The first and most important of these articles is this one, which lays out the Grand Unification Theory itself.  The GUTH remains the foundation of almost all my thinking and writing on the American healthcare system.  It is fully laid out, of course, in my book Fixing American Healthcare – Wonkonians, Gekkonians and the Grand Unification Theory of Healthcare.

This Oxford-rules debate took place on November 28 at the George Washington University School of Medicine, and was sponsored by the Benjamin Rush Society.  The resolution being debated was, “The Requirements of Social Justice are in Conflict with the Requirements of an Ethical Doctor-Patient Relationship.”  I and my debate partner (Dr. Lee Hieb, past president of the American Association of Physicians and Surgeons), braved the strikingly Progressive atmosphere of the GWU campus to argue the affirmative.

The debate was spirited, and I think Dr. Hieb and I more than held our own.  I thank the Benjamin Rush Society, and especially Dr. Beth Haynes (Executive Director of the BRS) and Dr. Bruce Shaver (chapter leader of the GWU chapter) for asking me to participate.

This YouTube video of the entire proceedings is almost an hour and a half long. If you are interested in seeing my major contribution, which lasted for only 8 minutes, fast forward to the 29:30 minute mark.

The voters have decided. Obamacare is the law of the land, and is neither going to be declared unconstitutional, nor repealed.

In my view, of course, we had very little chance of getting rid of Obamacare no matter who was elected. Repealing the legislation would have required not only the concerted effort of a President Romney who had favored a similar plan in Massachusetts, but also a large majority in the both House and Senate – large enough majorities to overcome the substantial number of Republican legislators who would have been cowed by: a) the absolute onslaught of TV and newspaper stories about specific sympathetic and deserving individuals whose healthcare (and very lives) would be placed into jeopardy by Obamacare’s repeal; and b) the public machinations of the health insurance executives, who would have viewed the repeal of Obamacare as removing their final lifeline, and who would have gone to great lengths to stop such a repeal (by, for instance, demonstrating to an increasingly frightened public just how unremittingly evil they would become without the constraints imposed upon them by Obamacare).

So if Mr. Romney had won, in my view the most likely outcome would have been a more-or-less half-hearted effort at repealing Obamacare – an effort which would peter out ignominiously, but only after the Republicans had burned through whatever public goodwill they might have started out with.  And what we we would have been left with is: Obamacare, with perhaps some of its more egregious provisions blunted a bit.  And then, in a few years, when the public began to really understand the personal price they’re paying under Obamacare, Mr. Obama (who would be running again in 2016) would be able to blame these now-obvious problems on those stupid Republicans, who had come along and bollixed up a perfectly good system.

If this sounds pessimistic, I suppose that it is. But the book I expended so much blood, sweat and tears writing earlier this year was never really intended as a plea to repeal Obamacare (an eventuality which, as I say, I have always found to be unlikely), but rather, was meant to let readers know what we should all expect under Obamcare, and what we should do – collectively and as individuals – to try to cope with it.

And now that we can see that Obamacare really is here to stay, and we are no longer distracted by long-shot efforts at getting rid of it, perhaps we can all move on to taking those necessary steps.

The details are in the final few chapters of my book. But the fundamental issue we now need to address – the line in the sand I hope we will finally draw – is whether individual Americans are to retain the right, under the law, to expend their own resources for their own well-being. This is not something we can take for granted. If we are to retain this right we will have to fight for it. It will be a hard fight, a dirty fight, and some of us will not survive it.

If we can maintain this last line of defense, then eventually (in a decade or two, perhaps) we can force Obamacare to evolve into a system that is not so bad, one that is certainly less destructive to the Great American Experiment than it now promises to be.

For those readers who still insist that our Progressive leaders will never try to limit individual prerogatives in such a way, I ask you to re-read Chapter 7 – and to pay close attention to what you see unfolding before your eyes.
________

Now read the rest of the story!

DrRich explains it all in Open Wide and Say Moo! The Good Citizen’s Guide to Right Thoughts and Right Actions Under Obamacare

Available On Kindle

Now available in the audiobook version!

