G. Keith Smith, M.D.

Brandon Dutcher, senior VP at the Oklahoma Council of Public affairs, sent me this Washington Examiner article by Tim Carney.  Mr. Carney assumes that his readers are familiar with King v. Burwell, a case before the Supreme Court that most agree represents a death blow to the Unaffordable Care Act.  For those who are not familiar, King v. Burwell will disallow Obamacare  subsidies to states which did not set up state exchanges.  The “law” clearly states that these subsidies will be distributed through “exchanges established by the states,” making no other allowance, namely an exchange of federal origin.  Oklahoma’s Attorney General Scott Pruitt has one of the leading roles in this court case, a case most agree is the last stand by states wanting nothing to do with Obamacare shoved down their throats.

If the good guys win, Obamacare will be irreparably crippled in the states (37, I think) that did not establish these exchanges.  Without these subsidies that hide the true cost of the “insurance,” the premiums will be exorbitant, the individual mandate will vaporize and no penalties can be applied to “non-purchasers." 

Back to Mr. Carney.  Whose support of the King v. Burwell effort is absent?  Mr. Carney rightly ridicules the liberal rag "Mother Jones” for claiming that King v. Burwell has no merit because corporate healthcare cronies aren’t supporting it. My favorite of his analogies is this one:

“If cutting defense spending is such a good idea, why is the military-industrial complex opposed?”

This is after all, the same logic used by the folks at “Mother Jones” in forming the basis of their skepticism of King v. Burwell.  Mr. Carney’s humorous article unveils the cronyism that forms the basis of the Unaffordable Care Act.  For more evidence, read this report about record setting revenues at one of the nation’s largest “insurance” carriers.  Cronyism like any other scheme or conspiracy survives only as long as few know the truth.  These two articles should help provide courage to those remaining skeptics to open their eyes to the true nature and purpose of Obamacare.

G. Keith Smith, M.D.

Two of my favorite Latin phrases with translations follow.  The first, a quote from Virgil, was the life motto of Ludwig von Mises:

Tu ne cede malis, sed contra audentior ito.  "Do not give in to evil but proceed ever more boldly against it.“

The second comes from Ovid:

Principiis obsta et finem respice.  ”Resist the beginnings and consider the ends.“

I have thought about these quotes recently as I continue to encounter the argument, ”…now that Obamacare is the law of the land, let’s get on with implementing it instead of fighting it,“ …or some similar version of this.  Interestingly, the same argument (strangely almost verbatim) is used nationally and locally, by the supporters of this federal takeover of the practice of medicine.  

I find the continued resistance and defiance, even of those who I suspect to be impostors and demagogues, refreshing.  I have no doubt that ”..never let a crisis go to waste,“ one of the core operational principles of any state (see: "Crisis and Leviathan” by Professor Robert Higgs), continues to drive ideologues of all stripes seeking power.  Those who would launch their political careers using anti-state rhetoric promote their own undoing and undoubtedly aware of this, know not to take this too far.  I believe the power represented by the public defiance encouraged by all those promoting anti-Obamacare or limited government ideas, dwarfs any political power to be gained by the promoters, political or otherwise.  Here’s why I say this.

Public judging of a law (Obamacare is just one example) as a failure invariably leads thoughtful people to dig deeper, wondering, for example if other laws have escaped the public scrutiny they deserved, and introduces an element of doubt about the sincerity of the players in the regime and even the legitimacy of the regime itself.  Having lost their health insurance as a result of Obamacare, a hitherto Obamacare supporter might entertain the unthinkable:  "If I was lied to about being able to keep this policy I liked, what else have they lied to me about?“  Most people in this spot initially direct their frustration at individuals rather than focus on the system itself, mistakenly believing that a different political course of action is all that is needed.

Much more important is the non-political form of defiance, for this represents the "lack of consent of the governed,” that brand of defiance that even the cruelest of tyrants have found difficult to crush.  Ignoring, ridiculing or laughing at the awkward cruelty and corruption of tyrants and their cronies have historically been more effective in deterring political bullies than even the best results of “mid-term” elections, in my opinion.  

I remain optimistic about free markets in healthcare and about liberty in general, in part because of the level of public defiance I am seeing everywhere.  State legislators and attorneys general all over the country are openly discussing nullification.   Not just a few governors are refusing to expand the federal Medicaid program.  If these public officials thought their political futures were threatened with such talk, it would not be nearly as widespread.  A great number of individuals see these individuals as their champions, their defenders against the leviathan federal government.  In short, political defiance is safe and popular because of widespread public defiance.  

This is truly remarkable, I think, and shows the extent to which a great number of people see that the federal government has overstepped.  Think of the vast numbers of young people refusing to participate in this latest Ponzi scheme, the physicians who are opting out of any involvement with federal medicine, whatsoever, and the great number of well-known medical facilities all over the country publicly announcing their refusal to participate with Obamacare.  I, for one, plan to cheer on anyone who proclaims defiance, as once the general public understands, just as Rothbard foretold, that without our consent, the ruling class is neutered.

