America the Beautiful: Rediscovering What Made This Nation Great

by Ben Carson, M. D.

  The next question, of course, is, how will the government pay for catastrophic health care? This is open for debate, but I think it would be quite reasonable to allow insurance companies a 15 percent annual profit, 5 percent of which would go to the government’s national catastrophic health-care fund. Since the government would now have the responsibility of paying for catastrophic health care, we as a society would be forced to examine the policies that have led to a situation in which 40 to 50 percent of all health-care dollars are spent during the last six months of a person’s life. We put dying people in intensive care units while testing, poking, and prodding them until they render up their last breath. Unlike most other countries of the world, many of us do not seem to acknowledge that death is not optional. It is perfectly reasonable to send terminal patients to hospice, where compassionate and comfortable care can be rendered until death takes place. Much of the excessive care that currently occurs when a patient is terminal is given by health-care providers who fear lawsuits if they fail to provide that care. Others are simply procedure-oriented, recognizing that they will be paid whether the patient survives or not. Fortunately, these individuals are relatively rare in the medical profession. Again, I can hear some people screaming after reading this that I am advocating for “death panels.” Some people like to put forth terms like this because they stir up emotional responses rather than encouraging people to engage in rational dialogue aimed at resolving issues. Obviously, as our population ages and as our medical technology becomes more sophisticated and expensive, the potential for bankrupting our society with medical costs skyrockets.

  We are facing a time when we have to be pragmatic, while at the same time exercising compassion. One day, we will be able to keep the average person alive for 150 or even 200 years due to medical advances, and we will then be faced with the question, should we use our advanced knowledge in a way that will rapidly overpopulate the world? The emotional answer would be, yes, of course, we should use our knowledge to extend every life, and we can worry about the consequences later. A more rational response would include examining the effect on the entire population of such action and perhaps advocating a more measured course of action.

  I remember a case of a prominent individual who had been in an automobile accident and was rendered a C – 1 quadriplegic, which means not only was he paralyzed from the neck down, but he could not breathe without assistance. We could have made the decision to keep him alive at all costs, but through a unique system of communication that we were able to work out with him, he indicated that he wanted to die. After much debate, we yielded to his wishes and withdrew ventilatory support. In the long run, I think our course of action was both compassionate and pragmatic. If we integrate compassion and logic into our decision-making processes, I am convinced that we will deal with newly emerging ethical dilemmas appropriately.

  When I was a member of the President’s Council on Bioethics, discussions on matters such as these were very complex, but they need to be engaged in now to avoid a reactive situation in the future. I believe age should not be the determining factor of the level of care that should be given. Rather we should consider a person’s potential for quality long-term survival. Many people in their eighties and nineties are very productive members of society, and they certainly should not be denied insurance coverage for certain procedures simply because of age alone. Approaching these problems with logic rather than with emotion leading us will yield the right answers, but it will require in-depth discussions by wise people. As the Bible says, “In the multitude of counsellors there is safety” (Proverbs 11:14).

  When a society faces major changes, such as drastically increased life expectancy, its people should examine the effects of such a change and make logical, appropriate adjustments. We should thoroughly examine the effects of our aging society on our way of life and devise compassionate methods of easing the burden of aging both on the individual and the family.

  PRODUCING AND PROTECTING OUR

  HEALTH-CARE DOLLARS

  “The only thing that prevents us from having the most fabulous health-care packages imaginable for every citizen of the United States is lack of money,” some may say. How can we get more money to invest in health care? Perhaps, as some have suggested, we can simply tax the rich since they have plenty and should be willing to share with everyone. Another idea — which now perhaps seems radical, but once was a pillar of the American way — is to grow the economy, providing a lift for every segment of society.

  Consider the following story to illustrate: There once were two brothers, each of whom got married, had children, and moved to separate deserted islands. Their diet consisted solely of trees, and they could eat every part of the tree, including the roots, bark, branches, and leaves. The family of one of the brothers always monitored the new growth of trees and anxiously devoured every tender sapling, which of course never allowed them to grow into mature trees. Eventually, that family ate every sapling on the island and died of starvation. The other family was very disciplined and — while they ate some of the trees — allowed most of the saplings to grow into mature trees, providing them with unlimited food forever.

  This is a simple story, but it is easy to see how it applies to a government that continues to tax the rich until there are no more rich, and then begins to tax everyone else without ever curbing its growth or its appetite for money. Eventually it destroys itself. A much wiser government in need of money would examine the methods used by the rich to obtain their wealth and would try to create an economic environment that would cultivate even more rich people, all of whom would pay their fair share of taxes, vastly increasing the government’s coffers. In other words, the more productive people you have in your society, the bigger your tax base, and if those people are paying their proportionate share based on income, it will be a big win for the government. All we have to do is study our nation’s own history of entrepreneurial innovation2 to understand what needs to be done to rev up our economy once again.

