CATHERINE AUTIN FITTS: And so what Trump is saying is that everything is on the table, because if I'm going to . . . if this model is going to work, we've got to get radical and change it.

She grew up on the streets of West Philadelphia.

Her dad was a doctor/surgeon out of the war. 

17:40.  At the end of World War II, George Keenan at the State Department, a very famous Diplomat, said, "We have 6% of the people and we control 50% of the resources.  And the only way we can keep that going is to drop a lot of bombs, and we are going to have to be very forceful and tough."

So Goldwater came along and he ran for president and he said, "We're going to have to drop a lot of bombs," and he lost, and the American people were like "No we're good Christians. We don't want to do that.

So Jimmy Carter came along and he said, "Okay, we're going to cut back," and he shivered in front of the fireplace, and said, "We have to cut back because we can't control all of the resources," and the American people said, "Oh, no, we like being powerful."

And so the Bushes came along, and they said, "You know something, you all are good Christians.  Here's your check.  Don't ask questions." So that was the political equation: "I will go off and run the global Empire.  I will extract a tithe for the empire.  We will make a lot of money.  I'll get rich, but I'll give you a check in the story of 'I am good.'"  So the political equation in America is we give you a check, and we give you the story of "I am good."  

And the problem that politicians have is the same one that that you have in the EU, the former head, the president of the EU said, "We know what to do.  We just don't know how to get elected after we do it."

19:20.  Trump has got a greater challenge now because that was 2000.  Let's talk about his challenge now.  If the first hundred days are really important for a president, what will he do in the first 100 days? 

19:32.  Here's the question: how much is what he will do, what he wants to do, and how much is what his major donors insist that he do?  And to me, that's the big question, and how much is it that the central bankers will insist that he do, you know, because they're financing the US government.  And if they say no he can't do it, but he's a prisoner of the red button problem, and, you know, will the American people support him in doing what has to be done?  There's not . . . we're talking about a society that doesn't share a common map of what's going on.  For example, if you look at what has happened with military technology and what the Russians are doing both with their new missiles and what they're doing in the North Sea in the Arctic, around the Arctic, it makes absolute sense that if you are Trump and you're responsible for military protection of a whole wide world of global interests, including Canada, it makes absolute sense you would want Greenland.  And yet when you hear him talk about it, you think, is this guy crazy?  But, in fact, if you look at the responsibility of running the global trade routes for the Western world and being responsible for military protection of the US, Canada, and European allies in NATO, . . .

21:00.  So you would be in favor of that?

21:03.  No.  I'm not saying I would be in favor of it.  What I'm saying is you have a model, and the model has to re-engineer, and you have to get the revenues up and the expenses down and take care of your responsibilities and it's a lot more difficult than it looks. And because of the changes in technology all around the world in many different Industries, you've really got to change.  And so what Trump is saying is that everything is on the table, because if I'm going to . . . if this model is going to work, we've got to get radical and change it.

21:35. So what kind of person do you see in Trump?

21:41.  Trump is a real estate developer and a business person, and it's very interesting.  If you live and work in New York as I did for 11 years, everything you do has to be economically successful or relevant, and you approach things from a point of view of cooperating to get a positive economic result.  So in New York things, everything starts, you know, every sentence starts with "Yes."  

So, could we build a bridge to the Moon?

Yes, but it would take a long time and it would be very expensive. 

Whereas in Washington, everything starts out with "No, no," and you've got a toll booth on every inch with people trying to extract the profit to let you do anything.  And one reason is in New York you have to make things work for the equity.  In Washington, if you're just printing government money, you know the equity doesn't have to work.  So Trump is, if you look at the people he's bringing in, he's looking at redoing the economic model and making it much more economically relevant but he approaches it as an entrepreneur which of course is driving all the people who are trained to be good government officials, it's driving them crazy, because they're not entrepreneurs.

23:00.  Why does he do this?  

23:04.  Because he knows that we need to change and he's trying to find a way to invent a productive change but he's so bold and how he does it and he's much too generous with taxpayers' money for himself . . . 

23:26.   What is his motivation, in your opinion?

23:28.  I think he's very frustrated by the way the world is working now and I think he really feels that he can do something about it is my impression.  

So every hundred years, the Central Banking warfare model does a reset, 80 to 120 years.  If you go back in the history, you know, they regularly do a reset.  We knew we had to do a reset.  We knew we were going to globalize, so we had to do a reset, and I thought I had permission from the group of people I knew, you know, high up in the financial system.  I was going to figure out how technology would impact a family, a business, a government, a not-for-profit, and I was going to figure out how we could re-engineer the model to do a reset successfully.  But I had a vision of a reset and I called it "The Building Wealth Reset," where you can create so much significant wealth bottom up . . . that the American people could continue to maintain a reasonable standard of living in the middle of globalization without having an environmental disaster.  We came up with the initial plans and it was really exciting because there was one brief moment when I really thought it was going to work.  And I presented it.  I had a group of the top pension fund leaders who were an advisory board to one of my subsidiaries of Hamilton [Dillion, Read, & Co.] and I presented the plan to them,  and I'll never forget it.  The president of the largest pension fund looked at me and he said, "Oh, my God."  He said, "This is what we tried to do long ago, but they were able to stop us." And I said, you didn't, you didn't have the technology, the learning metabolism can be so increased that you can get people that productive that fast.  We had built Learning Centers in poor neighborhoods and were able to teach people how to become very economically productive very fast.  And, you know, we had the numbers and the documentation to prove it.  And he looked at me, he was stunned, and he said, "It's too late.  They've given up on the country.  They're moving all the money out starting in the fall," and that was when the $21 trillion started to go missing from the US government.

