In healthcare, Washington currently plays four different roles: tyrant, physician, thief, and lawbreaker.  What role should Washington play?

"Healthcare" as one word means the system.  As two words, health care refers to a fiduciary, legally protected, voluntary service relationship between one patient and one care provider: physician, nurse, or therapist.

Medical care is the service.  Healthcare is the system.

In the U.S., every adult has (or should have) medical autonomy — the right to choose one's own medical care.  By its regulatory powers, fiscal controls, and coercive tactics, Washington has taken away Americans' medical autonomy, replacing it with federal tyranny.

The vaccination mandate is an obvious example.  Based on recommendations by a non-practicing, bureaucrat M.D., Anthony Fauci, medical tyrant Biden forced Americans to accept injection of an untested, unproven, unsafe mRNA "jab."  Universal vaccination was imposed despite an extensive list of adverse effects as well as limited efficacy of mRNA vaccines.  Washington's tyranny suppressed medical freedom.

By its eligibility standards, pre-determined insurance benefits ("benefit" means care), and authorization process for payment, Washington extends its tyranny into specifics of medical care: who gets care and who doesn't; what care people get, where they get it, and by whom.  These medical decisions are properly made by the patient with advice from a physician, not by a nameless, faceless, unaccountable bureaucrat in a cubicle at CMS (Centers for Medicare and Medicaid Services). 

Washington's tyranny is not only medical, but also fiscal.  Healthcare is a centrally controlled market.  A free market starts with consumers who decide where and how much money they spend. In healthcare, Washington dictates where consumer dollars go — to its bureaucrats or to providers — bringing to mind the Soviet healthcare system.

Washington bureaucrats are unlicensed physicians engaged in malpractice.  

Government officials can now triage critically ill Americans.  Instead of an E.R. doctor on the scene using his best judgment to decide who gets care first, physicians must obey "crisis standards of care" written by government officials.  In Pennsylvania, crisis standards include a weighted lottery that gives preference to historically underserved minorities.  Thus, a moderately ill Hispanic female would receive care before a white male bleeding out after an automobile accident.

Most patients believe that their doctor chooses medications for them.  Not so.  A PBM (pharmacy benefits management) organization decides medications, not their physicians.

Health insurers like UnitedHealth, Anthem, Aetna, and Cigna pay PBMs to determine the drugs in their pharmacies for patients enrolled in these health plans.  Doctors must choose drugs from a list of the least expensive, lowest-risk, and therefore least effective drugs.  Protected by Safe Harbor laws, federal bureaucrats are enabling PBM executives to practice medicine, usurping the patient's chosen physician.

Washington created all the bureaucracy, administration, rules, regulations, compliance, and oversight (BARRCO) for healthcare and medical care.

Washington exerts its control through a barrage of agencies such as CMS, the Centers for Disease Control and Prevention, the Federal Drug Administration, the National Institutes of Health, and the Office of Safety and Health Administration, to name but a few.  One look at their organizational charts proves how massive and incredibly costly federal BARRCO are.

From 1970 to 2010, the number of U.S. physicians increased 150 percent.  Over the same forty years, the number of federal healthcare bureaucrats increased more than 3,200 percent.

In 2021, American taxpayers spent $4.3 trillion on healthcare.  Between 31 percent and 50 percent paid for BARRCO: $1.33T to $2.15T of "healthcare spending" produced no care.  The funds to pay bureaucrat salaries were taken from payments to providers of care, viz., $716 billion taken from Medicare to pay for ACA bureaucracy. 

Every healthcare system exists first to provide care.  Spending that doesn't deliver care to patients is what management experts call non-value-adding activity.  Americans would complain that Washington is wasting trillions of hard-earned tax dollars.  Physicians would exclaim, "Imagine the care we could give Americans with two trillion more dollars!"

Article 1, Section 8 of the U.S. Constitution assigns 18 "powers" or areas of authority to Congress, viz., print and borrow money, regulate commerce, repel invasions, and 15 others.  Healthcare is not listed.  This was not an oversight: dozens of physicians were delegates to the Constitutional Convention.

The Tenth Amendment emphasizes this limitation on Congress.  "The powers not delegated to the United States [federal government] by the Constitution, nor prohibited by it to the states, are reserved to the states respectively, or to the people."

According to the Constitution, Congress should have no "power" over healthcare.

Medicaid law, Section 1801, reads: "Nothing in this title shall be construed to authorize any Federal officer or employee to exercise any supervision or control over the practice of medicine" (Hospital Insurance Program, 291).

There are a host of legal precedents establishing medical autonomy — a patient's right to choose — that prevent both government officials and even physicians from imposing their medical choices on patients.

Biden's requirement to take experimental mRNA vaccines against the will of many Americans is a direct violation of the Nuremberg code: "The voluntary consent of the human subject is absolutely essential." 

Washington is breaking its own laws, international law, and acting against the Constitution.

The roles Washington presently plays in healthcare are not only unethical, illegal, and unconstitutional; they do immeasurable harm to Americans.

There is death by queueing, viz., "47,000 veterans [who] may have died" waiting in line for medical care.  The same fatal outcomes occurred in 752 Illinoisans and a 12-year old Maryland boy with a toothache.  Because of an increasing regulatory burden and constantly declining payments, fewer physicians accept Medicaid or Medicare patients, wait times increase, and patients die waiting for care. 

The "ill-founded" COVID lockdowns devastated more than 200,000 small businesses, caused avoidable deaths especially in nursing homes, and took away educational opportunities from millions of children.  When Washington plays at being tyrant, physician, or thief, people suffer.

The proper role for Washington in healthcare is no role at all.

Get Washington out of both healthcare and medical care.  Put American consumers back in charge.  Support, don't harass, care providers.  Restore medical autonomy.

Deane Waldman, M.D., MBA is professor emeritus of pediatrics, pathology, and decision science; former director of the Center for Healthcare Policy at Texas Public Policy Foundation; and author of the multi-award-winning book Curing the Cancer in U.S. Healthcare: StatesCare and Market-Based Medicine.