Dr. Kirkwood’s new book, Socialized Health Care Reform, describes how and why the American healthcare system is much more “socialized” than the general public understands or the government and healthcare corporate sector wish to admit. He believes the nexus between major healthcare businesses, including insurance and hospitals, and political power creates conflicted functioning within individual doctorpatient relationships, which furthers the agenda of controlling healthcare spending at the expense clinical decision making, while leaving their own profit and political goals unscathed.

This eye-opening account of how the American healthcare system operates yields a new definition for socialized medicine, which describes its effective meaning, as opposed to the standard, economic policy definition, which becomes burdened with concepts such as public versus private payers, socialized medicine versus social insurance, government-run etc., etc. The reality of socialized medicine is manipulated, controlled doctorpatient relationships such that clinical decision making becomes conflicted by dollar management, and this is then used to satisfy a higher power’s agenda, generally greed, campaign finance for political re-election, or political ideology. In the USA, the business of medicine is privatized and the medicine of medicine is socialized.

Dr. Kirkwood notes that true healthcare reform cannot occur until the doctorpatient relationship becomes free of external control from any payer and returns to its primary position as the essence of medicine, to be supported and served by the entire system.

R. Garth Kirkwood, MD

Core Principle for the American Healthcare System: That It Meet the Needs of Everyone and the Primacy of the Doctor Patient Relationship

In my last post (, I listed three core principles upon which we can structure American healthcare reform: 1) That the system meet the needs of everyone; 2) That it be free at the point of delivery; and 3) That it be based on clinical need, not on ability to pay.

Does the American healthcare system meet the needs of everyone? The answer, of course, is a resounding NO! Why? Because the powers that be, major healthcare business corporations (health insurance companies, large hospital chains, pharmaceutical companies, and others) and our politicians (federal and state), have not figured out a way to make it happen. Why? Because they don’t want to figure out a way to make it happen. Why? Because that would disrupt their mutually beneficial nexus of intertwined tendrils of greed, aspirations for ongoing re-election, and ridiculous political ideologies of both liberals and conservatives. Until this nexus is torn asunder, the American healthcare system will simply never accomplish the goal of meeting the needs of everyone.

Certainly, there are good ways, which I have outlined in my new book, Socialized Health Care Reform (available soon), to genuinely accomplish this first core principle of meeting the needs of everyone. However, two fundamental questions arise: 1) Define needs; and 2) Is this goal correct for America?

Let’s examine the 2nd question first. Do the people in America want their healthcare system to meet the needs of everyone? I don’t know the answer to this question. I know my answer but I cannot speak for anyone else. And I DO NOT TRUST POLITICIANS TO SPEAK FOR US. I think I can state the answer many people would give to this question, i.e., “Yes, our system should meet the needs of everyone.” But do they really mean this in their heart. Does a rich man/woman, who has absolutely zero financial difficulty in purchasing first class health insurance for the entire family, really feel that the poor man/woman, who has difficulty feeding, clothing, and educating their children and who can’t even entertain the idea of a health insurance policy, deserve to see the same doctors; to wait in the same office waiting room; to have the same private room hospital facilities, the same after hospital care management, etc., as him/her? What is the true answer to that question?

“Define needs,” What does this mean? The healthcare system itself cannot answer this, nor can politicians or healthcare corporations. The only way to approach getting real factual data for this is through an individual, sound, ongoing, non-conflicted doctorpatient relationship for each person living in America. Do you think politicians and healthcare business people give a damn about the doctorpatient relationship for individual people living in the USA? You may respond, “Well, that’s a medical question; business people and politicians don’t have to and shouldn’t concern themselves with this.” That statement is incorrect a thousand times over. Thinking about how our system can make it happen that non-conflicted, sound, ongoing doctorpatient relationships are open to everyone is precisely the major goal with which politicians and healthcare business people should concern themselves. True healthcare reform will not occur until they accept that all of their other agendas must be subordinate to and exist to serve the primacy of the doctorpatient relationship.

