Tuesday, April 10, 2007

Socialized Medicine in Colorado -- An Open Letter to Colorado Physicians

Socialized Medicine in Colorado -- An Open Letter to Colorado Physicians
by Paul S. Hsieh, MD; paulhsiehmd@gmail.com

Dear Colleagues:

My name is Dr. Paul Hsieh, and I am a physician practicing in the south Denver metro area.

I am deeply concerned that socialized medicine may be imposed on Colorado by our state legislature within the next year or so under the guise of "comprehensive health care reform". I'm morally opposed to this because I believe it would be destructive to our medical practices and harmful to our patients. I'd like your help now in speaking out against this ominous prospect.

The political process which could lead to socialized medicine is already underway, but most working physicians I've spoken with have been unaware of it. Hence, I want to sound the alarm before it's too late.

As some of you may know, in June 2006 the Colorado state legislature authorized a special 24-person Commission (called the "208 Commission" after Senate bill SB208) to generate proposals to restructure the health care system in Colorado, and submit them for legislative approval. The Commissioners were chosen by politicians from both political parties. Currently, there are only two doctors on the 208 Commission; the other 22 are representatives of various special interest groups.

The basic premise of the 208 Commission is that the government must guarantee health care for all Coloradoans. During their public meetings, a significant number of the Commissioners have expressed support for some form of socialized medicine. Although they frequently use euphemisms such as "single payer" or "universal mandatory coverage", similar language has been used in other US states and in other countries to justify massive government control of medicine.

Simultaneously, the Colorado Medical Society (CMS) has developed an official position in which they urged that health care in Colorado should be "universal, continuous, portable, and mandatory".

On January 25, 2007, the CMS submitted those "Guiding Principles" to the 208 Commission, portraying them as the consensus of the doctors of Colorado. They have also stated that the "CMS believes, after extensive vetting and a unanimous vote at the 2006 House of Delegates, that the Guiding Principles represent a compelling consensus of Colorado physicians".

When I first learned of this, I was angered and appalled, because that position does not reflect my views or the views of many other physicians that I've spoken with. The CMS does not speak for me on this issue, and I am not part of this "compelling consensus".

I completely oppose any form of socialized medicine, regardless of whether it is called "single payer", "mandatory universal coverage", or anything else, because I believe it would be bad for both patients and doctors. Years of experience in the US and other countries have shown that these programs will hurt patients and even cause their deaths. As costs inevitably spiral upward, bureaucrats will ration medical services. Eventually, physicians will be forced to practice against their best medical judgment. This is a violation of the fundamental rights of both doctors and patients.

As a result, in states like Tennessee (which in 1994 implemented its own version of mandatory universal coverage called TennCare), many doctors find the practice climate intolerable and are either leaving the state or quitting medicine entirely. I do not want that to happen in Colorado. States like Massachusetts and California, which are also attempting to guarantee universal health care for their residents, will soon face similar problems.

Although I agree that there are genuine problems with the current system, more government interference in medicine can only make things worse. One basic principle we all learned in medical school was, "First, do no harm". This applies as well to politics as it does to clinical practice. Most of the problems of the current system have been the result of bad government policies. Adding more government bureaucrats to the mix will only make things worse.

In my opinion, it is not the government's role to guarantee health care for all Coloradoans, any more than it is the government's job to guarantee all citizens a car or a job. It is morally wrong and economically unsustainable. Doctors and patients ought to be able to freely contract for medical services to their mutual benefit without interference from the government. It is precisely the attempts by the governments in Canada and Great Britain (or states like Tennessee) to guarantee universal "cradle-to-grave" coverage that has led to the runaway costs and rapidly deteriorating health care in those places.

I recognize that not everyone will agree with me here, and this is part of my point. This is a very contentious issue amongst doctors. Based on my discussions with numerous physicians, I don't think one can accurately say that there is a "compelling consensus" of the doctors of Colorado.

So if you oppose socialized medicine on the grounds of medical conscience (as I do), then please contact the Colorado Medical Society and the 208 Commission, and let them know where you stand.

Even a one line e-mail like, "I oppose universal, mandatory coverage or any other form of socialized medicine, because it will be bad for me and my patients", could have a tremendous impact.

To contact the relevant members of the CMS and the 208 Commission go to: http://tinyurl.com/2y9t4f or send mail to 208Commission@coloradofoundation.org.

The CMS is speaking in your name on this issue, so if you disagree with their position (or if you believe that their position should not be portrayed as the physician "consensus"), then they need to know. The CMS has requested feedback from doctors including those who disagree with their current position, so I urge you to take them up on this.

