Thursday, June 19, 2008

Fisch Letter to Colorado Medical Society

Dr. Bruce Fisch, a nephrologist practicing in Denver, recently sent the following letter to the Colorado Medical Society (CMS) and the CMS Physicians' Congress on Health Care Reform, which I am reprinting with his permission:
Dear CMS Physicians' Congress Members,

It has come to my attention that the CMS is preparing to give an institutional endorsement to "single-payer universal coverage" as a preferred strategy for health care reform. I am writing to alert you that many CMS physicians view such health care policies as socialist, immoral, and contrary to the public good. Furthermore, using the CMS as an endorsement vehicle in this fashion conflicts with its mission as a promoter of the art and science of medicine, and threatens to alienate Colorado physicians who disagree with its position.

Incentive, achievement, excellence and ambition are the motivators that lead one to become the best possible physician. Caring and empathy, too, are critical, but Senator Kennedy, who was recently diagnosed with a malignant glioma, relied upon the former set of attributes when he selected the "most brilliant" neurosurgeon he could find to treat him. The irony is almost too painful to admit, for if we operated under a shroud of socialized medicine, Mr. Kennedy's surgeon would likely not exist, and if he did, the decision to resect the tumor would have been usurped by the government, taken away from the patient and his physician. We all know that his prognosis is dismal, but regardless, he has the means to pay for such treatment and the personal freedom to decide.

Unfortunately, American health care is both blessed and plagued by our own unsurpassed creativity and technological progress. Whereas advancements in industry, computing, finance, and agriculture lead to lower costs, medical advancement almost always leads to higher cost. But this is what Americans, like Mr. Kennedy, demand, when they get sick. The only ways to lower cost are to stifle advancement and limit access. At my core as a physician, both are abhorrent. That is one reason why some of us use "immoral" to characterize socialized medicine.

The values here in America are unique, contrasting drastically with Canada, Europe, and Asia. Liberty and free thought with regard to one's health and health care are paramount among them. One cannot accurately apply European models here in the USA.

I strongly discourage the CMS from endorsing or officially supporting any policies of "universal health care" or "mandatory insurance".

Bruce J Fisch, M.D.

Denver Nephrology
I applaud Dr. Fisch for speaking out against the current CMS position on "universal health care". I'd also like to note that in a free market, there is no necessary conflict between technological advancement and lower costs. In fact, in nearly every other sector of the relatively free American economy, we regularly see a pattern over time of lowered costs and improved quality -- just ask anyone who has bought a DVD player or computer recently. Similarly, in the sectors of medicine which are closest to a free market (i.e., least subject to government regulation) such as LASIK, we've seen a similar pattern of lower prices and improved quality over time. There's no reason that this can't be the norm for all of medicine -- if only we had a genuine free market. Furthermore, if patients wish to spend more money to achieve greater benefits to their individual lives, they should be free to do so without interference from a government bureaucrat whose primary concern is cost containment.

In response to letters from Dr. Fisch and myself, the president of the CMS (Dr. David Downs) has written:
I should note that we have explicitly avoided advocacy for particular financing strategies (including single payer) to improve access to care and to assure quality and efficiency.
I would also like to reiterate that there is no intent to advocate for a single payer strategy. While there are many advocates for this, we have assiduously avoided taking a position on financing issues that require a broader discussion.
I appreciate his statement on the specific issue of "single payer". However, in the document entitled "Guiding Principles for Health System Reform" issued by the CMS Physicians' Congress for Health Care Reform, the number 1 principle listed is:
Health coverage for Coloradans should be universal, continuous, portable, and mandatory.
Hence, it appears clear that the CMS supports the principle of mandatory universal health coverage. Dr. Downs also elaborated on this as follows:
The final position reflects the consensus of congress members that, in order for coverage strategies to be most effective and to avoid the chronic cost shifting that amounts to a 'stealth tax', all citizens should have coverage for care they would otherwise be unable to afford on their own. The policy does not prescribe whether that take the form of default enrollment, individual mandate or any other specific strategy.
Unfortunately, any such strategy for universal mandatory insurance is incompatible with basic individual rights -- namely the right of individuals and insurers to contract for services for their mutual benefit in a free market. Nor does it eliminate the problem of cost-shifting or "stealth tax". Mandatory insurance merely shifts that burden onto those who are paying artificially elevated premiums in order to subsidize those receiving subsidies so they can pay artificially lowered insurance premiums, or else it shifts the costs onto the taxpayers. The "stealth tax" is not eliminated, it is merely disguised in the form of higher insurance premiums or higher taxes. The failed experiment in Massachusetts with the individual mandate merely highlights this point.

This is all the more reason that I'm glad that physicians like Dr. Fisch are speaking out against "universal health care".