Surgery Center of Oklahoma Blog

The roof on my house is totaled from hail and wind damage. It will cost big bucks to replace it.  Problem is, my insurance company says it isn’t totaled and says here’s a few bucks to fix it.  Problem is, what they have offered to fix it is not enough to fix it at all…not even close.  Last winter I had ceilings inside the house cave in because the roof failed.  These areas of the roof have not been included in the “fix it” quote by my insurance company.

What do I do?  Do I sue them?  The insurance company has found “experts” to say that my roof isn’t totaled and can be fixed.  They all seem to agree on the same number.  You see, the real story is that my insurance company is broke, hoping to delay and deny long enough for current premium collections to catch up with their enormous hail losses here in Oklahoma last year.

What does any of this have to do with health care?

I am probably going to have to fix my roof myself, with my money, with no help from the insurance company, unless I want to run the risk of having ceilings cave in again this winter. We feel certain that if our house burned down we would receive the same treatment from this insurance company, so consider ourselves, essentially uninsured for the moment.  Problem is, no insurance company will touch this house unless we have a new roof.  Not a repaired roof.  A new roof.  And why should they?  Why should a new insurance company assume the risk of a failed roof, the repair of which should have occurred on the old company’s watch.  They won’t and they shouldn’t.  For if the new company did, everyone’s rates would have to increase to cover this certain, future loss.  Everyone’s insurance rates go up.  This coverage becomes even more unaffordable than before, and all because a “pre-existing condition” associated with my house was allowed and covered.  The young struggling couple down the street would be right to be angry about their rates increasing as a result of their insurance company acting irresponsibly and taking on high risk, certain loss leaders.

For all of you loonies out there that think that mandating insurance companies to cover individuals with health insurance, pre-existing conditions be damned, get ready for your rates to become unaffordable.  That is, of course, what the feds had in mind with mindless crap like this mandate.  If insurance becomes unaffordable then there will only be one place to go to get it…Uncle Sam.

I am probably going to have to fix my roof myself because my agent chose poorly when shopping for insurance companies.  My roof is not my neighbor’s problem and shouldn’t be. My bad fortune is just that:  mine and no one else’s.  Once my roof is replaced, I will be eligible for and will seek the best insurance for my home at the best rates and share the savings meant for those at low risk.

G. Keith Smith, M.D.

I recently received a speeding ticket near Denton, Texas on my way home to Oklahoma City.  A state trooper was positioned in a 55 mph zone that was sandwiched between two 65 mph zones and I (unfortunately for me) didn’t see the change in speed limit.  The officer was very nice and professional and his issue of a citation didn’t take him very long.  So far so good.  A few days later, I called to find out the payment procedure.  I was cited for 12 mph above the speed limit and the ticket was about $200.  Wow.  Ok.  ”Who do I make it out to?”  The woman on the other end of the phone said, “just make it out to the judge.”  I burst into laughter which she did not find funny at all.  I was thinking, “wouldn’t he rather I make it out to one of his children?” It gets better.  I repeated the amount just to be sure and she said, “or you can make it for $400 and we won’t report it to the state of Oklahoma so it won’t have any effect on your insurance.”  I asked, “is that your policy?”  She said “yes.”  ”So I make this out to the judge and if I double the amount, you won’t tell?”  Now she was mad.  I said, “your check for $200 is on the way and you should look up the words, ‘bribe’ and ‘extortion.’”

What’s my point?  Just because that’s the law there, it doesn’t make it right.  There are laws, local and national that just don’t make any sense.  I think that as this country loses its way, more and more of this blatant disregard for justice from those who are meant to serve justice is on the way.  I think that more and more we must think like individuals and not give those in uniform and the district attorneys of the world and the federal prosecutors the automatic moral high ground without question.

“More Cops More Stops” is a recent initiative here in Oklahoma City to crack down on…well…who knows until you get stopped at one of their checkpoints.  Could be that you don’t have your seat belt on.  Could be that you aren’t carrying the proper papers and documents.  Sounds like East Berlin not too long ago, no?  Will they nab a few drunks?  Sure.  Will they nab people with outstanding warrants?  Sure.  Will they have violated the rights of everyone unnecessarily hassled by this initiative?  Sure, but who cares about that anyway?  And if you are stopped and wrongly accused you have no reason to believe that you’ll be treated in any manner other than the utmost fairness, right?  Read this about a former district attorney and his rogue forensic chemist here in Oklahoma City.  Bob Macy died recently and folks around here seem to miss him.  They have forgotten about the people he deliberately sent to death row, knowing their innocence.