Trusting in the integrity of my readers, I base this offer on the honor system. Here’s the process:

Step 1) Purchase the Kindle e-book on Amazon, here.
Step 2) Using the same email address you use in your Amazon account, email me at “DrRich AT covertrationingblog.com,” and let me know you purchased the e-book.
Step 3) I will direct one of my audiobook vendors (Payloadz) to email you a download link for the audiobook.

(Since step 3 requires action on my part, and since I am not on the computer 24/7, please allow up to 24 hours to receive the download link.)

Finally, if you have purchased the Kindle e-book in the past and would also like to have the audiobook version, just let me know, and I will likewise arrange for you to receive it.

I have no use for your email address, and will employ it for no purpose other than directing the download link your way.

This offer expires at midnight Eastern time, on election day.

I now return to my prayers.

Open Wide and Say Moo! The Good Citizen’s Guide to Right Thoughts and Right Actions Under Obamacare – the Audiobook

UNABRIDGED

By Richard N Fogoros

Narrated by Richard N Fogoros

Publisher: Open Book Audio

Length: 14 hours 29 minutes

Publication Date: October 1, 2012

Available both in mp3 and in audiobook format

How To Purchase:

1) Purchase directly from the publisher for the introductory price of $5.99:

Buy Open Wide and Say Moo! – the Audiobook

(Note: After your payment is accepted, you will immediately receive an email with a download link, from which you can download the audiobook in whichever format(s) you wish.)

2) Purchase from one of these fine audiobook retailers:

Ambling Books

Audible.com

Audiobooks.com

iTunes (access through your iTunes store)

Simply Audiobooks

——
Open Wide and Say Moo! is also available in Kindle format, here.

Producing the audiobook version of Open Wide and Say Moo! was a much bigger challenge than I had anticipated, but I am very happy with the results of this effort.  And I am quite proud to say that my audiobook has been accepted for distribution by Open Book Audio, the premier (and most selective) audiobook producer and distributor for independent publishers.

Where You Can Get the Audiobook Version

There are two ways you can purchase the audiobook version of Open Wide and Say Moo!

1) The traditional way.

You can purchase the book from one of the major audiobook retailers who, courtesy of Open Book Audio, have listed the book so far.  The book is currently available from:

Ambling Books

Audible.com

Audiobooks.com

iTunes (access through iTunes store)

Simply Audiobooks

These are all very reputable audiobook sellers, and I would be delighted if you were to buy this audiobook from any of them.

2) The non-traditional way.

As anyone knows who has purchased audiobooks, the price of an audiobook is usually much higher than the price of the print version or the e-book version of the same book. (Now that I have gone through the substantial effort of producing a professional-quality audiobook, I begin to understand why this is the case.) And sure enough, the price currently being charged for my book by these audiobook retailers is much higher than the $5.99 price of the Kindle version.

While I cannot set the price the on-line audiobook retailers are charging for my audiobook, I have made an agreement with Open Book Audio that allows me to sell the audiobook version of Open Wide and Say Moo! directly to readers – and, at least temporarily, at a greatly reduced price.

And so, I am pleased to offer the Open Wide and Say Moo! audiobook – all 14.5 hours of it – to readers of this blog for the same price as the Kindle version, $5.99. This price allows you to download the book in mp3 format, or in m4b format (the audiobook format), or both.

To take advantage of this $5.99 price, exclusive to CRB readers, simply click on this link:

Buy the Open Wide and Say Moo! Audiobook for $5.99

(Note: when you click on this link, the email address you will see as that of the seller is mine. It looks like this: xxxxx@verizon.net.   After your payment is accepted, you will immediately receive an email with a download link, from which you can download the audiobook in whichever format(s) you wish.)

—-
(And you can always get the Kindle version here.)

