Last December [1999], the National Academy of Sciences has called for the establishment of a federal “Center for Patient Safety,” operating under the auspices of Public Health Service at a projected annual cost of $100 million. The “disinterested” NAS claims its research demonstrates that “medical errors kill 44,000 to 98,000 people a year,”–more than highway accidents, breast cancer or AIDS–such errors ranging from misread prescriptions to a lack of information in a “fragmented” health care system. The NAS concluded that “health care is a decade or more behind other high-risk industries in its attention to ensuring basic safety,” and that the solution to such “carelessness” is the mandatory reporting of errors to a federal bureau which could then publicize the results allowing patients to make “informed” choices about their health care.
Of the many observations to make about this report, the first seems trivial, but as the report ignores it, it appears the NAS regards it as unworthy of notice, so it must be said: physicians, nurses and hospitals save lives, and cure diseases and ailments that make life miserable. The tenor of the report’s language, and of media coverage surrounding the report, create the impression that hospitals exist merely to give health care professionals employment, and that, in marking their time-cards, they have grown sloppy and are causing more harm than good.
The margin of error built into the NAS’s central claim, approximately 30%, is reason enough to doubt the report’s accuracy. Additionally, the NAS is not as “disinterested” in reporting the truth as it might claim. As a government body, it exists by providing “results” such as these reports and has no vested interest in reporting the truth, only in justifying its own existence.
If any part of the report were true professionals–which premise I do not accept for a moment–it would be due to the fact that government intervention is turning medicine into a bureaucratic business, rather than a scientific and productive one. A certain amount of “carelessness” is likely caused by the amount of time and consideration health care professionals are compelled to give to filling out forms correctly and to “negotiating” with managed care organizations and health care bureaucrats. All of this certainly detracts from a physician’s focus on his primary function–caring for his patients–a point the report and the commentary carefully avoid.
Further, it is intriguing that the alleged solution to the problem is increased, if not total, federal oversight on health care practices.
What would this mean?
In practice, it would mean that procedures codified by federal authorities with which health care professionals must comply in order to maintain their good standing. To avoid being tainted with the stigma of carelessness, the new protocol for health care professionals will be the accurate completion of forms, not the best efforts of the physicians. Rather than looking down at their patients to diagnose and treat them, physicians will be looking over their shoulders at the health NAZIs from Washington.
“Did you take that man’s blood pressure?”
“Regulation 10-289 [sic] was complied with in all respects.”
“Was the ventilator operating properly?”
“Maintenance schedule WER-93 was filled out at the programmed time.”
“Was the medication given in the correct dosage?”
“Schedule 75-AV93 was followed exactly.”
“Why did the patient die?”
“I have no idea. All the paperwork was correct.”
That is the model implied and required by the NAS’s suggestion. That it can be realistically believed that medical practitioners will be more “careful” in their work with the sword of government stigma hanging over them than when they are free to concentrate on the patient before them is absurd. Other developments in health care policy, some even suggested in the report, indicate why and how the proposals might be accepted and implemented.
Part of the blame for the alleged carelessness is attributed to a “fragmented” health care system, by which is meant a de-centralized–i.e., private system–of health care professionals in which “doctors often do not have complete information about treatments prescribed for their patients by other physicians.” That “fragmented” system is, of course, today’s bastard-child–a semi-private, semi-public health care system. A “non-fragmented” system would be the monolithic, “single-payer” system that statists have proposed for decades.
The criticism of “fragmentation” comes one month after President Clinton proposed “medical privacy” legislation that would make place significant restrictions on the ability of private health care organizations to communicate such information. That, in turn, was suggested a matter of weeks after the Administration was entitled by 1996’s Kennedy-Kassebaum legislation to institute proceedings for the establishment of a National Health ID card, i.e., a national, governmental database of all health care records.
The sum total of these policies is: private health care professionals cannot be trusted with ensuring patient safety, and they do not communicate effectively–nor should they be allowed to. Conclusion: the only way to ensure patient safety and patient privacy is total government control of the health care system.
This horrendous package deal reeks of subterfuge and conspiracy, but this is neither necessary nor even remotely probable. The coincidence of these goals is due not to a conspiracy, but to a political philosophy which leads openly to these policies, without all the difficulties of concealing a Machiavellian scheme.
That philosophy is statism, the idea that has motivated every significant change in health care policy for the last four decades. It is the notion that our lives belong to the state, that individuals have neither the capacity nor the moral authority to look after themselves, and that it is the state’s duty to do it for us. What this philosophy creates is the gulags of Soviet Russia, the concentration camps of NAZI Germany, and the political prisons of China. In health care, the result is not patient privacy or patient safety, but the drunken incompetence of Soviet physicians, and the operating table of Joseph Mengele.
The deeper evil, one that has plagued health care–and America–for much longer, is the philosophy of altruism, the idea that we must all sacrifice for the sake of the needy; that doctors and the able must surrender their time, money and expertise for those who could not hope to equal their achievement. When the only acceptable motive for any action is “the good of the needy,” there is no incentive to improve the quality of your own work.
The answer to the alleged carelessness by American health care professionals–and all the problems with today’s system–is capitalism and self-interest: the profit motive. Not today’s mixed economy, but a fully deregulated, private, for-profit health care industry. In such a system, not only would health care professionals truly have to compete with each other according to merit, i.e., their care and success in treating patients, but private companies would exist to report on these professionals. Their reputation and financial success in turn would be determined by their accuracy, and the ultimate arbiter of both physicians and reporters would be the individual patients who used them.
The essence of the NAS report and the media coverage is propaganda. By demonizing the good name of health care professionals with unanswerable charges, the NAS is blaming alleged problems of the current system on a free market and commercial interests, and advancing the cause of a centralized, socialist health care system.
Americans for Free Choice in Medicine (AFCM) is a national non-profit, non-partisan educational organization. AFCM promotes the philosophy of individual rights, personal responsibility and free market economics in the health care industry. AFCM advocates a full, free market health care system by promoting medical savings accounts (MSAs), tax equity for the individual, and AFCM teaches the history of HMOs, which were instituted by a long, incremental process of government intervention.
