An Irresistible Force?

Russell L. Blaylock, MD


As I picked up the front page of the USA Today in the doctor's lounge, an article caught my eye. The headlines read: "Health-Plan Cost to Soar This Year." Even though I was late to start my myelogram, I sat down to read this incredible headline. It reported that large health benefit plans' costs will go up 7 percent on average this year, almost twice the rate increase of last year. But, of even more interest, it is drastically higher than the 1.5 percent inflation rate. You may recall that the leftist demagogues of days past used this as a justification for the total eradication of the free practice of medicine.

But, it gets worse, a survey by Towers Perrin, a human resources consulting firm, of 213 companies found that a faster pace of increases looms ahead like a specter on the land. Some are predicting that these managed care increases will soon become double digit. Translated, it means that all of those companies, especially corporate entities, that were so anxious to destroy the existing medical care system will see their cost go up dramatically. It is reminiscent of the Jacobins who were also anxious to see all of the traditions, mores, and previously existing order of the Monarchy destroyed in order to usher in their brilliant new system based on the "god of reason," only to die at the hands of those they brought to power. Much like the Frankenstein story, and perhaps more apropos here, as expressed by Danton alluding to Graeco-Roman mythology on the way to the guillotine, "Like Saturn, the revolution always devours its children."

The reason given for the sad turn of events is twofold: First, that mounting costs are being driven by consolidation of HMOs, which dampens competition. Well, isn't that even more justification for having tens of thousands of physician groups all competing against one another in a system of medical savings accounts (MSAs)? And, shouldn't this process of HMO consolidation stifling competition be justification for an anti-trust suit? After all, isn't that what the laws were enacted for? Their second reason for this catastrophe is that the managed care socialists offered their product far below market price in order to attract business. Again, an anti-trust violation (unfair competition).

I can recall telling the deluded physicians in High Point, North Carolina that HMO savings would be a one time savings and that prices would be held artificially low to steal patients from real doctors. I also explained that once the honeymoon was over, the price increases for HMOs would exceed that of fee-for-service practice. Ta-dah! But, before that, I gave a talk to all of High Point business leaders assembled at the Chamber of Commerce. It was an illustrious crowd consisting of furniture factory CEOs, the owner of the largest school bus manufacturing plant in America, hosiery mill CEOs, all of the local captains of industry. I gave the same speech I would give to the doctors.(1,2) They sat politely and listened and then told me that all they were interested in was saving money. They were convinced they would show me the virtues of HMOs. With the HMO they would save tons of money and crush the greedy physicians in the process.

Now, they have not only succeeded in destroying the free practice of medicine but the system they used to do it is now more expensive than the one they replaced it with and of much lower quality.

While most of us reflexively want to shout with joy, actually, we should find this grim news sobering. I am convinced that this will be the start of part two of the plan to totally socialize medicine. The leftist intellectuals' and their government minions' response to this news will be that it only means that the free market cannot provide medical care because there are two many competing entities, too little centralized control, and too much opportunity for greed (i.e., the same old Marxist-Leninist argument). That, the collectivists on the left will say, can only be done by government. They will use the enormous salaries of the HMO and managed care CEOs as examples of this greed, and this will have great propaganda appeal. A coalition will be formed between government bureaucrats and the existing managed care structures as the takeover begins. In the beginning, it will have all the trappings of a reasonable association, another seemingly innocuous public-private partnership. But, with time, the bureaucrats will do what they do so well: They will slowly eat away at the controlling organizations of the managed care system by regulatory fiat and the use of other government bureaus until they are in virtual total control. Doctors, initially hailing the association as a refreshing change, will only see the deception far too late. Some never. As it is said, "Against stupidity, the gods themselves struggle in vain."

This is a time that MSA proponents should go on the assault, since the only justification the managed care industry has, cost cutting, is now dead.




1. Blaylock RL. Managed care as an industrial product. Medical Sentinel 1996;1(1):19-22.
2. Blaylock RL. Running for cover --- the herd instinct among physicians. Medical Sentinel 1996;1(2):14-17.


Dr. Blaylock is a neurosurgeon in Jackson, Mississippi, and a member of the editorial board of the Medical Sentinel.

Originally published in the Medical Sentinel 1999;4(4):140. Copyright ©1999 Association of American Physicians and Surgeons (AAPS).