Healthcare Reform, Medical Ethics, Medicine, Op-eds, Politics

Halloween’s Over: Take off the Masks

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At a graduation of a family friend, out of the blue, one in our group began lamenting that progressives tended to live in cities. She proposed that progressives should move to rural areas and “purge [such areas] of those awful conservatives.” Thus spake the tolerant Left. I was stunned. Given the festive occasion, I kindly reminded her that this is America and we are lucky that we have all kinds of people. I wanted to ask her what we should do with the conservatives. Re-education camps? Death by a continuous loop of Bernie Sanders speeches?

It is unfortunate that such unreasonableness isn’t isolated within the D.C. swamp containment zone.

These pied pipers who offer free college, free food, free medical care, and free money for simply having a pulse freely admit they have no idea how to pay for it. Oh, yes: tax the “rich” and corporations who will pass the tax on to consumers and employees in the form of higher prices and lower wages. And eventually the heretofore untouchable middle class will be taxed directly. Let’s not forget that free food and housing are components of slavery.

These Einsteins are scientists when it comes to global warming and evolution but think it’s medically acceptable to permanently sterilize 7-year olds to avoid appearing like a “transgender” bigot. Science lesson: there are 2 genders. Every human has 23 pairs of chromosomes. The X chromosomes and Ychromosomes determine sex. With rare exceptions of random abnormalities, female is XX and male is XY.

These self-described health care experts try to debunk innovative medical care delivery methods like direct pay and direct primary care subscription practices by claiming these are reserved for the rich. A mere $1,500 per year ensures that you and your doctor, make your medical decisions—not the government. These “experts” are the same people who prop up the medical-insurance-government industrial complex at the expense of private physicians, writing laws that favor big-box retail clinics staffed by non-physicians. These swamp creatures equate physicians with “mid-level” practitioners with one fifth the training and education as physicians—but likely demand the chairman of the department when they themselves need medical services.

These compassionate legislators are keen on the government taking over the “social determinants of health,” including loneliness. I anxiously await an army of a government operatives coming to our homes and telling us to be happy or else. Most people just want to control their own lives, even if their life does not fit the government blueprint. If you want your life to be your own, and your body to be your own, then you cannot let the government’s foot in the door.

These forward thinkers decided it was good public policy to ban children’s fathers from the home in order for the family to receive government funds. It became normalized for the federal government to be the daddy.

These elitists castigate the middle class for not wanting homeless people sleeping and defecating in front of their houses for which they worked two jobs, saved, and sacrificed for years. Their remedy is a tent city in a middle-class neighborhood that is nowhere near theirs. These people do not want to admit that the disintegration of the family and the moral decay leading to drug use and detachment from society is the first problem that must be addressed.

And the biggest hobgoblins of them all are the peddlers of faux racism. Americans do not wake up every morning hating on each other. They ponder their family’s safety and keeping a decent job to pay their bills. Something is seriously wrong, indeed demented, when a former First Lady—unchallenged—claimed that white Americans are “still running” from minority communities when they move to another neighborhood. Perhaps they are getting away from homeless encampments (with mostly white people) or poorly run government schools in Democrat-controlled cities. Get over yourself.

Everything is not about race. Get out in the real world and sit at a local bar or cafe in central Mississippi and watch blacks and whites eating and laughing together. Who is the hatemonger?

America has had a few tragic well-publicized racially motivated incidents. Undaunted, we continue to strive for liberty for all—despite the calculated enmity and scab-picking by rich and famous black people who ran away from minorities to live on a $15 million estate on Martha’s Vineyard (and not in Oak Bluffs) and who expect us to swallow their vitriol-laced baloney.

This insanity is patently sick and sickening. It is about power at any cost and not what can help move America forward.

Health Policy, Healthcare Reform, Medicare, Medicine, Op-eds, Socialized Medicine

Expanded and Improved Medicare for All: Beware of Greeks Bearing Broccoli

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By Marilyn M. Singleton, MD, JD

During the Supreme Court oral arguments in the challenge to the Affordable Care Act’s mandate to purchase health insurance, people laughed when the late Justice Scalia asked whether the government could make you buy broccoli. Never happen? The laughable has become reality. A California bill awaiting the governor’s signature forbids restaurants from serving any beverage other than water or unflavored milk with kiddie meals. As of yet, the meal’s purchasers, unlike the restaurant, won’t be fined for ordering another beverage for their child.

