The Dumbed-Down Doctor

For a long time since I quit my job as a Sacramento surgeon in 2004, I have pondered Ronald Reagan’s remarkable prophecy from 1961 when he said, “One of the traditional methods of imposing statism or socialism on a people has been by way of medicine.”

Reagan did well at predicting where we would be today. However, having lived and worked through the overt development of “managed care” which began about 1989 just after his second term as president, I can speak to you as an experienced physician and fill in a few blanks.  

As part of the 1989 Omnibus Budget Reconciliation Act (OBRA) at the federal level, the Medicare RBRVS payment system was created. It was signed into law by George H.W. Bush.  To put it bluntly, private practice medicine became “price fixed” and  was changed into corrupt government run healthcare. And it has been ever since.  

In about 1992, I and all other physicians noted a profound drop in the reimbursement rate from Medicare, when the 1989 law took effect. And all the “private insurances” fairly rapidly followed suit.  This payment system has reimbursed physicians less and less over the past 30 years, the exact opposite direction demanded by inflation!  I don’t think Reagan would have put up with that. I sure didn’t. It’s a horrible way to try and make a living.  It also induces full blown burnout and bitterness in the doctor along with resentment and aversion to government policy.

Regarding Reagan’s 1961 prediction of how medicine can be a catalyst for the development of communism in a country already experiencing a free enterprise economic system, he also correctly defined the causative agent as being the doctor.

Here is a little of what he said:

“Let’s look at the freedom the doctor loses.  A doctor would be reluctant to say this. Well, like you, I am only a patient, so I can say it in his behalf. The doctor begins to lose freedoms, it’s like telling a lie, and one leads to another. (Author’s note: This means a doctor gives up his or her right and responsibility to lawfully obtain an informed consent from a patient!)  First, you decide the doctor can have so many patients. They are equally divided geographically, so a doctor decides he wants to practice in one town and the government has to say to him he can’t live in that town, they already have enough doctors. You have to go some place else. And from here it is only a short step to dictating where he will go.” 

Both horribly decreased physician reimbursement and controlling the doctors’ movements and choices have contributed to massive burnout, bitterness, numbness, and ineffectiveness in doctors. It’s kind of a Stockholm syndrome, a condition that explains why hostages sometimes develop a psychological bond with their captors.  

Doctors don’t care. They have become slaves of the government. And as such they have become “useful idiots,” a Stalinist term from the cold war.  Doctors are dumbed-down, or intellectually undemanding, and their physical and emotional spirit and drive have suffered greatly. In no way am I referring to their wisdom and God given power of healing. I am simply defining how our wayward government is treating them and abusing them.

Now a doctor who is dumbed-down is a weapon of the government. He does exactly what he’s told to do. She is taught that which the “managers” want her to know, and nothing more. The game plan is to prosper the crooked administrators financially and drive doctors and patients into the poor house. And the process is much, much too expensive. It’s a regulatory nightmare.

Is there a place for informed consent  in the actions of such a doctor? No.  They order the doctor not to explain the rationale, risk, and alternatives to the patient. The doctor becomes a bitter, lazy blob who desires to be around a patient as little as possible.

What options do patients have in such a system?  None.  Patients simply rationalize and say, “Well this is the system.  I don’t particularly like it, but I will put up with it.  The only thing that would make me change my mind is if the price were jacked up. Then I would get mad and fight it.” Why do most patients say this? It’s because most of our lives we are healthy, or “invincible” or cocky. Two extremes to this attitude are “the female reproductive rights phase,” as the communists put it, and the phase of  entitled “seniors,” when patients develop cancer and cardiovascular diseases. You could call patients a little dumbed-down or intellectually undemanding as well. Maybe they are useful idiots as are doctors, as the patronizing communist would say.

From my own experience, a physician has tremendous power when talking with and examining a sick, fearful, suffering and pain-filled patient. That patient will readily trust a doctor to alleviate the suffering they are going through. If the doctor is sick, the patient doesn’t have as much of a chance to get well as if the doctor were standalone from the government and thus healthy. 

In a communist regime, both doctor and patient become useful idiots, easily controlled by the tyrants. Both are captives and both eventually contract the Stockholm syndrome. The dumbed-down doctor begets the dumbed-down patient, and the lives, health, and welfare of both are doomed.

The good news? The process of “smarting-up” of both doctor and patient is readily available, a state in which both are free.