Wednesday, September 10, 2008

Dumb Is Good

It isn’t something your elected representative will talk about. You won’t find it mentioned in the campaigns for change. The democrats, republicans, and independents all would rather not talk about it. It’s universally a non-item. No, we’re not talking about torture in the United States - they talk about that some. And we’re not talking about how Americans lock up more citizens than any other industrialized nation. Election rigging, religion as government, mobster - canning the wife and family of ambassadors - that’s all part of what they do talk about. But there’s one thing, a dirty little secret, that they really don’t like you knowing about.
In 1996 California pioneered the “US Constitution Freedom of Choice Waiver”, a cute little piece of legislation that makes it possible for the government to control where MediCaid patients go for care. That place is the county of residence. When the county government took over the care of the indigent in California, restricting patients to their “catchment area”, the federal government noticed that it was a violation of freedom to choose your doctor. The experience patients had was they got a piece of mail saying “tell your doctor you are our patient now, and report to your county government for your counseling”. To gain approval with the DHHS this system would have to be better for patients and cost less money, both. Ingenious! The first medical system in the world that did better work while spending less! And with the government now auditing itself, the books look clean as a whistle. Turns out, any Constitutional Freedom of Choice Waiver need only be signed mutually by the president of the United States and the Governor, at the time Bill Clinton and Gray Davis in California. Didn’t know that I bet, did you? And you thought there needed to be a Constitutional Convention.
It was just the beginning. It started as a psychiatry “carve out”, where psychiatric care was separated from all other medical care, done at government facilities, and completely under the auspices of county government authority. A physical exam was no longer a part of psychiatric care. Medical doctors became psychologists with the prescription pad, while psychologists argued with more thrust that they could do just as well. Ruling out disease became a drug screen, something curiously useful to government clinics, a test that is never refused by “insurance“. The patient population is now completely monitored. The medical chart is the property of the government, and everyone makes a “confession” to the “confidential chart”, like what they smoked when they were a kid, and their sexual orientation. On the walls of county clinics hang posters which say you have a right to choose your own doctor (as long as it is one of theirs). The prisons began to fill up with substance abusers, and the patients began to display a paranoid delusion that somehow they were being watched. The professional journals began to report the statistics of substance abuse within the various catchment areas among “schizophrenics“.
But most important, it brought the health care dollar back to the county, where “the buck stops here” (just before it gets to the patient, that is). Huge new facilities and administrations cropped up, and if there was money left over after “patient care” it went straight into the surplus. For the first time in American history medical care became a government business that made profit when care was not provided. It was a big boom for rusty old docs who were languishing in the early 80’s because no patient liked going to the old farts. But the issue of big brother being your mind monitor is subject for a future essay.
So it caught on. The block grant from the feds came to the State, went to County, and didn’t leak out to the indigents, who just ended up costing more money anyway. Pretty soon Freedom of Choice Waivers were everywhere, not just in California, not just in psychiatry. Thirteen years later, the county controls it all, and squeezes out the health care dollar to providers it sees as fit, across specialties and across states, without the nuisance of doctors under some damn Oath.
The result is seen everyday in the papers. Michael Moore made an elegant description of the results in “Sicko”. Patients are dying in the waiting rooms. AIDS is getting called depression and the treatment is an antipsychotic and no physical exam or tests. Every AIDS patient that has no insurance, who gets tired and feels sick, who gets sample packs of antidepressant from the drug company for medical care below the radar of the CDC, saves the county about 50 grand a month. Every death is a budget boom. The money saving insurance company is the county, who is the politician, who is the pharmacy, and who tells the doctor what is proper medical care. They take out doctors who make straight calls. There is no tuberculosis in the USA, and we don’t torture prisoners here. When the USA castrates a prisoner, it is a compassion, doncha know. Many good doctors have chosen as an undeniable matter of conscience to leave the USA, but they would be run out if they were dumb enough to stick around. The USA is no place for old docs who speak their mind.
OK, so lousy medical care, for whatever reason, is no news. And as one prison psychologist said, prisoners go to jail just to get a doctors sometimes. Even Michael Moore pointed out that the prisoners at Guantanamo Bay have better medical care than the average citizen in “Sicko”. And historically the poor have always had lousy access to medicine. As Jesus said, “the poor you have with you always”, so why the beef?
Here’s why. Not only does the issue raise the fact that the president and governor co-signing can sign away any “inalienable” constitutional right (in this case the right to choose your own doctor). But if your right to choose can be taken away with regards to medical care, that could include other future rights. Rights that people will notice missing. Like the right to choose your gynecologist. The right to a doctor who will do an abortion when you get raped. The right to choose your representative. Any other issue that your choice is an active ingredient can be taken from you.
There’s something sinister in both universal health care, and in so called “private” systems when they don’t let you make the fundamental choice of whom your doctor is. Something grossly paternalistic. It pervades the political spectrum, corrupting both major parties. It results from executive order, and is enforced by no less than the powers of the executives in government. Any politician in their right mind knows better than to cross those lines, if you want to survive in politics. And, if you are a good politician, you can go to whatever doctor you want.
Why isn’t freedom to choose an election year topic? Because they don’t want you to know. You’re better off if you just read the poster that guarantees you Freedom of Choice. Don’t ask yourself why you are reading that in a county clinic. Dumb is good in the 21st century USA.
What else don’t they want you to know? More to follow. Thanks for reading!

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