R. Garth Kirkwood, MD

Core Principles for Our American Healthcare System: Building Blocks for Healthcare Reform in the USA

It would be good, before we start listing proposals to overhaul our American healthcare system, to state exactly what we wish to accomplish with any proposed changes. Myself, I do not want a clone of the British healthcare system, the NHS (National Health Service), transcribed on to our American system. Why? Because the government interferes with the practice of medicine there, because the British tolerate significant waiting lists, and because I do not want to be beholden to our government so that I can get up and go to the doctor, when I feel a need to do so. I really don’t like being bribed with my own money, which is exactly what the politicians do to the American people.

In America, those, who can afford it, are dependent upon insurance companies, with their ever-increasing premium and deductible payments coupled with other dollar-garnering mechanisms, for health care coverage. So, before any doctor or hospital visit, comes the question, “Have I met my deductible?” This is another roadblock as palpable as a waiting list. Those, who cannot afford health insurance, become, in one way or another, part of an Entitlement population, which carries another whole load of problems, including easily recognized discrimination, anger and dejection at being disenfranchised, and more ideological cover for increasing insurance premiums and deductibles via the purported cost shift mechanism, ensuing because of inadequacy of public payments for the entitlement populations.

It appears to me that both the British and American systems have a central control mechanism designed to block people from receiving advanced medical evaluation. In Britain, it is the government; here, it is the insurance companies. What is their motive? In Britain, it is the British pound and in America, it is the dollar bill. In America, if you have enough money, none of this affects you. You can override the insurance company roadblocks because you can meet their price.

How can we create an American healthcare sytem, which dispels these realities? I think the core principles that the British started with in 1948 can point us in the right direction:

1. That the system meet the needs of everyone
2. That it be free at the point of delivery
3. That it be based on clinical need, not on ability to pay.

I think these three are wonderful goals. The trouble that I see is that neither the Americans nor the British have figured out how to accomplish them, while making sure that superb, advanced medical care takes place without bankrupting individuals, companies, or the country. In a series of posts on this blog, I intend to discuss each of these core principles and mechanisms for their achievement, which will not only control healthcare expenditure but also keep healthcare businesses and providers economically stable and satisfied.

R. Garth Kirkwood, MD

Socialized Medicine and Healthcare Reform: The Relationship Between Doctor and Patient Must Achieve Autonomy From All Payers

The following three references were used for information for this post:

  1. The New Oxford Dictionary of English, Oxford University Press 1998

Socialized Medicine indicates the provision of medical and hospital care for all by means of public funds.

Socialized Medicine refers to a health system in which the government owns and operates both the financing of health care and its delivery.

What does this mean for the people living in a country, in which these definitions apply? It means the government of that country can strongly influence and control how medicine is practiced there.

Wait a minute! What about the doctors and the patients? The doctors are supposed to be practicing medicine within the context of the doctorpatient relationship. This relationship is between the doctor and the patient; the government has nothing to do with it. When the government employs the doctor, it has everything to do with it. The government can end the independent functioning of the doctorpatient relationship. If you think this potential control and interference is good, then this type of health system is just right for you.

What about in America? We don’t have socialized medicine here, do we? Our nation’s V.A. health system, reserved for our veterans, is the purest form of socialized medicine.

Our Medicare system, although often decried as “socialized medicine” and funded in significant amounts by general tax revenues, is a form of social insurance, coupled on the healthcare delivery side with a mixture of government-owned facilities (e.g., municipal hospitals), private nonprofit hospitals, and private for-profit facilities. Medicare was originally established as a single-payer, government-run, fee-for-service plan; however, starting in the 1970s, Medicare beneficiaries have had the option of enrolling in a variety of health plans offered by private insurers. So, our Medicare system is not, strictly speaking, socialized medicine. Yet, our government still has huge potential for influencing the practice of medicine for Medicare beneficiaries.

Well then, we just can’t have a “Medicare For All” system in America. That would mean government control. We need to stick with private insurance carriers. The private insurance carriers as what, what is their job? They attempt to control the doctorpatient relationship like government payers do. They view doctors as employees, the doctorpatient relationship as a tool to drive their profit, and their own business accomplishments as the definition of health care. What they should be doing is the simple clerical duty of paying claims. However, by complicating this with tedious, cunning business manipulations, they have evolved light years beyond this simple, clerical function into mega financial empires.