Will Grigg has become one of my favorite writers.    Grigg worries and argues that as government at all levels becomes more and more tyrannical (a slippery slope from which there is usually no recovery), the police will be forced to choose between their tyrant bosses and the people they are supposed to protect and serve.  Now let me be clear.  I have met many police officers who are well-adjusted nice guys.  I have seen them as patients and even on traffic stops.  The purpose of this blog is not to impugn the reputation of the police in general.  It is to reassess the relationship between the people and the government that every day is less and less representative of us as individuals.  The police at all levels over time will increasingly be in a difficult situation and be presented with the dilemma posed above.

The old boy scout attitude “just obey the law and you don’t have anything to worry about” will be increasingly ineffective for even the law-abiding citizen of the future.  ”Just pay the fine for not buying their health insurance and then you don’t have anything to worry about.”  ”The law says that if you’re over 70 years old you aren’t eligible for brain surgery.” “It’s the law, you know.”

The purpose of the law, as Bastiat wrote, is to protect property, as the concept of property predates the concept of law.  The purpose of the criminal justice system was until recent times about restitution, not about headline grabbing DA’s.  As time goes by I think we will need to examine the freedom tools we have at our disposal and must guard against automatically granting the moral high ground to people that are put in positions of trust and power.

G. Keith Smith, M.D.

Another great article.  This comes out of an organization funded by our tax dollars whose agenda and mission have been celebrated by none other than our own Hillary Clinton.  Basically the article says that health care costs too much in the United States and that unless you need really specialized care (at which we are apparently very good if not the best) you are better off living in a different country.

The authors, like many others, are confusing costs with charges.  No one knows what health care costs in the United States.  No one knows what it costs anywhere–what it should cost, anyway.  We know what a gallon of milk should cost when we go to the store.  If we’re not sure, all we have to do is go down the street to the competitor’s store and see what it costs there.  Comparison shopping for health care costs is simply not available here or anywhere.  The only way to keep the “cost” down according to bureaucrats like the authors writing this article is to have some very smart people on committees deciding who gets care and who doesn’t.  Rationing and price controls.  That is all that bankrupt governments know when it comes to stuff like this.  Go to one of the countries that the authors are holding up as examples of “how to do it right” and find your place in line.   Get your care in the U.S. and prepare to be fleeced by the hospital administrator.  Another Morton’s fork!

How about letting the market work?  How about a model like that which governs plastic surgery and Lasik surgery?  Low costs, high quality.  Think that is where the authors of the article end up at the end of the article for their recommendation?  Think again.  “Pearson (one of the authors) said one reason prices are higher in the United States is that the healthcare system lacks what other countries have:   an effective government mechanism that acts to keep prices down.”  Ouch.  Price controls.  Shortages.  Less spent on health care.  The majic formula revealed.

Let me see…get control of the health care system and reduce the price paid to a physician for the performance of a total hip replacement so low he doesn’t want to do them.  Less total hip surgeries are done.  Less money is spent on total hip surgeries.  Money is saved.  Government works, doesn’t it?  Well, unless you need a total hip surgery!

Don’t think they’ll try that here in the U.S. once the new health care law has bankrupted us, do you?  Think again.

G. Keith Smith, M.D.

This article will take you some time to read.  It is worth it.  It is the real story of Thanksgiving, never mentioned in any school I ever attended.  Basically, the first Thanksgiving was a celebration of plenty, a celebration of a bountiful harvest by the Pilgrims and the resulting feast.  This was in 1623, 3 years after they landed at Plymouth Rock.  About half of the original group was dead.  What of the harvests in the first two years and why such a bountiful harvest in 1623?

Governor Bradford, their leader, had instituted “all for one, one for all,” basically, when they landed in 1620.  This “communistic” approach nearly killed all of them.  They basically starved to death.  It is fascinating, I think, to read his account of the effects of this policy.  Having seen that this was not going to work, Bradford did a 180 and instituted “every man for himself.”  The results of this change are exactly what you would expect.  Women and children went in to the field to work.  Loafers became workers.  The surplus was such that food trades were made with Indians and others for furs and other supplies!

This story and Governor Bradford’s diary and his writings were apparently well-known to the founders and had a keen and profound effect on Jefferson and his Declaration.  Let us all give thanks for the opportunity we have had to live free lives and stay alert to any and all attempts to herd  us away from our natural right to freedom.