25:39.  $21 trillion?

25:40.  $21 trillion, so in the mid-90s the government was supposed to start publishing their annual audits of their financial statements because under the Constitution you're supposed to report, you know, here's how much money we collected or borrowed, and here's how much we spent, and you're required to do that disclosure with the exception of the black budget piece.  So the government started a process of reporting undocumentable adjustments in between fiscal 1998 and 2015.  They reported $21 trillion of undocumentable adjustments.  At the time we published that number, $21 trillion in 2017, the U.S. debt was up to $21 trillion.  So the US government borrows $21 trillion, the money comes in to Treasury, and then $21 trillion disappears.  

26:49.  The big question is where does it end?  

26:53.  So I thought he meant that we are reallocating the equity in the Pension funds to invest in the Emerging Markets which made sense what I didn't understand though is that's not what he meant he literally they started to move trillions and trillions of dollars out of the federal you know they borrow money and pull the money out and they were literally building a second civilization separately they were literally draining as much money as they could through the federal mechanism because remember that's just a laundry from the Pension funds you sell a treasury bond to the pension funds and you move the money to Treasury, you take it out the back door, and you're just moving the money out of the pension funds into I'm assuming it's a new endowment for a new government.  So we are in the middle of a reset, and that reset is fundamentally changing how the financial system will work.  The central bankers want who basically are the key bureaucracy, and if they want to do what they want to do which is to take over control of fiscal policy and be free of the Constitutional framework, they need changes.  And that's the war that's going on right now, and Trump will have to be right in the middle of that.

28:15.  So this new society in the short term, how's it going to look like?  

28:19.  I used to say that COVID was the operation by which the new Society broke back in and took control.  So what they want is they want digital IDs, they want all digital monetary system, they want the central bankers controlling fiscal policy.  So the central bankers can literally decide what the taxes are and just take it out of your account.

28:40.  A new currency? 

28:42.  It's not a currency, it's a control system.  There are no markets.  It's technocracy.

28:50.  He claims he's going to drain the swamp.

28:51. No that's not going to happen.  

28:53.  At the same time, he's working with people like . . . you can't re-engineer the model and you and your pals make money and drain the swamp at the same time.  That's not going to happen.  So, you know, his number one focus is going to be re-engineering the model of getting it economic, and while he's doing that, unfortunately, he's got a whole lot of major donors who are trying to maximize their profit.  So he's got to manage that.

29:19.  So he's not going to drain the swamp.

29:20.  There are three questions.  Is he going to implement a digital ID?  Because then he's implementing the swamp.  Is he going to allow an all digital monetary system?  Because then he's building the swamp.  Is he going to allow the DOGE and Vivek and Elon to let the central bankers take over control of fiscal policy through corporate contractors?  Then he's implementing the control model, one, two, three.  Now he can do that on the all-digital monetary system.  He can do that with CBDC.  Or, he can let the FED get out of the Constitutional provisions and do Central Bank CBDCs, which will probably be the way you go after you beat everybody up with crypto and they make a lot of money.

30:10.  He doesn't seem like a guy that wants that for his voters, and his voters don't seem to want that.

30:16.  So I think it is Trump's instinct to loathe the idea of total central control.  This is a guy who doesn't . . . he wants to be a sovereign individual, and if you look at some of what he says and does I think he really enjoys the idea of being part of a civilization where people have sovereignty both in their governments and individuals.  The reality though is he's in a system where he doesn't have control, which of course always frustrates him.  There will be tremendous pressures on him to do what the bankers want.

31:00.  Also, some people behind the scenes, like Peter Thiel.  Is it Palantir that decides what the government does, or is it the other way around?

31:10.  Of course, that's the question.  I think the government in theory decides because you have a contract in payments, and they only do what they're authorized under the contract and the payments to do.  At the same time, a lot of the bureaucracy is no longer in a position to tell the corporate contractors what they do.  The corporate contractors have more power.  So there's a whole team of people.  Elon Musk is not a person, it's a team and it's playing a role.  And how much is that Elon Musk as a person is still doing?  

31:55.  Can Trump see through that? 

31:56. Of course.  He's operating in his system. He doesn't control the system, and he's dealing with the system the way it is.

32:16.  And he does want to change it in your opinion?

32:19.  O, I think he does want to change it. I think he does want America to remain the global hegemon.  I mean that's what he said, "Make  America great again." He really wants America to be successful.  His biggest problem is that he has allies who think they control him and major donors, so . . .

32:42.  That's an interesting situation.  Trump got into this position first of all because everybody underestimated him, right?

32:53.  No. He got in this position because the Republican establishment decided, okay, this is the guy who can get us the control grid.  This is the guy who can get the heartland to go along with digital IDs to stop . . .

33:09.  Basically that's what I'm saying, because in your opinion, he's not willing to do that.  He's schooling them.

33:17.  I'm saying it is not his inclination.  It is not his nature.  If you're a successful entrepreneur, you know that total control is bad economics and I think he still feels and and I think he still and I think he still feels he wants to make America great again but I think his first time through he understands that you know if you don't do what they say they kill your family right so for example when I finished the litigation I published a book I mean I wrote a book and I wanted to publish it I put it up online because there's so much documentation behind it it was better to do it digital three times I've tried to publish it the last time I tried to publish it they threatened to kill somebody in my family if I did I backed off you know my family didn't buy into this and I don't have a right to put my family at risk but 

34:05.  So the only person who can change the system is someone, some really big interests.

