Health Reform by Cloward and Piven
Monday, May 24, 2010 at 11:19PM by aaps By: Richard Amerling, MD
May 24, 2010
Richard A. Cloward and Frances Fox Piven were Columbia University sociologists who founded, in 1966, the National Welfare Reform Organization, a “parent organization” of the Association of Community Organizations for Reform Now (ACORN). They advocated what became known as the “Cloward-Piven strategy,” which “seeks to hasten the fall of capitalism by overloading the government bureaucracy with a flood of impossible demands, thus pushing society into crisis and economic collapse.” This is an instructive prism through which to view the recent health care legislation.
The legislation pushes millions into Medicaid, whose costs are already crushing state and local taxpayers into powder. Flooding it with new beneficiaries will hasten its bankruptcy. Likewise, Medicare is to be cut by $500 billion at a time when the baby boomers will be enrolling. The program is already running at a deficit, and will simply be unable to provide seniors the same level of service they currently enjoy. In other words, both systems will implode.
At the same time, incentives for employers to provide health care will be lessened, and many will drop coverage, sending millions to the government cooperatives for coverage. These policies will be heavily subsidized by the taxpayer, and will dramatically swell an already very bloated public sector. We are already mired in debt, and still bailing out Fannie and Fred with tens of billions of dollars each quarter, and with no end in sight. The health bill may be the coup de grace for our struggling economy.
Doctors are not blind, nor are they asleep. Many understand that “unsustainable” means collapse is inevitable unless Washington does an about-face. How is the medical profession responding?
Two articles published this week provide a glimpse into the future. Scott Gottlieb writes in the Wall St. Journal, “In 2005, doctors owned more than two-thirds of all medical practices. By next year, more than 60% of physicians will be salaried employees. About a third of those will be working for hospitals.” On the other side, the Houston Chronicle reports that Texas physicians are not only declining to take new Medicare patients, but that “new data shows 100 to 200 a year are now ending all involvement with the program. Before 2007, the number of doctors opting out averaged less than a handful a year.” The article quotes Dr. Susan Bailey, president of the Texas Medical Association: “This new data shows the Medicare system is beginning to implode. If Congress doesn't fix Medicare soon, there'll be more and more doctors dropping out and Congress' promise to provide medical care to seniors will be broken.” In other words, the “Cloward-Piven strategy” is being implemented.
How to reconcile these reports? We are moving towards a dual system in medicine. There will be hospital-based physicians who will be mostly salaried, full-time or part-time employees. Their primary loyalty will be to their employer. They will follow protocols and guidelines, and work shifts. They will be assigned patients, rather than develop their own practices. They will eventually come under the heavy hand of the SEIU. As hospital revenues suffer under ObamaCare, they will find themselves increasingly burdened. Quality of care will deteriorate.
Outside the hospital setting will be a thriving, private, medical marketplace, anchored by a growing number of private physicians who are opting out of Medicare and other third party arrangements. These doctors will develop busy practices, and will be able to stay in business by setting their own rates, cutting overhead, and controlling their volume. They will be able to spend enough time with patients to ensure a high quality experience, and will work to keep patients healthy and out of the hospital. Unmoored from price controls, the cost of good care will plummet. Doctors, labs, and imaging facilities will compete on quality and price. There is no reason why an MRI shouldn’t cost $100 in a competitive marketplace.
Patients must understand the reality of what is about to happen. As of this writing, Health Savings Accounts are still available. Get them while you can! Creating and funding an HSA is the best way to insure against the coming implosion of government-run health care. Even seniors on Medicare should set up these accounts. They should also consider opting out of Part B, which pays for doctors’ services, since they will have difficulty finding private physicians who will accept Medicare. They will still have Part A in case they need hospitalization.
Like the doomed Korean ship the Cheonan, our health care system has been torpedoed. It hasn’t sunk yet, but it will. Man the lifeboats!
Richard Amerling, MD, is a nephrologist practicing in New York City. He is an Associate Professor of at Albert Einstein College of Medicine in New York, and the Director of Outpatient Dialysis at the Beth Israel Medical Center. Dr. Amerling studied medicine at the Catholic University of Louvain in Belgium, graduating cum laude in 1981. He completed a medical residency at the New York Hospital Queens and a nephrology fellowship at the Hospital of the University of Pennsylvania. He has written and lectured extensively on health care issues and is a Director of the Association of American Physicians and Surgeons. Dr. Amerling is the author of the Physicians' Declaration of Independence (http://www.aapsonline.org/medicare/doi.htm).