G. Keith Smith, M.D.

Imagine that you are sitting on a jury.  The fellow in shackles has been accused of refusal to pay the fine associated with the new health care law.  He had health insurance that suited him, but it didn’t suit the suits in D.C.  He was required to buy a new and more expensive type of insurance.  He refused.  He was told, “fine…you have to pay a fine then.”  Once again, he refused.  A warrant was issued for his arrest and here he is in front of the judge and you, as part of the jury.

You hear the facts of the case and the judge looks at you and tells you that if indeed you find that the defendent did not pay the fine, you must issue a verdict of guilty.  You leave the room along with the other jurors.  Having kept up with this blog you are familiar with Lysander Spooner’s writings on jury nullification.  This, as I have recently written, is the notion that the job of the jury is not only to deliberate on the facts of a case, but also the merits of the law itself.  If the law is thought to be unjust, then a verdict of not guilty is appropriate, no matter the facts of the case.  You convince your fellow jurors of your case of the unjustness of this law and when asked by the judge if you have reached a verdict, you simply report, “not guilty.”

Now the law has fewer teeth.  If this catches on the law (and other stupid laws) have no teeth at all.  None of this trash coming to the states and cities from D.C. has any legitimacy at all if we don’t enforce it on ourselves.  Pretty soon, the local police would stop arresting people for not paying the fine because they know it’s pointless, no jury having given out a “guilty” verdict for this “crime” in recent memory.

The current debate in many states, Oklahoma included, centers on whether the states should set up the “insurance exchanges” mandated by Obamacare or refuse only to have some federal creep inflict his version on us later.  Keep Spooner in mind when you hear a local politician say that we are better off inflicting this garbage on ourselves than having some federal goon cram it down our throats.  I am troubled by this preemptive surrender.  Seems like cowardice to me.

G. Keith Smith, M.D.

Check out this article.  After you read it, imagine that you are in a room with the author, Mr. Zelman.  Deep down you know his advocacy for making people buy health insurance (more on what this really means later) against their will is wrong.  How would you counter the points he makes, points he considers rhetorical?  I’ll deal with the article point by point because the points he makes are important, he just happens to be wrong (thought I’d go ahead and give you the punchline, trusting that you’ll stay with me on this one). This op-ed piece from the LA Times is written in the style that so many statists use, that seems water-tight, or impenetrable.  This is achieved by leaving out certain details, the inclusion of which reveal the holes in their argument.  This is also achieved by asking what are meant to be rhetorical questions, usually weighted with subtly biased terms.  Finally, conclusions drawn from faulty logic, a technique that has become unconscious in folks like Mr. Zelman, is rather commonplace and begs the reader, I think, to challenge the premise, not the conclusions that come later.  Ok.  Let’s take him on.

At the beginning he says, “Would conservatives (he is obviously not one of these) rather have government impose a financial requirement on people who choose not to buy healthcare, or have those who behave responsibly bear the financial burden of a few?”  This is the crux of the entire article and employs what is called a choice characterized as a “Morton’s Fork.” He might as well have said, “would you prefer to be robbed by a government thug or be mugged by the hospital administrator when you pay your bill?”  The obvious answer to me is “neither.”  The way this sentence is crafted, however, leaves little comfortable room for dissent, and makes more difficult the idea that another possibility exists.

Later in the article he says that if you are responsible, you are going to buy insurance anyway, so the effect on you is basically “zero.”  Wow.  He has left something out, hasn’t he,  and his ommission is deliberate as he is no fool.   Remember that this guy is the chairman of a large public health department in LA and their county health plan.  Here is his ommission:  the definition of health insurance once this wonderful mandate becomes effective, changes in to what the federal government says it is.  The type of insurance you will be required to buy to “qualify” as a  legitimate purchaser of health insurance and therefore not subject to the penalties applied to non-purchasers, will be different than what you now have.  You must purchase those policy provisions that Uncle Sam says you must purchase with deductible and co-pay restrictions as the feds see fit.  You won’t, for instance, be able to maintain a high deductible plan and mostly pay as you go, reserving your insurance for catastrophic issues.  You will be forced to purchase mental health coverage and obstetrical coverage and other politically correct and protected services, that you might neither want or need.  This is a huge problem for the author at this point in the article and throws the rest of his reasoning out as duplicitous, in my opinion.  He might as well have said, if you are responsible you are going to buy food anyway so the effect on you of a statute requiring you to buy food would be “zero.”  See the error in this logic?  Substituting anything other than “health insurance” into the variable box exposes what Mr. Zelman believes the role of government should be:  a nanny state.  He never once contemplates whether it is the proper role of government to compel the purchase of something.  He does not have the same concept of property rights as most readers of this blog, I would think.

