-Some doctors are crooks;  this guy is some doctor;  this guy is a crook-

A few weeks back, the Wall Street Journal, which has been running a series of articles on Medicare fraud, ran an article detailing the proclivities of a particular back surgeon in Oregon for treating back pain with spinal fusions.  In many cases it turned out that he had done several spinal fusions on the same patient, as many as seven. 

The surgeon’s operating privileges were recently suspended, and he now faces investigation by the Oregon Medical Board, from the most recent Journal article:

Providence Portland Medical Center revoked Vishal James Makker’s surgical privileges last week following a March 29 article in The Wall Street Journal that identified Dr. Makker as having the highest rate of multiple spinal-fusion surgeries among 3,407 surgeons who performed the procedure on 20 or more Medicare patients in 2008 and 2009.

How it is that anyone would so faithfully trust in the biased opinions of a physician to allow them to operate seven times for the same problem six previous surgeries failed to fix is beyond me.  What you say, physicians aren’t biased to do things that make them money?  Thus physicians are demi-gods, or perhaps actually gods?  Because only gods operate (no pun intended) without consideration of the profit motive.  Even if the profit isn’t always measured in dollars, humans beings are like all animals, selfishly concerned with their own priorities.  Every diagnosis a for-profit (i.e., one that is paid a salary) doctor makes necessarily has an eye, if only glancingly in some cases, at the impact it might have on his bottom line.

In this example we see the confluence of a number of societally-debilitating factors.  It’s hard to imagine that the doctor could have gotten away with seven surgeries on one patient if the patient was paying out of his own pocket.  When society allows the cost line of the net benefit calculus to be shifted to an entity other than the one receiving the benefit, then any benefit that might arise, no matter how small, is enough to proceed. 

Society goes further, however.  It not only makes another surgery virtually cost-free (in dollars) to the patient, it refuses  to question the doctor’s judgment, or at least refuses until his outrageous conduct is revealed by some dirt-digging journalists.  The Supreme Court has kept the Medicare payment records of individual doctors mostly out of the public realm, a rule that has recently been loosened (the impetus for the Journal reports), so the public itself can’t do much to monitor a doctor’s judgment.  And Medicare barely tries.  It just pays the doctor bills according to a fee schedule, and as it runs out of money, bothers not in the least to evaluate the efficacy of care, instead just cutting doctor’s fees across the board.  The US healthcare industry is perhaps the greatest fraud ever devised by man, and Medicare is the greatest fraud within it.  There are literally scores of businesses working every day trying to imagine new ways to benefit from the fraud that is Medicare.  From chairs that hover to drugs that cost ninety grand to extend life for four months, everyone it seems wants to plunder its little slice of a society that is aging almost as rapidly as it grows in decadence.

But there’s more.  The specialization of labor that came with industrialization as applied to healthcare means these days that we don’t even bother to understand our own bodies.  We place unwavering trust in the judgment of our physicians and our pharmacologists to know what’s best for our bodies, but there is only one human being on the planet that can have specialized knowledge of any particular body, and that’s the one whose soul inhabits it.   How phenomenally stupid must one be about their own body until they finally quit trying in vain to fix a problem after seven painful surgeries fail?  Never mind that Medicare picked up the tab.  How could anyone hate themselves that much?

Medicare is a fraud.  It is perhaps the pre-eminent fraud in all of American culture and history.  Its fraudulent construct is even more dangerous to our continued survival than are our imperialistic adventures or our mark-to-fantasy financial system.

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