The importance of medical privacy

I'm republishing a report on a health care town meeting in Rochester, Minnesota, May 7, 1994, which included this statement on medical privacy. Over the years I have frequently recounted Dr. Henderson's point,

The final speaker, Dr. Ed Henderson, retired from Mayo Clinic, and presently the executive director of the Zumbro Valley Medical Society and Emeritus Professor of Orthopedic Surgery in the Mayo Medical School, began with appreciation for being included at this event. He expressed his belief that physicians have been deliberately left out of the debate. The important facet of health care disregarded as a result has been the physician-patient relationship, the direct contact between doctor and patient that serves as a basis for care. The patient must see his doctor as his advocate, making sure that decisions are made that will ensure that patient will get the best treatment. Trust is critical. The confidentiality of their conversation is necessary for a proper diagnosis and treatment. I asked Dr. Henderson if he was aware of any organization taking a strong stand on the principle of medical privacy. He was aware of not one such group.

Shall we trust Clinton? Why not trust ourselves?

Casey Bowman, Minnesota Libertarian, June 1994, p. 7

Here's the rest of the report, which preceded the two paragraphs above,

Health Care Reform Meeting
by Casey Bowman

On May 7, the American Legislative Exchange Council (ALEC) sponsored their second Meeting on Health Care Reform. Before the meeting began, MN State Representative Gil Gutknecht, who chaired the host committee and introduced the speakers at this event, came up to us members of the LPM and talked with us in a manner of mutual respect. ALEC organizers gave us permission to put our "Project Health Choice" literature describing the National Libertarian Party health care proposal at the welcome desk. ALEC was true to its own words "empowering citizens in the health care debate."

The speakers in attendance were Congressman John Linder from Georgia, Wendell Cox of ALEC, Carl Parks from Citizens for a Sound Economy, Congressman Rod Grams, and Dr. Ed Henderson, Emeritus Professor of Surgery at the Mayo Medical School.

Congressman Linder attributed to Disraeli a sequence such as, "Bondage... Faith... Understanding... Courage... Liberty... Abundance... Complacency... Dependency... Bondage..." We need to learn from history and rebuild "understanding" before "dependency" sets in. Linder also warned that the Clinton plan intends to control entry into specialist practice.

The next speaker, Wendell Cox, warned against the coming rationing by waiting in line, by age, and/or by whom you know. He mentioned the "equality of poverty" experienced in the USSR, to which I might add it was an "equality of the graveyard" for millions.

Carl Parks, of Citizens for a Sound Economy, a group founded ten years ago at George Mason University with 250,000 current members, started by explaining that the term "universal coverage" is fine rhetoric, but what it means for everyone is a system like that provided to the veterans in VA hospitals. Parks felt the government is currently pushing the Gulf War Syndrome under the rug because they do not want to spend the money correcting the problem.

The speakers pointed out that the debate in Congress is not fair and the vote will not be either. Medical Savings Accounts have strong bi-partisan support and would be in the fore if Clinton had not been elected. The problem is the committee power hierarchy. For example, Senator Dingell is chair of some important committee. In exchange for the votes of four southern oil state members, he promises his support on oil import fees. Let us hope that Congressman Linder, who serves on the Committee on Committees, will work on the reform of committees. If the Republicans fail to reform the inequality in Congress among those elected to the same office, the Libertarians must address this issue vociferously. It is crucial.

Many in attendance believed that the Clinton plan was only a temporary stop on the way to a single-payer plan. That is, the socialization of medical care will necessarily follow the socialization of health care insurance. Representative Gil Gutkneckt reported that our own state Senator Linda Berglin is advocating MinnCare as a temporary plan that will lead our state down the road to a single-payer system.

The final speaker, Dr. Ed Henderson...

This article was originally published in The Minnesota Libertarian, June 1994, pp 5, 7. The author and the original publication are due attribution.

The first two questions

Out of purely historical interest—were it only so—, here are the first two questions at the "town hall meeting" hosted by KSTP in the Twin Cities on April 8, 1994.