Shrugging off assertions that the ACA was about control, not care, President Obama quipped that his opponents acted like the ACA “was a Bolshevik plot.” That supposedly ludicrous plot is embodied in a too-good-to-be-true congressional bill, H.R. 676, the “Expanded & Improved Medicare For All”. With no dollar amounts in sight, the bill gives the government a blank check to exert total control over our medical care.

H.R. 676 provides that all individuals residing in the United States showing up at the doctor’s office are “presumed to be eligible” for benefits. The federal government will pay for unlimited “medically necessary” health expenses, including pharmaceuticals, mental health, substance abuse, vision, dental, hearing, and long-term care — with no deductibles or other cost-sharing. Unless a patient opts out, all interactions will be memorialized in a “standardized, confidential electronic patient record system.” Yes, those same electronic records that have been hacked and are contributing to physician burnout.

Overseen by regional offices and the Presidentially appointed 15-member National Board of Universal Quality and Access, participating institutions will receive separate monthly fixed sums for capital expenses (e.g., buildings, improvements) and for operating expenses (including physician salaries). Non-salaried physicians can be paid based on a national fee schedule that is “fair and optimal” as decided by the government. Finally, each geographic region would receive a single allotment to cover long-term care.

There are some restrictions. Only public or not-for profit institutions may participate. Private physicians and clinics can exist but cannot be investor-owned. And to keep the patients on the reservation, private health insurers are prohibited from selling health insurance coverage that duplicates the government-sponsored benefits.

Ever magnanimous, the government will pay for “reasonable financial losses” resulting from the conversion from for-profit to nonprofit status through the sale of U.S. Treasury bonds, assuming we choose to buy them. Additionally, the government will compensate insurance and other relevant clerical, administrative, and billing personnel up to $200,000 per person for losing their jobs.

Patients would have “free choice of participating physicians and other clinicians, hospitals, and inpatient care facilities.” But under the business restrictions and capped payments, the better institutions and clinicians may choose not to participate, thus decreasing access.

There is a big bad wolf in this fairy tale. In 2016, the feds spent more than $1.2 trillion on Medicare, Medicaid, and Children’s Health Insurance Program (CHIP). Total national health expenditures by all government levels and private entities were $3.3 trillion.

H.R. 676 provides funding from appropriations for federal public health care programs, including Medicare, Medicaid, and the Children’s Health Insurance Program (CHIP); an unspecified increase on personal income taxes on the top 5 percent of income earners; a “modest and progressive” excise tax on payroll and self-employment income; a “modest” tax on unearned income, and a “small” tax on stock and bond transactions.

Fast forward to 2026, when the government predicts that the Medicare Hospital Insurance Trust fund will be depleted and total national health expenditures will be $5.7 trillion. The federal government collected about $100 billion in Medicare premiums and a total of $3.32 trillion in taxes last year. Given the projected costs, no cost-sharing, and the $2.4 trillion shortfall, the bill’s “modest” tax increases will soon be obscene.

Not only will the benefits decrease as the money runs out, patients will see real world consequences of total control. For example, Oregon’s Medicaid program wants to limit coverage for opiates for some chronic pain conditions and taper off patients who have been taking opioids long-term — even if they have no signs of addiction. Long-term care will be an easy target; the ACA’s long-term care program was scuttled due to cost concerns. With current nursing home costs averaging $7,500 per month, inevitably when the monthly allotment is depleted, hospice care becomes the medically necessary treatment.

Tell the sponsors of H.R. 676 that it’s your money, your health, your privacy, your life. The government is neither our parent nor our benefactor. The government is not the middleman you want between you and your doctor. At a time when the movement toward innovative and personalized care is moving forward, care via government control is taking us backwards.

Dr. Singleton is a board-certified anesthesiologist. She is also a Board-of-Directors member and President-elect 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.

