In 2003, Newt Gingrich wrote Saving Lives & Saving Money: Transforming Health and Healthcare. It does offer some “free market” solutions. But doctors are apparently free only as long as they do what Newt thinks they should.

The backup plan is: “When all else fails, mandate.” Specifically, physicians who “insist on doing it the old way…should simply not be allowed to practice medicine.” As far as I know, even Obama doesn’t go this far.

In developing his plans and strategies, the CHT boasts a lot of allies: along with top leaders in federal and state governments, it includes “key corporations, top hospitals, disease advocacy groups, professional and industry associations, and leading research institutions.” Many if not all of them probably endorsed the Patient Protection and Affordable Care Act (“ObamaCare”).

Newt has embraced the key fallacy that “the number of uninsured in America is a threat to our civilization.” He thinks that medical errors are “morally unacceptable,” and that they could somehow be prevented by forcing everybody to use the health information technology that his supporters, just coincidentally, happen to sell. He speaks favorably of outgoing CMS director Donald Berwick, an avowed admirer of the British National Health Service’s rationing system. He is convinced that “disease management programs” can” dramatically improve outcomes.”

Apparently, what Newt thinks we need to do is to get all medical care paid for (or denied) by approved third parties and all health information into a form that permits monitoring and surveillance. Cost escalation because of third-party payment; difficulty defining what a “medical error” is in the absence of an infallible judge; potentially deadly outcomes related to software flaws; absence of evidence that existing disease management and other schemes either save money or improve health—none of these are problems for a big-idea man like Newt.

Newt avoids obvious gaffes like accusing doctors of taking out tonsils or cutting off legs just to make more money. He sticks to generalities such as the need to “drag the medical system into the 21^st century.” That system provides miraculous imaging technology and marvelous advances in noninvasive surgical techniques, but falls down on having information on your every sniffle accessible to the System.

Although he has no apparent qualifications in medicine or science, he seems to think all doctors could benefit from government supervision, and he freely offers his own health advice. For example, you should vote for zoning changes that encourage walking, and wash dishes with your nondominant hand.

The Gingrich “transformation” doesn’t look all that different from Obama’s to me—either in concept or in the cheerleaders it appeals to. Based on the tone of the book, the two men also don’t seem to be that different in level of self esteem, condescending attitude, or tendency to sermonize.

In my review of the book for the Journal of the American Medical Association on Jan 14, 2004,  I wrote that “this book is primarily useful as a guide to the mind of Newt Gingrich.” It also showed his political ambitions, featuring 14 pages of photographs of himself with dignitaries, babies, and constituents.

Perhaps Newt has been converted from his dedication to top-down central planning for American medicine, and really would repeal ObamaCare without “replacing” it with something very similar. He should know that before absolution comes confession and repentance. So far, I haven’t heard a disavowal of this book.

Michelle Obama may deplore playground name-calling, humiliation, and taunting. But she says nothing about powerful administrators wrecking the careers of our most promising students and distinguished professors, by actions and not just words?

Here’s the background: In one of the most astonishing races in the 2010 election, renowned scientist Arthur Robinson took on 12-term progressive incumbent Peter DeFazio for his congressional seat in Oregon’s District 4. DeFazio won the 2008 election with 82% of the vote. When the polls showed Robinson coming very close to winning, DeFazio unleashed a last-minute smear campaign.

That much is not unexpected. Americans have gotten used to vicious lies by politicians. Character assassination seems to be protected political speech.

But on November 4, after the election results were known, another campaign took off: against the three younger Robinson children, who are working toward their Ph.D. degrees in nuclear engineering at Oregon State University (OSU). The stellar academic records of all six home-schooled Robinsons (a Ph.D. in chemistry from Caltech, two veterinary medicine doctorates from Iowa State, and undergraduate degrees in chemistry or mathematics for the younger Robinsons) were an embarrassment for DeFazio, who is strongly supported by public education unions.

The twins, Joshua and Bethany, have nearly finished work that would qualify them for a Ph.D. at any normal university. They are highly regarded by the scientists and engineers who have worked with them. They continued to work hard, while noticing some oddities—that made sense when Professor Jack Higginbotham alerted them to plans hatched in closed-door departmental meetings. Political ideologues in control of the department had decided that Joshua and Bethany, and if possible their younger brother Matthew, would not be allowed to complete their degrees at OSU.

Getting good grades, following all the rules, working hard—and achieving mastery of a difficult, important field in which few Americans can qualify—are not enough, if your name is Robinson.

