Roger’s Rules

What It Means (first in a series)

Shock-and-Awe-Statism“: that’s the phrase Indiana Governor Mitch Daniels used to describe the Obama administration back in June of 2009. Are you getting it yet? Last weekend’s disreptuable drama over the fate of medical care in the United States provided little glimpses of the shock, bite-size snippets of the awe, department of bribery, arm-twisting, and pork-barrel politics. It was an unedifying spectacle, but you shouldn’t let yourself be distracted by the sideshow aspect of the theater. What we saw last weekend was not just beltway-politics-usual, another installment in the long running sit-com called Capitol Hill Follies. It was a minatory reminder of how the new statism will proceed. Elections have consequences, as some Obamacon observed in the wake of the 2008 election. We’re just beginning to see what some of the consequences are for America.

I’ve often quoted Barack Obama’s announcement, made in late October 2008, that he was only “a few days away from fundamentally transforming the United States of America.” I’ll continue quoting it because there still seems to be some confusion about just what that might mean. “Toutes choses sont dites déjà,” André Gide once observed, “mais comme personne n’écoute, il faut toujours recommencer.”

“Fundamentally transforming the United States of America.” What might that mean?

This last weekend we got a preliminary taste. You and your children will be finding out soon enough. Take a look at your tax bill. Where’s all that money going? Consult your doctor. Do not be surprised if you get a letter like this one that Daniel Foster reproduced yesterday over at NRO. It’s from Linda Johnston, a family doctor, to her patients. I’ve picked out a few passages for special delectation:

My Dear Patient,

As you must know, Congress has just passed extensive legislation governing health care delivery and insurance systems. Whether you agree with what it does or not, we are all now subject to this law and its sweeping changes.

I have always conducted my medical practice with my patient’s best interests as my first priority. Although not legally obliged to do so, I have routinely provided you with a receipt that has all the codes necessary to bill your own health insurance company for any reimbursement to which you are entitled. Until now, that insurance company was a free enterprise despite the fact that it was heavily regulated by state and federal laws. Now the situation is quite different. Through the new law’s mandates, regulatory powers and reform, health insurance is and will be largely a government activity which will have an ever larger jurisdiction over how doctors practice, make clinical judgments and are paid.

The new law provides for about 150 new government agencies, many of which are designed to be ‘oversight’ bureaucracies which will have the right to decide what medical care is legal to provide through insurance. Among other things, they will have the right to review my medical care of you and read your medical record. Now, as soon as you submit our economic transaction to your insurance company for reimbursement, you have involved me in these regulations and put me in the jurisdiction of government for my activities, decisions and behavior as your doctor.

No one can have two masters. Either I can serve you as my patient or I can serve the government. Either I can continue to make your welfare and health my only concern, including the protection of your privacy and medical records, or I can abide by ever-increasing amounts of government regulations and dictates to my decisions. I can’t do both. I choose to continue to follow my conscience and practice medicine to serve you.

For this reason, I am responding to the situation created by this new law by exercising my right not to participate in any health insurance program. I will still provide you with the same medical services that I always have, but the interaction will be exclusively and privately between you and me. This means that I will provide you only with a receipt for the services you have paid for, but without the additional information that is required to submit your receipt for reimbursement to your health insurance company. That is the only way I can make sure there will be no conflict between following the law and serving you. Because the law is now in effect, so must these changes be to my practice.


Linda Johnston, MD

Hope, that is to say, and change.