Monday, September 6, 2021

The Healthcare Credibility Problem

Editor's Note: This column was published in the American Thinker on September 4

I am a strong supporter of doctors and the healthcare industry in general. I grew up with a step father who was a general practicing physician and a surgeon. He was a family doctor in the truest sense of the word. He made house calls, delivered more than 5,000 babies, bartered for fees, and often just waived the charges. He had a God-given genius for diagnosis, and he spoke to his patients in plain English, sometimes very colorful language. But my mother was always quick to remind him, “After all, you are just ‘practicing’ medicine!”

People have a tendency to venerate doctors, and when they heroically save your life, this hero worship can be justified. Our long-time family doctor is another diagnostician extraordinaire, who also happens to be one of my best friends and hunting buddy. When he sewed up my son’s forehead on our dining room table, he too was vaulted into that hero category.

But something has happened to the medical profession and the healthcare industry—at 15% of the US economy, it has become an industry complete with industry titans—and as the pandemic accelerated, healthcare’s credibility problem only worsened.

Beginning in the 1990s, many doctors stopped practicing medicine on their own as the medical profession model changed from entrepreneurial to corporate medicine. As doctors and their offices began to be overwhelmed with insurance claim processing, Medicare and Medicaid compliance, malpractice suits, and medical liability insurance issues, doctors saw the hospital-affiliated-clinic model as the way to skip the bureaucratic headaches and allow the professional to focus on practicing medicine. However, corporate medicine brought corporate practices: cutting back time with patients to increase cash flow, more Medicare/Medicaid compliant procedures rather than patient-centric medicine, and outsourced billing and collection systems.

Around the same time, pharmaceutical companies began marketing drugs directly to the consumers. Like the “Mother’s Little Helper” of the sixties, new medicines were being developed at a staggering pace. Television ads portray every drug as the new panacea for whatever ails you. In fact, consumers become so mesmerized by the truth-in-beauty scenes of a perfect life that they almost never hear the legally required disclosure of contraindications that should scare anybody who listens. “May cause an uncontrollable urge to gamble” one drug ad warned! I remember watching a football game with my 12-year-old son around 2002. One ad for a giddyup (ED) drug kept showing a guy throwing a football at a moving tire swing. As I watched the imagery, I was not paying attention and wondered out loud, “I wonder what this drug does?” My son’s reply was priceless: “I think it makes you throw the ball better.” About ten years ago, a pharmacist told me that the average customer was on 5 to 6 different prescription medicines, and several of those were to counteract the bad side effects of the other drugs. The proliferation of pharmaceuticals has even created a spin-off industry for lawyers: 1-800 BAD DRUG!

Queue up the American Medical Association-supported Obamacare. Not only did I not get to keep my insurance, my doctor refused to see me because I had the Bronze Level health insurance plan from the federal marketplace. Doctors, who had for decades been trying to make ends meet with increasingly lower limits on what Medicare and Medicaid would pay for visits and procedures, were now being forced to accept less from the new federally underwritten health plans being forced upon millions of Americans.

As though all these trends were not bad enough, the SARS Coronavirus-2 Covid-19 pandemic has undermined doctors’ credibility. Doctors can be found everywhere arguing about the merits of wearing a mask, social distancing, excessive handwashing, quarantine time, the efficacy of various treatments promoted by some and castigated by others, and the efficacy and risks of vaccines. Many doctors bemoan the fact that Covid is keeping people from their regular checkups and screenings. My dermatologist diagnosed seven melanoma skin cancers during the first month of the shutdown in 2020, while the number of patients she saw was about one half of her normal workload. She lamented that perhaps an equal number of melanomas went undetected during the same timeframe. People were suffering heart-attack symptoms but would not go see their doctors. Colonoscopies, mammograms, and many other cancer screenings went by the boards. While medical professionals, policymakers, and especially the media whipped up Covid fears, cases of depression and suicides increased dramatically, and now, schools are finding multiple psychological problems among returning school children.

Hospitals stopped scheduling elective procedures to make room for the onslaught of Covid patients, even though elective procedures have long been the cash cow of every hospital business model. Since this threatened their financial stability, the federal government came to the rescue with cash payments for each confirmed Covid patient treated. This created a perverse economic incentive to make every patient a Covid patient, regardless of their condition. There are thousands of anecdotal reports of doctors wanting to report deaths as Covid related no matter the actual cause of death.

Most medical professionals recognize that Covid will never be eliminated. We hope to control it and learn to live with it. The world has an aspiration of reaching what is known as “herd immunity,” where the percentage of population that has been vaccinated or has developed natural immunity (antibodies) is high enough that the disease no longer presents a threat to humanity as a whole. The concept gives people a goal and a hope, but instead we have arguments and changing estimates among the medical and scientific communities, about what percentage constitutes herd immunity.