Mr. Rob Horner [from St. Paul]: Hi. Welcome to Minnesota. It's indeed an honor. I'd like to talk philosophically. The philosophical basis for universal health coverage. I'll go first. Then I'd like to hear your philosophical arguments in support. I've got an interest in the ethics of redistribution. I firmly believe that the redistributionist policy undermines the basic sense of personal responsibility by transferring authority for decisions, crucial life decisions, from individuals to the state. When a do-everything government assumes control over a person's most personal responsibilities, we lose faith in our capacity to make our own decisions. And we've seen the deleterious effects of dependency upon an institution such as...

KSTP: Go ahead and ask your question.

Mr. Horner: OK, my question is: Is your plan really a health plan or is it a power grab? I'd like the philosophical arguments in support of your plan. I do not want to hear compassion. I want something more concrete.

President Bill Clinton: Compassion is part of my philosophy. But anyway.. Philosophically, I don't believe the government can solve all the problems for people and I don't think you should rob people of their personal responsibilities or their personal choice. That's why I don't have a government-run plan. It's private insurance, and people who don't have insurance have the responsibility to provide it themselves. But I believe philosophically it is wrong for people not to assume responsibilities for themselves and let other people do it. And what's happening today—let me just give you two examples. Self-employed person X decides, "Well, I"m not going to have any insurance." Then they get in a wreck. They show up in the emergency room. They can't pay. They could have had insurance, but they didn't do it. That's fine for them. Except they get the care. Nobody lets them die, and nobody thinks they should, and then the rest of us pay for it, and that is irresponsible. Another example: Restaurant X and restaurant Y next together. One covers employees. The other doesn't. One is fulfilling a responsibility not only to himself and the employees, but to the rest of society by not asking us to bear the risk of anybody getting sick. The other isn't. The other has a competitive advantage in business. I don't think that's right, and the system we have is not an individual responsibility system. It's an irresponsibility system. I don't plan to take over the health care system. I don't want the government to run it. I think the government should help to organize the markets so that small business people and self-employed people can afford to have insurance, and so that they're not disadvantaged as compared with big business and government, and I think it is irresponsible for people not to provide for their own health care and irresponsible for the government not to make it possible for people to do it no matter what their station in life.

KSTP: Mr. President, Angela has your next question on the other side of the room.

KSTP: Mr. President, this is Shirley Kaiser. She's a school principal from St. Paul, and she's concerned about losing certain benefits. Shirley...

Ms. Shirley Kaiser: Good evening, President Clinton. I have been real concerned about the health policy. I followed it along since your beginning presidency. I wondered about your and Hillary's true concerns, if this is... I've been concerned that it might be a political issue with you, and I wondered how it will affect all Americans.

Will we really receive better service? I wondered, like people who have insurance, will we have to pay more. Will we get less then? Will we have less choice of doctors, less choice of hospitals? Will the doctors have less choice of the services that they could provide? Will we have more government debt? Will we have more taxes? I'm wondering if your program is about controlling rather than better service. And I realize that we in Minnesota are ahead of many states, but I do have real concerns.

President Clinton: Well, let me try to answer two or three of those questions. You asked ten at once, so, hah.. I, uh,.. The only real tax we have in this plan.. We have to raise funds to pay for the unemployed uninsured, which we're all paying for anyway, folks. When they get sick, they wait till it's too late, it's too expensive. They show up in the emergency room, and we pay. Under our plan, we would raise a fund to pay for them and to pay for the discounts on small business from two sources: one, a tax on cigarettes, and the other, a modest assessment on the biggest American companies that will get the biggest windfall from this. That is, most big companies are paying way too much in insurance now to subsidize the rest of us. They'll get a windfall. We ask for a portion of that back to create a fund for discounts for small business and for the unemployed uninsured. There will be more choice under our plan. This idea that every American today has a choice of doctors is a myth. More than half the American people who are insured in the workplace today don't have a choice. They get one plan, and that's it. Ninety percent of the American people who're insured in small businesses with twenty-five or fewer employees have no choice. Under our plan, there well be more choices. That's why so.. one of the reasons why so many medical groups have endorsed this plan. Not just the nurses, but the family practitioners, the pediatricians, any number of other medical groups have endorsed our plan because they know it guarantees more choice. Now, if you have a plan today that is better than the one in our bill, you can keep it. In other words, if you have a plan today where your employer pays one hundred percent of your health insurance, not eighty percent, and you continue to do that, that's perfectly alright. We don't change that at all.

