The ‘Science’ of Eugenics: America’s Moral Detour
Group Purchasing Organizations: Gaming the System
Fake History and the Constitutional Value of a Black Person
By Marilyn M. Singleton, MD, JD
“Representatives and direct Taxes shall be apportioned among the several States which may be included within this Union, according to their respective Numbers, which shall be determined by adding to the whole Number of free Persons, including those bond to Service for a Term of Years [i.e., indentured servants], and excluding Indians not taxed, three fifths of all other Persons [i.e., slaves].” U.S. Constitution, Art. I, Sec. 2.
In the spirit of fake news, Black History Month provides a forum for news pundits to lament that the Founding Fathers thought the relative worth of black persons was three fifths of a person. They should (and likely) know better. The Three-fifths Clause is not about black or white but was a formula for counting slaves for purposes of congressional representation and taxation. Clearly slavery dehumanizes the enslaved, but the Three-fifths Clause was a compromise that was a partial win for abolitionists.
Free black persons existed long before the Constitution was written. The first Africans brought into captivity to colonial Virginia in 1619 became indentured servants who were freed typically after 7 years just as their white counterparts. Other slaves were freed when they converted to Christianity.
The proposed Constitution allowed one representative to Congress for each 30,000 inhabitants in a state, in contrast to the existing Continental Congress, where each state had an equal vote. The initial suggestion at the sometimes contentious 1787 Constitutional Convention was that representation be based on all free persons. But slaves were half the population in some southern states. Despite slaveholders counting slaves as their property, they also wanted to count slaves as if they were free inhabitants (i.e., “whole persons”), thus increasing the South’s representation in Congress—and essentially be rewarded for having more slaves. Cleverly, Northern abolitionists argued that if the South could count slaves, then the North should be able to count livestock for purposes of representation.
To resolve the issue, liberal Pennsylvania delegate and future Supreme Court justice James Wilson proposed the Three-fifths clause as a necessary compromise to gain the South’s support for the new Constitution. The three-fifths of a vote provision applied only to slaves, not to free blacks in either the North or South. Thus, the much-maligned clause actually benefitted the abolitionists and the slaves by limiting the pro-slavery States’ representation in Congress.
The first U.S. census in 1790 showed a population of about 4 million Americans. Nineteen percent were black and about 13 percent of those black Americans were free. By 1860, as more states abolished slavery and slaves were voluntarily freed or purchased their freedom (manumission) in the South, about a half million free blacks lived in the U.S. with more in the southern states than in the North.
Electorally, slave status mattered. Free blacks could hold office in some states and could vote. As Justice Benjamin Curtis noted in his dissent in the infamous 1856 Dred Scott decision, “Several of the States have admitted persons of color to the right of suffrage, and, in this view, have recognised them as citizens, and this has been done in the slave as well as the free States.” Black votes were not trivial: black votes helped to ratify the new Constitution and in Baltimore, Maryland in the 1700s, more blacks than whites voted in elections.
Today’s “woke” social justice warriors rail that the racist Founding Fathers should have abolished slavery altogether right then and there. Our Founders would have preferred to do so. Great Britain was making boatloads of money from the slave trade and prevented the abolition of slavery in the colonies. In 1774, at the First Continental Congress, delegates Thomas Jefferson and Benjamin Franklin called to end the importation of slaves by December 1, 1776. This provision was put in the Articles of Association of the Continental Congress. At the January 9, 1776 Second Continental Congress, a resolution to end of the importation of slaves to America was passed. Of course, the 13th through 15th Amendments freed the slaves, gave them full citizenship, and males the right to vote.
Witnessing our current vitriolic political divides over less weighty issues, it is hard to imagine the determination and negotiating skills our Founders’ needed to bring differing philosophies together to form a new country with new values based on liberty for all. Rectifying our social ills begins with telling the whole truth. Truth #1: The Three-fifths clause was not about the relative worth of a black person. Truth #2: Black people owned slaves (as workers, not family). Truth #3: All white men are not bad—now or 400 years ago.
Bio: Dr. Singleton is a board-certified anesthesiologist. She is Immediate Past President of the Association of American Physicians and Surgeons (AAPS). She graduated from Stanford and earned her MD at UCSF Medical School. Dr. Singleton completed 2 years of Surgery residency at UCSF, then her Anesthesia residency at Harvard’s Beth Israel Hospital. While still working in the operating room, she attended UC Berkeley Law School, focusing on constitutional law and administrative law. She interned at the National Health Law Project and practiced insurance and health law. She teaches classes in the recognition of elder abuse and constitutional law for non-lawyers.
Fraud and Anonymity: The Perils of Medical Care Bureaucracy
By Marilyn M. Singleton, MD, JD
The high cost of medical care is on the lips of every politician and draining the pocketbooks of most Americans. After creating the Medicare/Medicaid monster, the government’s expanded intervention into the medical care marketplace with the inaptly named Affordable Care Act doubled the premiums and deductibles for both employer-sponsored and individual insurance. Piling on more laws, regulations, and agencies is not the answer.
Anonymity, complexity, and opacity invite shady behavior. Individuals, companies, and patients who defraud the massive federal “health system” would never dream of lifting money from their patients’ wallets or stealing from their doctors’ cash drawer.
The government’s track record does not bode well for imposing more bureaucracy to remedy a problem created by the layers of third-party payer bureaucracy. Waste, fraud, and abuse are so rampant that the government has a Medicare Strike Force to root out and recover lost federal funds. Medicare fraud—about $60 billion in 2016 alone—is about 10 percent of Medicare’s total payments. By contrast the typical private business loses 5 percent of its revenues to fraud. Unfortunately, since its inception in March 2007, the Medicare Strike Force has recouped less than $2 billion per year in misappropriated funds.