Culture & Society, Health Policy, Healthcare Reform, Law, Medicare, Socialized Medicine, Uncategorized

Mission Possible: Saving Freedom in Medical Care

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by Marilyn M. Singleton, MD, JD

In the original Mission: Impossible series, against all odds, through brilliant strategizing the good guys thwart stealth communist plots to undermine democracies. In trying to provide affordable, quality, personalized medical care, independent physicians face seemingly insurmountable obstacles: digging out from under piles of electronic paperwork, breaking free of third-party red tape, dodging hospital buyouts, and shielding patients from data mining and privacy intrusions.

But the biggest obstacle to great medical care is the socialist brigade rallying around Medicare for All, the proposed federally financed program that boasts no premiums, deductibles or copays, and medical, dental, vision and hearing benefits. What could possibly go wrong? As they say, show me the money. The Congressional Budget Office estimates the federal government will spend about $1 trillion on healthcare programs in 2018. A detailed Mercatus Center analysis concluded that Medicare-for-All would add $32.6 trillion to federal expenditures during its first 10 years.

Currently, payroll taxes and income tax on Social Security benefits fund Medicare’s Part A Hospital Insurance Trust Fund. The Centers for Medicare and Medicaid (CMS) estimates this fund will be depleted in 2026. General tax revenues and beneficiary premiums fund medical services coverage (Part B). Medicare for All would be financed by current Medicare funds – minus the insurance premiums – and would be supplemented by the ever-popular “taxing the rich.” Beware: the definition of “the rich” will be ratcheted down to encompass more taxpayers.

Then there is the coercive nature of Medicare. A beneficiary’s opting out of Medicare Part A means forfeiting all past and future Social Security benefits. Medicare for All makes it clear that no straying from the herd is allowed: neither private insurers nor employers can offer insurance that competes with the government.

Fortunately, more choices are becoming available for potential patients. The House of Representatives recently passed two packages of expansions of Health Savings Accounts (HSAs) (H.R. 6199, H.R. 6311). To name a few benefits, the contribution limit for an HSA nearly doubled to $6,650 for individuals and to $13,300 for families. HSAs would be allowed to pay for direct primary care (DPC) monthly fees. Best yet, anyone would be able to purchase a lower-premium catastrophic plan — removing the ACA’s under age 30 restriction. And purchasers of “bronze” and catastrophic (“copper”) plans would be able to contribute to an HSA.

Improving HSAs is not a trivial goal. HSAs are portable. HSA contributions reduce taxable income, money in the account grows tax-free, and money can be withdrawn tax-free to cover qualified medical expenses. The Employee Benefits Institute estimates that a person saving in an HSA for 40 years, assuming a 2.5% return, could accumulate up to $360,000.

The Executive Branch acted on CMS’s report that lower-cost alternatives were necessary given the rising premiums responsible for the decline in the purchase of unsubsidized ACA plans. The Administration created new rules for short-term limited duration (STLD) insurance policies, which are not bound by the ACA’s restrictive mandates.

STLD plans, defined by the Obama administration as less than three-months duration, can be up to 12 months duration and can include an option for guaranteed renewal up to 36 months. Californians may be out of luck if the proposed consumer protection legislation prohibiting STLD policies makes it to the governor’s desk.

According to CMS, in the fourth quarter of 2016 the average monthly premium for individuals for a STLD policy was approximately $124, compared with $393 for an unsubsidized ACA-compliant plan with comparable $5,000 deductibles. That is an annual savings of $3,228. Even adding $50 per month for a direct primary care practice, an individual saves $2,628 a year. With DPC, all primary care services, including chronic disease management and access to low-priced commonly used medications are included in the upfront price.

The HSA bills and the new STLD rules are an antidote to the erosion of our freedom to contract under the guise of protecting us from “junk” insurance. Medicare-for-All is not the cure for health care ills. Once the central planners lure the masses into dependence on “free” stuff, abuse of power ensues. Voluntary participation by physicians becomes mandatory. When the money tree withers, the non-negotiable provider payments are slashed, and services to patients are rationed.

To mitigate the unacceptable, sometimes fatal wait times in the Veterans Administration health system a bipartisan Congress looked to the backbone of great medicine: private practice physicians. Independent medical practices will lead the way to achieving great affordable medical care through competition and consumer choice.

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.

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.