We have now entered the stage where medical professionals and policymakers are proposing vaccine mandates, vaccine passports, and a return to school closures and economic shutdowns as the delta variant of Covid moves through the population with renewed vigor. But amid all this vaccination focus, somehow natural immunity is no longer a consideration. This is most distressing since National Institute of Health research suggests that natural immunity is more robust than vaccine-induced immunity. Studies have shown that survivors of the Spanish Flu epidemic of 1918 were immune up to 90 years later. Similar studies show that survivors of the first SARS Coronavirus epidemic in 2003 are still immune. Because of significant skepticism about the credibility of the healthcare system, it is well known that there are possibly tens of millions of unreported Covid cases, and those people likely have natural immunity.

As Miss Marple says, “Good advice is often given, but seldom taken.” My advice to healthcare providers is to stop speaking in absolutes, recognize that there has always been healthy disagreement among medical professionals, and most of all, recognize that when people decline their well-intended advice, it is because the healthcare community has a serious credibility problem. Most of all, healthcare professionals need to remember that, after all, they are only “practicing” medicine.

Wednesday, September 1, 2021

Where is the Outrage?

The headlines tell the story, and it’s not a pretty one. Climate realists, like me, are losing the climate change debate. Not because we are wrong. Factually, we win every time! But, we are losing the hearts and minds of the people because we have failed to tap into their emotions.

The climate alarmists don’t care about the facts. They beat us down with children, like Greta Thunberg, and lecture us about self-interest and our cowardice in the face of a “mass extinction event.” They play to our natural emotions and worst fears by linking climate change to those uncontrollable things we are most afraid to face—hurricanes (lions), wildfires (tigers), and tornadoes (and bears, oh my!).

Despite these facts:
  • Climate change models have failed to accurately predict the future global average temperature change.
  • There is no ideal average temperature for a world where on any given day the temperature could be -50 degrees F in one place and 120 F above zero somewhere else. (Remember, if you live by averages, you would be comfortable standing with one foot on a block of ice and the other in a fire.)
  • Global average temperatures have fluctuated much more and have changed much faster in the geologic past and well before humans started burning carbon-based fuels in significant quantities.
  • Weather patterns are much more attributable to cyclical changes in ocean currents than to climate change.
  • The use of oil, gas, and coal creates a significantly higher quality of life for billions of people, reduces poverty, provides abundant food supplies, and means cleaner air and water.
  • There is overwhelming evidence that climate change is neither caused primarily by humans nor an existential threat to mankind or any other species.
Despite all this and more, we are gradually losing the battle for the minds of the people when it comes to the climate change debate. And we are not just losing the debate at the political level. We are losing in the board rooms, and not just the woke corporations like Amazon, Nike, Apple, or Google, but in the corporate board rooms of the utility companies, the oil & gas industry, and the manufacturers.


We tend to make our case using wonky science that even scientists don’t fully understand. People can’t get their heads around our rational explanations, but they darn sure understand fear of events that may affect them directly and personally.

We tend to argue about the adverse macro-economic effects of climate change policy—the loss of millions of jobs, green energy costing trillions of dollars, and the failed goals of wealth redistribution. These effects are real and catastrophic.

However, have you ever wondered why the voters do not support Social Security or Medicare reforms, despite the overwhelming macro-economic evidence that both systems will likely be bankrupt within the next decade? The answer is fairly simple. People make decisions based on micro-economics, not macro-economics. People will choose to protect their personal benefits over the solvency of the system—every time.

Consider these examples of the micro-economic impacts of climate-change policies. Here in Virginia, Dominion Energy is closing coal-fired power plants in favor of solar and wind farms, and this move toward renewable energy sources will lead to a $1,000 per person per year increase in electric bills by 2030.

Ask anybody if they are willing to pay a thousand dollars a year when it is not likely to change the average global temperature at all? This question brings the issue home, and the answer will much more often be a resounding “No!” Ask the same person if they think climate change is a threat and whether we should do something about it, and you will get many more affirmative responses.

The Transportation & Climate Initiative, a regional collaboration of 12 Northeast and Mid-Atlantic states plus DC, is proposing a 20-25% reduction of carbon dioxide emissions for the region. Their policy of choice is a “carbon [dioxide] tax.” Recently, Virginia enacted a carbon dioxide tax on utility generation, and the General Assembly will be considering one on transportation fuels that may include a 28 cent per gallon gasoline tax and a 26 cent per gallon diesel tax. Based on current mileage rates and miles driven per capita, these tax increases could cost each driver more than $1,000 per year! Once again, I can fairly easily predict the response from most people to the question of whether they are willing to pay another $1,000 per year for no material effect on the climate.

People expect their lights and their computer to work when they flip the power switch. Talk about the potential for rolling brown-outs, or planned black-outs, so that someone else can charge their electric vehicle at the charging station built with tax dollars (ever seen a government-built gas station?), and I think you will get a predictable negative response.

I am certain that we can come up with many more examples, but my point is this: let’s take the case against climate change down to the personal, micro-economic level. Remember the charge against George H. W. Bush: “It’s the economy stupid!” It wasn’t that Bush didn’t understand that there was a recession; it was that he failed to recognize how that recession affected people at the personal level.

To put it another way, everything in life is political, except politics, that’s personal. When you explain how a policy threatens someone’s pocket book, you’ll get their attention.