34:10. No.  Here's how you change the system.  You don't change the system by one guy riding in on a white horse and fixing everything.  You change the system by so many people shifting their time, their money, their intention, their prayers, that crowd moves this way and you can't force them to go this way.  It's too out of control.  In 2016, I was planning on not going back if Clinton had won because it wasn't safe.

34:38.  For you?

34:38.  For me.

34:40.  Why?

34:42.  So during litigation I dealt with a huge amount of physical harassment and surveillance and it was very dangerous.

34:48?  Physical harassment?

34:49.  Yeah, oh yeah. 

34:52.  In the US?  What does that look like?  

35:00.  So your house gets broken into.  You get poisoned.  You get followed.  People run you off the road.  

35:08.  They poison you.

35:08.  I was poisoned 8 times.  I wouldn't settle.  We were publishing and designing and making a tool called, Community Wizard, and Community Wizard made accessible . . . Right now, if you go to the White House, or at that time if you go to the White House, and read the federal budget, it says here's how all the money works in military.  Here's how all the money works in housing.  Here's how . . . but it doesn't say here's how all the federal money works in your neighborhood, because if you can see it in your neighborhood you can get it changed, right.  And so the finance chairman of the campaign would get it, but you don't get the disclosure you need to vote for political representation.  You can get some for your state, but even now some for your county, but you can't get really good data.  So we were making a software tool where you could go in and dial and download all the data and start looking in ways that were very visual and you can start to really grapple and that you could start to change the money and make it much more efficient.  And so one of the things that they did was seize our offices.  They seized the software tool and kept it locked up for years.  It took me years to get it back out, and by the time I got it back out it was all Legacy software and we literally tried several times to start from scratch.  The politics were . . . so, in 2019, some of the harassment kicked up again; it was one of the reasons I finally decided to come do the Dutch residency.  And it was really funny because when it happened, you know because I had had so many amazing miraculous experiences dealing with the poisonings and the physical harassment . . .

36:50.  When they poisoned you they were trying to kill you?

36:53.  No.  Here's my theory because you only know what you experienced you don't know what the facts are so there is one time I think it was intended to kill me I think the others were just intended to scare me and make you tired you know it really when you get toxic because I described to people there is in America a great poisoning going on people are really being poisoned and they're being poisoned in a variety of ways and it's intentional and as if you steal people's retirement funds you got to lower life expectancy it's just math.

37:25.  What is your goal in life? 

37:28.  So I just want to be free.  

37:29.  Do you feel free here?

37:30.  What I said to somebody at the time is I'm just tired of playing Tomb Raider.  I just don't . . . if you look at what I want to do in my life, I want to help people figure out the Building Wealth Reset and I want to help people push it in that direction, because the problem is not what are these guys doing.  The problem is when these guys fail, what's our point?

37:54.  Did that change your approach to what you're doing right now? 

37:57.  Yeah I spend a lot less time worrying about security, right.  So I'm a little rusty in terms of my gun use, but no, no I'm very good with a gun I'm very good with a gun.

38:14.  They're not legal here, right, you know?

38:15.  Well I in Hickory Valley there's a joke, so in Hickory Valley, Tennessee, there's a joke that the men have to sleep with bulletproof vests because the women are so well armed.  

If I was Trump, I would do exactly what he's proposing to do at HHS with Kennedy.  I would get the data out and use the data to put the question back to the American people.  Look at the data, what does the data say, and then based on what the data says, what do you think we ought to do?  So he's trying to get the population engaged in helping him re-engineer the model.  His greatest strength is he's always done that, he's always, while the media is trying to just push the official narrative, he's trying to get people educated about reality enough to support him in the changes.

So step by step.

Yeah, so, and, of course, everybody goes crazy because it's like being in a ballroom and everybody's doing the waltz and some guy walks in and says what do you think, should we do a Tango? and starts to play tango music, and everybody starts crashing and bumping into each other and gets mad, you know, because they're like, "A Tango?  What?  I don't know how to do a Tango. I'm going to lose money.

39:40.  Is this transition going to be paid for?

39:42.  Yes.

39:44.  What's that going to look like?

39:49.  Your guess is as good as mine he's going to be trying to recalibrate the model at the same time you've got all these people who are going to be trying to plunder the government now that they've won.  

40:00.  So it's going to be interesting times.

40:01.  It's going to be wild.  It's going to be wild.  So for example,

40:06.  Are you looking forward to it?  So I don't know if you have ever seen . . . my father was a surgeon, so we talked about this at the dinner table, so forgive me, if you've ever seen a serious infection rise to the surface and turn into a a boil that then pops and drains, it's a really despicable process, but it's very good for your health to get the infection to rise to the surface.  So you know the red button question is now rising to the surface, and I think it's, you know, it's healthier than continuing to try and pretend.

40:40.  If you would have a red button here right now on this table and it will bring you in danger and your family in danger would you still push it?

40:50.  Slavery is a worse danger than the chaos that will ensue you know if we push the red button.  I have news for you, the world is pushing it as we speak, so get ready, put on your big boy pants, and get ready to rock and roll.

41:07.  We walked the road to the future.  Is this the future 4 years from now where we are standing?