Medicare’s $16.7 billion per year hospice program is fertile ground for the unscrupulous. Hospices are paid a fixed daily sum for each patient enrolled “regardless of the services provided.” One amoral scheme recruits patients who unknowingly forgo curative treatment options by joining hospice. A recent Office of Inspector General (OIG) report revealed that in 2012 hospices billed Medicare more than $250 million for services to patients in long-term care or assisted-living residences who did not require hospice care, costing four times more than the appropriate level of care. Even worse, the OIG found that the quality of care suffered in 31 percent of programs. The bureaucratic morass allows the perpetrators to pocket the fixed fee and skimp on the services.
Further, the government cannot keep track of its program dollars. According to another OIG audit, in 2009, Medicare Prescription Drug program paid $33.6 million and hospice patients paid $3.8 million for medications that should have been included in the hospice daily fee. Even after discovering the snafu, the problem got exponentially worse. In 2016 the government paid $160.8 million for drugs that hospice organizations should have paid for from its fixed daily fee. Our tax dollars paid for the drugs twice.
Physicians know what patients want and are acting on it. Free from the restraints of government “healthcare” programs, the physician-led, price-transparent, direct-pay Surgery Center of Oklahoma performs some surgeries for less than the copays of some insurance policies. Direct Primary Care physicians provide 24/7 access and basic labs for as little as $50 per month with at-cost medications and low-priced x-rays.
The corporate private sector has learned a thing or two from innovative physicians. Care Accelerator is Sam’s Club’s version of “affordable [medical care] options with transparent pricing.” To offer relief from high out-of-pocket costs, $50 (individual) to $240 per year (families) buys access to lab screening for diabetes and heart disease, free generic drugs, telehealth, and up to a 30 percent discount on vision, dental, and other ancillary services. Additionally, Walmart is training its own employees for jobs in the health sector and ideally to staff Walmart’s own medical services. For their employees, Apple has “health care built around you” with its AC Wellness that offers office and home visits; Amazon launched its Amazon Care telemedicine services.
Given the outrageous price of drugs—largely due to the pharmacy benefit manager middlemen—Good Rx discount coupons are just what the doctor ordered. Good Rx is free to the consumer and makes money from advertisements on the website and referral fees. One typical victory is a Medicare patient whose neurologist prescribed a drug for his Parkinson’s disease symptoms. The government demanded testing that could not be done because of the patients debilitated condition. Despite a sympathetic ear and supporting research, the government arbiter could only parrot the party line: because the drug was not on the “list,” it was not covered by Medicare. In a fortunate twist of fate, with a Good Rx coupon the patient paid $34 per month cash instead of the drug’s $1,100 per month price with 20 percent patient co-pay that would have been charged through the Medicare Prescription Drug program.
Congress claims it plans a full-frontal attack on the high cost of medical care (with the same results as the war on poverty and drugs?). Frankly, we are better off with Congress engrossed in its impeachment clown show and keeping its nose out of our medical business.
Bio: Dr. Singleton is a board-certified anesthesiologist. She is Immediate Past President of the Association of American Physicians and Surgeons (AAPS). She graduated from Stanford and earned her MD at UCSF Medical School. Dr. Singleton completed 2 years of Surgery residency at UCSF, then her Anesthesia residency at Harvard’s Beth Israel Hospital. While still working in the operating room, she attended UC Berkeley Law School, focusing on constitutional law and administrative law. She interned at the National Health Law Project and practiced insurance and health law. She teaches classes in the recognition of elder abuse and constitutional law for non-lawyers.
Russia, Racists, and Ridiculousness
By Marilyn M. Singleton, MD, JD
Now that the Russia collusion story has lost its glow, the left’s narrative du jour is that anyone expressing a contrary opinion is a racist. It is so exhausting! What is a racist, anyway? A racist believes that race is the primary determinant of human traits and capacities and that racial differences produce an inherent superiority of a particular race. Tethering a rival to racism is designed to be a career-ender. Thus, some presidential hopefuls profess embarrassment and remorse because they are Caucasian while others believe themselves to be morally superior because they are not.
The political pot-stirrers wail that our country is racist, despite the fact that we elected the son of a black African and a white American to be our leader. At about 12 percent of the population, the “black vote” could not have unilaterally pulled this off. Obama captured the white vote even after his pre-election unity speech publicly shamed his beloved white grandmother for her “cringe[worthy]” comments involving racial stereotypes. All to atone for supporting a pastor whose “incendiary language” expressed hatred toward white folks. Because they shifted their political allegiance, the same 2008 Obama voters are now racists.
We have arrived at a place so vitriolic and demented that Ivanka Trump was called a racist because she bought a little white puppy for her child. By that “logic” the Obamas are racist because they bought a pure-bred black dog—and not a shelter dog as they promised to adopt. So of course, they likely harbor ill will against the homeless.
By today’s standard, President Clinton is a racist because his ill-fated Waco tank attack in 1993 killed some 40 ethnic minority persons. And who is the racist? Eric Holder’s Justice Department refused to allow a North Carolina town to hold nonpartisan local elections on the grounds that removing the partisan cue (Democrat) in municipal elections would likely eliminate the single factor that allows black candidates to be elected to office.
Is black filmmaker Spike Lee a racist for making the movie, Chi-raq highlighting Chicago’s violence and black on black murders? Is Baltimore’s black former mayor Catherine Pugh a racist for saying she could smell the dead animals while touring her city’s impoverished neighborhoods? No. They were stating facts that in today’s brave new world white persons are forbidden from uttering. Of course, the light shed on Baltimore inspired many “racists” to help clean up distressed neighborhoods.