To summarize: It is axiomatic that a woman has a perfect right to choose what she does with her own body, right up until the point that her choice infringes on the equally inherent rights of another person.  (If this were not an axiom, then the whole concept of natural rights would be destroyed, and a person’s right to take some action that harms a second person would depend only on how much power the first person has over the second.  While this arrangement is indeed common enough, we generally do not consider it to be right, or proper, or ethical, or a suitable basis for establishing a civil society.) So the key question is: When, during the creation of a human life, is a new human life actually created?

When we allow our Experts to establish an arbitrary point, after fertilization of the egg, which defines when a human life is present and when it is not, then no matter what logic they may have invoked in the process, it will be all too easy for the Experts to shift this arbitrary dividing line at any time, under duress or for matters of convenience, to exclude from “human life” other categories of individuals such as babies, or the elderly, or disabled people, or demented people, or fat people.

And to illustrate the point, I pointed out that Progressive ethicists are already arguing that the definition of “non-personhood” used by proponents of abortion is readily extensible to young children, and thus permits (at the least) infanticide. Specifically, given that abortion is permitted for any reason, these ethicists argue, parents also should be permitted to terminate the lives of their young children for any reason they may choose. (And thus, presumably, Casey Anthony should have been left alone without all the fuss and muss of a trial.)

So again, my secular, logic-based objection to abortion boils down to a single question: Is there some objective criterion by which it is OK to terminate a fetus, without also making it OK to terminate an inconvenient infant or toddler (or other types of inconvenient humans)? Progressive ethicists have determined that there is not. To me, this startling fact makes abortion problematic.

This brings us, at last, to President Obama. I have implied that Mr. Obama and I have some common ground when it comes to the issue of abortion – even though our conclusions about abortion are opposite one another. That common ground is this: when we allow Experts to define “human life” arbitrarily, we are opening ourselves up to a slippery slope. Specifically, any arbitrary definition of human life you can devise is readily extensible to places we would not like to go, and will result in horrible abuses. President Obama and I completely agree on this point.

This fact is made apparent from remarks made by then-State-Senator Obama in 2003, when he chaired the Illinois Senate Health and Human Services Committee. At that time, Senator Obama’s committee was considering the Born Alive Infant Protection Act (BAIPA) a proposed bill aimed at protecting infants who are born alive after botched “induced labor abortions,” a type of abortion sometimes used when the fetus is well beyond the first trimester.

In induced labor abortion, labor is induced prematurely with drugs. The idea is to produce a “late miscarriage.” Specifically, the result of this premature labor is supposed to be the delivery a lifeless (albeit baby-shaped) mass of tissue. And for pregnancies that are no more than 20 or 21 weeks along, this is generally what happens.

But, as is always the case with advanced medical techniques, some doctors insist on “pushing the envelope,” and have taken to offering induced labor abortions to women who are further along into their 2nd (or even third) trimesters. And (predictably) when this is done, the mass of tissue that ends up being delivered turns out occasionally to be a live baby.

Needless to say, a live birth invariably proves deeply embarrassing to any self-respecting abortion doctor who has his professional reputation to think about. So, naturally, steps are taken to correct the situation. In certain Illinois hospitals, whose actions had induced the introduction of the BAIPA, the usual remedy, apparently, was to place the inconveniently living product of the botched abortion on a shelf in the Soiled Linen Room, where it would remain unattended and alone until it no longer impersonated a live baby, a process which might take a few minutes or a few hours. Some hospital personnel found this procedure disturbing and reported it to state legislators, who were moved to write the BAIPA.

The BAIPA noted that any person born in the United States is a US citizen according to the 14th Amendment, and as a citizen that person is entitled to the same medical care that would be routinely given to any other citizen. Furthermore, such routine medical care, when given to babies born prematurely at the same gestational age as many of these aborted babies, not infrequently results in a healthy child.

State Senator Obama objected to the bill for more than one reason. For instance, he held that, once the abortion doctor determines that a fetus is pre-viable, it should be taken as law that the child is pre-viable even if (oops!) it is born alive. The fact that the child is alive, and might potentially respond to medical care, seemed to carry no weight with him. And the fact that these tiny babies invariably die soon enough when banished alone to the cold, dark hell of the Soiled Linen Room might even constitute evidence that he is correct – although even full-term babies would not survive for very long in such environs.