Ms. Kaiser: [Barely audible (It won't cost me more if)] ... it's an individual when you go for universal coverage? If I were to have a policy isn't it true that it will cost people that now pay for insurance more?

President Clinton: No, if you don't pay your.. If your employer pays all of your insurance now..

Ms. Kaiser: They don't pay for all of my insurance. I..

President Clinton: Well..

Ms. Kaiser: .. carry family coverage..

President Clinton: .. the question is whether it will cost you more...

Ms. Kaiser: [inaudible, still speaking]

President Clinton: It depends on a lot of factors. In all probability you won't. All the.. Not our studies but all the non-partisan studies that have been done show that more than half the people will get the same or better insurance for the same or lower cost. By and large, the people who will pay more are people who aren't paying anything now, people who have only very bare-bones coverage, and young single workers will pay more so that older people can pay less and we can have a large community rating. Otherwise, most other people will pay the same or less. But if you have a better plan than we require, what this does is to put a floor under you.

[increasingly flustered...]

We've got—keep in mind—I mean, I don't know where.. You know.. I understand.. I saw all those ads putting out all that propaganda. This is just politics. This is just a power play and all that. Tell that to these people who are disabled, who can't get insurance. Tell that to these old people who choose between medicine and food every month. Tell that to the one hundred thousand Americans a month who lose their health insurance. Tell that to the farmer and the small business people who insure at thirty-five percent and forty percent higher rate. I mean.. This is a bunch of hooey.

If people don't agree with me, let them come forward and contest me with their ideas, but I am sick and, I think, a lot of you must be sick of all this hot-air rhetoric in all these paid television ads and all these hit jobs for people who are making a killing from the insurance business that we have today. It is wrong, and we should change it.

KSPT: Mr. President..

President Clinton: I don't.. Let me just say something. I don't go around.. First two questions.. I don't.. I don't.. I mean, I don't mind doing this. I'll do this all night, but it never..

One of the things I've learned in twenty years of public life is you don't get very far questioning other people's motives. Most people I've met.. Contrary to what you read, most of the people I've met in public life are honest, well-meaning. They're not crooks. They're trying to do the right thing. We have differences of opinion. But this health care debate in my judgement has really been retarded, in more ways than one, by all this motive-throwing-around we've had. You know, if I hadn't wanted to take on a tough issue, I could have found something else to do with my time. I believe we have to do this, and if we don't do it, you're going to have more people without insurance, more people who can't afford what they got and a terrible situation in this country, and that's why I did it. That doesn't mean I'm right, but let's argue about what should or shouldn't be done, and not talk about other people's motives. I've even tried to convince the insurance industry I don't want to attack their motives. I just want us to argue about what we should do.

Transcribed by Casey Bowman (1994)

Is universal coverage really a power grab? Is it about controlling?

I wrote a letter to the Minnesota Libertarian, which was published in their June 1994 issue

Now President Clinton is attempting to socialize the health insurance system. Beyond the issue of dependency discussed in the last newsletter, there is another essential point to see: insurance companies invest. Beware of those who would like to control via government where these investments go, whether to their favorite businesses or movements. As one advisor of the Clintons, Mr. Michael Lerner, put it in his book The New Socialist Revolution (a self-described "attempt to explain why the only changes that will make sense in America are those that will move this country to socialism..."): "The rub, as in so many areas, is the absence of money."

I suspect that these "new socialists" are going after our nest eggs. There lies the real power grab.

See - "The Meaning of the Politics of Meaning", Wall St. Journal, p. A15 (Jun 3, 1993). Lerner writes,

Hillary Clinton has been under fierce attack for having advocated a "politics of meaning" and advocating a societal tilt away from selfishness and toward caring and community. According to Paul Gigot on these pages last Friday [May 28], I am Mrs. Clinton's guru in these matters.

It's certainly true that the Clintons and I are on the same wavelength on this issue. But what, exactly, is so frightening about the politics of meaning?