The 208 Commission is a public body, and has also asked for input from all citizens of Colorado. So if you want to protect your right to practice good medicine and protect your patients' best interests, they need to hear from you before they submit their proposals to the state legislature for a vote.

For further information about this issue, one excellent resource is the website www.WeStandFIRM.org, a non-profit group of Coloradoans devoted to freedom and individual rights in medicine. I especially recommend their article, "Health Care is Not a Right" by Dr. Leonard Peikoff. If you wish to stay informed on this topic, I also encourage you to sign up for their mailing list or read their blog.

Also, please feel free to forward this open letter to any other Colorado physicians that may be interested. A copy of this letter is also available online at: http://www.WeStandFIRM.org/docs/Hsieh-01.html.

Paul S. Hsieh, MD
E-mail: paulhsiehmd@gmail.com

Disclaimer: I am neither a Republican nor a Democrat, but an independent voter. My objections to socialized medicine are unrelated to party politics.



I've listed some references for those who want more information. These are optional resources for those who want to learn more about these topics, but not required reading. (I do not necessarily endorse every item in full):

"Health Care is Not a Right" (HTML format or PDF format):
[Online essay] This brilliant essay was written by Dr. Leonard Peikoff, a philosophy PhD living in Colorado Springs. The original version was written in the 1990's after Hillary Clinton proposed her infamous national health care plan, and has been updated by Lin Zinser and Dr. Peikoff for 2007. He argues that a "right" to health care does not exist and that any attempt to create one necessarily leads to disaster, because it runs antithetical to the genuine rights that were recognized and codified in the Constitution by the American Founding Fathers.

"A Short Course in Brain Surgery":
[Video] This astounding 5-minute video tells the story of an Ontario man with a brain tumor who couldn't get the care he needed under the Canadian system because the waiting lists for an MRI scan and for a neurosurgeon were too long. Fortunately, he was able to get appropriate treatment in Buffalo, NY.

"Health Insurance in the United States"
[Online article] This informative article covers the development of the U.S. health insurance system and its growth in the twentieth century, including the development of Medicare and Medicaid. It also examines the role of government policy in setting the stage for nationalized health care.

"The History of Health Care Costs and Health Insurance":
[Online article] This report was written by Linda Gorman, who is a health-care economist at the Independence Institute in Golden, CO. In this article, she covers the history of spiraling health care costs and government control of medical care, and shows how bad laws and other government interference in medicine have led to the current problems. She also offers some positive market-based alternatives to socialized medicine which have been proven to simultaneously increase patient outcomes and decrease costs, including Health Savings Accounts (HSA's), insurance deregulations, etc.

"Your Doctor Is Not In: Healthy Skepticism About National Health Care":
[Book] This book by Jane Orient, MD, is an illuminating and provocative analysis of the immorality and impracticality of government interference in medicine in general, and single-payer systems in particular. Dr. Orient is the Executive Director of the Association of American Physicians and Surgeons.

"The Cure: How Capitalism Can Save American Health Care":
[Book] This book was written by Dr. David Gratzer, a physician who has practiced in both the US and Canada, and has first-hand experience with the pros and cons of both countries' medical systems. His documentation of the long waiting lists in Canada and the higher mortality rates for treatable conditions is chilling. He also provides excellent historical background on how health insurance became linked to employee benefits as a result of bad IRS policies, with all the resultant problems. His basic conclusion is that capitalism, not socialism, is the way to address the problems. He offers a number of practical, concrete proposals to fix our current problems, all of which are based on decreasing government interference in medicine.

Podcast interview of Dr. David Gratzer at Instapundit.com:
[Podcast] A 30 minute interview by Glenn Reynolds of Instapundit.com with Dr. Gratzer on the problems and solutions to America's health care problems.

"Universal Health Care -- Call It Socialized Medicine":
[Online essay] Lawrence Huntoon, MD, PhD, discusses why "universal health care" is synonymous with "socialized medicine". He also observes:
Indeed, "universal coverage," nationalized health care, or socialized medicine, regardless of what you choose to call it, is not the same as medical care. All of the citizens of Canada, for instance, have "universal coverage." What they often don't have, however, is the medical care that they need when they need it. That is why we see Canadians crossing the border into the United States in droves to obtain the health care that they can't get when they need it in their own country. Their government rations access to health care and thus attempts to control costs by making MRI scans, radiation oncology, bypass surgeries and many other health services largely unavailable to their own people.
Dr. Huntoon is a former president of the Association of American Physicians and Surgeons, and is a practicing neurologist in New York state.