The Robinsons tried to work with university procedures. Things looked better when Joshua passed his oral qualifying examination with flying colors, despite apparent attempts to rig the process against him. But the university attacked Professor Higginbotham, in an effort to ruin his distinguished career. That serves as an example to the rest of the department, lest anyone might be inclined to help a Robinson. Higginbotham’s staff and students, including Matthew Robinson, will be collateral damage in this scorched-earth campaign.

Last week Joshua was denied entry to the facility where he needs to do his work, which was continuing under the direction of his former advisor, who is now at a different university (www.oregonstateoutrage.com).  Is there something wrong with his work? The university declines to tell Joshua. And it is evidently good enough to be seized by the husband of the department chair, to advance his own career (he is now just an instructor) and that of two other graduate students. Joshua has been told he will get no credit, even though he designed and built the apparatus.

Art Robinson went public, and OSU has received thousands of phone calls, letters, and emails, protesting the university’s actions. The response: stonewalling. OSU spokesman Todd Simmons invokes federal law against discussing student records, although Joshua signed a waiver. In any event, the issue is the university’s actions, not the students’ records.

Is the university violating its own procedures? Is it seizing and plagiarizing Joshua’s and Bethany’s work for its own benefit, in violation of basic academic ethics? Is it acting under the direction of the Democrat political machine? (Note that DeFazio, a life-long opponent of nuclear energy, got an exclusive VIP tour of the nuclear engineering department during the campaign.) Did it violate federal law during the congressional campaign? Are departmental policies tainted by nepotism and other conflicts of interest? Does the department use double standards in evaluating students, perhaps tolerating cheating by favored students? Are the Robinsons perhaps in an unusual position of knowing too much about departmental corruption, and being able to speak about it without implicating themselves because they did not participate in it? If so, it would be very convenient to get rid of them and discredit them in the process.

The university administration apparently believes it can get away with violating its own rules as well as civility, human decency, academic ethics, and perhaps even federal law. After all, the taxpayers will pay its legal fees and any damages in the event of litigation. It is also willing to risk its reputation and academic standing. Why?

Maybe Arthur Robinson is a bigger threat. He came too close to unseating Peter DeFazio, who brags about helping to bring in $27 million in federal earmarks. Robinson has already announced his candidacy for 2012. And there’s more: OSU brings in lots of grant money to “find” evidence for human-caused climate change. Art Robinson distributed the petition, signed by 31,000 American scientists, that explodes the myth of consensus about the catastrophic climatic effects of atmospheric carbon dioxide (www.petitionproject.org).

The President’s Commission on the Status of Women announced concerns about bullying at a January meeting at OSU. None of the involved officials have been interested in helping the Robinsons, however. For one thing, they are not members of a “suspect class” (those considered vulnerable to discrimination, e.g. gays or minorities).

Freedom-loving Americans had better take notice. In totalitarian states, one of the Party’s most devastating tactics to maintain its grip on power is to threaten the families of dissidents. Such horrors develop in small incremental steps, as the regime learns what people will tolerate, and gets them used to atrocities in small doses. Your children could be next.

What kind of emergency is that?

It’s not a healthcare emergency. It’s what might be called a Madoff emergency.

Whether starry-eyed utopians or cynical malefactors, the unnamed, possibly unnameable they have high ambitions for Washington to achieve their objectives. The stars are aligned for their coup d’etat, but there is one little problem: the country is out of money.

This problem threatens to stop not only their agenda, but the whole game. Washington has 2 million employees on the payroll, earning on average twice as much as those in the private sector. And probably more than a hundred million dependents—recipients of Social Security, Medicare, Medicaid, and grants and subsidies of all types. What happens if the checks stop coming?

David Brooks spilled a key insight in the New York Times: he noted that health care has become the “bank” out of which President Obama plans to fund the bulk of his agenda. “By squeezing inefficiencies out of the health care system, he could have his New Deal and also restore the nation to long-term fiscal balance.”

But most politicians and commentators appear to be in deep denial. The country has accumulated unpayable debts—not to mention future unfunded liabilities—that threaten its survival even without any new entitlements.

To keep the music going a while longer, Washington needs to suck what remains of private capital into its coffers. Healthcare is one of the few remaining healthy industries. And it is something on which human beings voluntarily spend their last dime.

While overall employment has been falling, healthcare employment has been growing. As Richard A. Cooper, M.D., former dean of the Medical College of Wisconsin, pointed out, without the 2.8 million jobs added in the healthcare sector in the past decade, unemployment last April would have been 10.5% rather than 8.5%.

Washington needs to bleed American medicine, in order to transfuse the federal government.

To do this, it needs mandated premiums and taxes, and increased control. The degree of micromanagement is reflected by the occurrence of the word “Secretary” 2,489 times in the House bill, and 2,500 times in the Senate bill.