He next lists all those who are “winners” in the scheme to require the purchase of health insurance, including those who can’t afford it and will be added to expanded Medicaid roles.  Where does he think this money will come from?  Does this new revenue not also come from the hapless taxpayer or cost-shifting victim he addresses in his first questions at the beginning of the article?  He is really falling apart now.

Now he comes to his conclusion, his punchline.  ”In fact, the only individuals who may actually be forced to do something they would not do voluntarily are those who can afford insurance but choose not to buy it.” He almost redeems himself here.  But keep in mind his conclusion is based on the faulty premise that property rights are violable.  He has long since moved to the place where morally and ethically he has no trouble denying you your wages to support someone else on Medicaid and denying you the right to prioritize your family budget which might include not buying health insurance this year or that.  He is also not addressing (ever) the false high cost of the care, the burden of which he maintains is passed on to us as taxpayers or health bill payors at the hospital or clinic.  He is pretty good, but has gotten a little cocky and sloppy with his statism at this point in the article.

Now, armed with a stuffed animal and a paper sword, he goes in for the kill:  first he blurs the distinction between charity and theft, the difference between charitable care and care funded by taxpayer robbery….then…..

“In considering the individual mandate, conservatives need to address three questions. First, why is it so troubling that the government is requiring responsible individuals to purchase what they would purchase anyway? Second, is it fair or appropriate to make the responsible pay more in order to protect the rights of the irresponsible? Third, what should be done when the principle of limited government clashes with that of individual responsibility?”

“Or, put another way, is the principle of limited government so compelling that it should cause us to penalize the responsible and reward the irresponsible?”

Seems like there’s no escape from his rhetorical corner,  right?  Wrong.  Why is it so concerning that government is making me buy something that I would buy anyway?  First they are going to make you and I buy something that we would not buy anyway:  their brand of “health insurance.”  Second:  leave me alone you goon.  If I’m going to buy it anyway, why do you need to make me buy it?  Second:  is it fair to make you and I pay more for those who can’t pay?  The answer is “no.”  What ever happened to the whole idea of mutually beneficial exchange?  Why does another man’s disease have to represent a pre-existing liability on my balance sheet or yours?  Why does one man’s motorcycle wreck mean my family can’t go on vacation this year?  If I want to help the unfortunate that is another matter entirely.  If the hospital administrator wants to blister me for a portion of someone else’s bill through “cost shifting” that is not OK and is easily solved with a little thing known as price transparency and market competition.  I just won’t go to those places that cost-shift…how about that?  Third, and finally,   the simple answer to this goon is:  ”Health care is not a right!”  This is the premise upon which his entire article rests and which must be challenged.  As a follower of this blog you know that you have no right to anything, the exercise of which, results in the violation of another’s rights.  A right to health care by one, for instance, violates the property rights of another.

Finally, another assumption made in this piece that while hard to see is just barely under the surface:  health care is a national problem.  Mr. Zelman, and those like him, are not idiots and the concept of the doctrine of subsidiarity is not unknown to them.  Simply put, the government that governs the best, governs closest to home.  Why are the various health care challenges in Lousiana the problem of folks in Montana?  Why not let each state/city deal with these issues without the federal goon squad’s involvement.  Lord knows that the politicians in D.C. don’t have the guts to deal with entitlement programs like Medicare and Medicaid that are bankrupting us.  I would imagine that health care issues and needs in Montana are quite different from those in Louisiana, requiring different solutions, anyway.  The state of Lousiana has a Charity hospital system, the funding for which is partially derived from a tax paid by tourists visiting and staying in New Orleans hotels.  If you don’t like that, don’t go there.  Maybe Montana would put a 1% tax on saddle sales…something like that.  There is no end to the possible ways to deal with issues like this in various places and at different times.  Mr. Zelman, like most radical socialists, seems to have figured it out for all of us no matter where we live.

Sparring with socialist folks like this can get tiring, as their ability to polish and spin can make the flaws in their arguments hard to see.  This, unfortunately, is the kind of trash that policy makers and legislators are exposed to every day and pseudo-intellectuals like Mr. Zelman shoulder much of the blame for the mess we are in.  I believe that his agenda is clear and however clever he may think his little op-ed piece is, it is more of the same banal, statist balderdash….in my opinion.

