plans to build the first government- and corporate-controlled medical school, Kaiser issued a press release stating: “Demographic changes in the U.S. population have created increasingly diverse communities. Physicians in the 21st century require cultural competency and fluency in order to meet the needs of their patients and to best serve their communities.”

Sounds reasonable, right? After all, who isn’t for “cultural competency and fluency?” And who doesn’t want to “serve their communities?”

Edward M. Ellison, MD, Kaiser’s Executive Medical Director, was quoted as stating, “We have an opportunity, even an obligation, to redesign medical education and be a catalyst for change.” He further opined that new generations of Kaiser-trained physicians “will be well-prepared to meet the total health needs of communities across the nation, including the necessary work of addressing health disparities.”

So . . . the new generation of Kaiser physician will “be a catalyst for change” and focus upon meeting “the total health needs of communities across the nation.” He or she will also strive to address “health disparities.”

Warning: That is liberal government-speak for “Gullible young doctors will be taught to consider society’s needs over your needs, and they will be taught to use your health care to correct historic injustices for which you are not responsible.” That, in turn, is code for “They will be taught to practice medicine in such a way as to make us rich and you sick.”

Please keep in mind that a bleeding heart cannot keep you alive for long.

Indeed, by their own admission, Kaiser’s stated mission is the very definition of redistribution and social engineering through health care. It is the main—and by far the most important—argument against Obamacare and socialized medicine.

It gets worse:

The same day as the press release, the LA Times published an article about Kaiser’s plans. As one of Kaiser’s most important objectives, Ellison told the paper, “Kaiser plans to train students as emergency medical technicians when they arrive at the school,” after which it will send them out “into the community, visiting patients’ homes.”

Hmmm . . . That seems suspiciously like they plan to provide a lower level of training, get the students out into the field quickly (where many of them will remain, having gotten accustomed to making money and having decided not to return to the classroom to become a doctor), and at the same time keep patients at home and away from the ER and hospital. That can be very dangerous, particularly in the hands of a wet behind the ears recent college graduate with no real medical school training.

That, too, is the very definition of intentionally rationing care by blocking patients’ access to that care. Because with all due respect, a young college kid with a medical bag and a stethoscope standing in your living room is about as capable of saving your life as that nurse’s aide dialing 911.

The point is so obvious that even the young LA Times reporter felt compelled to address it.  By way of a passing reference, she noted that critics of Kaiser’s plans worry “that a Kaiser medical school would focus on cutting costs that could negatively affect patient care.”

I don’t think there is any question about that.

History Repeats

The problem is as old as the history of dictators and despots. It is also as filled with the tragedy of needless human suffering and death as are their tales of conquest and defeat through the control of human beings.

Hitler's Physicians - Karl-Brandt Sentenced to Dealth by Hanging - RESIZED

Physician and Nazi Officer Karl Brandt being sentenced to death by hanging by the Nuremberg War Crimes Tribunal, 1947.

Keep in mind that one of the very first steps that Adolf Hitler took was to require all physicians—in both Germany and its German-occupied neighboring territories—to swear an oath promising—innocently enough, it seemed—to treat their individual patients in accordance with their social utility and for the good of German society rather than the individual.

More specifically, the order of the Reich Commissar of 19 December 1941 read in part as follows:

“It is the duty of the doctor, through advice and effort, conscientiously and to his best ability, to assist as helper the person entrusted to his care in the maintenance, improvement and re-establishment of his vitality, physical efficiency and health. The accomplishment of this duty is a public task.”

To their credit, the physicians of the Netherlands immediately recognized the new oath for what it was—a directive to ration care. According to Leo Alexander, MD, Chief U.S. Medical Consultant at the Nuremberg War Crimes Trials, the physicians of Holland recognized Hitler’s oath as “the concentration of their efforts on mere rehabilitation of the sick for useful labor, and abolition of medical secrecy.”

Alexander continued: “Although on the surface the new order appeared not too grossly unacceptable, the Dutch physicians decided that it is the first, although slight, step away from principle that is the most important one.”

They refused to obey Hitler’s order to take the oath. All were stripped of their medical licenses and put out of business. Many were imprisoned. Many were eventually murdered in cold blood for their refusal to take the oath and practice medicine according to Hitler’s directives.

Of those physicians who took the oath, Hitler gradually transformed them from caring healers into cold-blooded killers. They let him, because they had no choice. Soon, they became the monsters Hitler had envisioned—his personal army of killing machines. They became professional torturers, and maimers, and executioners without kindness, or mercy, or compassion, or pity. They became utterly soulless.

A Dark Path to a Dead End

Dark Path 01 - dark_path_2_by_stephariara - RESIZED

We are on that same dark path. It is an overgrown path at first discovered, then cleared (with the help of an optimistic community of believers), by all dictators, despots, and social engineers. It is the same path that, once unburdened of its wild overgrowth, is walked—first enthusiastically, then willingly, then reluctantly, then fearfully—by all civilized societies that embark upon the practice of socialized medicine. All believe that they will be different. None are. Ever.

Kaiser is Obama’s Josef Goebbels. While Kaiser paints happy pictures for young reporters of optimistic young doctors caring for the world, that is propaganda. It is pretty wrapping obscuring a most ugly package. Once that package is unwrapped and the beast springs forth into plain sight, it will be too late. By that time, the beast will be grown, unleashed, and uncontrollable. Just like Hitler’s army of physicians. Even the most casual student of history—and of medicine—knows that.

Heaven help us all. For this sad story will end no better for us than it did for Nazi Germany. Because it never does end well.

That, too, is a fact.

Welcome to Obamacare. I’m sure you’re going to hate it. You’re also going to fear it, for good reason.

Those are my thoughts. Please let me know yours.