“Edward Annis, MD, spoke eloquently to an empty Garden and to one of the biggest TV audiences of the times.
He explained directly to viewers: “This is not health care insurance … It will put government smack into your hospitals … deciding who gets in, who gets out, what they get, and what they don’t get. … This King-Anderson Bill is a cruel hoax and a delusion. … It will stand between the patient and his doctor. And it will serve as a forerunner of a different system of medicine for all Americans.”
In the late 1990s I asked Dr. Annis what was in the King-Anderson Bill that enabled him to predict in 1962 the insolvency of Medicare and the coming government takeover of healthcare. He replied with a smile, “Cost-plus financing. It was a license to steal.”
Indeed, Medicare ushered in unbridled spending for two decades before approaching insolvency.
But, as predicted by Dr. Annis, the system became insolvent by the early nineties… Hospitals and many providers became addicted to the easy money and abused the system. Why not? Cost-plus meant guaranteed profit.
Faced with Medicare insolvency, the insurance lobby persuaded Hillary Clinton to have secret meetings, without physician input.
Though Hillarycare never became law, the effort brought a sea change. Patients could no longer choose their doctor. Insurance companies now owned the patients. Participation in HMOs rose from 10% to 50%. Your doctor could no longer refer you to the best hospital or consultants if they were “out of network.” The doctor-patient bond had been successfully severed.
Medicare does not mandate who gets into hospitals, but it forces patients to get out by paying for only a limited number of days.
For the past two decades, hospitals have aggressively been buying up medical practices. The goal is to establish accountable care organizations (ACOs). Private practitioners are being elbowed out slowly but surely. General practitioners (GPs) cannot admit a patient to the hospital without “hospitalists” taking over. Hospital surgeons cannot refer to private surgeons, etc. Even the concierge model will be wiped out.
The Medicare approach to ACOs requires three things: 1) electronic medical records, 2) a “Quality Care Protocol,” and 3) a “Protocol for the Elimination of Non-Compliant Physicians.”
This is the ideal rationing system.
The computer will eventually dictate all allowed testing and treatments according to a “quality,” or more likely “cheapest way to do it,” protocol. Providers will ration according to the computer or they will fall into the “protocol for elimination of non-compliant physicians.”
In the new system, no one has a doctor. Doctors have a shift. The doctor you see on the morning shift has absolutely no responsibility for you when his/her shift is over or on a day off. A nurse practitioner takes the patient history and physical, further fractionating care. A system like this requires that all doctors are created equal. They are not.
Politicians and bean counters have never understood healthcare delivery. It was used and abused as a political tool.
No one listened to the warning of Dr. Annis. The AMA is often demonized by historians for opposition to Medicare, but it understood healthcare delivery and the destructive nature of cost-plus financing. I blossomed in the Golden Age of Medicine and bear witness to the fall.