41:12.  We're standing and we are facing a period of unprecedented change, and what we say at the Solari Report for 2025 is "Our Year Will Be Endowed by Grace," because when things break down and change at this high speed and radical ways, you know it can be very uncomfortable and very disconcerting, but can also open the window for Grace to come in and operate by faith.

41:39.  The sun is shining in your face right now

How Government Killed the Medical Profession

This article appeared in the May 2013 Issue of Reason.

by Jeffrey Singer

I am a general surgeon with more than three decades in private clinical practice. And I am fed up. Since the late 1970s, I have witnessed remarkable technological revolutions in medicine, from CT scans to robot-assisted surgery. But I have also watched as medicine slowly evolved into the domain of technicians, bookkeepers, and clerks.

Government interventions over the past four decades have yielded a cascade of perverse incentives, bureaucratic diktats, and economic pressures that together are forcing doctors to sacrifice their independent professional medical judgment, and their integrity. The consequence is clear: Many doctors from my generation are exiting the field. Others are seeing their private practices threatened with bankruptcy, or are giving up their autonomy for the life of a shift-working hospital employee. Governments and hospital administrators hold all the power, while doctors—and worse still, patients—hold none.

The Coding Revolution

At first, the decay was subtle. In the 1980s, Medicare imposed price controls upon physicians who treated anyone over 65. Any provider wishing to get compensated was required to use International Statistical Classification of Diseases (ICD) and Current Procedural Terminology (CPT) codes to describe the service when submitting a bill. The designers of these systems believed that standardized classifications would lead to more accurate adjudication of Medicare claims.

What it actually did was force doctors to wedge their patients and their services into predetermined, ill-fitting categories. This approach resembled the command-and-control models used in the Soviet bloc and the People’s Republic of China, models that were already failing spectacularly by the end of the 1980s.

Before long, these codes were attached to a fee schedule based upon the amount of time a medical professional had to devote to each patient, a concept perilously close to another Marxist relic: the labor theory of value. Named the Resource-Based Relative Value System (RBRVS), each procedure code was assigned a specific value, by a panel of experts, based supposedly upon the amount of time and labor it required. It didn’t matter if an operation was being performed by a renowned surgical expert—perhaps the inventor of the procedure—or by a doctor just out of residency doing the operation for the first time. They both got paid the same.

Hospitals’ reimbursements for their Medicare-patient treatments were based on another coding system: the Diagnosis Related Group (DRG). Each diagnostic code is assigned a specific monetary value, and the hospital is paid based on one or a combination of diagnostic codes used to describe the reason for a patient’s hospitalization. If, say, the diagnosis is pneumonia, then the hospital is given a flat amount for that diagnosis, regardless of the amount of equipment, staffing, and days used to treat a particular patient.

As a result, the hospital is incentivized to attach as many adjunct diagnostic codes as possible to try to increase the Medicare payday. It is common for hospital coders to contact the attending physicians and try to coax them into adding a few more diagnoses into the hospital record.

Medicare has used these two price-setting systems (RBRVS for doctors, DRG for hospitals) to maintain its price control system for more than 20 years. Doctors and their advocacy associations cooperated, trading their professional latitude for the lure of maintaining monopoly control of the ICD and CPT codes that determine their payday. The goal of setting their own prices has proved elusive, though—every year the industry’s biggest trade group, the American Medical Association, squabbles with various medical specialty associations and the Centers for Medicare and Medicaid Services (CMS) over fees.

As goes Medicare, so goes the private insurance industry. Insurers, starting in the late 1980s, began the practice of using the Medicare fee schedule to serve as the basis for negotiation of compensation with the doctors and hospitals on their preferred provider lists. An insurance company might offer a hospital 130 percent of Medicare’s reimbursement for a specific procedure code, for instance.

The coding system was supposed to improve the accuracy of adjudicating claims submitted by doctors and hospitals to Medicare, and later to non-Medicare insurance companies. Instead, it gave doctors and hospitals an incentive to find ways of describing procedures and services with the cluster of codes that would yield the biggest payment. Sometimes this required the assistance of consulting firms. A cottage industry of fee-maximizing advisors and seminars bloomed.

I recall more than one occasion when I discovered at such a seminar that I was “undercoding” for procedures I routinely perform; a small tweak meant a bigger check for me. That fact encouraged me to keep one eye on the codes at all times, leaving less attention for my patients. Today, most doctors in private practice employ coding specialists, a relatively new occupation, to oversee their billing departments.

Another goal of the coding system was to provide Medicare, regulatory agencies, research organizations, and insurance companies with a standardized method of collecting epidemiological data—the information medical professionals use to track ailments across different regions and populations. However, the developers of the coding system did not anticipate the unintended consequence of linking the laudable goal of epidemiologic data mining with a system of financial reward.

This coding system leads inevitably to distortions in epidemiological data. Because doctors are required to come up with a diagnostic code on each bill submitted in order to get paid, they pick the code that comes closest to describing the patient’s problem while yielding maximum remuneration. The same process plays out when it comes to submitting procedure codes on bills. As a result, the accuracy of the data collected since the advent of compensation coding is suspect.

Command and Control

Coding was one of the earliest manifestations of the cancer consuming the medical profession, but the disease is much more broad-based and systemic. The root of the problem is that patients are not payers. Through myriad tax and regulatory policies adopted on the federal and state level, the system rarely sees a direct interaction between a consumer and a provider of a health care good or service. Instead, a third party—either a private insurance company or a government payer, such as Medicare or Medicaid—covers almost all the costs. According to the National Center for Policy Analysis, on average, the consumer pays only 12 percent of the total health care bill directly out of pocket. There is no incentive, through a market system with transparent prices, for either the provider or the consumer to be cost-effective.