For more and perhaps an answer to Lerner's question, and the "first two questions", read - Michael P. Lerner (1971) The New Socialist Revolution: An Introduction to its Theory and Strategy. Lerner writes,

This book is an attempt to explain why the only changes that will make sense in America are those that will move this country to socialism... (p. xi)

The collapse of the American economy ... would create international havoc and thus the conditions for significant struggle in all of the advanced industrial societies, where revolutionary forces would find it easy to seize the moment.... (p. 275)

There is every good reason to think that a revolution will not occur in this country before fifteen or twenty years, and it may be as far as thirty years away. (p. 276)

Probably one of the first actions of a socialist government would be to make free such essential services as health care.... (p. 310)

The rulers must come to understand that if there is to be a sea of blood, it will be made of their blood as well. The one thing that can make the American [socialist] revolution less violent is the clear and public determination of a majority of people to defend that revolution with violence. (p. 279)

The pleasant gentleman on the Long Island Railroad reading his Wall Street Journal or the quiet technician working in Palo Alto or on Route 128 in Massachusetts, the Wall Street banker or the assistant secretary of state or agriculture or defense, the professor of political science who runs the institute on Latin America or the liberal senator—all participate daily in making decisions that sustain the daily violence upon which this system rests. ... [S]urely the violent men who surround us, with their gentle manners and sweet smiles and well-manicured lawns and all the rest of the petty concealments that hide a life of "honorable" crime, should be tried for their crimes by the peoples of the world. (p. 271)

But what do we want? In a word, "socialism." ... But let us be clear what we mean by "socialism." Socialism is the ownership and control of the means of production, and, through that, the control of all areas of life, by the majority of people who work.... Socialism is radical democracy, democracy extended to every area of our collective lives. (p. 287)

On the classical republican theory of government

In classical republican theory, government was to be a mixture of forms: the one, the few, and the many, each balancing the two others. In our Constitution, this mixture may be found, for example, in the offices of the President, the Senate, and the House of Representatives. We, the people, fill each office in democratic elections, but the natures of these offices differ, being leadership-oriented, principle-oriented, and poll-oriented, respectively. Ideally the House of Representatives ought to reflect closely the wishes of the people between elections. Thomas Jefferson spoke of two requirements for just lawmaking: majority will and respect for the equal natural rights of the minority. I believe that Representatives should, as delegates, reflect the will of their constituents and that Senators should, as trustees, focus on whether or not a bill respects the natural rights of all. As a little-d democrat little-r republican, I believe ... that the American people ought to be able to stand in the way of any legislation whatsoever, especially through what should be the most democratic branch of our republic, the House of Representatives. I also believe that small-l libertarians ... ought to be elected to the Senate so as to prevent oppressive legislation, standing up for those great general interests—the Declaration and the Constitution.

Casey Bowman (1994)

This is an example of the noise we in the Libertarian Party of Minnesota made in 1994 in the debate over health care. In my last post, I mentioned how noisy we had been. I wanted to give an example.

Here's a reprint of the full article -

Life, Liberty, and the Pursuit of Health

[W]e both ... love [the people] with parental affection. But you love them as infants whom you are afraid to trust without nurses; and I as adults whom I freely leave to self-government.

Thomas Jefferson (1816)

by Casey Bowman

On July 6, members of the Libertarian Party of Minnesota attended a town hall meeting on health care legislation, hosted by Wes Minter and broadcast live on WCCO radio (830 AM). Responding to questions from the audience and callers were four panelists: Congressman Rod Grams, Senator Paul Wellstone, Dr. John Goodman (co-author of Patient Power), and Ms. Lois Quam (Clinton task force member).

Minter began the show by citing a quote in that morning's Wall St. Journal, made by Senator Jay Rockefeller on April 18: "We're going to push through health care reform regardless of the views of the American people." Indeed, some big-D Democrats have now become little-a anti-democrats. In a defense of his statement in a letter to the Wall St. Journal, July 21, Rockefeller went on: "My point has been that the half-truths and hysteria turned out by special-interest groups may have confused the public on some of the details of reform...." So Rockefeller was not blaming the people, only special interest groups. "... [R]eprehensible are those who sow such confusion and uncertainty," he wrote.