"Universal Health Care's Dirty Little Secret":
[Online article] Trying to provide universal coverage doesn't actually result in better care, just rationing.

"No 'Crisis' of Uninsured":
[Online article] Rocky Mountain News columnist Mike Rosen debunks the myth that there is a "vast army of people... who are permanently unable to obtain health insurance".

"Why Are Health Costs Rising?":
[Online article] A nice short analysis on why health care costs have risen so much. Again, the basic problem is government interference in normal market mechanisms. As anyone who has bought a cell phone or a DVD player recently knows, the natural course of the marketplace is higher quality goods for lower prices over time. Even in the medical field, this has been the pattern in LASIK and cosmetic surgery, i.e., in the types of medical care where patients pay for themselves and are therefore incentivized to be prudent shoppers.

"Colorado Medical Socialism":
[Online article] A strong critique of the CMS position on universal mandatory health care by Boulder Weekly writer Ari Armstrong.

There is no health care crisis in Colorado:
From Lin Zinser's 3/28/2007, "Report on the 208 Commission" (scroll down to her "second point"). She notes, "According to Colorado voters there is no crisis of health care in Colorado. According to Colorado voters polled in December 2006 for the Denver-Metro Chamber of Commerce, 77% of Colorado voters believe their own health care is good or excellent and 60% believe the quality of health care in Colorado as a whole is good or excellent. More to the point, only 7% describe the situation in Colorado health care as a crisis."

Problems with Tennessee's universal health care system, TennCare [online articles]:
"The Price of Seduction"
(A devastating criticism of TennCare from family practice physician, Dr. Sydney Smith.)
"Tennessee: Lesson for California"
"TennCare: A model for how American socialized medicine will fail"

Problems with Massachusetts' universal health care system [online articles] :
"Universal Healthcare Boondoggle"
"Universal Health Care: Proceed with Caution"
"Intensive Care for RomneyCare"
"Bad Medicine: What's Wrong With RomneyCare"

Problems with California's proposed universal health care system [online articles] :
"One Step Forward, Ten Steps Back: How California Will Make Health Care Much More Expensive"
"Schwarzenegger's Folly"
(Analysis by John Stossel, co-anchor of ABC News' "20/20".)

Freedom and Individual Rights in Medicine:
[Organization] From their website:
Freedom and Individual Rights in Medicine (FIRM) promotes the philosophy of individual rights, personal responsibility, and free market economics in health care. FIRM holds that the only moral and practical way to obtain medical care is that of individuals choosing and paying for their own medical care in a capitalist free market. Federal and state regulations and entitlements, we maintain, are the two most important factors in driving up medical costs. They have created the crisis we face today.
I encourage all physicians interested in staying informed on these issues to sign up for their mailing list. FIRM also runs a weblog.

The Colorado Medical Society and some key officers:
Alfred Gilchrist (Executive Director): Alfred_Gilchrist@cms.org
Chet Seward (Director of Health Care Policy): Chet_Seward@cms.org
Lynn Parry, MD (President): nurvdr@mac.com
David Downs, MD (President-Elect): David_Downs@cms.org
Mark Laitos, MD: mlaitos@comcast.net
Ben Vernon, MD: wbvernon@qwest.net

The 208 Commission official website:
The full list of the 208 Commissioners and the publicly available e-mail addresses:
William N. Lindsay III, Chairman: 208Commission@coloradofoundation.org
Erik Ammidown: erik.ammidown@qwest.com
Elisabeth Arenales: earenales@cclponline.org
Clarke Becker: unknown
Carrie Besnette: cbesnette@gmail.com
David Downs, MD: David_Downs@cms.org
Steve Erkenbrack: unknown
Lisa Esgar: lisa.esgar@state.co.us
Linda Gorman: Linda@i2i.org
Julia Greene: jgreene@seiu105.org
Allan Jensen: allanjensen@earthlink.net
Grant Jones: grant@caahealth.org
Donna Marshall: cbghealth@aol.com
Pam Nicholson: pamnicholson@centura.org
Ralph Pollock: ralph@apaccess.com
David Rivera: unknown
Arnold Salazar: Arnolds@chnpartners.com
Mark Simon: mbsimon@juno.com
Dan Stenersen: unknown
Steven Summer: steven.summer@cha.com
Mark Wallace: unknown
Joan Weber: unknown
Barbara Yondorf: byondorf@rcfdenver.org
Peg Burnette: peg.burnette@dhha.org
Donald Kortz: dkortz@fullercompany.com
Lynn Westberg: lynn@sjbhd.org

[This letter was slightly edited on 4/17/2007. -- PSH]