G. Keith Smith, M.D.

To learn more about the Surgery Center of Oklahoma check out our website and links:

www.surgerycenterok.com

1)I prefer to give the patient the medical care they need, rather than the so-called care some bureaucrat thinks the patient should get. 

2)I prefer that the care I give to patients remain a matter known only to them and me and whoever else they deem a party to this knowledge.  I am aware of no clause authorizing betrayal in the Hippocratic oath.  The push of electronic medical records and the scam of “meaningful use,” which commands patient betrayal is one of the most sinister aspects of the “law.”

3)If people believe that health insurance companies are restrictive now on what they will and won’t pay for, they will soon realize with the exchange plans the true fulfillment of the wildest dreams of the corporate health cronies.  The taxpayer will unwillingly fund these companies and the government will simultaneously define and limit what claims these companies must pay, a certain recipe for profits, the obscenity of which has likely never been seen.  They actually can’t accurately be called “profits” as the whole system has been and will increasingly be rigged.  It is no coincidence that government-funded research is already claiming that the preventitive care guaranteed by Obamacare is unnecessary, prostate screenings, mammograms, colonoscopies, etc.

4)Certain states are rejecting the Medicaid expansion of Obamacare.  Many if not most of the young people are recognizing this as the next government Ponzi scheme, refusing to participate.  State attorneys general (Oklahoma’s Scott Pruitt, in particular) have identified weaknesses in the “law” and are basically attempting to nullify it.  More employers are seceeding from the game and taking the path of “self-insurance."  It is time for the physicians to step up and join the ranks of the resistors.  Without uniform and widespread physician participation, this "law” is dead on arrival.  Refusal to participate will hasten a healthy and new consumer market in health care where patients, by and large, purchase health care, not coverage, the health coverage reserved for only the most daunting and expensive of challenges.

G. Keith Smith, M.D.

Dr. Doug Cox, a Republican state legislator here in Oklahoma, has written this piece, in which he bemoans Governor Mary Fallin’s rejection of Obamacare’s Medicaid expansion.  Among his complaints?  Hospitals, facing a loss of their DSH (disproportionate share hospital) payments (this cut is in Obamacare, but is by no means final..the hospitals will in all likelihood retain these payments in some form) will have to cost shift much more aggressively, now that they can’t count on all of the uninsured folks being “covered” by Medicaid.  You can refresh your memory on DSH payments, the uncompensated care scam and more here.  

Let’s get started by revealing that Dr. Cox is an employee of Integris Health, the largest hospital system in Oklahoma.  Yep.  You read that right.  OK.  Try to concentrate on the other remarks in this blog like anything else that I jot down matters compared to that little gem.

Cox relays two sob stories, one of which is about a woman that needs her gallbladder removed, the price for which at our surgery center is $5865 and posted online.  Our price includes the surgeon, anesthesia and facility charges.  And yes, we are making a profit at this price.  Having established that, it goes without saying that the actual cost for this procedure, an amount representing no profit (not for profit?) would be less than $5865.  Dr. Cox maintains that the big hospitals will have to jack up their prices (what are their prices, anyway?) to cover losses like this.  Keep in mind that “not for profit” means that these institutions don’t pay tax.  What’s that perk worth?  Try to fathom how much these hospitals spend on print and television ads.  Try to imagine how much they spend sponsoring sports franchises.  You already have some idea what their administrative overhead is if you have seen “Oklahoma Doctors vs Obamacare,” the Reason documentary about our facility’s free market approach to health care.  (Try to also keep in mind that Jim Epstein of Reason Magazine discovered during his research on this documentary that our online pricing is less than what Medicaid pays the hospitals for the same procedures.  Yes, you read that right.)  

The hospital expenditures above pale in comparison to what is spent building new and unnecessary facilities, hostile takeovers of physician practices and buying out their competitors, particularly the rural hospitals.  Seriously.  Where are they going to find any money to cover a gall bladder removal for a poor uninsured woman?  You would think these hospitals were operating pretty close to their margin reading Cox’s piece, since the only way they can survive, offering an occasional gall bladder surgery at a discount or free of charge, is to charge all of the rest of us much more.  

His economics is no better.  "The federal reimbursement for the expansion of Medicaid would have been 100% of the cost through 2016….“  Where does Cox think this "federal” money comes from?  And who should know better than a legislator the folly of trusting future government payments?!

Finally, and perhaps the most troubling part for me is this:  "The fact is, it (Obamacare) is now the law, whether we like it or not.“  Translation?  "Give up.” “Surrender.”  "Lie back and enjoy it.“ "It’s time to join up!” I find this Vichy attitude disgusting.  I am glad that rather than surrender to and collaborate with the regime the governor and the attorney general and several legislators in this state still have some fight in them.  Obviously, Cox isn’t in this camp.

As one friend wrote to me regarding Cox’s piece:  "Obamacare cost my family thousands in debt and made us go without health insurance.“ "I’m glad I don’t live in Doug Cox’s Oklahoma.”  Another wrote to me: “I love that he can be compassionate by taking money from my children and grandchildren." 

We can only hope that more people see the promotion of Obamacare’s Medicaid expansion by individuals as conflicted as Doug Cox, as completely and utterly lacking in credibility.

G. Keith Smith, M.D.