But to get a flavor for Senator Obama’s chief objection to the BAIPA, let us turn to the transcript of his own words from one of the hearings held for this bill:

“….as I understand it, Sen. O’Malley, the testimony during the committee indicated that one of the key concerns was – - is that there was a method of abortion, and induced abortion, where the – - the fetus or child, as – - as some might describe it — is still temporarily alive outside the womb. And one of those concerns that came out in the testimony was the fact that they were not being properly cared for during that brief period of time that they were still living……Number one, whenever we define a pre-viable fetus as a person that is protected by the equal protection clause or the other elements in the Constitution, what we’re really saying is, in fact, that they are persons that are entitled to the kinds of protections that we would be provided to a – - a child, a nine-month-old – - child that was delivered to term. That determination then, essentially, if it was accepted by a court, would forbid abortions to take place. I mean, it – - it would essentially bar abortions, because the equal protection clause does not allow somebody to kill a child, and if this is a child, then this would be an anti-abortion statute.”

And here is the key point. Mr. Obama was arguing that we simply cannot define these living babies as being people because doing so would start us down a slippery slope that, at the end of the day, “would forbid abortions to take place.” Mr. Obama was explicitly recognizing that there is no real, fundamental, definitive, essential difference between this squalling, squirming struggling blob and a newly fertilized egg.

If we say this is a person, he is arguing, then that is tantamount to saying that any fetus is a person – which is the same thing as saying that abortion should not be permitted. Therefore, this baby cannot be a person.

And this, dear reader, is the point upon which President Obama and I agree on abortion. It is the most important point of all, and really, is the only point that matters: Once we allow the Experts to define “human life,” then the definition can be changed arbitrarily, at any time, to any definition you want.

While we agree on this fundamental point, however, President Obama and I reach different conclusions about its implications. Given the clear (but suppressed) history of Progressivism, a history featuring the enthusiastic devaluation of various types of inconvenient human life, and given the fact that Progressives are now running our healthcare system and are in charge of deciding who gets what, when and how, I believe we should insist on the most conservative definition of human life possible – the point of fertilization of the egg. Anything else invites grave abuses.

President Obama, on the other hand, insists on a completely open definition of human life, one that allows a very expansive idea of what constitutes, for instance, non-viability. Pinning down the definition of human life, he is saying, will be too limiting. It will certainly limit abortion. As it happens, it will also limit other medical policies that will become necessary in the future as Obamacare rolls out.

I am arguing that any definition of human life that allows abortion will too easily also allow infanticide and other abuses. President Obama emphasizes the other side of this same argument: that disallowing infanticide (and by necessary extension, disallowing the termination of other forms of inconvenient human life) threatens to disallow abortion.

In any case, on the fundamental question, President Obama and I are brothers.
________

Now read the rest of the story!

DrRich explains it all in Open Wide and Say Moo! The Good Citizen’s Guide to Right Thoughts and Right Actions Under Obamacare

Available On Kindle

Now available in the audiobook version!

Unlike those small-minded zealots who rage against abortion based on religious grounds – people who Progressives like to dismiss as being mired in superstition and magical thinking – I base my objections to abortion purely on reason and logic, tempered, of course, by my study of human behavior and human history. So it really should not be so surprising that my reasoning about abortion is not so very different from the reasoning of Progressives on abortion, since Progressives insist that their political and economic philosophy is also based on pure reason and logic. And thus, it also follows that my thoughts on abortion might have much in common with the thinking about abortion of the Progressive-in-Chief.

People who have read my book, “Open Wide and Say Moo!” (both of you) will know that my major objection to Obamacare is that it systematically destroys the autonomy of the individual in America, within the healthcare system and everywhere else. Among other things, it forcefully eliminates individual choice in making healthcare decisions. In other words, in every area of healthcare except abortion, Obamacare is anti-choice. Why this inconsistency when it comes to abortion?