And recall the CNN radio host’s stunning response to a black man after he expressed his belief in the merits of responsibility and hard work: “by virtue of being a white male you have white privilege.” Talk about racial stereotyping! How could a black person possibly believe that individuals, not the government, hold the key to success?
Many black workers knew that government is not always their friend. In the 1930s, many referred to Franklin Roosevelt’s National Recovery Administration (NRA) as the Negro Removal Act, the Negroes Ruined Again, or Negroes Robbed Again.
The new minimum wage regulations on hiring practices favored the all-white skilled labor unions. Many black workers were unskilled and consequently lost their jobs.
Additionally, the New Deal’s Federal Housing Administration refused to insure mortgages in and near black neighborhoods. Moreover, the FHA subsidized developers who were building whites-only tract homes. But somehow this administration that is advancing opportunity zones to encourage long-term investments in low-income urban and rural communities nationwide is racist.
In a misguided attempt at reparation, the War on Poverty drove children’s fathers out of the home as a condition of financial assistance. Elite colleges admitted unprepared black students with lower SAT scores and GPAs, resulting in a mere 38 percent graduation rate. Worse yet, some of these colleges have blacks-only dormitories. Since when is exclusion and segregation preferable to inclusivity and integration that we so strenuously fought for?
What happened to “why can’t we just all get along?” Jettisoned. The panderers who want to fundamentally transform America need miserable people to swallow their baloney. In truth, most of us do get along. People from California to Mississippi are socializing and working together and marrying each other at a steadily increasing rate. One-in-six U.S. newlyweds were married to a person of a different race or ethnicity in 2015, a fivefold increase since 1967.
Today, given his views on self-determination, the runaway slave Frederick Douglass would be ejected from the tribe. “What I ask for the Negro is not benevolence, not pity, not sympathy, but simply justice.… What shall we do with the Negro?… Do nothing with us! Your doing with us has already played mischief with us.… All I ask is, give him a chance to stand on his own legs!”
And to those who tar their opponents as racists: if it weren’t for double standards you would have no standards at all.
Bio: Dr. Singleton is a board-certified anesthesiologist. She is President of the Association of American Physicians and Surgeons (AAPS). She graduated from Stanford and earned her MD at UCSF Medical School. Dr. Singleton completed 2 years of Surgery residency at UCSF, then her Anesthesia residency at Harvard’s Beth Israel Hospital. While still working in the operating room, she attended UC Berkeley Law School, focusing on constitutional law and administrative law. She interned at the National Health Law Project and practiced insurance and health law. She teaches classes in the recognition of elder abuse and constitutional law for non-lawyers.
The Soylent Green New Deal is Three Years Away
By Marilyn M. Singleton, M.D., J.D.
In an effort to cut carbon emissions from burials and cremations, the state of Washington, led by staunch environmentalist Governor Jay Inslee, became the first U.S. state to legalize human composting. To think, people can be criminally prosecuted for disrespecting a human corpse, a symbol of a once-living person. But the religion of Mother Earth now supersedes all cultural decency.
We’ve already cemented the contempt for life at the front end. I thought we had evolved since the ancient Greek elders determined that only the strong newborns survived and the weak were left to die. Virginia’s Governor Ralph Northam made it clear that infants were once again throwaways at will. In explaining the procedure of an “abortion” of a child who was born alive, he said “the infant would be resuscitated if that’s what the mother and the family desired, and then a discussion would ensue between the physicians and the mother.”
Now we must be acutely aware of what is happening at the other end of life’s spectrum. In the U.S., elders are all too often considered expendable by society at large and sadly, by their own families. Such disregard in some 10 million cases escalates to abuse in many forms. Government-certified entities make a significant contribution to this contemptible crime.
In many states court-appointed guardians cravenly plunder their wards’ assets with no repercussions. A U.S. Government Accountability Office (GAO) report identified hundreds of allegations of abuse, neglect, and exploitation by guardians in 45 states and the District of Columbia between 1990 and 2010. An investigation of a small sampling of the allegations found that court-appointed guardians had stolen or otherwise improperly obtained $5.4 million from 158 incapacitated victims, mostly older adults. Moreover, such crimes were frequently overlooked by judges.
Soon after coming into office, President Trump signed into law the Elder Abuse Prevention and Prosecution Act that provided for 90 prosecutors and “elder justice coordinators” nationally to prosecute those committing elder abuse, including guardianship cases. Currently, a sleepy little bill in the wings, the Stamp Out Elder Abuse Act, will direct the proceeds of a new postage stamp to enforcing laws against elder abuse.
These new laws may be for naught with the advent of more physician-assisted suicide laws. New Jersey is the latest, complete with a cute acronym: MAID – Medical Aid in Dying. All the calls for government-controlled medicine are terrifying to those of us who remember a dystopian film where in 2022, with rampant food shortages and homelessness, the only food available is a high-energy wafer purportedly made from plankton. Alas, we witness humans entering a processing center for a happy death and emerging as the main ingredient of Soylent Green.
I contend that the trend of placing older people into hospice before the ink is dry on the hospital admission papers is a new form of elder abuse. Hospice has become the new Medicare cash cow for unscrupulous facility owners who abuse and neglect patients. One study found that 8 percent of the hospices studied did not provide a single skilled visit—from a nurse, doctor, social worker, or therapist—to any patients who were receiving routine home care in the last two days of life in 2014.
