The Constitution --- Plain and Simple

Part III: The Practice of Medicine is not an Industry

Curtis W. Caine, MD

This column on the Constitution appears in the Medical Sentinel to remind us that it is the unConstitutional (and thus illegal) activities in medicine and all other facets of our lives that have trampled on and outlawed our God-endowed freedom and liberty.

In Parts I and II of this article, we have explained that when physicians form their own union they have an inside-of-medicine, doctor instigated labor union --- and by so doing they admit (even if unwittingly) that the practice of medicine is a trade, is an industry; and is not a profession.

Doctors are hopeful that with the clout they expect their union to give them their problems are soon to be no more because they are now strong and in control. For whom will that clout be used, the doctors, or the union, or management (government, etc.)? Don't forget that union bosses do make deals with management!

And how far will that clout be wielded? To strike? Riot in the streets? Those are the tactics unions often use. Then comes injunction, and court lawsuits, and jail.

You can bet the cunning, corpulent "organized labor" leaders are ecstatically gleeful (incontinent with joy) in the cigar smoke-filled back room of the union hall. Why? Because the doctors have fallen for their bait and unionized, placing themselves in the custody of the labor controllers. The word "fallen" here has at least two meanings: 1) fallen for, been suckered into, and 2) toppled from their high ground of noble and ethical professional character. From the point of view of collectivists, it is much easier to manipulate a union of a thousand members than to have to manipulate the same number of independent, individual doctors one at a time, especially if they are ethical and principled.

They count on "all the king's horses and all the king's men" not being able to "put Humpty Dumpty back together again" because the practice of private medicine has been destroyed and replaced with subservience to the health care system.

As we examine the balance sheet, we note some hoped for benefits in the credit/assets column but many disadvantages in the debit/liability column. Among the latter, we find that laws governing unions are going to apply to physicians, too. So, a whole can of worms (some of them two-legged) is opened to slime up the deal. This brings up the National Labor Relations Board (NLRB), wage and price controls, hours, negotiating, minimum wage (doctors are already being told they may not treat a colleague as a courtesy), maximum wage (limiting charge), punching a clock, keeping a documented record of CME points earned (paid for), collective bargaining, etc. OOPS! There, it slipped out again! Collective deals with collectivism, which by definition is socialism, which is a euphemism for communism, the antithesis of the centuries old traditional code of medical ethics and Americanism. Once again democracy (rule of men), the antithesis of our republic (rule of law), raises its hydra head --- another Constitutional issue.

Halt! What's going on here? A principled, ethical physician lowering himself to bargain with anyone other than his patient? Caramba! Mon Dieu! In today's morass the doctor is already forced to bargain (one more point per procedure and/or one more nickel per point) with many interlopers, if he expects to be able to pay his office rent (practice overhead), much less eat (net income). With a union, much more intrusion is intrinsic. All ultra vires --- outside the law.

And when the doctor has an employer other than his patient, he is wrongfully the servant of that other entity and not rightfully of his patient --- answerable to it, not him. That is the veterinary ethic in which the vet is paid by the owner to do to ("for") the animal what the owner wishes, without the documented permission of the beast. Remember? Everything has to be documented in the record and signed, including informed consent! The bargaining goes on between the owner and the vet, and the critter is the hapless recipient that is bred or spayed or "put to sleep" --- not for the primary benefit of the beloved pet, but at the whim, or at the pleasure, of the owner.

But people are not pets and doctors are not third party agent vets. That is, not supposed to be. The prospects are blood curdling if we don't order: "Halt!"

Who runs labor unions? Workers? Come on, get rational --- of course not. The lowest common denominator(s) gravitate to and end up running the show, which means the practicing doctor, busy in his office and in the operating room or endoscopy lab, is proxied by full-time doctor labor union bosses. And the bosses recruit like-minded organizers who, in turn, recruit physician labor to be organized into the doctor labor union which they, not the doctors, run. Ever hear of "organized medicine?" Do you really believe that the doctor back home, busy delivering babies and fighting hypertension, runs organized medicine? Did the doctor back home arrange the Sunbeam endorsement fiasco? Or the secret copyright CPT code deal? Of course not. But the deals were consummated using his good name without getting his written consent, and then imposed on him.

The term "boss" means the owner gives orders to his employees. Why? Because management designs and markets the product and pays the employee. The payer is over the payee. In the free market, industry/management takes the risk of making ends meet, but the worker gets his pay. That's why the patient is properly the only one to be over the physician. The patient is assured of conscientious care and the physician takes the risk of being paid. And whenever someone or something other than the patient pays the physician, that someone or something becomes the employer of and the controller of the physician (and, not incidentally of the patient, too). As Sherlock Holmes would say, "Elementary, my dear Doctor Watson."

The final Part IV will appear in the next issue. It will clinch the assertion that "medicine is not an industry."

Dr. Caine is an anesthesiologist in Jackson, Mississippi, and a member of the Editorial Board of the Medical Sentinel.

Originally published in the Medical Sentinel 2000;5(3):108-109. Copyright©2000 Association of American Physicians and Surgeons (AAPS)