In a similar vein, a few readers have now complained to me that my own anti-abortion views are glaringly incompatible with my overall “pro-choice in healthcare” message. How can I be “anti-choice” regarding abortion, and pro-choice everywhere else? Am I being disingenuous, insincere, or just plain stupid?

As it turns out, the reason that both Progressives and certain non-Progressives (such as myself) display a similar apparent disconnect between their pro-choice/anti-choice views in general, and their specific pro-choice/anti-choice views when it comes to abortion, is the same reason.

It has to do with this fact – at some point in time during the creation of a new human life, a new human life is created. And at that point (whenever we decide what that point is), that new human life is endowed with the same rights as any other human life. When that point is reached, we ought not to allow some other entity to act in such a way as to arbitrarily terminate this new human’s natural right to life, liberty, etc. Even Progressives agree with this (or, at least, if they do not agree with it they are unwilling to say so publicly).

Since we all agree (or are unwilling to say that we do not agree) that before a new human life exists a woman has a perfect right to do what she wishes with her own body, but that after a human life exists she only has that right to the extent that she does not infringe upon the natural rights which nature endows to that new life, then the crux of the problem is to define when it is, during the course of the creation of a human life, that a new human life is deemed to be present.

The most conservative definition of human life is when the egg becomes fertilized, and a new entity is created that has a genetic composition distinct from that of the mother. Prior to that, no new entity existed. After that, further distinctions are a matter of degree.

My entirely-non-religious argument against abortion is that the moment we allow our Experts to establish a less conservative definition of when a human life is present and when it is not, our Experts will necessarily be establishing that definition arbitrarily. And whatever logic they may use to determine what does and what does not constitute human life can be – and, based upon a study of human behavior, eventually will be – extended to many other categories of what most of us would consider today to be part of humanity. It is simply my contention that we ought to opt for a conservative definition of “human life” because anything else too easily bleeds into a definition that might exclude live babies, or toddlers, or Old Farts, or disabled people, or demented people, or fat people. These things have already happened within recent memory, and even though we’re Americans, I believe that they could happen again if we are not vigilant. So, I say again, my objection to abortion is entirely logical, that logic being further informed by the disturbing history of Progressivism over the past 120 years.

For readers who think I might be overly concerned about what might follow from a more liberal definition of human life than I have proposed, I will remind you of a recent article, published by two medical ethicists earlier this year in the Journal of Medical Ethics, entitled, “After-birth abortion: why should the baby live?” Here is the authors’ abstract:

“Abortion is largely accepted even for reasons that do not have anything to do with the fetus’ health. By showing that (1) both fetuses and newborns do not have the same moral status as actual persons, (2) the fact that both are potential persons is morally irrelevant and (3) adoption is not always in the best interest of actual people, the authors argue that what we call ‘after-birth abortion’ (killing a newborn) should be permissible in all the cases where abortion is, including cases where the newborn is not disabled.”

These earnestly Progressive ethicists, in other words, propose to allow parents to kill their young children for any reason they might have invoked to abort that child prior to birth – that is, for any reason at all. The key point being made by these ethicists is that, by whatever reasoning a fetus can be considered a non-person, so can an infant, and perhaps even a toddler. And, while they do not say so, so can several other kinds of human life that may not meet their definition of “personhood.”

We should note that these ethicists were not attempting to be particularly provocative, but were merely producing (for the purposes of advancing their academic careers, most likely) yet another scholarly article that simply takes the next, entirely logical and completely unremarkable step in Progressive thought on the matter. Indeed, according to subsequent news reports, these ethicists were entirely stunned and very disturbed by the firestorm of anger their article produced. I mean, who the heck reads the Journal of Medical Ethics?

In any case, it turns out that it is regarding this very issue – that is, in being very, very careful about where we draw the line between human and non-human life – where, I have discovered, my reasoning on the matter turns out to be very similar to the reasoning of none other than President Obama. In a later post I will show exactly how this remarkable happenstance is true.

Here is Part 2 of this article.