Recall that President Obama robbed Medicare of $716 billion to fund the Affordable Care Act, including $56 billion from hospitals serving poor people. Recall that an ethics advisor for ObamaCare, Ezekiel Emanuel, MD, advocates for the “Complete Lives System” of medical care where resources are directed to those with “future usefulness.” Dr. Emanuel proudly claims he wants to die at 75 years of age. Tell that to the countless lives Mother Teresa transformed when she was her 80s. Tell that to John Glenn, who went back into space for 9 days at 77, and to the 20 million other over-75 disposables—or should I say, recyclables.
Quite coincidentally, eliminating the over-75 crowd from the insurance pool would help fund government-sponsored insurance for this country’s remaining uninsured. In other words, hurry up and die before the Medicare program goes bankrupt.
My gratitude goes to those congresspersons who recognize that our elders need protection. Given that the federal trust fund that finances much of the Medicare program is projected to run out in 2026, let’s hope these compassionate people realize that the first losers of Medicare for All are our elders.
Bio: Dr. Singleton is a board-certified anesthesiologist. She is President of the Association of American Physicians and Surgeons (AAPS). She graduated from Stanford and earned her MD at UCSF Medical School. Dr. Singleton completed 2 years of Surgery residency at UCSF, then her Anesthesia residency at Harvard’s Beth Israel Hospital. While still working in the operating room, she attended UC Berkeley Law School, focusing on constitutional law and administrative law. She interned at the National Health Law Project and practiced insurance and health law. She teaches classes in the recognition of elder abuse and constitutional law for non-lawyers.
Can We Trust the Government with Our Medical Care?
By Marilyn M. Singleton, MD, JD
The short answer is No. And thinking that, we would be in good company. A new survey finds that Americans trust Amazon more than the federal government.[1] The most trusted entities were our military, Amazon, Google, local police, and universities. Congress came in as the least trusted, edging out political parties and the press.
Bureaucratic incompetence and cronyism are not the only reasons we should be wary of government involvement in our medical care. The federal government has a checkered history when it comes to medical judgments.
Forced Sterilizations
In light of state governments’ recent love affair with post-term abortions (aka infanticide), forced sterilizations are at the top of my list. Although other states had tried, Indiana became the first state in the country to successfully pass a forced sterilization law in 1907. The law applied only to the “feebleminded.” California and Washington jumped on board in 1909. By the 1920s, 33 states had forced sterilization laws. Heads of psychiatric institutions were free to sterilize anyone they considered social misfits. [2]
We now cringe at the words of the revered Supreme Court Justice Oliver Wendell Holmes in the 1927 case, Buck v Bell, upholding Virginia’s sterilization law for the institutionalized “feeble-minded.”[3]
[Carrie Bell’s] welfare and that of society will be promoted by her sterilization. It is better for all the world if, instead of waiting to execute degenerate offspring for crime or to let them starve for their imbecility, society can prevent those who are manifestly unfit from continuing their kind…. Three generations of imbeciles are enough.
In fact, Carrie’s mother was a prostitute, but not feebleminded. After Carrie’s release, she maintained a job as a domestic worker and became an avid reader. Her “feebleminded” daughter was on her school’s honor roll.
With the third branch of the federal government on board, between 1909 and 1979 more than 20,000 government-funded forced sterilizations were performed. The last legal forced sterilization was in 1981. These went beyond the mentally challenged. Latinos and blacks were easy targets, particularly in the 1970s after Medicaid-funded family planning service offered sterilization. Some patients were bullied into consenting with threats of having their welfare benefits or medical care taken away. Sometimes patients were coerced into a tubal ligation immediately after their infant’s delivery. At other times, tubal ligations were done during Cesarean sections unbeknownst to the patients. These sterilizations were such an open practice in the South that that they became known as a “Mississippi appendectomy.”[4]
In North Carolina, an IQ of 70 or lower qualified a person for sterilization. Here, state social workers could file petitions for sterilization. One social worker sterilized her entire caseload.[5]
The Indian Health Service with its captive audience was worse. Between 1973 and 1976 some 3,400 Native American women— including minors—were sterilized without permission or with defective consent forms.[6]
The Tuskegee Study
The “Tuskegee Study of Untreated Syphilis in the Negro Male” lasted from 1932 to 1972. The U.S. Public Health Service used 400 mainly poor, illiterate, black sharecroppers with syphilis as lab animals. They were told they had “bad blood,” but not that they were actually suffering from a serious disease. That was the extent of the “informed consent.” In exchange for having their lives ruined, the men received free medical exams, free meals, and burial insurance. Although originally projected to last 6 months, the study actually went on for 40 years. The men were never given adequate treatment for their disease. Even when penicillin became the drug of choice for syphilis in 1947, researchers did not offer it to the subjects. Nor were the subjects given the choice of quitting the study. All subjects succumbed to untreated syphilis so our government could track the natural progression of the disease. Once the study became public in 1972, it took a nine-person panel appointed by the assistant secretary for health and scientific affairs to decide that the study was “ethically unjustified.”[7] A class-action lawsuit filed the next year resulted in a $10 million settlement for the victims and their families.
Germ Warfare
This one is personal. My first patient that died, whose name and face I still remember, was a drug addict with bacterial endocarditis due to Serratia marcescens. The medical resident was baffled. Drug addicts are more susceptible to unusual bacteria, but where did this Serratia come from? It came from our own government.
Throughout a week in September 1951 as part of the U.S. Navy’s “Operation Sea Spray,” a presumably harmless bacterium, Serratia marcescens, was sprayed over San Francisco in a biological warfare test.[8] The U.S. Army’s monitoring of 43 sites around the city determined that San Francisco had received enough of a dose for nearly all of its 800,000 residents to inhale millions of particles each day during the week of spraying. Consequently, cases of urinary tract infections and pneumonia in San Francisco also increased after Serratia marcescens was released.