A full response I dared not broach live on the Wes Minter Show, but I shall now. In classical republican theory, government was to be a mixture of forms: the one, the few, and the many, each balancing the two others. In our Constitution, this mixture may be found, for example, in the offices of the President, the Senate, and the House of Representatives. We, the people, fill each office in democratic elections, but the natures of these offices differ, being leadership-oriented, principle-oriented, and poll-oriented, respectively. Ideally the House of Representatives ought to reflect closely the wishes of the people between elections. Thomas Jefferson spoke of two requirements for just lawmaking: majority will and respect for the equal natural rights of the minority. I believe that Representatives should, as delegates, reflect the will of their constituents and that Senators should, as trustees, focus on whether or not a bill respects the natural rights of all. As a little-d democrat little-r republican, I believe, in contrast to Rockefeller, that the American people ought to be able to stand in the way of any legislation whatsoever, especially through what should be the most democratic branch of our republic, the House of Representatives. I also believe that small-l libertarians (hopefully some big-L ones, too) ought to be elected to the Senate so as to prevent oppressive legislation, standing up for those great general interests—the Declaration and the Constitution.

Other Libertarian Party members were vocal. Charles Test read aloud a quote from the Minnesota State Department of Health, which had been cited in the Minneapolis Star Tribune that morning: "The emphasis in medical savings accounts on individual autonomy and personal economic gain ... is largely incompatible with the policy goals of universal health coverage and managed care." Reflecting on this, Test asked, "Aren't individual autonomy and personal economic gain basic principles that America was built upon?"

Later Test quoted the Ninth Amendment to the United States Constitution: "The enumeration in the Constitution, of certain rights, shall not be construed to deny or disparage others retained by the people." This amendment affirms that the Constitution must respect the natural rights touched on by the Declaration of Independence that we, as individuals, retain.

Wes Minter followed up on Test's note of the Ninth Amendment by asking him how the founders might view the current policy debate. Test said they are all probably rolling in their graves. Minter asked which founders we Libertarians revere, Franklin, Jefferson? Test continued with a full list of founders, on up to Dolly Madison.

LPM member Evan Williams asked Dr. Goodman if it were true that 5% of Canadians are waiting for some medical procedure. Dr. Goodman responded by saying that 177,000 persons there are waiting for important surgery. Adding those waiting for non-life-saving surgeries, the total becomes one million, which all agreed was indeed about 5%.

Sen. Wellstone, at one point, claimed that a single-payer system would give people more choice rather than less choice. In reaction to one such remark, there was tumult in the audience. I remember, as one of the restless natives, crying out something about how part of the health care system closed down in Canada for a period. Wes Minter clearly enjoyed the enthusiasm exhibited by his audience. Wellstone also demanded that insurance companies never be allowed to deny anyone coverage, a remark in sync with Hillary Rodham Clinton's latest surreal lament on a morning show comparing insurance companies to car dealers who charge different prices for different cars and so restrict our choices.

In a parting shot at Rockefeller's remarks on special interests, I shall quote from an article written by the secretary and treasurer of the Arizona chapter of the Association of American Physicians and Surgeons, Mr. Richard Fisher ("Behind the Task-Force Veil", Liberty, July 1994):

In February 1993, the Association of American Physicians and Surgeons filed suit under the Federal Advisory Committee Act ... to force the Clinton administration to reveal the task force's composition. In November, the admin[i]stration was ordered to comply. The documents thus made public suggest a very different picture of the task force than the White House has presented....

Among the special interests represented were United Health Care Corporation, Chicago Health Maintenance Organization, Aetna, Travelers, Liberty Mutual Insurance, Wausau Insurance Company, National Capital Preferred Providers Organization, Harvard Community Health Plan, Kaiser Permanente, U.S. Health Care, EDS Health Care, PCS Health Systems, First Health, Blue Cross/Blue Shield, and Alliant Health Systems....

One corporation represented on the task force was MCI Communications—the likely primary vendor for the 250 million cards Clinton's plan would require. Potential contractors for other parts of the Clinton plan were also amply represented, including the Rand Corporation, Alpha Center, Telesis, Cooper & Lybrand, Price Waterhouse, and the Principal Financial Group....

It is plain that ... Lois Qualm, vice president of United Health Care Organization, [and others] have conflicts of interest in helping formulate federal health-care policy. Yet these officials and executives of major managed-care concerns played significant task-force roles without obtaining waivers for conflicts of interest, despite the requirements of the law. ...

Rather than admit to the prominent participation of special interests in the formulating its health-care proposals, the White House chose the path of secrecy and closed doors. In doing so, it trampled on the law.

This article was originally published in The Minnesota Libertarian (State Fair edition) August 1994. The author and the original publication are due attribution.