________

Now read the rest of the story!

DrRich explains it all in Open Wide and Say Moo! The Good Citizen’s Guide to Right Thoughts and Right Actions Under Obamacare

Available On Kindle

Now available in the audiobook version!

Long time readers of this blog will know that I am a strong proponent of direct-pay practitioners, of doctors who “drop out” of the system to establish medical practices in which they are paid directly by their patients. This kind of arrangement is the only way today for physicians and patients to enjoy the classic doctor-patient relationship; you know, the relationship where the patient agrees to confide completely in the physician, and the physician agrees to work solely for the benefit of the patient.

In the modern healthcare system, especially under Obamacare, this classic form of the doctor-patient relationship is not only frowned upon, but is considered unethical. It is unethical because doctors have formally adopted a “new ethics” which obligates them to work for “social justice,” which is a pleasant-sounding euphemism for covert bedside healthcare rationing. The direct-pay model allows physicians to avoid this odious new responsibility.

The entire healthcare system today is disposed to hate the direct-pay model. The reason typically given is that this model of practice will establish unfair “two-tiered” healthcare, the new, undesired tier, of course, being the one in which patients would enjoy the benefits of a professional advocate who is looking out for their individual needs. Accused felons can still enjoy such a personal advocate as they face a complex legal system, but not so for patients facing a hostile and parsimonious healthcare system.  (If patients do not like this, well, they should have taken better care of themselves.)

Direct-pay physicians are being castigated all across the land for being greedy, elitist, selfish, lazy and unethical.  And if they cannot be shamed into returning to the medical gulag, they will soon be prosecuted into doing so.

When the attacks become serious, direct-pay doctors need to be prepared with a clear and compelling answer; an answer that does not offer any apologies; an answer that does not rely on the “goodies” that go along with having a direct-pay physician (things like same-day appointments, or access to the doctor’s cell phone number and e-mail address); an answer that instead boldly expresses in plain language that what they are doing does not destroy but salvages medical ethics, and indeed, it is the ONLY way that remains for doctors to practice their profession ethically.

What direct-pay doctors need is a John Galt speech.

And since I fear most of you have missed it, I reproduce my proposed John Galt speech here.

(I have liberally borrowed parts of the first three paragraphs from the actual John Galt speech in Atlas Shrugged. The blame for the rest of it falls solely upon your faithful author.)

A John Galt Speech For Direct-Pay Physicians

“You demand to know what has happened to us, the physicians you thought you controlled. You have cried that our sins are destroying the world and you have cursed us for our unwillingness to practice the virtues you demanded. Since virtue, to you, consists of sacrifice, you have demanded more sacrifices at every turn. You have sacrificed all those evils which you held as the cause of your plight. You have sacrificed justice to mercy. You have sacrificed independence to unity. You have sacrificed wealth to need. You have sacrificed self-esteem to self-denial. You have sacrificed happiness to duty.

“While you were dragging us to your sacrificial altars, we physicians who value justice, independence, reason, and self-esteem – we finally came to see the nature of the game you were playing, which we had previously been too innocently generous to grasp. And we have chosen to play no longer.

“All the physicians who have vanished from your system, the doctors you hated, yet dreaded to lose, we are gone from you. Do not cry that it is our duty to serve you. We do not recognize such duty. Do not cry that you need us. We do not consider your need a claim. Do not cry that you own us. You don’t. Do not beg us to return. We are making our own way, apart from you.

“In your cynical attempt to control the healthcare system, you have coerced us – with your threats to our livelihood, threats of massive fines, threats of jail – to abandon our sacred obligation to our patients. Society must come first, you say. The needs of the collective are paramount, you insist. We must do what the experts tell us to do, you demand. And in the process you have destroyed the doctor-patient relationship which is the backbone of our profession. You have reduced physicians to ciphers, to puppets. And you have reduced our patients – the living, loving, hoping, striving people who come to us, who place their trust in us and their lives in our hands – to interchangeable members of a vast herd. You have demanded that we guard society’s interests, and abandon our sick to their own devices in your cruel and parsimonious healthcare system.