As the third party payment system led health care costs to escalate, the people footing the bill have attempted to rein in costs with yet more command-and-control solutions. In the 1990s, private insurance carriers did this through a form of health plan called a health maintenance organization, or HMO. Strict oversight, rationing, and practice protocols were imposed on both physicians and patients. Both groups protested loudly. Eventually, most of these top-down regulations were set aside, and many HMOs were watered down into little more than expensive prepaid health plans.

Then, as the 1990s gave way to the 21st century, demographic reality caught up with Medicare and Medicaid, the two principal drivers of federal health care spending.

Twenty years after the fall of the Iron Curtain, protocols and regimentation were imposed on America’s physicians through a centralized bureaucracy. Using so-called “evidence-based medicine,” algorithms and protocols were based on statistically generalized, rather than individualized, outcomes in large population groups.

While all physicians appreciate the development of general approaches to the work-up and treatment of various illnesses and disorders, we also realize that everyone is an individual—that every protocol or algorithm is based on the average, typical case. We want to be able to use our knowledge, years of experience, and sometimes even our intuition to deal with each patient as a unique person while bearing in mind what the data and research reveal.

Being pressured into following a pre-determined set of protocols inhibits clinical judgment, especially when it comes to atypical problems. Some medical educators are concerned that excessive reliance on these protocols could make students less likely to recognize and deal with complicated clinical presentations that don’t follow standard patterns. It is easy to standardize treatment protocols. But it is difficult to standardize patients.

What began as guidelines eventually grew into requirements. In order for hospitals to maintain their Medicare certification, the Centers for Medicare and Medicaid Services began to require their medical staff to follow these protocols or face financial retribution.

Once again, the medical profession cooperated. The American College of Surgeons helped develop Surgical Care Improvement Project (SCIP) protocols, directing surgeons as to what antibiotics they may use and the day-to-day post-operative decisions they must make. If a surgeon deviates from the guidelines, he is usually required to document in the medical record an acceptable justification for that decision.

These requirements have consequences. On more than one occasion I have seen patients develop dramatic postoperative bruising and bleeding because of protocol-mandated therapies aimed at preventing the development of blood clots in the legs after surgery. Had these therapies been left up to the clinical judgment of the surgeon, many of these patients might not have had the complication.

Operating room and endoscopy suites now must follow protocols developed by the global World Health Organization—an even more remote agency. There are protocols for cardiac catheterization, stenting, and respirator management, just to name a few.

Patients should worry about doctors trying to make symptoms fit into a standardized clinical model and ignoring the vital nuances of their complaints. Even more, they should be alarmed that the protocols being used don’t provide any measurable health benefits. Most were designed and implemented before any objective evidence existed as to their effectiveness.

A large Veterans Administration study released in March 2011 showed that SCIP protocols led to no improvement in surgical-site infection rate. If past is prologue, we should not expect the SCIP protocols to be repealed, just “improved”—or expanded, adding to the already existing glut.

These rules are being bred into the system. Young doctors and medical students are being trained to follow protocol. To them, command and control is normal. But to older physicians who have lived through the decline of medical culture, this only contributes to our angst.

One of my colleagues, a noted pulmonologist with over 30 years’ experience, fears that teaching young physicians to follow guidelines and practice protocols discourages creative medical thinking and may lead to a decrease in diagnostic and therapeutic excellence. He laments that “ ‘evidence-based’ means you are not interested in listening to anyone.” Another colleague, a North Phoenix orthopedist of many years, decries the “cookie-cutter” approach mandated by protocols.

A noted gastroenterologist who has practiced more than 35 years has a more cynical take on things. He believes that the increased regimentation and regularization of medicine is a prelude to the replacement of physicians by nurse practitioners and physician-assistants, and that these people will be even more likely to follow the directives proclaimed by regulatory bureaus. It is true that, in many cases, routine medical problems can be handled more cheaply and efficiently by paraprofessionals. But these practitioners are also limited by depth of knowledge, understanding, and experience. Patients should be able to decide for themselves if they want to be seen by a doctor. It is increasingly rare that patients are given a choice about such things.

The partners in my practice all believe that protocols and guidelines will accomplish nothing more than giving us more work to do and more rules to comply with. But they implore me to keep my mouth shut—rather than risk angering hospital administrators, insurance company executives, and the other powerful entities that control our fates.

Electronic Records and Financial Burdens

When Congress passed the stimulus, a.k.a. the American Reinvestment and Recovery Act of 2009, it included a requirement that all physicians and hospitals convert to electronic medical records (EMR) by 2014 or face Medicare reimbursement penalties. There has never been a peer-reviewed study clearly demonstrating that requiring all doctors and hospitals to switch to electronic records will decrease error and increase efficiency, but that didn’t stop Washington policymakers from repeating that claim over and over again in advance of the stimulus.

Some institutions, such as Kaiser Permanente Health Systems, the Mayo Clinic, and the Veterans Administration Hospitals, have seen big benefits after going digital voluntarily. But if the same benefits could reasonably be expected to play out universally, government coercion would not be needed.