Follow Dr. Marilyn Singleton on Twitter @MSingletonMDJD

More info about Dr. Marilyn Singleton

Culture & Society, Doctors, Health Policy, Media & Press, Medical Ethics, Medicine, Op-eds, Politics

The Courage to Trust Medical Care to Patients and Physicians

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by Marilyn M. Singleton, MD, JD

The days of trusting your legislators to have your best interests at heart are in the rear view mirror. Apparently, their main interest is parroting the buzzwords of the moment to get elected and then being too busy banking lobbying money to listen to the voters. Our legislators have become spectators who wait for the perfect moment to pounce on their political “enemy” and then go on cable news shows to boast about it.

The “us against them” attitude, punctuated by hyperbolic, apocalyptic rhetoric closes the door to finding solutions. Our interests would be better served by having town hall meetings where voters could state their concerns, air their differences, and learn what legislators are doing about their issues. Caution: meetings at 9 a.m. on Wednesday when paid activists are guaranteed to outflank the working general public are prohibited.

There are strong differences of opinion on how to attain a healthy citizenry. Educating potential patients about what drives up medical care expenditures can start the conversation. Well-informed patients would demand solutions based not on corporate interests or government or political agendas, but on a fair, competitive market that maximizes choices and achieves lower costs.

Eight years of the Affordable Care Act have borne out Congressional Budget Office predictions that abandoning basic principles of insurance—which compensates only for events beyond the insured’s control and is priced according to the degree of risk—would lead to higher and higher premiums, fewer participating insurers, and unsustainable government expenditures to subsidize insurance premiums. The data in three recent Centers for Medicare and Medicaid reports on ACA exchanges show “individual market erosion and increasing taxpayer liability.” The average monthly premium for coverage purchased through the exchanges rose 27 percent in 2018, and federal premium subsidies increased 39 percent from 2017 to 2018.

A less frequently discussed cost driver is the disturbing trend of private doctors’ offices being scooped up by hospitals, health insurance companies, and venture capital groups. Prices tend to rise when health systems merge, because of decreased competition. And not only do hospitals and health systems generally charge more than private physicians’ offices, the government compounds this problem by paying more to hospitals than independent offices for the same service. A review of 2015 Medicare payments showed that Medicare paid $1.6 billion more for basic visits at hospital outpatient clinics than for visits to private offices. Patients are the biggest losers: they paid $400 million more out of pocket and had their tax dollars wasted. The study also found hospital-employed physicians’ practice patterns in cardiology, orthopedic, and gastroenterology services led to a 27 percent increase in Medicare costs. This translated to a 21 percent increase in out-of-pocket costs for patients.

Similarly, a U.C. Berkeley School of Public Health study of consolidation of California’s hospital, physician, and insurance markets from 2010 to 2016 concluded “highly concentrated markets are associated with higher prices for a number of hospital and physician services and Affordable Care Act (ACA) premiums.” In consolidated markets (defined by the Federal Trade Commission’s Horizontal Merger Guidelines), prices for inpatient procedures were 79 percent higher and outpatient physician prices ranged from 35 percent to 63 percent higher (depending on the physician specialty) than less concentrated markets.

Big medicine and third-party financing are taking the cost curve in the wrong direction. This speaks to the urgency of encouraging cash friendly practices that bypass insurance and direct primary care (DPC) practices. With DPC, all primary care services and access to low-priced commonly used medications are included in an affordable upfront price. Importantly, DPC’s time-intensive and individualized management of chronic diseases decreases hospital admissions, paring down Medicare’s $17 billion spent on avoidable readmissions.

Why corporations want to marginalize private practice seems clear; the government’s motive is open to debate. Surveys consistently find that patients overwhelmingly want “personalized provider interactions.” Thus, herding patients into government-directed programs is not the solution. One core problem with government systems is their reliance on the goodwill of politicians. As President Ford said, “a government big enough to give you everything you want is a government big enough to take everything you have.”

It’s time for Congress to scrutinize anti-competitive health system mergers. It’s time to bring to the floor over a dozen bills to expand and improve Health Savings Accounts (HSAs) to give patients more control over all facets of their medical care.

Congress, the clock is ticking on this legislative session. Stand up for patients. Or did the dog eat your courage?

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.

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.