“Your process is now firmly established. Your methods have been legislated by Congress, embodied in volumes of rules, regulations and “guidelines” (strictly and ruthlessly enforced), upheld by the courts, and finally (and most tellingly) sanctioned as being entirely “ethical” by your allies, the leadership of our own professional organizations. You have made the healthcare system untenable for doctors who value true medical ethics.

“You have placed us into a position where we must either resign ourselves to an unethical, demeaning, health-destroying style of practice, or get out. We have gotten out.

“We have gotten out. We have left your Program. We refuse to sacrifice ourselves for you any longer. We will not sacrifice our livelihoods, our morals, our independence, our minds, or our patients for your bastardized idea of virtue.

“We will practice medicine in the only manner that still permits us to behave ethically toward our patients, in the only way that we can honor the true doctor-patient relationship, in the only way we can legitimately regain the title of professional. We have chosen to be paid directly by the people to whom we provide our services, by the people to whom we dedicate ourselves as professionals. We have chosen to cut you out.

“To argue that direct-pay practices are unethical – to argue that any innovation that would somehow restore both our professional integrity and the patient’s rightful advocate is unethical – is completely upside down. This argument only reveals your own inner corruption. We are taking the only pathway that remains to us to restore the true foundation of medical ethics, to restore our profession – to always place the patient first.

“To argue that direct-pay practices threaten the general welfare completely ignores reality. We are doing the only thing we can do to begin restoring protections that people are supposed to have when they are sick and facing a healthcare system that is utterly bent on withholding their care whenever it can be gotten away with.

“To argue that direct-pay medicine will create a two-tiered healthcare system is absurd on its face. It provides a mechanism by which at least some of your intended victims can escape the deadly obstacles you have laid before them. Saying that it amounts to a two-tiered healthcare system is as absurd as arguing that slaveholders were wrong to free their slaves before Emancipation, because doing so would create an elite subpopulation of former slaves; that until all slaves are freed, no slaves should be freed. But when a few slaves were freed and walked the earth as free men, that action was not only ethical, but it also showed others what was possible. Over time, it created a widespread expectation for freedom that eventually could no longer be ignored, and that, at huge cost, was finally fulfilled.

“You wouldn’t understand this – you who already know everything, you whose experts already have all the answers – but any innovation that can potentially spare patients from some of the harm you have in store for them will necessarily be applicable to only a few patients at first. That is how disruptive processes work. In your proposed perfect system, of course, disruptive processes are anathema – because they disrupt. But in the real world disruptive processes are creative processes, processes of growth, processes of rejuvenation, processes that create opportunity. This is why you always try to suffocate disruptive processes, with your cries of “unfair!”

“Disruptive processes always begin as niche products or services, attractive only to a few high-end users; too expensive or too marginal for the vast majority; ignored, ridiculed or castigated by current providers. But if at their core they are offering something fundamentally useful, they will slowly demonstrate their worth – and eventually all the potential users will see the light, and demand for the product will become explosive. At this stage the means are invariably found to make the new product affordable and available to meet the demand, while preserving the core benefits. And when that happens, the traditional providers (who never saw it coming) are suddenly out of business.

” We are a disruptive process, and the process we are disrupting is yours.

“We are not playing your game any longer. We will no longer be victims; we will no longer subject ourselves to your attempts to make us guilty. We will no longer walk, heads bent down, to your altar of sacrifice.

“You no longer have any hold on us. We have done our time. We are getting out. If we decided to leave medicine and open a road-side fruit stand, or become lumberjacks, or just spend our time puttering around in the basement, you would have no objection to that. So by what right do you object if we hang out our shingles, and see a few patients who voluntarily come to us, using their own resources to do so? You can have no rightful objection to such a thing. So be quiet about it, or admit to your own corruption.”

_______________

Now read the rest of the story!

DrRich explains it all in Open Wide and Say Moo! The Good Citizen’s Guide to Right Thoughts and Right Actions Under Obamacare

Available On Kindle

Now available in the audiobook version!