It boils down to a simple question: Who is the doctor’s employer? Is it the government; the private insurance carrier; a health plan; some combination of these; or, beyond commonsense understanding in our current milieu, could it be the patient? Wonderful healthcare reform will not ensue until the ethos of the American healthcare system becomes identical with the reality that sound, ongoing, non-conflicted doctorpatient relationships must be the primary goal to be accomplished for everyone living in America; that these relationships are employee—employer relationships; and that all healthcare businesses exist primarily to serve these relationships and not their own profit goals, which, although necessary and important, must be assigned to a secondary rank.

This employee—employer relationship is, to be sure, an unusual one in that the employee, the doctor, retains autonomy. He/She does not do what the employer, the patient, tells him/her to do. The doctor, based on his/her medical training and experience coupled with information from the patient including patient preference, develops a plan of diagnosis and treatment. The patient can accept or reject this plan and works with the doctor to develop a way forward, which is individually suitable for himself/herself, while the doctor guides the relationship to accomplish what is necessary for each circumstance of the patient’s illness.

Health insurance companies make significant efforts to influence this relationship with concepts such as: financial incentives for doctors and patients, managed care, information sharing, medical home, cost effectiveness, evidence-based medicine, and on and on. New ideas continue to evolve to manipulate the doctorpatient relationship, because this is where the money is spent, i.e., where clinical decision making regarding diagnosis and treatment occurs. Thus, if insurance carriers can manipulate the doctorpatient relationship, they can control the money. This control is not altruistic in nature, not for the benefit of individual patients or for our country, but rather for lining their own pockets. Unrelenting increases in premiums and deductibles further this cause.

When the general public understands that insurance carriers’ attempts to influence and control the doctorpatient relationship are the same thing as attempts to control it by government payers in socialized systems beyond our borders (e.g., England, Canada), maybe they will come to the realization that true healthcare reform cannot occur until the doctorpatient relationship itself gains autonomy from all payers. Until then, enjoy the rhetoric and propaganda put forth by politicians, pundits, and the healthcare businesses, which support them.

R. Garth Kirkwood, MD

The Purpose of To Delineate the True Nature of Socialized Medicine and To Clarify the Realities of America’s Healthcare System

This blog offers a platform for me to share my ideas about our healthcare system and its reform. As I read various blogs, journals, and newspapers and watch cable news programs of politicians and pundits discussing healthcare reform, it becomes apparent that people are not discussing the essence of health care. They seem to center discussion around the business of medicine as opposed to talking about the medicine of medicine, which is the doctor patient relationship. This distinction is very important because transparent reform, advantageous for all the people living in America, cannot occur, unless the influence of the business of medicine on the doctorpatient relationship is removed, thereby allowing these relationships to blossom, free of external control imposed by any payer. This external, business and political control is the true nature of Socialized Medicine, no matter which payer is exerting it. And this is how the politicians and the business people who lobby them fool us into thinking that they are working on true healthcare reform. They are not. What they are working on is trying to manipulate us into believing that one form of control, multiple payer, is better than another form of control, single payer. They call the latter socialized medicine and leave the former unlabeled with an implied idea that it is privatized medicine, i.e., American health care. But what they never get around to telling the American people is that their goal is to introduce and maintain ever-increasing control over the functioning of the doctorpatient relationship. If they control this, they can control costs without regard to the individual well being of any of us. And when they control costs, they can line their own pockets. The game is: Privatize the business of medicine and Socialize the medicine of medicine. The business people and the politicians are the only players in the game. You and I are the waterboys, who bring not water but dollars so that the game can continue. Our involvement ends there. The doctorpatient relationship, the essence of medicine, is just a tool, like a football, to be tossed around for each side to get as many points as it can.

Transparent and good healthcare reform cannot occur until the ethos of our politicians and healthcare business people has as its central tenet that independent, free-from-payer-control, sound, ongoing doctorpatient relationships, equally open to everyone, are the ultimate goal and that greed and greed-driven, ideology-driven, re-election-driven political agendas must be removed from our healthcare system and never again introduced.

R. Garth Kirkwood, MD