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General Thanksgiving

By the PRESIDENT of the United States Of America

A PROCLAMATION


WHEREAS it is the duty of all nations to acknowledge the providence of Almighty God, to obey His will, to be grateful for His benefits, and humbly to implore His protection and favour; and Whereas both Houses of Congress have, by their joint committee, requested me “to recommend to the people of the United States a DAY OF PUBLICK THANKSGIVING and PRAYER, to be observed by acknowledging with grateful hearts the many and signal favors of Almighty God, especially by affording them an opportunity peaceably to establish a form of government for their safety and happiness:”

NOW THEREFORE, I do recommend and assign THURSDAY, the TWENTY-SIXTH DAY of NOVEMBER next, to be devoted by the people of these States to the service of that great and glorious Being who is the beneficent author of all the good that was, that is, or that will be; that we may then all unite in rendering unto Him our sincere and humble thanks for His kind care and protection of the people of this country previous to their becoming a nation; for the signal and manifold mercies and the favorable interpositions of His providence in the course and conclusion of the late war; for the great degree of tranquility, union, and plenty which we have since enjoyed;– for the peaceable and rational manner in which we have been enable to establish Constitutions of government for our safety and happiness, and particularly the national one now lately instituted;– for the civil and religious liberty with which we are blessed, and the means we have of acquiring and diffusing useful knowledge;– and, in general, for all the great and various favours which He has been pleased to confer upon us.

And also, that we may then unite in most humbly offering our prayers and supplications to the great Lord and Ruler of Nations and beseech Him to pardon our national and other transgressions;– to enable us all, whether in publick or private stations, to perform our several and relative duties properly and punctually; to render our National Government a blessing to all the people by constantly being a Government of wise, just, and constitutional laws, discreetly and faithfully executed and obeyed; to protect and guide all sovereigns and nations (especially such as have shewn kindness unto us); and to bless them with good governments, peace, and concord; to promote the knowledge and practice of true religion and virtue, and the increase of science among them and us; and, generally to grant unto all mankind such a degree of temporal prosperity as he alone knows to be best.

GIVEN under my hand, at the city of New-York, the third day of October, in the year of our Lord, one thousand seven hundred and eighty-nine.

(signed) G. Washington

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Gird yourself up, doctors. Prepare to join Oil, Pharma, Insurance, Finance, and Automotive as the next group of terrible villains who are victimizing the American people. Prepare for the hue and cry of the media against you and your ‘greed’. Prepare to watch as your motives are purposefully distorted. Prepare to be accused of actually wanting to deny those who are sick and harm those who are well.  Steel yourself for pictures of ill children and elderly accompanied by commentary from reporters about how broken the American system.  Do not be surprised or alarmed but most of all DO NOT BE INTIMIDATED.

There are a lot of reasons to oppose a system that concentrates control in the hands of bureaucrats- too numerous to review in this column.  I will talk about the one reason that the media and politicians will talk about though- GREED.  Doctors will be accused of greed- just wanting to make money.  Sure, there are some greedy doctors out there just as there are greedy cab drivers, professional athletes, waitresses, and accountants.  There are even greedy politicians- greedy for power and influence and the spoils that come therefrom.  So do not allow yourself to be so easily characterized.

Three things about medicine make it a relatively highly paid field: First, it is a high value-added product and as such is more expensive than low value-added products; second, there is a huge investment involved in becoming a physician both in terms of time (7-12 years after college) and money.  Large investments require a higher rate of return to justify them and attract participants; third, the pool of people who are capable of doing the job and actually want to do the job is small.  One of the reasons the profession is able to attract capable people is the prospect of higher earnings in the future.

Do not be made to feel guilty about making good money, doctors- the product is valuable, the job is hard and the investment is large.

But do not forget, doctors, that this debate is about more than money- it is about FREEDOM.  In particular, it is about the patients and their freedom.   The freedom to own and live their lives without the all-invasive oversight and influence of government.  A government that claims to be doing things for them but in actuality is doing things to justify its own existence.