During Senate subcommittee hearings in 1977, the army revealed that between 1949 and 1969 open-air tests of biological agents were conducted 239 times in populated civilian areas, including Minneapolis; St. Louis; Mechanicsburg, Pa.; the Washington, D.C., National Airport; and New York’s subway system.[9] Had President Nixon not terminated the program in 1969, how many more sprayings would we have had?
Experimental Vaccine
In 1989, a study sponsored by the Centers for Disease Control and Prevention (CDC) tested an experimental measles vaccine on 1,500 six-month old black and Hispanic babies in Los Angeles. The CDC director, Dr. David Satcher, admitted in 1996 that “a mistake was made” and “it shocked [him].”[10] The consent papers the parents signed said the children would receive one of two vaccines, but they were not told that one of the vaccines was experimental and unlicensed.
A deceptive brochure was distributed with the consent form. The brochure advised: “This vaccine has been shown to be effective in younger children. Over 200 million children around the world have received this vaccine, but Los Angeles County is the first place in the United States where it is being offered.”It was not until a significant number of children in Africa and Haiti had died from the vaccine that the study was stopped in 1991.
The Veterans Health Administration
The Veterans Health Administration (VA) is the current model of a government-sponsored single-payer health system. Let the headlines do the talking. A 2014 report by Sen. Tom Coburn (R-Okla.) found that more than 1,000 veterans may have died in the last decade because of malpractice or lack of care from VA medical centers.[11]
Even after the long waits were revealed, “Deceased” notes on files were removed to make statistics look better: veterans would not be counted as having died while waiting for care at the Phoenix VA hospital.[12]
In January 2015 it was reported that more than 1,600 veterans waited between 60 and 90 days for appointments at facilities operated by the VA Greater Los Angeles Healthcare System. About 400 veterans waited 6 months for an appointment. The average wait time, according to documents dated Jan 15, 2015, was 48 days.[13]
By April 2015, despite major reforms, government data show that the number of patients facing long waits at VA facilities had not dropped at all. The number of medical appointments delayed 30 to 90 days has largely stayed flat. The number of appointments that take longer than 90 days to complete has nearly doubled. This was far from the government’s goal of 30 days.[14]
A 2018 report from the Department of Veterans Affairs inspector general found that the Washington, D.C., VA Medical Center has for years “suffered a series of systemic and programmatic failures to consistently deliver timely and quality patient care,” and heightened potential for waste, fraud and abuse of government resources.[15]
Finally, in May 2018, veterans saw relief with the VA’s Choice program, when the bipartisan bill passed and was signed by the President. Under the law, if the VA cannot provide the veterans with the level of care they need or the level of care they expected, or had long wait times, the veteran can seek care in the private sector.[16]
Q.E.D.
Conclusion
The noted 19th century statesman and orator Daniel Webster said, “Good intentions will always be pleaded, for every assumption of power; but they cannot justify it…. It is hardly too strong to say, that the Constitution was made to guard the people against the dangers of good intention, real or pretended.”[17] Given the government’s track record, even the most jaded bureaucrat cannot justify such betrayals of patients’ rights and the public trust.
There is another theme between the lines: offer the people free stuff and then use it as a cudgel to keep the recipients in line. The helpless, the poor, and Native Americans were easy targets. Now “Medicare for All” threatens to trap the rest of us in a system with no escape.
Marilyn Singleton, M.D., J.D., an anesthesiolologist, serves as president of AAPS. Contact: [email protected].
Download PDF of this article: https://jpands.org/vol24no2/singleton.pdf [originally published as “From the President” column in Summer 2019, JPandS.
REFERENCES
- Tiffany K. In Amazon We Trust—but Why?; Oct 25, 2018. Available at: https://www.vox.com/the-goods/2018/10/25/18022956/amazon-trust-survey-american-institutions-ranked-georgetown. Accessed April 2, 2019.
- Zhang S. A long-lost data trove uncovers California’s sterilization program. Atlantic, Jan 3, 2017. Available at: https://www.theatlantic.com/health/archive/2017/01/california-sterilization-records/511718/. Accessed April 3, 2019.
- Buck v Bell, 274 U.S. 200 (1927). Available at: https://supreme.justia.com/cases/federal/us/274/200/. Accessed April 3, 2019.
- Garcia S. 8 shocking facts about sterilization in U.S. history. Mic; Jul 10, 2013. Available at: https://mic.com/articles/53723/8-shocking-facts-about-sterilization-in-u-s-history. Accessed April 2, 2019.
- Schoen J. Reassessing eugenic sterilization: the case of North Carolina. In: Lombardo PA, ed. A Century of Eugenics in America. Bloomington, Ind.: Indiana University Press; 2011:141-160.
- Government Accounting Office. Investigation of Allegations Concerning Indian Health Service HRD-77-3; Nov 4, 1976. Available at: https://www.gao.gov/products/HRD-77-3. Accessed April 3, 2019.
- Centers for Disease Control and Prevention. The U.S. Public Health Service Syphilis Study at Tuskegee; Dec 22, 2015. Available at: https://www.cdc.gov/tuskegee/timeline.htm. Accessed Apr 3, 2019.
- Subcommittee on Health and Scientific Research of the Committee on Human Resources, U.S. Senate, 95th Congress. Examination of Serious Deficiencies in the Defense Department’s Efforts to Protect the Human Subjects, of Drug Research. Hearings; Mar 8 and May 23, 1977. https://babel.hathitrust.org/cgi/pt?id=mdp.39015005321081;view=1up;seq=1
- Mahlen S. Serratia infections: from military experiments to current practice. Clin Microbiol Rev 2011;24(4): 755–791. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3194826/. Accessed Apr 4, 2019.
