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Ep. 63 A Voice for Freedom in Medicine

Jane Orient, MD

In the mind of the public, American physicians are represented by one prominent organization, namely, the American Medical Association.  Yet, only a minority of American physicians currently belong to the AMA, which has long grown comfortable with political and government intrusions into healthcare.

Who should represent physicians when doctors may hold very divergent views on matters of politics, economics, ethics, and even science?  Should there be one voice or a plurality of voices?  Our guest today is the executive director of the Association of American Physicians and Surgeons (AAPS), an organization that sprung up in the 1940s as an alternative to the AMA and to staunchly defend private medicine free of government interference or coercion.

Dr. Jane Orient obtained her medical degree from Columbia University and is in a solo internal medicine practice in Tucson, AZ.  She is a prolific writer, having penned hundreds of op-eds in national and local media outlets.  She is the author of numerous books, notably Your Doctor is Not In: Healthy Skepticism About National Health Care and Sutton’s Law, a novel about where the money is in medicineShe is also the editor of the famous textbook Sapira’s Art and Science of Bedside Diagnosis, now in its 4th edition.

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6 Comments

  1. David D on 02/15/2019 at 2:54 AM

    That was a most scary interview. Lots of arguments that claim patient interest when they really are physician interest. The opposition to Obamacare seems purely political and contrary to the groups patient centric party line.

  2. Philip Kruseman on 02/16/2019 at 1:55 AM

    Very strong points made on both sides of the argument/debate. Being a very liberty-minded ICU doctor I sympathize with Dr. Orient and Dr. Accad more. And the the point regarding the crowding-out effect is astute and very true based on historical data in all sectors of the economy. A comprehensive and through look at history, especially in regards to railroad, highway construction and even education demonstrate the insidious affect of government subsidies, political favoritism/kickbacks and regulatory framework lead to lower degrees of innovation, increased prices due to mismatch of supply/demand and overall lead to rent-seeking behaviors as in the case perfectly evinced by the AMA over the last 50-60 years. This is a case of what the great French classical liberal Bastiat called the “seen vs the unseen” benefits.

  3. LP on 02/16/2019 at 6:42 AM

    Around 33:15, Anish makes the claim that hundreds of chiropractic patients say that spinal adjustments have helped their cardiac health. In context, he implies that these claims by chiropractic patients are absurd. This is an excellent example of a professional physician dismissing out of hand a claim where he can see no obvious, direct, way for it to be true. I believe that, were he to consider the question ‘how could chiropractic treatment lead to improved cardiac health?’ he would be able to find an answer. It is generally believed that moderate exercise leads to improved cardiac health. Similarly, high blood pressure and high cortisol levels for prolonged periods are correlated with increased risk of cardiac problems, as is insufficient sleep. All three of those are, in turn, correlated to chronic pain, which also interferes with efforts to regularly exercise. If chiropractic treatment, often coupled with physical therapy, can correct a patient’s source of chronic pain, it’s not obvious that the patient’s cardiac health will not improve due to the treatment.

  4. Anthony Perry, MD on 03/02/2019 at 2:19 PM

    Apropos the low key debate between Anish and Dr Orient: My senior year at Temple (where we were used in place of interns) in ’63-’64 and my internship at Penn in ’64-’65 were done before Medicare. Low income elderly were treated gratis in open wards by physicians-in-training. My Internal Medicine residency, starting in 1965, was done at SF General once again in open wards. However Medicare was now in play and, whereas the more senior residents gave us accounts of wards which were previously overflowing, requiring beds in the hallways, there was now plenty of empty space. The ungrateful seniors had abandoned us to private hospitals and experienced doctors.

    So before Medicare, charity, including that provided by local governments, filled the void in taking care of people but did a rather second rate job. When Medicare became available, the low income seniors voted their preference with their feet. I feel that these events demonstrated that there was a justifiable rationale for federal intervention, unless one was comfortable with the status quo. However, President Johnson, in his proclaimed desire to avoid a two-tiered system, did not restrict the federal involvement to those who needed it and gave us the present idiotic Medicare travesty.

    I am a supporter of AAPS and have been a member for many years. However I think some of its leaders such as Drs. Orient and Huntoon, while they are mostly on the right track, nevertheless suffer from excessive dogmatism. From the standpoint of effectiveness I’m not sure whether that’s a good or bad thing. However, I commend you for putting them on so we can hear their point of view and I also commend Anish for offering a challenge.

    • Michel Accad on 03/02/2019 at 5:07 PM

      Hi Anthony,

      I don’t believe Dr. Orient would dispute that the elderly poor (and not so poor) have benefitted from the Medicare program when it was first rolled out. But the fact that one class of citizens benefit from a government subsidy in the short or long term doesn’t necessarily mean that the subsidy was justified. As Henry Hazlitt and Frederic Bastiat remind us, the effect of the policy must be considered not only in terms of those directly targeted, but in terms of society at large, and in the long term as well as the short term.

      Now, I also agree that the situation for poor elderly patient was pretty bad before Medicare. The question is why? In my posts on the economic history of American healthcare I show pretty clearly that medical cost inflation (which hurts the poor most of all) was caused by direct state interventions since the 1910s: licensing, regulations, and subsidies for employer-based insurance. It is incontrovertible that those policies hurt the poor and the elderly.

      Given that, I don’t know that it’s a bad choice to remain steadfast on principles and not support further government intervention but to ask instead for less government involvement and a rollback of unconstitutional policies that always ultimately hurt many people even if they can help some at the expense of others.

      But yes, it was a great convo and it’s important for ideas to be challenged. Thanks for listening!

  5. Anthony Perry, MD on 03/02/2019 at 11:23 PM

    Michel
    I agree that Medicare has been overall a practical and fiscal disaster and continues to get worse. The question remains as to what was to be done with the situation I described. I’ve heard the AAPS leaders fall back on the solution being charity, but charity is what was going on at the time and wasn’t working well.

    Thinking back, I have to agree with your analysis about price inflation. Even in the 60’s that phenomenon was going on relative to the way things were in the 40’s and early 50’s when I was a kid and most people paid cash. In the 60’s when I did my stints on the “Private Service” as opposed to the “Ward Service” most of the patients I think had insurance and pretty much the private docs ordered and the patients accepted anything that came to mind.

    Overall no argument from me about the evils of, in particular, federal government intervention. It seems to me that, like the Soviet Union, socialized medicine will collapse of its own absurdity, hopefully sooner rather than later. The DPC movement, 3rd party free practices and even the concierge docs are a ray of hope.

    By the way I happened to read Milton Friedman’s discussion about licensing in medicine some time ago. It’s eye-opening. Until you are exposed to his arguments the concept almost seems heretical. Has Anish read it? He seems to ridicule you slightly when you bring it up.

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