Follow Dr. Marilyn Singleton on Twitter @MSingletonMDJD

More info about Dr. Marilyn Singleton

Culture & Society, Doctors, Medical Ethics, Medicine, Op-eds

Making Lemons from Lemonade: Squeezing the Joy Out of Medicine

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By Marilyn M. Singleton, M.D., J.D.

Scandal upon scandal has dominated the airwaves and the web. Other than those involved, we have no way of knowing the truth or misremembering of the allegations. But we do know it is beyond sad that our congressional representatives who have the privilege and honor to serve their country have used the public purse to whitewash their misdeeds. These critters certainly know how to drag a noble calling into the gutter.

In the case of medicine, it is not the few well-publicized bad apples, but government and corporations injecting themselves into clinical practice that is driving the down trajectory of patient care. The days of physician as independent member of the community are fast waning—thanks to those paragons who run our country.

According to an American Medical Association survey, by 2016 only 47.1 percent of practicing physicians owned their own practice. Another report noted that hospitals acquired 31,000 physician practices, a 50 percent increase, from 2012 to 2015.

Now UnitedHealth Group plans to purchase the physician group from DaVita, a chain of dialysis centers, adding to their urgent care and surgery centers. Insurers owning (enslaving?) physicians is hoped to contain costs. While innovation in improving delivery of medical care is laudable, it is not without risks. Patients likely will have fewer choices of physicians or be told whom to see. As far as insurance pricing, economists agree that more competition benefits consumers.

We must be wary: as these behemoths consume and control medical care, sins are mounting. A few transgressions include Northern California’s Sutter Health that intentionally destroyed 192 boxes of documents that employers and labor unions were seeking in a lawsuit that accuses Sutter of abusing its market power and charging inflated prices. Anthem, the second largest health insurer in the U.S., was fined $5 million by California’s Department of Managed Health Care for “flouting the law” in dealing with consumer complaints. In 2016, insurance company denials were overturned in nearly 70 percent of medical review cases. California had already fined Anthem more than $6 million collectively for grievance-system violations since 2002.

And the federal government has stacked the deck in its new Quality Payment Program that “adjusts” physicians’ government payments if they don’t comply with the complex metrics. First, electronic medical records are a must. On the clinical front, anesthesiologists are scored on the percentage of current smokers who abstain from cigarettes prior to anesthesia on the day of elective surgery or procedure. Is the anesthesiologist supposed to send a proctor home with the patient? How is patient compliance grafted on to a physician whom the patient just met—no matter how convincing the anti-smoking pitch?

And then for internists there are “Additional improvements in access as a result of QIN/QIO TA” [Quality Improvement Network/Quality Improvement Organization technical assistance]. Or participation in a QCDR that promotes use of patient engagement tools. And what is a QCDR? A qualified clinical data registry. “A QCDR is a CMS-approved entity (such as a registry, certification board, collaborative, etc.) that collects medical and/or clinical data…”

The new medicine is forcing the remaining independent physicians to devolve from trusted confidants to automatons in order to survive in medicine’s brave new world. And it is not so pleasant for the patients: the algorithms, electronic computer screens, and hospitalists taking over care often with no consultation with the primary care physician.

Call me old-fashioned, but I come from a line of private practitioners who provided “population health” by being an integral part of the community. The Bradfield Community Association of Lima, Ohio, was formed in 1938 and named after my grandfather, Joseph C. Bradfield, M.D., a World War I veteran and beloved physician. The San Diego Board of Supervisors adjourned in memory of the death of my father, E.B. Singleton, M.D., a Tuskegee flight surgeon and primary care physician who charged people what they could afford and accepted tamales as payment. He didn’t need to take classes on dealing with denied insurance claims or filling our government forms.

Dr. Benjamin Rush, a signatory of the Declaration of Independence said, “Without virtue there can be no liberty and liberty is the object and life of all republican governments.” Liberty is also the cornerstone of good medical care.

Ask yourself do government bureaucrats and nameless faceless insurers have the moral authority to tell us what is just in delivering medical care to our populace? If the current happenings do not convince you that you and your private physician are your best advocates, then nothing will.

I wish you love, peace, and joy in this blessed season.

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.

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.