- Cimons M. CDC says it erred in measles study. Los Angeles Times, Jun 17, 1996. Available at: https://www.latimes.com/archives/la-xpm-1996-06-17-mn-15871-story.html . Accessed Apr 4, 2019.
- Devine C. Bad VA care may have killed more than 1,000 veterans, senator’s report says. CNN; Jun 24, 2014. Available at: https://www.cnn.com/2014/06/24/us/senator-va-report/. Accessed Apr 4, 2019.
- Bronstein S, Griffin D, Black N, CNN Investigations. VA deaths covered up to make statistics look better, whistle-blower says. CNN; Jun 24, 2014. Available at: https://www.cnn.com/2014/06/23/us/phoenix-va-deaths-new-allegations/. Accessed Apr 4, 2019.
- Bronstein S, Griffin D, Black N, Devine C. It’s not over: veterans waiting months for appointments. CNN; Mar 14, 2015. Available at: https://www.cnn.com/2015/03/13/us/va-investigation-los-angeles/. Accessed Apr 4, 2019.
- CBS News. “Livid” VA patients still facing long waits times for health care; Apr 9, 2015. Available at: https://www.cbsnews.com/news/va-patients-still-facing-long-waits-times-for-health-care/. Accessed Apr 4, 2019.
- Summers J. Systemic failures plague DC veterans hospital, inspector general finds. CNN; Mar 7, 2018. Available at: https://www.cnn.com/2018/03/07/politics/washington-dc-va-hospital-inspector-general/index.html. Accessed Apr 4, 2019.
- Summers J, Landers E. Senate passes proposal to expand private health care for veterans. CNN; May 23, 2018. Available at: https://www.cnn.com/2018/05/23/politics/veterans-health-care-senate-vote. Accessed Apr 4, 2019.
- AZquotes.com. Available at: https://www.azquotes.com/quote/1315991. Accessed Apr 3, 2019.
Playing Political Games Does Not Improve Patient Care
by Marilyn M. Singleton, MD, JD
Now that it is the political season where divisiveness rules the day, the bevy of President wannabes’ interest in maternal health is suspect. After all, none of them have joined the many maternal health advocates who praised the President for signing into law the Preventing Maternal Deaths Act which gives grants to the states to help identify the causes of maternal mortality.
According to the Centers for Disease Control and Prevention, black and American Indian/Alaska Native women are about 3 times as likely to die from a pregnancy-related cause as white women. These politicians are neither epidemiologists nor medical personnel yet they have diagnosed differences in maternal outcomes of black women as a product of racism. Their racial pandering serves to foment disharmony rather than initiate an honest examination of the problem.
Of course, those vying for political real estate will not preface their theories with some medical facts: uterine leiomyomas (fibroids), a cause of post-partum hemorrhage, are present in three times as many black women as white women. Or that the higher rates of high blood pressure in black Americans may be due to a gene that makes them more salt sensitive. Perhaps this contributes to the 50 percent higher incidence of hypertension of pregnancy (pre-eclampsia/eclampsia) in black women than in any other racial or ethnic group. White and Hispanic women have substantially the same rate of the disease and Asian and Pacific Island women have the lowest rate of any ethnic group. As a noted black female obstetrician patient safety and risk management expert called the cause of pre-eclampsia a “mystery” and noted, “older schools of thought attempted to use socioeconomic status as a reason to explain the problem, but it doesn’t hold up under statistical analysis.”
Do these politicians who label medical personnel as racists also tell you that 11 percent of obstetrician-gynecologists are black women (same as the general black population) and they were more likely than white or Asian ob-gyns to practice in federally funded underserved areas and areas with high poverty levels? Are these physicians racists?
Health problems are multifactorial and must be rigorously researched. While bias and social factors cannot be ignored, painting medical care personnel as racists will not advance the conversation.
Nor will depriving medical personnel of their religious rights eliminate discrimination in the delivery of medical care. Right of conscience laws have been on the books since the 1970s but the rules had been weakened and medical personnel began reporting workplace retaliation and harassment for their beliefs. Thus, the recently finalized Protecting Statutory Conscience Rights in Health Care rule ensures that medical personnel have the right to abstain from delivering certain medical services on the basis of religious beliefs or moral convictions.
The ink was barely dry on the final rule when San Francisco filed a lawsuit claiming it was “discriminatory.” The lawsuit alleges that the rule “prioritizes providers’ religious beliefs over the health and lives of women, lesbian, gay, bisexual, or transgender people, and other medically and socially vulnerable populations.”
First, as far as vulnerable populations, it appears black women have no trouble finding abortion providers: 49 percent of abortions are performed on white women and 40 percent on black women despite the fact that black women of childbearing age make up 14 percent of the population. Second, the lawsuit assumes that many physicians will wantonly begin to discriminate against LGBT patients. No one in the emergency room is asking the sexual history of a hemorrhaging patient.
Physicians who abide by the Oath of Hippocrates pledge to do no harm to their patients. Many physicians in their medical judgment do not believe that, for example, assisted suicide, sex-change surgery, and hormone blockers are harmless. Additionally, some surgeons simply have no desire to perform certain procedures just as breast cancer surgeons have no interest in bowel surgery.
The lawsuit contends that it is “the fundamental obligation of the medical profession and the right of patients to receive quality patient care.” The best care will come from physicians familiar and comfortable with the treatments sought. Certainly, in San Francisco with a major medical school and several large health systems, competent physicians who are well-versed in transgender surgery, sterilization, pregnancy termination, and euthanasia are available. The lawsuit is a political stunt.