Instead, Congress made that business decision on behalf of thousands of doctors and hospitals, who must now spend huge sums on the purchase of EMR systems and take staff off other important jobs to task them with entering thousands of old-style paper medical records into the new database. For a period of weeks or months after the new system is in place, doctors must see fewer patients as they adapt to the demands of the technology.

The persistence of price controls has coincided with a steady ratcheting down of fees for doctors. As a result, private insurance payments, which are typically pegged to Medicare payment schedules, have been ratcheting down as well. Meanwhile, Medicare’s regulatory burdens on physician practices continue to increase, adding on compliance costs. Medicare continues to demand that specific coded services be redefined and subdivided into ever-increasing levels of complexity. Harsh penalties are imposed on providers who accidentally use the wrong level code to bill for a service. Sometimes—as in the case of John Natale of Arlington, Illinois, who began a 10-month sentence in November because he miscoded bills on five patients upon whom he repaired complicated abdominal aortic aneurysms—the penalty can even include prison.

For many physicians in private practice, the EMR requirement is the final straw. Doctors are increasingly selling their practices to hospitals, thus becoming hospital employees. This allows them to offload the high costs of regulatory compliance and converting to EMR.

As doctors become shift workers, they work less intensely and watch the clock much more than they did when they were in private practice. Additionally, the doctor-patient relationship is adversely affected as doctors come to increasingly view their customers as the hospitals’ patients rather than their own.

In 2011, The New England Journal of Medicine reported that fully 50 percent of the nation’s doctors had become employees—either of hospitals, corporations, insurance companies, or the government. Just six years earlier, in 2005, more than two-thirds of doctors were in private practice. As economic pressures on the sustainability of private clinical practice continue to mount, we can expect this trend to continue.

Accountable Care Organizations

For the next 19 years, an average of 10,000 Americans will turn 65 every day, increasing the fiscal strain on Medicare. Bureaucrats are trying to deal with this partly by reinstating an old concept under a new name: Accountable Care Organization, or ACO, which harkens back to the infamous HMO system of the early 1990s.

In a nutshell, hospitals, clinics, and health care providers have been given incentives to organize into teams that will get assigned groups of 5,000 or more Medicare patients. They will be expected to follow practice guidelines and protocols approved by Medicare. If they achieve certain benchmarks established by Medicare with respect to cost, length of hospital stay, re-admissions, and other measures, they will get to share a portion of Medicare’s savings. If the reverse happens, there will be economic penalties.

Naturally, private insurance companies are following suit with non-Medicare versions of the ACO, intended primarily for new markets created by ObamaCare. In this model, an ACO is given a lump sum, or bundled payment, by the insurance company. That chunk of money is intended to cover the cost of all the care for a large group of insurance beneficiaries. The private ACOs are expected to follow the same Medicare-approved practice protocols, but all of the financial risks are assumed by the ACOs. If the ACOs keep costs down, the team of providers and hospitals reap the financial reward: surplus from the lump sum payment. If they lose money, the providers and hospitals eat the loss.

In both the Medicare and non-Medicare varieties of the ACO, cost control and compliance with centrally planned practice guidelines are the primary goal.

ACOs are meant to replace a fee-for-service payment model that critics argue encourages providers to perform more services and procedures on patients than they otherwise would do. This assumes that all providers are unethical, motivated only by the desire for money. But the salaried and prepaid models of provider-reimbursement are also subject to unethical behavior in our current system. There is no reward for increased productivity with the salary model. With the prepaid model there is actually an incentive to maximize profit by withholding services.

Each of these models has its pros and cons. In a true market-based system, where competition rewards positive results, the consumer would be free to choose among the various competing compensation arrangements.

With increasing numbers of health care providers becoming salaried employees of hospitals, that’s not likely. Instead, we’ll see greater bureaucratization. Hospitals might be able to get ACOs to work better than their ancestor HMOs, because hospital administrators will have more control over their medical staff. If doctors don’t follow the protocols and guidelines, and desired outcomes are not reached, hospitals can replace the “problem” doctors.

Doctors Going Galt? 

Once free to be creative and innovative in their own practices, doctors are becoming more like assembly-line workers, constrained by rules and regulations aimed to systemize their craft. It’s no surprise that retirement is starting to look more attractive. The advent of the Affordable Care Act of 2010, which put the medical profession’s already bad trajectory on steroids, has for many doctors become the straw that broke the camel’s back.

A June 2012 survey of 36,000 doctors in active clinical practice by the Doctors and Patients Medical Association found 90 percent of doctors believe the medical system is “on the wrong track” and 83 percent are thinking about quitting. Another 85 percent said “the medical profession is in a tailspin.” 65 percent say that “government involvement is most to blame for current problems.” In addition, 2 out of 3 physicians surveyed in private clinical practice stated they were “just squeaking by or in the red financially.”

A separate survey of 2,218 physicians, conducted online by the national health care recruiter Jackson Healthcare, found that 34 percent of physicians plan to leave the field over the next decade. What’s more, 16 percent said they would retire or move to part-time in 2012. “Of those physicians who said they plan to retire or leave medicine this year,” the study noted, “56% cited economic factors and 51% cited health reform as among the major factors. Of those physicians who said they are strongly considering leaving medicine in 2012, 55% or 97 physicians, were under age 55.”

Interestingly, these surveys were completed two years after a pre-ObamaCare survey reported in The New England Journal of Medicine found 46.3 percent of primary care physicians stated passage of the new health law would “either force them out of medicine or make them want to leave medicine.”