Follow Dr. Marilyn Singleton on Twitter @MSingletonMDJD

More info about Dr. Marilyn Singleton

Doctors, Elections, Health Policy, Healthcare Reform, Medical Ethics, Medicare, Medicine, Op-eds, Politics

The Dry Tortugas and Being a Deplorably Good Physician

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By Marilyn Singleton, MD, JD

Hillary Clinton recently said that half of Donald Trump supporters belonged in the “basket of deplorables” and were irredeemable. Many believe that Dr. Samuel Mudd, the physician who treated John Wilkes Booth, was deplorable. While some say he was merely being a good doctor, setting a broken leg for a man in pain, others argued that he knew of the conspiracy to assassinate President Abraham Lincoln. After a speedy trial, he was sentenced to life imprisonment at Fort Jefferson on the Dry Tortuga Island off the Florida coast.

An 1867 outbreak of yellow fever took the lives of prisoners and the prison doctor. Dr. Mudd took over and saved some 1000 lives. Conspirator, maybe. I’d like to believe he sought redemption and his physician better angel emerged and he did what he was trained to do: take care of patients. After laudatory letters from the prison and continued local advocacy, Dr. Mudd was pardoned by President Andrew Johnson in 1869.

Over the last few years we have seen the deplorable consequences of the Affordable Care Act. Most of the newly “insured” are folks placed on Medicaid. There is a reason Clinton calls for “Medicare for all” and not Medicaid for all. Then there’s the lack of choice in insurance policies and the consequent lack of choice of physicians; unaffordable premiums and sky-high deductibles for virtually unusable insurance, and mergers of major insurance companies, further lessening choice.

A new study looking at California hospitals shows that as more hospitals become part of large chains, the prices go up – as much as 25 percent. As more hospitals consolidate, this trend is likely to be replicated across the county. Again, less choice and competition have their consequences.

With regard to medications, competition in stores like Walmart some ten years ago caused cash prices to be much lower than deductibles. But now many pharmacists are barred from discussing the cash price under terms set by contracts between them and the middlemen-insurers.

And as for that doctor that you liked but couldn’t keep, the government has doubled down on the red tape to receive compensation for treating Medicare patients. The 962-page Merit-Based Incentive Payment System (MIPS) forces your doctor to complete reams of paperwork showing compliance with complex metrics or they will get a downward “adjustment” of their Medicare payments.

Particularly troubling is the “Resource Use,” measurement which begins as 10% of the score and increases to 30% in 5 years. This metric measures the cost per beneficiary based on the government’s review of claims submitted. But this metric does not address the fact that patients have different needs. Some patients may require more visits for the same illness.

Worse yet, the new system spells the demise of our beloved solo practitioner. The Center for Medicare and Medicaid Services estimated that 87 percent of solo practitioners would be penalized.

Government regulation has reached the tipping point. Even the citizenry of progressive Seattle, Washington had their limit. The city authorized a plan to impose a $1 fine on residents each time their garbage cans were filled with more than 10 percent food, compostable waste and paper products. Trash collectors were forced to snoop through the garbage to ensure compliance. A lawsuit was filed and the ordinance was deemed unconstitutional.

The regulatory escalation confirms that the ACA and its progeny were about control, not improving medical care. As more patients complain about unaffordability and inaccessibility, the answer from the social engineers is to say we have to just make health care free! But experience with human nature shows that paid products carry more value. Physicians want patients to value their health. Physicians want to care for patients, not become paper-pushing robotic “providers.”

There is another answer. Physicians can break out of the third party payer trap. We have learned the hard way that if you take their money, you follow their rules, no matter how restrictive or onerous. The majority of patients would pay for routine care, the cost of which is far less than the current insurance premiums. Remove the ACA’s restrictions on insurance policies for catastrophic illnesses. These policies were inexpensive and available to all. Finally, let physicians get back to delivering unfettered charity care.

Remember, the core of Mrs. Clinton’s 1993 Health Security Act was to “put the common good, the national interest ahead of individuals.” Mrs. Clinton’s plan massively expanded the health care fraud definitions and penalties. Physicians faced $50,000 penalties for rendering care outside of the system or seeking payment for care that did not comply with her National Health Board’s medical necessity standards.

In Clinton’s eyes, if you are a patient seeking individualized care or a private physician, your name is Mudd.

Dr. Singleton is a board-certified anesthesiologist and Association of American Physicians and Surgeons (AAPS) Board member. 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.