No doubt some patients have experienced professionally unacceptable treatment. Fortunately, the universe filled with ethical professionals that this U.C. San Francisco-trained black female physician inhabits is more common than not. I have taken care of thousands of patients in public and private hospitals across the country. I’ve worked with hundreds of medical personnel, some of whom were not particularly warm and fuzzy with any of their patients. I cannot tell you what was in their hearts, but they always behaved professionally and competently.
Bio: Dr. Singleton is a board-certified anesthesiologist. She is President of the Association of American Physicians and Surgeons (AAPS). She graduated from Stanford and earned her MD at UCSF Medical School. Dr. Singleton completed 2 years of Surgery residency at UCSF, then her Anesthesia residency at Harvard’s Beth Israel Hospital. While still working in the operating room, she attended UC Berkeley Law School, focusing on constitutional law and administrative law. She interned at the National Health Law Project and practiced insurance and health law. She teaches classes in the recognition of elder abuse and constitutional law for non-lawyers.
Thought Police (Oops, Medicare) For All
by Marilyn M. Singleton, MD, JD
The new Medicare for All bill (H.R. 1384) has come and hopefully will go the way of the pet rock. Everybody now knows the basics: the government will take care of all medical, dental, vision, pharmacy, and long-term care services with no out-of-pocket expenses. The bill prohibits parallel private insurance, and has the glaring absence of a financing mechanism.
But as usual, bills contain hidden gems. Section 104 of the bill tracks the Affordable Care Act’s “anti-discrimination” rule, making it clear that no person can be denied benefits, specifically including abortion and treatment of gender identity issues “by any participating provider.” The bill does not correspondingly reaffirm the federal laws protecting conscience and First Amendment religious freedom rights of medical personnel. Such protections relate to participation in abortion, sterilization, assisted suicide, and other ethical dilemmas.
Most sane individuals agree that we do not want our government to control any aspect of our individual lives—particularly not our religious beliefs and moral codes. When the Department of Health and Human Services (HHS) sought to clarify such conscience protections, thousands of commenters offered evidence of discrimination and coercion to violate the tenets of the Oath of Hippocrates and their own ethics. Some left their jobs or left the medical profession entirely when their conscientious objections were not honored.
Conscience protections are vital in this time of unabashed devaluing of life. Last year, the Palliative Care and Hospice Education Training Act (PCHETA), passed the House but died in the Senate. This bill would have dedicated $100 million in additional taxpayer dollars to persuade patients to forgo treatment that might prolong life in exchange for a steady stream of increasing doses of narcotics. Already some families feel they are not merely offered hospice as a choice but are steered toward it when their older relatives fall ill, even when the medical prognosis is uncertain.
The focus on palliative care and lowering costs by reducing “aggressive” end-of-life treatment is one more incremental under-the-radar step along the road to government control over life and death. A culture of hastening death has gradually evolved, disguised as “death with dignity.” California, Colorado, Oregon, Washington, Montana, Vermont have legalized physician-assisted suicide with 20 other states considering implementing such laws.
Subtly devaluing life primes the pump for rationing of medical care at all stages by a government-run program that is the exclusive purveyor of medical “benefits.” Our western counterparts with single payer have discovered that offering fewer benefits is the simplest way to control costs. The “Complete Lives System”—the brainchild of ObamaCare physician architect Ezekiel Emanuel—includes worrisome determinants of who should receive care. The system prioritizes adolescents and persons with “instrumental value,” i.e., individuals with “future usefulness.”
This year, legislators were not so subtle. It is bad enough that our elderly are pushed into hospice, but now the compassionate legislators have set their sights on newborns. New York passed, and Virginia floated laws that permit the killing of babies after birth. The U.S. Senate garnered only 53 of the 60 votes needed to pass the Born Alive Survivors Protection Act which would mandate medical care and legal protections to infants born alive after an attempted abortion.
Starting in the 1970s, the federal government clearly saw a need to protect medical personnel from the tyranny of the government mandates that could violate religious or moral convictions. Personal liberty is an integral part of our democratic republic. While a physician’s calling is to render treatment to all patients, this is balanced with an individual physician’s moral beliefs. This is no more apparent than in legislation permitting physician assisted suicide and post-delivery “abortions.” Sadly, under threat of discrimination lawsuits, some physicians have acquiesced to patients’ requests for medications and surgical procedures that conflict with their moral code.
As anthropologist, Margaret Mead so brilliantly wrote, “One profession, the followers of [Hippocrates], were to be dedicated completely to life under all circumstances…This is a priceless possession which we cannot afford to tarnish, but society always is attempting to make the physician into a killer—to kill the defective child at birth, to leave the sleeping pills beside the bed of the cancer patient. … It is the duty of society to protect the physician from such requests.”
We must not let the government bury our conscience and beliefs under layers of bureaucracy. Medicare for All may mean independent thought for none.
Dr. Marilyn M. Singleton, MD, JD is a board-certified anesthesiologist and member of the Association of American Physicians and Surgeons (AAPS).
Dr. Marilyn Singleton ran for Congress in California’s 13th District in 2012, fighting to give its 700,000 citizens the right to control their own lives.
While still working in the operating room, Dr. Marilyn Singleton attended UC Berkeley Law School, focusing on constitutional law and administrative law. She also interned at the National Health Law Program and has practiced both insurance and health law.
Dr. Marilyn Singleton has taught specialized classes dealing with issues such as the recognition of elder abuse and constitutional law for non-lawyers. She also speaks out about her concerns with Obamacare, the apology law and death panels.