  Generating more money to go toward our nation’s health care also requires protecting the money we have — and we lose tens of billions of dollars to Medicare and Medicaid fraud every year. This is something we have not been able to control, either because we don’t care very much and view other issues as much more important, or because we are incompetent. Both of these problems we can fix, which gives me hope that we will not forever be robbed. If we are ever going to have adequate funding for health care and other major line items in our budget, however, we have to put an end to waste and fraud throughout the government, and we must create a friendly climate for economic growth.

  These are such basic, commonsense ideas, I have a hard time understanding why so many of our government officials totally lack insight on this. I have heard important people in Washington say that fraud, waste, and abuse are an integral part of our system of government and that there is really nothing to be done about it. I hope and pray that we have not fallen to accepting the very things our founding fathers so desperately wanted to avoid. We cannot capitulate to moral decay, and our history dictates that we should not give up this fight.

  It is extremely difficult to estimate how much money is wasted in the health-care arena because doctors engage in defensive medicine to avoid lawsuits. During the health-care debate prior to the passage of the bill in 2010, many opponents of tort reform said that adding that to the health-care bill would only save us in the neighborhood of $5 billion a year. That $5 billion is nothing to sneeze at, but I think the savings would be much greater than that. Many more tests and procedures are ordered than are needed to bolster the defense in case of a lawsuit. My wife and I were at a public forum in Virginia during the fall before the health-care law was voted on and one of the speakers was Dr. Howard Dean, whose campaign for president some years ago famously ended with a wild scream. I do not agree with many of his political views, but he is an honest individual as far as politicians go. Someone asked him the question, “Why is tort ref
orm not included in the health-care bill?”

  “It’s really quite simple,” he replied. “The Trial Lawyers Association gives us [the Democratic Party] a great deal of money, and they don’t want it in there.”

  Many people in the audience were shocked at his candor. He only said what many of us knew was true, but very few in the Democratic Party were willing to admit it. As a neurosurgeon, which is one of the two most-sued specialties, I have witnessed many lawsuits against doctors that destroyed careers, confidence, and families when the doctor had done nothing wrong. Unfortunately, in many such cases a patient suffered an unfortunate outcome, even though everyone was trying extremely hard to solve the problem. In our country there is no way to recoup lost income, lost potential, or other losses, including emotional distress, other than filing a lawsuit against the health-care provider or the hospital.

  Most other countries have figured out a way to take care of injured individuals by providing some form of redress, but our great nation simply has no clue how to solve this problem. Obviously that’s not true, and like almost everything else in our nation that doesn’t make any sense politically, a special interest group is heavily involved behind the scenes. In this case, it’s the Trial Lawyers Association. As long as we continue to empower and submit to the influence of special interest groups, nothing we do will ever make sense or benefit the general populace.

  By dealing with the problems I’ve discussed in this chapter, we could reduce the cost of our health-care insurance to the point that most individuals and families could afford to own their own policies. This would provide portability between health-care providers (limiting exclusions for preexisting conditions) and the potential to further reduce health-care premiums for those with healthy lifestyles. For instance, if people owned their own policy, a premium reduction could be offered for anyone having an annual physical examination. We would detect many medical problems during the early stages of development, when treatment is much easier and less expensive. Also, if the patient owns his or her own health-care policy, the doctor would not likely order excessive testing without being questioned about it, since doing so could impact the patient’s premiums. A fiduciary relationship would develop between the doctor and patient since there is no detached third party receiving the bills — and that, of course, would result in tremendous savings. In other words, your doctor’s responsibility would shift from what is required by the insurance company to what is medically and financially good for you, the patient. Also, if people owned their own health-care policies, they would not have to relinquish them when they turned sixty-five, which might alleviate some of the pressure on Medicare. These are only a few of many ideas to solve our health-care crisis.

  As we continue to try to improve health-care access and quality for everyone, we might do well to ask ourselves the question, if the Golden Gate Bridge fell down, who would we get to rebuild it — structural engineers or people who like to talk about building bridges? In like fashion, we would be wise to put health-care reform in the hands of the people who know the most about health care — those providing the care and those receiving it.

  — CHAPTER 11 —

  A NATION DIVIDED

  GROWING UP IN BOSTON AND DETROIT, I had political views that largely reflected those of the adults around me. Family, friends, and neighbors generally felt that they had been oppressed and that the responsibility for redressing these injustices rested with the government or with others. By the time I reached high school, the civil rights movement was in full swing, and the Democratic Party was positioning itself as the champion of civil rights. Like most young black people, I accepted the label of Democrat and endeavored to be a part of that struggle. After President Kennedy was assassinated and Lyndon B. Johnson took over, a host of social programs were unleashed, aimed at helping oppressed minorities and people like us living in poverty. I was particularly thrilled with Johnson’s “War on Poverty,” which I thought would significantly improve our family’s lifestyle. Even though my mother worked very hard cleaning other people’s houses, we still benefitted from government commodities such as cheese and flour. We also received food stamps and bus tokens. Even though she was not a welfare mom, my mother still very much appreciated the government assistance we did receive from time to time. Still, I had an inherent dislike for government assistance and was frankly quite embarrassed that we had to accept anything from them.