G. Keith Smith, M.D.

Having written a scathing blog yesterday on the inablity of the “Constitution” to reign in an out of control federal government, I thought I should reveal my sources and simultaneously give you a Christmas idea.  Have a friend who thinks they know everything about U.S. history?  Have a friend who thinks he is a conservative “radical?”  Get them this book by Lysander Spooner.  Your friend will be rethinking lots of things after reading just part of this stuff!  There are so many gems inside this book whose author was a  19th century northern abolitionist, secessionist. His writings on the Constitution are radical even for the anti-federalists that preceded him.  He says for instance that he doesn’t have to obey the Constitution because…ready?…he didn’t sign it.  He goes on to say that he defies anyone to show him a contract to which he can be legally bound by a third party’s signature, long since dead.  He says that the Constitution simply doesn’t apply to him.  It only applies to the government. 

He recognized the legal right to secession while adamantly opposing slavery.  His brilliant writings in opposition to the fugitive slave laws (where escaped slaves had to be returned to the south..interestingly supported by Lincoln) are rivetting reading.   His brilliant essay “On Vices and Crimes” represents the start of libertarianism in the social arena according to many scholars.  His equally brilliant essay on jury nullification is must reading for anyone that might ever serve on a jury (almost everyone!).  Jury nullification is the simple concept that juries sit to evaluate not only the facts in a case, but the law itself.  If the law which a man is accused of breaking is determined to be unjust, then even if the facts show that the law was broken the jury is obligated to find him not guilty by reason of an unjust law, no matter the instructions of the judge.  This is how many tyrannical laws were overturned during colonial days.  The prosecutor would prove that a man had violated The Stamp Act, for instance, and the jury would agree that he had indeed violated the act but would render a not guilty verdict because they thought the law to be unjust!  This “jury nullification” concept was well known to the founders and was thought to represent the last and ultimate check on federal power.  If the feds rained unjust laws down on the people, juries could simply nullify them using this approach.  That is why judges now give strict instructions to juries that “if you find that the defendant did indeed commit this or that act then you must render a  verdict of guilty.”  The founders would cry foul, as judges were never to be given this type of power and juries were never to be denied theirs. 

Introduce yourself and a friend to Spooner this Christmas.  You won’t be sorry.  Here is the website devoted to this man  and his writings.

G. Keith Smith, M.D.

Here’s a prediction:  the U.S. Supreme Court will uphold the constitutionality of the individual mandate requirement of Obamacare.  It is time to let your inner cynic out of the closet if what I have just written makes you feel defensive for that hallowed, “independent” branch of government.  Let me ask you this:  in what areas has the “Constitution” been used or cited to restrain the federal government in your lifetime?  Why do you think it will be any different this time?  I am reminded once again of Joe Sobran’s hilarious comment years ago, “..if the Iraquis need a constitution, let them have ours.  We’re not using it.”

You say,”It’s not constitutional to make me buy health insurance!”  ”They can’t make me buy something I don’t want!”  Really?  Don’t make me laugh.  Can you honestly say you support even 25% of what the federal government makes you buy?  Remember that the government has no money that they didn’t originally take from you by force.  Everything they buy, you are buying.  Do I need to make a list?

The court will rule that …ahem…”pertaining to the matter of everyone in the United States who has a rational ability to think for themselves versus the Affordable Care Act, the court finds the constitutional power inherent in a document which we never consult, rely on or seriously study (and under the Commerce clause of which anything and everything we do can be justified), requiring a citizen of the United States to purchase a federally qualified health insurance benefit package, is not materially different from that same federal power requiring that same citizen to contribute a portion of his/her earnings toward other federal programs from which they derive no direct benefit, and indeed, from which might even suffer,  such as abortions on demand,  criminal bailouts of favored cronies, undeclared wars for corporate benefit, gropings at the airport, concerts and theatre or frog habitats.”  Seriously, the real reason they will rule in favor of its constitutionality is that the fix is already in.  This is a political debate, not a debate about constitutionality, for all of the talk otherwise, and both parties benefit from a thumbs up ruling on the law. 

What?  The Democrat president would be destroyed if this law is annulled  and the court knows this and is not going to do this, for a number of reasons, primarily the backlash that would undoubtedly result from the executive branch toward the department of justice, in general.  There is no limit to what tyrants current and past will do (and have done) to maintain their power. Remember that this president is the first to openly assassinate a citizen without a trial.  The court doesn’t want to piss this guy off.  Ok.  Enough about the obvious.