To buy just enough votes to pass a monstrous bill, the Democrat leadership has been willing to promise whatever it takes: indefinite Medicaid subsidies, abortion rights, abortion restrictions, “mental health parity,” a “doc fix,” a continued ban on drug reimportation, and probably lots of other things that haven’t come to light.

None of these have anything to do with the heart of the bill: forced purchase of “insurance,” and a massive transfer of power to executive agencies.

And if an all-powerful executive breaks a promise, what are you really going to do about it?

A government that is already beginning to default on Social Security, by withholding cost of living increases, can’t be trusted with lesser obligations either.

So what’s the point of delaying the day of reckoning? Current officeholders might hope to be out of power, with a fat pension. But then, maybe they won’t be.

How will a population reduced to penury, dependent on government for the means of survival, bring about a regime change? No money to fund political opponents, no time to think of anything but providing for minimal food and warmth, no freedom to protest without fear of loss of eligibility for ration coupons—likely not even any pitchforks or a bus to get to Capitol Hill.

The battle for freedom in medicine is the battle for freedom.

Yet some people I know, even doctors, do not want to buy health insurance.

And I know of at least one person who was very lucky to have had hers cancelled.

Here’s her story. She told an acquaintance, who happened to be a physician, about her eye symptoms. “Wouldn’t you know! I lost my insurance a couple months ago, and now this!”

The physician happened to have an ophthalmoscope in her truck, and took a look in the patient’s eye. Then she called a retinal surgery practice and told the receptionist the patient’s history, and the results of the limited examination she could do. She thought the patient might have a detached retina.

The receptionist asked what type of insurance the patient had and was told she had none.

“Oh, self pay,” the receptionist said.

The technician said to send her over. “And by the way, ask her not to eat or drink anything in case she needs an operation.”

The outcome? The patient was seen within a couple hours, diagnosed, and treated immediately. Fortunately, she just had a retinal tear and a lot of blood in her eye. A simple in-office procedure probably prevented a detachment. The bill: $900. She’ll pay it off over time.

“What’s an eye worth?” she asked.

Now, what would have happened if the Medicaid program hadn’t cut her off—because she earns $100/month too much? In that case, she wouldn’t have had to worry about the bill.

But—the receptionist would have had to say: “You’ll need to fax over a referral.”

A Medicaid patient can’t be billed, except for a nominal copayment. Without a referral, Medicaid can’t be billed. So if the specialist, or in this case subspecialist, sees the patient, he cannot be paid. Moreover, he is probably violating a rule and conceivably might be prosecuted for soliciting business (that’s called “fraud”). Discounts and freebies are marketing strategies, after all, and the poor and vulnerable have to be protected.

Not just any doctor can give the patient a referral. This doctor couldn’t. It has to be the patient’s primary care provider, who is contracted with the patient’s plan. And the specialist has to be in the plan too.

Say that a seizure patient needs to see a neurologist promptly to have his medications adjusted. Sorry, the emergency room doctor can’t write the referral. Neither can the hospitalist who is discharging the patient from the hospital. It has to be the “primary.” If the primary happens to know the patient, he might just send the referral. But most of the time, the patient will have to come in. The primary won’t want to risk getting an unnecessary referral or an incident of “inadequate documentation” on his report card.

For a retinal problem, there are probably three hurdles: the primary gatekeeper (who might not even think of the diagnosis), then the general ophthalmologist (who will make the diagnosis but can’t treat it), and finally the subspecialist. All probably have waiting times for appointments, especially for Medicaid patients. Most doctors can’t afford to see very many of those.

Not just Medicaid, but all managed-care plans have a structure like that. It’s part of the cost-containment strategy. I know of three insured patients who had retinal detachments. They all had premonitory symptoms, and they all—eventually—had elaborate and costly operations, as many as six procedures. They were “covered,” and they didn’t get a bill for $900, but they had a poor visual outcome that might have been prevented by prompt treatment.

With “health care reform,” most Americans, aside from politicians, would be stuck in such a system. The new idea is “to change the [fee-for-service] payment model to a system in which doctors and hospitals earn more by keeping patients healthy and out of doctors’ offices and hospitals” [emphasis added].

And we need more primary care providers and fewer specialists, the “experts” say. More people to “coordinate care” and determine eligibility and conduct smoking cessation counseling. Fewer doctors to actually give care or examine eyes.

The system will not prevent retinal detachments, or epilepsy, or leaking aneurysms, or appendicitis, or other conditions that need a doctor with specialized skills. It will just create barriers to direct, timely access to such physicians.