Reader Comments (14)
I would really appreciate AAPS doing an article on MSAs for those who have no choice but to be on Medicare.
"Richard A. Cloward and Frances Fox Piven"
Rhetorical fearmongering bullshit. How you think this is relevant is beyond me. Most countries do just fine with significantly more bureaucracy than we have.
"The legislation pushes millions into Medicaid, whose costs are already crushing state and local taxpayers into powder."
Since we have one of the world's highest GDPs per capita and one of the world's lowest rates of taxation, could you explain to me how the most wealth per person and lowest taxation rates per person crushes Americans to powder? Are we that weak? Or do we just like whining about having to contribute anything to society?
"At the same time, incentives for employers to provide health care will be lessened"
Yeah. That's why the public option was so important. First kill the key piece of the solution, then whine about how the solution won't work? It's kind of your fault. And as for the public option being expensive--that's just wrong: most countries have a public option, and it helps to keep costs down to a quarter of ours without impacting quality of care.
"Doctors are not blind, nor are they asleep."
But they're selfish greedy pigs, apparently. You're answerable first to the Hippocratic Oath or some variation on it, aren't you?
"Outside the hospital setting will be a thriving, private, medical marketplace, anchored by a growing number of private physicians who are opting out of Medicare and other third party arrangements."
Sounds lovely. I hope you're right. Specifically: I hope that medical care is always inexpensive, and that no combination of condition and doctor will ever exist that will set a patient back more than he can afford. When I get six kinds of cancer from all the toxins that the Republicans want me to breathe and eat and drink, will you treat me for under $1000?
How about this solution:
People like Ben can pay into and utilize a government-run health care system.
The rest of us who want free choice in health care can operate outside of that system, working privately with doctors of our own choice, paying the true market value of that health care. I'll pay my doc directly and Ben can pay the government to provide his medical services.
"Rhetorical fear mongering bullshit. How you think this is relevant is beyond me. Most countries do just fine with significantly more bureaucracy than we have"
Isn't it amazing? Some people are well educated w/o being very bright. such is Ben's case. "The proof is in the pudding." France, Portugal, Spain, and of course, Greece are all Socialist countries and their economy is failing. Next is England. Let us not underestimate the same potential here, in the US, if we don't tighten our belts very soon. Final observation. Your "name-calling" is SOP for left-wing radical extremists. Your "shout psychology" is doomed to fail.
I don't know what world Ben is living in, but I guess it is not anywhere near where he can hear the news of what is happening in Europe. Ever hear of Greece, Ben? How well are they doing with their socialist, Big Brother government? Gee, I heard that they were rioting in the streets due to higher taxes, salary and benefit cuts, cuts in services and on-infinitum.
Oh, and by the way -- where is the money coming from for TARP, and bail-outs? From the U.S.'s largess of cash? No Ben. The government is creating more debt for current and future generations to come by printing money out of thin air and loaning out DEBT! The country is truly bankrupt Ben. Approximately 12 trillion in debt. Who is the collateral for all the debt? WE ARE BEN -- WE ARE!
well Ben I can see you are part of the problem not the solution You really speak with no facts. Since when it is the JOB of the Government to provide Healthcare to me or anyone else? Also tell me what Government program has worked well under the Government...Medicaid? Medicare? Post Office? Social Securty? All close to Bankruptcy. You obviously have not looked into Canada's or UK's healhtcare system and the long lines and wait time just to see a primary care Physician and yes rationing. My friend is from Canada and tell me the stories. I suggest you start getting some information before you think this is all great but then you must feel it's Governments job to provide for you. We don't have a healthcare crisis but a healthcare cost crisis. This bill was not about better heathcare but about Government control (now Government owns 47% of the private sector) I feel bad for the folks that keep thinking Obama is looking out for them. Ever wonder why his approve is been below 50% for awhile now??) It will be a hard pill to swallow when your freedom is taken away and taxes are sky high and hyperinflation hits. Look at Greece and you will see what Big Government, entitlement programs, free healthcare, big unions can do to a country. Now the UK is close behind. Don't think for one minute it won't or can't happen here.
Mary, you are correct. I agree totally. And the ballot box is our only way out! This administration is CRAZY for complete control over this entire country! And its ruination!
