Dr. Ghaly correctly summarizes the state of medicine today in the USA in his essay, “What Happened to the ‘PatientFirst’ and the ‘Do No Harm’ Medical Principles?”

The real reason the changes have happened in medicine and healthcare is related to the centralization of control of HealthCare Services (socialized medicine), which is the most important part of establishing communism or socialistic control over the people. When you control their health care, you control their lives. Once the state gains control of everyone's health care, they control all the people. Next, they take all the guns away to protect bureaucrats and their self-appointed elite leaders from the collective uprising of the people. That is the central reason behind gun control, to put the power over the people in the hands of those who control the socialist system. There is no other argument than that which establishes complete control over each individual than taking away their guns. There rest of the arguments are nonsense. There is abundant evidence that when the people have guns, violence decreases substantially as everyone knows the next person has a gun. Thus, disagreements are resolved non-violently. The elite then gain control of the press and education systems, essentially all the information people receive. Societies and cultures are destroyed as immigrants overwhelm the country with radical beliefs as in the European Community, while socialism erodes its principles from within. Centrally controlled socialism is then established. Just look around and see how much has changed in the ways I have described in your country.

As the US government became involved in medicare, or health care for the aged, in the 1960s under President Lyndon Johnson, it only added health care to social security and pensions offered by the corporations as settlements to communist inspired union disputes. These benefits then became established entitlements. The people believed that the government owed them these entitlement programs as a “right.” These programs now have costs that go way beyond what can be provided as promised by the politicians and political leaders to gain control of the people. Such a result happens, as one would expect, in a system in which all the expenses are paid by a third party, not the user of the services. Under such a system, no one cares about the expenses as someone else is paying the costs. It is “credit card” medicine with the credit card being paid by the government. Really, the people are paying, but they do not realize it. Nevertheless, their health-care services decline, the costs rise, and delays in care occur with a shortage of drugs and testing facilities. Quality and talented people choose other professions that are less regulated than medicine; so, the quality of applicants for medicine decreases. The costs go up as more bureaucrats are involved in the distribution of the money collected by the government for health care.

No centralized system of health care can determine the millions of individual demands in the market place for each patient. This principle is the fundamental failure in the economics of socialism. No bureaucrat can determine what is needed in every location in the USA or a country or town as those factors are determined best by the local market place. This allows each individual physician an opportunity to achieve his/her best in providing health care for the customer, who is the patient.

Since the locally controlled free market system was replaced with centrally controlled socialism, there had to be some way to determine what the doctor is doing for their government pay. So, complex medical records were developed, with forms to be filled out that have little to do with patient care but are used by the bureaucrats to control the doctors. Since the government, which now runs health care, does not know how to distinguish good from bad physicians, they instituted a system of payment in which all are basically paid the same for each operation.

The only way the doctors could make more money was to develop more complicated operations as in the spine surgery, for which their pay was rewarded at a higher level. Thus, the biomedical industry which benefitted from this incentivization to buy equipment supported this system. So, prices got higher for complex spine surgery, and doctors made more money. The evaluation of these products against standard operations and against each other was not done, as it would have destroyed the incomes of the biomedical companies and show that much of the complex surgical equipment is unnecessary. This is a worldwide problem. So, everyone is playing the “system” to gain the most money they can. You can see where this thinking will end with the corruption and eventual destruction of medicine as we know it. The system has failed in Russia, Communist China, most of the Europe, South America, and now is failing in the USA. Free enterprise and free markets have never been fully tried in health care, although the bureaucrats are quick to say that the free market does not work in medicine. Being 80 years of age, I witnessed medicine for 70 years with my father as a physician, and the free market did work as did health care. Doctors gave away much medical care to those who could not afford it at the time, although the costs were never mentioned or recorded.

When the government entered medical care, they took away the doctors’ rights to perform X-rays, lab tests, and distribute drugs in the office; they gave that right to the hospitals. As one can imagine, the hospitals charged more for these services than the doctor. The government eventually gave the hospitals 3% over their costs for doing these tests and taking care of patients. Naturally, the hospitals raised their charges to make more money under the 3% rule. So, prices for care at hospitals climbed to ridiculous levels as one can see if he/she inspects a patient's bill today.

Hospital administrators do not contribute to the health care of patients. Now, they run the hospitals and control the money that is generated by the physicians. Add to that more bureaucrats to run this complex centralized controlled system; this gives you health care today as explained by Dr. Ghaly.

It is doubtful that medicine will return to a free market system. So, what Dr. Ghaly has described is the result of socialisms, not only in medicine but in industry and other parts of our economy. Medical care is headed for a total failure as the costs get higher and the controls over the doctors and the workers by the bureaucrats limit what they can do and how they get paid. Incentive to practice the “best” medicine is lost, because it is not rewarded. The quality of health care is declining as is the education of medical students under an increasingly socialized educational system. This system rewards outcome and does not incentivize each individual to do his/her best. Would it matter if everyone were paid the same in the end? So why work so hard?

In a free-market system, each person is incentivized to do his best for him/herself and family. And yes, some are better than others and deserve more for their creativity. But Karl Marx stated, “From each according to his ability to each according to his needs” as the fundamental principle of socialism. In a socialist society, the successful and rich are supposed to support the others, including the bureaucrats. Socialism is supposed to guarantee equal outcomes for all, which never occurs because of the inevitable corruption of the bureaucrats who control the socialistic system (e.g., taking the peoples’ money, leaving little for those in need). Socialism will fail as we see Venezuela, the USSR, Communist China, and other authoritarian forms of government in Europe and the USA. Health care will also fail as is seen in those countries.

So, I am sad to say that this is your future in health care and in socialism. It will become increasingly more centrally controlled and costly as it supports bureaucrats and not those in need. It will fail. As history has shown, failing governmental systems are replaced by dictatorships – not by more freedom and liberty, for the individual. From my perspective, the future for socialism and the USA, if it follows the path to socialism, is very bleak. Freedoms will be lost; the freedom of religion, the freedom of expression and speech, and the freedom of the press which is disappearing now in many countries as well as the USA. The right to defend yourself will be taken away. The principles that provide the foundation for a great society of people will vanish under each person's desire to get as much as he or she can for him or herself from “the system” in a centrally controlled system.