Insurance is supposed to help you pay bills in the rare event of a catastrophe. If it morphs into a scheme for emptying your wallet in advance, and then prevents bills by preventing treatment, we  just might be better off without it.

But we do know some of the critical unforgiving numbers. And we have strong reason to suspect that radical changes to Medicare Part E (as in Medicare for Everybody) is the real endgame, whatever the interim steps are called: public option, cooperatives, or mandated Insurance Exchanges.

We have the unmentionable truth that Medicare is insolvent. And the common dogma that Medicare is efficient, popular, and impregnable. Is it a Hegelian thesis and antithesis? With the synthesis being to throw the whole rest of the system, which is also allegedly bankrupting the country, into Medicare?

Are our leaders stark, raving mad? Or diabolically clever?

The on-the-books public debt is around $12 trillion, and Congress needs to pass still another law to increase the debt limit. The annual deficit is close to, or even exceeds,  40% of expenditures, the point that some call the tipping point for hyperinflation.We’re not going to grow our way out of this, not with GDP already down 25%, compared to 2000, if calculated in euros.

Then there are the unfunded liabilities of Medicare and Social Security, about which former U.S. Comptroller General David Walker has been sounding the alarm for years. Estimates are as high as $100 trillion or more—orders of magnitude greater than any conceivable ability to pay.

So here we have a legal obligation to pay back the $12 trillion we have loaned out, much of it to Chinese, Saudis, and other overseas investors. And the moral obligation, backed by politicians’ full faith and credit, to soon-to-be-retiring Baby Boomers.

The Chinese and the Saudis have the industry and the oil we absolutely need to live. Not to mention the Chinese army, nuclear weapons, and missiles. American seniors have—the vote.

It is incontrovertibly true that seniors, especially of the Baby Boomer generation, have been taxed all their working lives to pay for their medical needs in retirement. Their money has gone—into the “lock box”? Wherever it is, it is in the form of IOUs. Whose IOUs will get paid first?

Americans have been robbed by the Medicare system, just like Bernie Madoff’s investors were, only in vastly greater amounts. And they are just as likely to get their full benefits from Medicare as investors are to get their money back from Madoff’s prison cell.

No politician, however, wants to default openly, not on his own watch. There’s the danger to his career, from a voter revolt. And when voting doesn’t work, and peaceful demonstrations don’t work, people could become very surly indeed—and worse possibilities loom.

So here’s the con: We put everybody into the comprehensively reformed system. We suck in huge amounts of new revenues, not called “taxes” but rather “premiums,” “penalties,” “fees,” “surcharges,” or “shared responsibility payments.” Since the thresholds aren’t indexed for inflation, the “responsibility” to “share” the load for other people’s needs migrates down the social scale as the dollar deteriorates. Remember, also, that current health care proposals envision the government collecting new revenue for several years before full benefits–i.e. costs–kick in. Its health care on a layaway plan. A neat trick to plug some budget holes without admitting it.

Now comes the allocation part. We make everybody dependent on the system: patients for their care, doctors for their livelihood, so everybody is in a cooperative mood. An inspiration from a consummate politician named Bismarck, also implemented by Lenin and Stalin. Is there any other way than promising “universal care” that politicians could get away with cutting hundreds of billions from expected Medicare expenditures?

We let politicians off the hook by delegating the key decisions to an appointed Federal Reserve-like agency.

We set up a “fair,” “evidence-based” system, with the apparently laudable goal of improving the overall health of society. No discrimination of course—“disparities” are to be eliminated.

Remember, however, that age discrimination is not “invidious.” Every 60-year-old was once 20. The “complete lives system” (a.k.a. “Reaper Curve”) favored by Ezekiel Emanuel is by this logic completely fair.

Here is what it means: people over age 65 would get 3.4 times less care than a 50-year-old. At present, however, spending on people over age 65 is about 3.1 times higher than for 50-year-olds (Uwe Reinhardt, Health Affairs November/December 2003). Under the Emanuel system, older people would get only about one-tenth as much care as they do now [1/(3.4 x 3.1)].

The elderly would not all be cut off at once. They would simply be placed in an overloaded boat with everybody else, with lower-priority people pitched overboard—one at a time.

No death panel is needed. The system simply ratchets down doctors’ pay to the minimum they will tolerate, then punishes those on the top end of the spending curve. It will know who they are because of intense electronic monitoring of everything. Rational rationing—“equitable redistribution”—will occur.

Key words include “universal” and “consensus.” With “everybody in, nobody out,” social hydraulics will occur. Pull one lever at the top, and everybody beneath it is complicit in the “hard” decisions.

Default? No, no. Just a change.