The reason I am pleased to be able to say this is: my ability to do so indicates that I was not killed, nor put into a vegetative state from injuries, during my bicycling/camping trip along the Great Divide Mountain Biking Route in Montana. I learned some things during this adventure, including a) Getting some water is more important than getting some electricity; b) If you’re doing the GDMBR, have the right equipment – a really good hybrid bike, even if you soup up the components, will not do. You should have an actual, very sturdy mountain bike; and c) Turns out that I really am getting old. It was a great trip, though, and I would highly recommend this portion of the GDMBR (roughly between Glacier National Park and Yellowstone) for anyone who might be looking for a bicycling challenge in a beautiful environment.

After this adventure, I was ready to get back to more sedentary activities. So. . .

In the process of preparing my book for publication, I made several revisions and edits that I hope have improved it, many of which were suggested by readers over the past six months. I sincerely thank all of you who took the time to give me your feedback (whether positive or negative) during this long project. Your interest is truly appreciated.

If you like my book, I hope you will consider leaving a comment about it on the Amazon page. You don’t actually have to buy the book to decide whether you like it – I intend to leave it up on this blog for the foreseeable future for your reading pleasure/displeasure. But you might consider recommending that your friends buy it.  I am, after all, a greedy conservative capitalist pig.

You can find Open Wide and Say Moo! here at Amazon.

I am going to spend the next couple of weeks away from the book, away from this blog, and mostly away from civilization. For much of that time I will not have access to electricity, let alone the Internet. I will let this project percolate.

When I return I will begin the task of editing the book into a more final form, then preparing it for e-book publication. I thank all who have posted comments and criticisms – I will be taking all of your remarks into account as I do this work. (It is far from too late to add any comments you might have, since it will be at least mid-August before I can get back to this.)

My goal is to have a final version of the book available in Kindle format by mid to late September.  This is an ambitious schedule.

In the meantime, you should expect my postings on the Covert Rationing Blog to be at least extremely sparse, and more likely nonexistent. However, whenever I am within reach of the information superhighway I will still be monitoring (and responding to, where appropriate) your comments.

Also in the meantime, please know how much I appreciate any of you who have hung in there with me during this project, who have read at least parts of this work, or who have offered your words of encouragement or advice. It has meant a lot, and has kept me going.

Here’s the link to the complete archive of Open Wide and Say Moo!

DrRich

Comments, criticisms and suggestions are solicited, which I’ll thank you to leave here.
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Update – September 1, 2012

Open Wide and Say Moo! is now revised and published!

You can find it on Kindle here.

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My Rationale For Writing This Book

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Introduction

Part I – Progressive Healthcare, and Why We Have Chosen It

Chapter 1 – Run For The Hills, As We Are All Doomed!

Chapter 2 – The Demise of the Health Insurance Industry

Chapter 3 – The Cowing of the Medical Profession

Chapter 4 – The Four Ways To Control Healthcare Spending

Chapter 5 -  A Practical Theory Of The Progressive Program

Part II – What We Can Expect From Obamacare

Chapter 6 – Some Implications Of A Right To Healthcare

Chapter 7 – Limiting Individual Prerogatives in a Progressive Healthcare System

Chapter 8 – The Real Infrastructure of Obamacare

Chapter 9 – An Introduction To Herd Medicine

Chapter 10 – A Tyranny of Experts

Chapter 11 – Preventing Preventive Medicine

Chapter 12 – Your Duty to Maintain Wellness – or – The Importance of Demonizing the Obese

Chapter 13 – Age-Based Medicine and End-of-Life Healthcare

Chapter 14 – Stifling Medical Progress

Part III – What We Can Do About It

Chapter 15 – The Critical Importance of Individual Autonomy

Chapter 16 – Individualized Medicine – Our Last, Best Hope

Chapter 17 – What We Need To Do

Chapter 17 can be found here.

Chapter 16 can be found here.

Chapter 15 can be found here.