  By the time I entered college at Yale University, I was running away from poverty and didn’t want to discuss that part of my life with anyone. But neither did I identify with the wealth on constant display at Yale. At that time in my life, I was proud to see groups such as the Black Panthers standing up to brutal police tactics, and though I never joined any radical student organizations, I kept abreast of the activities of the Students for a Democratic Society (SDS), the Weathermen, and other groups willing to use aggressive tactics to accomplish “social justice.” When George McGovern became the Democratic nominee to run for president of the United States, I voted for him enthusiastically along with multitudes of young people, all of us looking forward to a utopian world of peace and love. We envisioned it as a world without war, racism, or poverty. Plenty of hippies and flower children around me smoked pot, used illicit drugs, and engaged in free love as part of that utopian dream.

  Because of my love of God and my religious upbringing, I didn’t become involved in sex or drugs, but I still identified strongly with the antiwar protesters and the revolutionaries. I was quite unhappy when George McGovern was soundly defeated by Richard Nixon in 1972 and it looked as if life would go on as usual. I was a senior in college at the time and starting to think more about medical school than social justice.

  When I entered medical school the following fall, I immersed myself deeply in my studies and paid little attention to the political scene. The first year of medical school required a significant lifestyle adjustment in order to master so much material. There was not a lot of compassion for students who fell behind, and I saw many of my friends’ hopes and dreams shattered by the merciless monster of academia.

  As I struggled early on, my academic advisor strongly suggested that I forget about medical school and pursue another area of study. Fortunately I ignored his advice and redoubled my efforts to succeed. It meant getting up at 6 a.m. and studying constantly until 11 p.m. six days a week, only taking off the Sabbath in order to recharge my batteries. That intensive effort not only salvaged my academic career, but allowed me to flourish and begin to earn top grades and respect from teachers and students alike. Although I was still a Jimmy Carter Democrat, I was starting to sympathize with people who advocated for personal responsibility and self-reliance, since those were the traits largely responsible for my success in medical school.

  By the time I began training as a neurosurgical resident at Johns Hopkins, I began paying attention to politics again and was particularly intrigued by the optimistic speeches of Jimmy Carter versus the no-nonsense, very practical — although sometimes harsh — speeches of Ronald Reagan. Although Reagan’s logical approach to many of our social and international problems appealed to me, he was a Republican. Because of my bias in favor of the Democratic Party, I figured Reagan must, by definition, be greedy, selfish, and callous toward the poor.

  As I got to know more Republicans and conservatives, however, I came to realize that many of my political beliefs were based on nothing other than propaganda, and that there were just as many decent Republicans as there were decent Democrats. I found that it was the Republicans who were responsible for the abolition of slavery and for the passage of the Civil Rights Act. I also began to realize that it was not political biases that were largely responsible for the plight of African-Americans in our nation, but rather racist attitudes. After the many gains realized through the civil rights movement, racist people from both parties adopted a paternalistic attitude toward African-Americans and enacted federal and state programs designed to take care of people who couldn’t tak
e care of themselves — people who were ignorant, stupid, or just plain lazy. In the process of being “do-gooders,” both Republicans and Democrats removed much of the drive and determination from innumerable African-Americans, who found it easier to accept government charity than continue on a path of hard work and self-reliance. Once people learn that their irresponsible behavior, such as having babies that they cannot care for, results in larger paychecks from the government, those lifestyle choices have negative implications for the entire nation for generations to come. Any attempt to withdraw government charity is seen as a heartless attack upon the most vulnerable members of our society. Most of the national media had aligned themselves with those involved in the civil rights struggle, which was the right thing to do. Unfortunately, most of the media also failed to recognize the long-term harm caused by those with good intentions who were robbing poor families of the incentive to obtain the American dream through their own efforts.

  This kind of smothering political “compassion” that skewed the mindset of large segments of our nation’s populace after the gains of the civil rights movement reminds me of the problems facing Yellowstone National Park in the 1950s. Many tourists, full of good intentions, were eager to feed the bears, who were very cute in their antics to encourage visitors to hand over food. The bears quickly lost their fear of people, and instead of hunting for their traditional prey, they began invading camps and breaking into cars and campers looking for food. The forest rangers quickly realized they had a major problem on their hands, one that endangered the tourists’ lives. The park enacted rules forbidding feeding of the bears, which exacerbated the situation acutely for a while. But through brilliant management, the bear population relearned how to fend for themselves and began to stay away from the people.