It has certainly affected my plans. Starting in 2012, I cut back on my general surgery practice. As co-founder of my private group surgical practice in 1986, I reached an arrangement with my partners freeing me from taking night calls, weekend calls, or emergency daytime calls. I now work 40 hours per week, down from 60 or 70. While I had originally planned to practice at least another 12 to 14 years, I am now heading for an exit—and a career change—in the next four years. I didn’t sign up for the kind of medical profession that awaits me a few years from now.

Many of my generational peers in medicine have made similar arrangements, taken early retirement, or quit practice and gone to work for hospitals or as consultants to insurance companies. Some of my colleagues who practice primary care are starting cash-only “concierge” medical practices, in which they accept no Medicare, Medicaid, or any private insurance.

As old-school independent-thinking doctors leave, they are replaced by protocol-followers. Medicine in just one generation is transforming from a craft to just another rote occupation.

Medicine in the Future

In the not-too-distant future, a small but healthy market will arise for cash-only, personalized, private care. For those who can afford it, there will always be competitive, market-driven clinics, hospitals, surgicenters, and other arrangements—including “medical tourism,” whereby health care packages are offered at competitive rates in overseas medical centers. Similar healthy markets already exist in areas such as Lasik eye surgery and cosmetic procedures. The medical profession will survive and even thrive in these small private niches.

In other words, we’re about to experience the two-tiered system that already exists in most parts of the world that provide “universal coverage.” Those who have the financial means will still be able to get prompt, courteous, personalized, state-of-the-art health care from providers who consider themselves professionals. But the majority can expect long lines, mediocre and impersonal care from shift-working providers, subtle but definite rationing, and slowly deteriorating outcomes.

We already see this in Canada, where cash-only clinics are beginning to spring up, and the United Kingdom, where a small but healthy private system exists side-by-side with the National Health Service, providing high-end, fee-for-service, private health care, with little or no waiting.

Ayn Rand’s philosophical novel Atlas Shrugged describes a dystopian near-future America. One of its characters is Dr. Thomas Hendricks, a prominent and innovative neurosurgeon who one day just disappears. He could no longer be a part of a medical system that denied him autonomy and dignity. Dr. Hendricks’ warning deserves repeating:

Let them discover the kind of doctors that their system will now produce. Let them discover, in their operating rooms and hospital wards, that it is not safe to place their lives in the hands of a man whose life they have throttled. It is not safe, if he is the sort of man who resents it—and still less safe, if he is the sort who doesn’t.

Jeffrey Singer practices general surgery in Phoenix, Arizona, writes for Arizona Medicine, the journal of the Arizona Medical Association, is an adjunct scholar at the Cato Institute, and is treasurer of the U.S. Health Freedom Coalition.

One of many reasons the West can never forgive the Serbs https://t.co/vzlM2qK6dz

— Kit Klarenberg (@KitKlarenberg) August 18, 2023

From Global Research.  This story revolves around Patrice Lumumba, 1925-January 17, 1961, but it is really a story about U.S. foreign policy in dealing with independent states erupting all over Africa.  Later that year, the UN Second Secretary General, Dag Hammarskjold, was killed in a plane crash.  It was sabotage.  It was an assassination.  

The conflict is an old one: Colonial Rule vs. Self-Government.  There is/was the British Empire.  The Congo was ruled under Belgian colonial rule.  

I have learned much about  William A.M. Burden II from Peggy and I.  I was best acquainted with his 20-year tenure… as Chairman of the Board of the Institute for Defense Analyses [IDA] and his contribution to the quality of the output of this “think tank’s serving the Secretary of Defense and the Joint Chiefs of Staff…His government service reached its apogee during his two years, 1959-61, as Ambassador to Belgium…He has been most responsive over these years also to the needs of Columbia University which he has served as a trustee…” – General and former IDA President Maxwell Taylor in foreword to Columbia University Life Trustee William A.M. Burden’s 1982 book, Peggy and I: A Life Too Busy For A Dull Moment

“Before I accepted my ambassadorship in Belgium I had been given in 1957…appointment as ‘a public trustee’ of the Institute for Defense Analyses [IDA]. It became one of the top priorities of my life.  I was elected chairman in May 1959.  One of the unfortunate side-effects of the student protest movement against the Vietnam War was that IDA itself became a target for anti-war protests, and its member universities were subjected to faculty and student pressure to cancel their ties…” – Columbia University Life Trustee William A.M. Burden in his 1982 book, Peggy and I.

“Only prudent, therefore to plan on the basis that Lumumba Government threatens our vital interests in Congo and Africa generally. A principal objective of our political and diplomatic action must therefore be to destroy Lumumba government as now constituted…” – Columbia University Life Trustee and U.S. Ambassador to Belgium William A.M. Burden in a July 19, 1960 cable to the U.S. State Department.

“The Belgians were sort of toying with the idea of seeing to it that Lumumba was assassinated. I went beyond my instructions and said, well, I didn’t think it would be a bad idea either, but I naturally never reported this to Washington—but Lumumba was assassinated. I think it was all to the good…” – Columbia University Life Trustee William A. M. Burden in a 1968 Oral History Interview with Columbia University School of Journalism’s Advanced International Reporting Program Director, John Luter.

. . . 

When Columbia and Barnard students first occupied Hamilton Hall on Columbia University’s campus on Apr. 23, 1968, one of their six demands was “that the university sever all ties with the Institute for Defense Analyses [IDA] and that [then-Columbia] President Kirk and Trustee Burden resign their positions on the Executive Committee of that institution immediately.”