Let me say this to the Patients, though- do not fall for the usual political gimmick- divide and conquer.  Do not allow yourself to be driven by envy and class warfare- they rot your souls and make you pawns in the hands of a demagogue.  You are smarter and better than that.  In your heart you should rejoice that America is the sort of place in which people can work hard and enjoy the legitimate fruits of their labors in free exchange with others.  For in such a place, the sky is the limit for you and your children.

Get ready, doctors, this battle is not for the faint of heart…

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This is first of what will be several posts about the responsibilities and role of patients in health/healthcare.  The first and foremost is that they must take responsibility for their own health and healthcare.  While people do not have a right to healthcare, they have the right (even, perhaps, an obligation) to manage their health in the manner they deem best.  This means that they are the primary decision-maker but it also means they are primarily responsible for their own health.

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This is a letter I recently sent to the Journal of the American Medical Association and the New England Journal of Medicine:

What about freedom?

Over the course of my medical education, I have spent a lot of time with physicians of many specialties, genders, and ages.  On each rotation the conversation inevitably comes around to the future of US healthcare.  While the range of opinions is wide, I am struck that so many physicians believe in the inevitability of a centrally controlled, national healthcare system.  Many physicians, convinced that health care is a right, support the development of such a system believing that it is the best way to improve access and/or control costs.  Others, who do not think such a centralized system is the right answer, believe that idea has too much political momentum to be stopped.  Practically all are frustrated with the current system- frustrated by the amount of resources consumed in dealing with the insurance companies (public and private) and frustrated by the high degree of control the insurers exert over patients and physicians.  

 

It is curious to me then, that, given the almost universal dislike for bureaucratic sclerosis and delay, so many doctors (and medical students) are either actively advocating or passively willing to accept a centralized system.  Why are we willing to exchange the tyranny of many bureaucracies for the even greater tyranny of a single Bureaucracy?  Such a Bureaucracy would dictate treatments to doctors and patients.  The Bureaucracy would also set and control compensation for all activities.  (In economics this is called a monopsony and it is as destructive as a monopoly)  Physicians become the slaves of the state and patients become the wards of the state.

 

Have we forgotten what it means to be free?  That freedom is our right- the right to own our lives and our labor and to dispose of them according to the dictates of our conscience- in a manner according to our own values.  If anyone is compelled to do something then they are not really free for compulsion is antithetical to freedom.

 

We must understand that by fighting for our own freedom- the freedom to practice medicine to the best of our ability- we are actually fighting for our patients and their freedom.  We fight to preserve the most precious relationship in healthcare- the doctor-patient relationship.  We are fighting for the freedom to partner with them in a voluntary association the focus of which is their well-being.   We are fighting for the right to try treatments we and our patients think could be beneficial even if they might not be entirely mainstream.  Fighting for the privilege to love our patients because they are ‘our’ patients and we are ‘their’ doctors.

 

The Bureaucracy does not revere the doctor-patient relationship- it seeks to replace it with a committee whose broad dictates and conclusions would apply to every situation but not really fit any.   

 

Do we want to be remembered as the generations of physicians who delivered their patients over to the bureaucrats?  who grew weary of standing up for their own freedom and that of their patients?  who grew so comfortable that we could not be roused to a good fight?

 

I close with a quote from Samuel Adams:

“If you love wealth better than liberty, the tranquility of servitude better than the animating contest of freedom, go home from us in peace. We ask not your counsels or arms. Crouch down and lick the hands which feed you. May your chains set lightly upon you and may posterity forget that ye were our countrymen.” –Samuel Adams

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in general- FREEDOM- in particular this blog is about HEALTHCARE- about addressing the problems in healthcare- cost, access, quality- by expanding the freedom of the primary stakeholders- patients and physicians.  How do we liberate medicine?  By liberating patients to make their own choices about their health, their healthcare, and their health insurance.  By liberating physicians to practice medicine to the best of their ability and training, without undue influence by government and/or insurance companies.  Such an effort is in keeping with the founding principles of this nation- individual responsibility/accountability/opportunity, limited government, and free markets.

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