Eugenics, Euthanasia, Infanticide, and the Lord’s Work
by Marilyn M. Singleton, MD, JD
New York’s Catholic Democratic Governor had the World Trade Center in lights to celebrate its abortion-on-demand-until-the-d
How can we tolerate this moral regression? Infanticide was the norm throughout ancient Athens and Sparta where the elders inspected the newborns to ensure that only the strong survived, and the weak were left to die. Early Roman law decreed that deformed children would be put to death. Fortunately, by the 4th century, European law, religion, and medicine rejected the intentional killing of an infant.
Americans have been sucked in before by pretty words that mask the brutal reality of “evolved” policies. There was a time when America’s best and brightest were teaching Dr. Josef Mengele a thing or two about eugenics, the “science” of improving the human gene pool for the preservation of society.
At the First International Eugenics Congress in 1912, a Carnegie Institute-supported paper, Preliminary Report of the Committee of the Eugenic Section of the American Breeder’s Association to Study and to Report on the Best Practical Means for Cutting Off the Defective Germ-Plasm in the Human Population (“Breeder’s Report”), analyzed the problem of the “unfit” and the need to find solution to “cut[ting] off the supply of defectives.”
Even black intellectuals jumped on board. The Harvard-educated professor and civil rights activist W.E.B. DuBois believed only fit blacks should procreate to “eradicate the race’s heritage of moral iniquity.” The NAACP promoted eugenics theory by hosting “Better Baby” contests.
The Model Eugenical Sterilization Law (1914) was the blueprint for the sterilization of the “socially inadequate” including the feebleminded, insane, criminalistic, epileptic, inebriate, diseased, blind, deaf, deformed, dependent, orphans, ne’er-do-wells, tramps, the homeless, and paupers. By the 1920s, thirty-three states had compulsory sterilization laws.
Margaret Sanger, the founder of Planned Parenthood, advocated for mandatory IQ testing for the lower classes and the issuance of government-approved parenthood permits as a prerequisite to having children. Sanger criticized philanthropy as tending to perpetuate “human waste.” She also proposed that “the whole dysgenic population would have its choice of segregation or sterilization.”
Compulsory sterilization of the “feebleminded” was etched in stone by the revered liberal Supreme Court Justice Oliver Wendell Holmes. Buck v. Bell (which has never been overruled) concluded that “the principle that sustains compulsory vaccination is broad enough to cover cutting the Fallopian tubes.”
With Congress steamrolling exclusively government-controlled medical care with Medicare-for-All, we must reflect on our past as well as the present policies of our civilized neighbors. What happens when the government runs out of money to pay for everything our politicians promised?
The Model Sterilization law’s selling point was that sterilization of those maintained wholly or in part by public expense was cost-effective: segregation for life cost $25,000 and sterilization a mere $150.
In Belgium, a nine and an eleven-year-old were euthanized for conditions that we in the United States vigorously treat: cystic fibrosis and muscular dystrophy. Canada is considering allowing such barbarism-aka medical assistance in dying—to be perpetrated upon its children.
Iceland has virtually eliminated Down’s syndrome through abortion. Coincidentally the Ministry of Health lists Down’s syndrome as the most expensive disease for the state-funded health care program.
The British National Health Service’s Institute for Health and Care Excellence supports the use of “quality-adjusted life years” (QALY) to measure the quality and quantity of life added due to a particular medical treatment. If the cost per QALY gained exceeds a predetermined amount, the government denies payment for that treatment. ObamaCare architect Ezekiel Emanuel’s “Complete Lives System” prioritizes adolescents and persons with “instrumental value,” i.e., individuals with “future usefulness.” With current nursing home costs averaging $7,500 per month, hospice care could be the default medically necessary treatment for the disabled.
It was not too long ago that the top Democrat official, Nancy Pelosi said “[Republicans] pray in church on Sunday and they prey on people the rest of the week. And while we’re doing the Lord’s work, ministering to the needs of God’s creation, they are ignoring those needs which is to dishonor the God who made them.” I don’t know whose “lord” she is talking about—perhaps the overlords who aim to take over mankind in sci-fi stories or the “Lord of the Flies.”
The day erecting a barrier to stop drug and human trafficking is considered immoral and killing viable live babies is celebrated is the day some Americans tossed morality into the abyss.
Dr. Marilyn M. Singleton, MD, JD is a board-certified anesthesiologist and member of the Association of American Physicians and Surgeons (AAPS).
Dr. Marilyn Singleton ran for Congress in California’s 13th District in 2012, fighting to give its 700,000 citizens the right to control their own lives.
Despite being told, “they don’t take Negroes at Stanford”, she graduated from Stanford and earned her MD at UCSF Medical School.
Dr. Marilyn Singleton then completed two years of surgery residency at UCSF, followed by an anesthesia residency at Harvard’s Beth Israel Hospital.
Dr. Marilyn Singleton was first an instructor, then Assistant Professor of Anesthesiology and Critical Care Medicine at Johns Hopkins Hospital in Baltimore, Maryland before she returned to private practice in California.
While still working in the operating room, Dr. Marilyn Singleton attended UC Berkeley Law School, focusing on constitutional law and administrative law. She also interned at the National Health Law Program and has practiced both insurance and health law.
Dr. Marilyn Singleton has taught specialized classes dealing with issues such as the recognition of elder abuse and constitutional law for non-lawyers. She also speaks out about her concerns with Obamacare, the apology law and death panels.
Dr. Marilyn Singleton has conducted make-shift medical clinics in two rural villages in El Salvador.
Congressional candidate Dr. Marilyn Singleton presented her views on challenging the political elite to physicians at the Association of American Physicians and Surgeons annual meeting in 2012. (Audio version of the speech to AAPS doctors by Dr. Marilyn Singleton.)