Coincidentally, besides representing Columbia University—with the (now-deceased) Grayson Kirk—on the Executive Committee of the Pentagon’s IDA  weapons research think-tank in 1968, Columbia Life Trustee William A.M. Burden was also the U.S. Ambassador to Belgium who recommended fifty-seven years ago, in July 1960, that “a principal objective” of the Republican administration in Washington, D.C. of former Columbia University President Eisenhower  “must therefore be to destroy” the democratically-elected “Lumumba government as now constituted” in Belgium’s former Congo [Zaire] colony. As David Talbot recalled in his 2015 book, The Devil’s Chessboard: Allen Dulles, the CIA, and the Rise of America’s Secret Government:

“Dulles, Doug Dillon (then serving as a State Department undersecretary), and William Burden, the U.S. ambassador to Belgium, led the charge within the Eisenhower administration to first demonize and then dispose of [Patrice] Lumumba. All three men had financial interests in the Congo. The Dillon family’s investment bank handled the Congo’s bond issues. Dulles’s old law firm represented the American Metal Climax (later AMAX), a mining giant with holdings in the Congo…Ambassador Burden was a company director…Ambassador Burden was a Vanderbilt heir…

“Burden, who had acquired his ambassadorship by contributing heavily to the 1956 Eisenhower campaign, spent his days in Brussels attending diplomatic receptions…It was the ambassador who first raised alarms about the rising Patrice Lumumba…Burden began sending agitated cables to Dulles in Washington well before Lumumba’s election…By the…summer [of 1960], Burden was cabling Washington ‘to destroy Lumumba government’ as a threat to ‘our vital interest in Congo.’…”

“…At an NSC [National Security Council] meeting in August 1960, Eisenhower gave [CIA Director Allen] Dulles direct approval to ‘eliminate’ Lumumba. Robert Johnson, the minutes taker at the NSC meeting…said there was nothing ambiguous about Eisenhower’s lethal order. ‘I was surprised that I would ever hear a president say anything like this in my presence or the presence of a group of people’…

“…Lumumba ‘would remain a grave danger,’ Dulles told an NSC meeting on Sept. 21, 1960, ‘as long as he was not yet disposed of.’…”

A Life Trustee of Columbia University since 1956, Burden (who died in 1984) was among the “people in the Eisenhower administration” who “hunted for ways to reduce Lumumba’s influence” and, along with CIA Director Allen Dulles “and the CIA’s man in Leopoldville [Kinshasa],” Larry Devlin, “devised actions,” according to Katholieke Universiteit Leuven Professor of History Emmanuel Gerard and University of Pennsylvania Professor of History Bruce Kuklick’s 2015 book, Death in the Congo: Murdering Patrice Lumumba.

The same book also noted that Devlin was “a CIA agent from the late 1940s” who “began spying for the CIA in Brussels, where he had a cover position as an attaché’” in 1958 and where he “made contacts with the Congo’s politicians, who came to Belgium for various deliberations.” After his appointment as the CIA’s chief of station in the Congo in “the second part of 1959,” Devlin “went there with Burden” in March 1960, when the Columbia Life Trustee and his wife traveled through the still not-yet independent Belgian Congo. Coincidentally, besides being a Columbia trustee in 1960, Burden was also a trustee of the Farfield Foundation that was utilized by the CIA, during the Cold War Era of the 1950s and 1960s, as a conduit for covertly financing projects and journals, like the American Congress of Cultural Freedom [CCF] and Encounter magazine, which promoted U.S. power elite foreign policy objectives.

Following his March 1960 trip to the Congo with CIA Station Chief Devlin, “Burden told the Department of State that America could not permit the Congo to go left after independence,” according to Death in the Congo. And after the Congo [Zaire] was granted its formal independence on June 30, 1960, the Columbia Life Trustee–who also “maintained during his ambassadorship, a directorship in American Metal Climax, whose Rhodesian copper interests were to make it the leading corporate defender of a conservative order…in Katanga (where Belgian troops began supporting an illegally-established secessionist regime on July 11, 1960), according to Roger Housen’s 2002 paper “Why Did The US Want To Kill Prime Minister Lumumba Of The Congo?”–began pushing for the removal of the democratically-elected anti-imperialist Lumumba as Congolese Prime Minister in July 1960. As Madeline Kalb observed in her 1982 book, The Congo Cables: The Cold War in Africa:

“The U.S. Embassy in Brussels, replying to the U.S. State Department’s query on July 19…took a very strong line regarding Lumumba, recommending openly for the first time that the United States try to remove him from office. The U.S. ambassador,William Burden, said he believed the situation called for ‘urgent measures on various levels.’…Burden concluded by noting that while the U.S. Embassy in Leopoldville [Kinshasa] had the primary responsibility for dealing with the internal political situation in the Congo, the CIA in Brussels would be ‘reporting separately some specific suggestions.’”

The Death in the Congo book also noted:

“…Burden barraged Washington with memos asking greater sympathy for the [Belgian] imperialists…He understood, he told [then-U.S.] Secretary [of State Christian] Herter, why the United States would look at issues from the point of view of the Congo. Nevertheless, America should instead pressure the UN to support Belgium. At the end of July Burden briefed Dulles when returned to Washington for discussions. From Europe, Burden would continue as a mouthpiece for the more rabid anticommunism guiding Dulles’s report to the NSC [National Security Council]…”

Continue reading . . .