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Health Reform by Cloward and Piven
Tuesday, May 25, 2010 at 2:19AM
By: Richard Amerling, MD

May 24, 2010

Richard A. Cloward and Frances Fox Piven were Columbia University sociologists who founded, in 1966, the National Welfare Reform Organization, a “parent organization” of the Association of Community Organizations for Reform Now (ACORN). They advocated what became known as the “Cloward-Piven strategy,” which “seeks to hasten the fall of capitalism by overloading the government bureaucracy with a flood of impossible demands, thus pushing society into crisis and economic collapse.” This is an instructive prism through which to view the recent health care legislation.

The legislation pushes millions into Medicaid, whose costs are already crushing state and local taxpayers into powder. Flooding it with new beneficiaries will hasten its bankruptcy. Likewise, Medicare is to be cut by $500 billion at a time when the baby boomers will be enrolling. The program is already running at a deficit, and will simply be unable to provide seniors the same level of service they currently enjoy. In other words, both systems will implode.

At the same time, incentives for employers to provide health care will be lessened, and many will drop coverage, sending millions to the government cooperatives for coverage. These policies will be heavily subsidized by the taxpayer, and will dramatically swell an already very bloated public sector. We are already mired in debt, and still bailing out Fannie and Fred with tens of billions of dollars each quarter, and with no end in sight. The health bill may be the coup de grace for our struggling economy.

Doctors are not blind, nor are they asleep. Many understand that “unsustainable” means collapse is inevitable unless Washington does an about-face. How is the medical profession responding?

Two articles published this week provide a glimpse into the future. Scott Gottlieb writes in the Wall St. Journal, “In 2005, doctors owned more than two-thirds of all medical practices. By next year, more than 60% of physicians will be salaried employees. About a third of those will be working for hospitals.” On the other side, the Houston Chronicle reports that Texas physicians are not only declining to take new Medicare patients, but that “new data shows 100 to 200 a year are now ending all involvement with the program. Before 2007, the number of doctors opting out averaged less than a handful a year.” The article quotes Dr. Susan Bailey, president of the Texas Medical Association: “This new data shows the Medicare system is beginning to implode. If Congress doesn't fix Medicare soon, there'll be more and more doctors dropping out and Congress' promise to provide medical care to seniors will be broken.” In other words, the “Cloward-Piven strategy” is being implemented.

How to reconcile these reports? We are moving towards a dual system in medicine. There will be hospital-based physicians who will be mostly salaried, full-time or part-time employees. Their primary loyalty will be to their employer. They will follow protocols and guidelines, and work shifts. They will be assigned patients, rather than develop their own practices. They will eventually come under the heavy hand of the SEIU. As hospital revenues suffer under ObamaCare, they will find themselves increasingly burdened. Quality of care will deteriorate.

Outside the hospital setting will be a thriving, private, medical marketplace, anchored by a growing number of private physicians who are opting out of Medicare and other third party arrangements. These doctors will develop busy practices, and will be able to stay in business by setting their own rates, cutting overhead, and controlling their volume. They will be able to spend enough time with patients to ensure a high quality experience, and will work to keep patients healthy and out of the hospital. Unmoored from price controls, the cost of good care will plummet. Doctors, labs, and imaging facilities will compete on quality and price. There is no reason why an MRI shouldn’t cost $100 in a competitive marketplace.

Patients must understand the reality of what is about to happen. As of this writing, Health Savings Accounts are still available. Get them while you can! Creating and funding an HSA is the best way to insure against the coming implosion of government-run health care. Even seniors on Medicare should set up these accounts. They should also consider opting out of Part B, which pays for doctors’ services, since they will have difficulty finding private physicians who will accept Medicare. They will still have Part A in case they need hospitalization.

Like the doomed Korean ship the Cheonan, our health care system has been torpedoed. It hasn’t sunk yet, but it will. Man the lifeboats!


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Richard Amerling, MD, is a nephrologist practicing in New York City. He is an Associate Professor of at Albert Einstein College of Medicine in New York, and the Director of Outpatient Dialysis at the Beth Israel Medical Center. Dr. Amerling studied medicine at the Catholic University of Louvain in Belgium, graduating cum laude in 1981. He completed a medical residency at the New York Hospital Queens and a nephrology fellowship at the Hospital of the University of Pennsylvania. He has written and lectured extensively on health care issues and is a Director of the Association of American Physicians and Surgeons. Dr. Amerling is the author of the Physicians' Declaration of Independence (http://www.aapsonline.org/medicare/doi.htm).