Mar, excellent post also.
It is unreal just how ignorant people like Ben really are. I mean we all should use this to understand how such a thing as ObamaCare actually got passed. People actually BELIEVE that this will make things better. Very scary. The people who will lose the most are the patients. The quality of care in this country will free fall from the best in the world to a mediocre system where those who work subsidize those who don't leading to a crisis in Europe. Medical care will be like the DMV if we don't replace and repeal this piece of trash legislation. I tell all my patients how innovation will suffer and quality will decline if this legislation isn't repealed. Empower people by telling them how it really is.
Well said, Dr. Amerling. The HSA is already threatened. New rules restrict its use and limit contributions. Any tool useful to maintaining independence from government control will be broken. Look for medical licensure to be tied to participation in the healthcare Obamanation. At that time, what can you do but shrug?
Glen Beck has been predicting and educating regarding Cloward and Pavian for more than a year. All he said has come true. The idiots that think a government option is the way to go have not reached 65. I have already been declined by 2 doctors citing they don't accept Medicare. I have paid into the system since I was 14 years old. The ER tried to send my Mother-In-Law home from the hospital with a broken pelvis when no one at her home is qualified to take care of her. This is a direct result of an overburdened the system and it is only going to get worse. When a large number of doctors leave the system and you government option supporters can't get health care, maybe you will finally wake up. Wait until your child or family member can't get help for any amount of money. Nothing that the conservatives suggested for health was implemented. It was strictly a partisan bill. What a shame.
So? This has been in the works for a long time. Why does this not surprise me about our government? We need to set Term Limits. I believe that some of our elected officials have lost sight of what they are representing. I am tired of writing, contributing, emailing and faxing my elected officials because it seems that they are on their on mission which does not reflect mine. I am a retired Baby Boomer. I have insurance that I pay for and am lucky that I can afford it at this time in my life. I worry about this country. I worry about my children and their children (my grandchildren) and what kind of world they will have when they grow up. Our heads were in the sand. We have finally pulled our heads out of the sand and are beginning to see what is happening and we are not happy. I will continue to email, fax and write to my elected officials. I will not give up trying to "Take My Country Back". I hope that you continue your emails and your fight as well. It is all we have at this point and I have to believe that it will make a difference at some point.
The name "public option" strikes me as very ironic. What is the option? To force others to pay for your health care. Nobody who pays taxes can opt out of having that money taken from him. I attended a meeting of people pushing for that a while back. They chanted, "All we want is the option!" In other words, all they want is to be able to choose to force you to pay for their health care. If you refuse, they just want the option to send men with guns to take your property and imprison you if you resist. If you resist strongly enough, they just want the option to have you shot. The options for the person on the other side of this struggle are pretty dire - cough up the money or deal with the gunmen.
Ben, did you know that the unfunded liabilities (future estimated shortfall) for Medicare and Social Security add up to $106 trillion dollars, according to the trustees of those programs? How are you going to deal with that in your world?
Some of the physicians that I talk with are in Ben's BS camp and others are in the conservative defensive/offensive mode.
Personally I cannot understand how ANYONE in the healthcare field can be so delusional as to NOT see what is happening to their profession. The only answer that I can come up with is that they are letting emotions, misdirected as they might be, overpower rational thought.
Here is an email that I sent out to some of my friends yesterday. It was sent only to those of the conservative and thinking persuasion as I am now sadly convinced that the liberals have taken too much Kool-Aid and will never be able to think for themselves again.
The first one is just a Google search page reference, but you can take you pick of the information on Clowen-Piven.
The other is a readable page about Saul Alinsky and the tentacles that he left behind.
I particularly like the Opening Page Dedication by Mr. A. To wit: “Lest we forget at least an over-the-shoulder acknowledgment to the very first radical: from all our legends, mythology, and history... the first radical known to man who rebelled against the establishment and did it so effectively that he at least won his own kingdom — Lucifer.”
http://www.google.com/#hl=en&source=hp&q=Clowen-Piven+strategy...&btnG=Google+Search&rlz=1R2GFRC_enUS332&aq=f&aqi=&aql=&oq=Clowen-Piven+strategy...&gs_rfai=CbITGKmgCTJrmEqX4McGSveIHAAAAqgQFT9CDIgE&fp=2a0dbe5263c501d8
http://www.crossroad.to/Quotes/communism/alinsky.htm