This guy in the executive office and his national health care plan are the best things that have ever happened to the Republican party.  I doubt that there could be better fundraisers for them.  Make this law go away and the people relax and the political contributions dwindle.  What I think the Republicans would like is for the court to uphold the law, throwing it back to the Congress to deal with and they will repeal the law….piecemeal.  They won’t repeal the entire law as some remaining vestige of the law will serve as a useful threat for a possible resurgence once a partial repeal has taken place.  This kernel of left over  evil will serve to keep the money flowing.  I envision a repeal of some part, not the individual mandate, of course, as that is the real money maker.  More money would be needed to make that go away at a later date.

Too cynical for you?  I hope I’m wrong.  But think about this. How many legislators do you know who will put principle ahead of their political careers?  I know there are a few, but not enough to matter.  If trashing the nation’s health care makes them richer in D.C., which court decision would they support?  What do you think they’ll do?  Does what they always do provide a clue?  

I have said from the beginning of this debate that the individual states will have a shot at deciding whether this nightmare becomes a reality and whether we live in individual states in this country or just colonies as before.  We may be witness to that soon.

G. Keith Smith, M.D.

A few million here and a few million there…pretty soon you are talking about real money.  The Sister’s of Mercy have gone on a spending spree.  I guess the billions they have bilked from the sick were burning a hole in their habit.  In addition to the billions they have announced they plan to spend, a 19 million dollar 50 bed rehab hospital doesn’t seem like much.  That’s right.  They’re building a rehab hospital almost across the street from Mercy hospital in Oklahoma City.  I keep reminding myself that they have to charge everyone more because of all of the indigent care they render in their emergency room.  This seems to have worked out pretty well for them in their quest to get rich not making a profit.

Try to keep all of this new construction in mind when you review your next bill from this outfit. They employee what I call the “reverse Enron” accounting method:  exaggerate your losses to maintain the fiction of not making a profit.  I will think of this little 19 million dollar rehab hospital as an ornamental jewel on a fine, massively expensive dress….an afterthought to this giant corporation.

Oh well.  Transparent and honest pricing like the approach at our surgery center is a nightmare for this scam and is sorely needed.  The not for profit hospital business model is inherently unstable and will fall under its own weight with just a tiny bit of market competition.  

G. Keith Smith, M.D.

My son had surgery last week.  It was a reminder to me how all parents must feel during this very stressful time.  My partners and I anesthetize many children at our facility and a reminder of what it is like to be on the patient’s and parent’s side is a good thing.

 I picked his surgeon by thinking through the surgeons I had seen do this surgery and make it look easy.  Picking a surgeon at our facility is very tough because there are so many great ones to choose from.  Often times when I am asked by a friend to refer them to a surgeon I base my response on personality issues and who I think they will like the best, as the skill set amongst our partners here is so far above the norm that making a referral on ability wouldn’t rule any one out!

 I narrowed the surgeon choice for my son down to four orthopedists.  I had seen these four guys do this particular operation and make it look easy.  My boy had his operation, it went well, and he is fine.  I have an insight as a facility owner and director and as a physician that few others have about the quality of my son’s experience here.  Suffice it to say that as a connoisseur of surgery center operations there is not one thing (nothing) that I would have had done differently.  It was simply a perfect experience.  My most sincere gratitude to those who helped my boy.

 As I write this I can’t help but wonder how the administrator at a big hospital would choose his surgeon.  What if he was one of those guys who had been aggressive with physicians and hostile towards them?  What if he had hired surgeons?   In my experience surgeons that are employees of big hospitals are typically the victims of hostile takeovers of their practices or surgeons who don’t compete very well in private practice.  The first guy would be angry with the administrator and the second guy probably isn’t very good.  So what would the administrator do…how would he choose?  How would he choose a facility?  Would he “take one for the team” and have his surgery at his own facility by one of his employed doctors and bet the farm that there is no difference between doctors “A” and “B?”  Or would he go to a competitor’s facility and use a reputable surgeon, knowing that was the best thing for him, but not for his business plan?

 And what would he do if something went wrong?  What if at his own facility, his employee surgeon made a mistake, the severity of which was such that the entire medical community knew what had happened within hours?  Would he begin to think that physicians and facilities disciplined by the marketplace provide better care than those protected by his cartel-like arrangements? 

 Oh well.  If this were to happen, I would wish him a speedy recovery and hope that he might entertain the possibility that as a victim of the non-free market medical world he has helped to create and maintain, there is a better way.

 G. Keith Smith, M.D.