Curtis W. Caine, MD
May 1, 1960
Dear Esteemed Colleague:
Although I am willing to take the time away from
my practice and expend the necessary energy, it is obviously
impossible for me to personally visit with each individual
physician i n Mississippi for a serious discussion of
Medicare, Besides, 1900 cups is a whale of a lot of coffee!
Therefore, I have tried to write down what I would
say. I invite you t o consider that we are sitting in your
living room, Please patiently " listen to what" follows.
Let me state at the outset that in all candor I do
not i n any sense or t o any degree consider myself an
ultimate authority on this or any other subject.
What I am about t o say is my conviction based on years of study,
research , observation, and reflection , I wish to make it
perfectly clear that I do not maintain that I cannot be
wrong, for I could very well be.
What follows is my honest
opinion, else I would not say it.
of my conviction and concern, and not intended to imply that
there is no room for honest difference of opinion.
you to point out where I am incorrect so I may incorporate
your correction in my thesis.
Furthermore, I have no least design to inflict my
ideas on you. But I make no bones about the fact that I am
earnestly trying to courteously and convincingly persuade you.
Please pardon the length of this epistle , but the
gravity of the situation demands a more penetrating study than
one page would afford .
If I sound dogmatic, it is just a manifestation
of my conviction and concern, and not intended to imply that
there is no room for honest difference of opinion.
Not wishing to remain in error , however, I invite you
you to point out where I am incorrect so I may incorporate
your correction in my thesis.
Furthermore, I have no least design to inflict my
ideas on you. But I make no bones about the fact that I am
earnestly trying to courteously and convincingly persuade you.
Please pardon the length of this epistle , but the
gravity of the situation demands a more penetrating study than
one page would afford .
The time has come.
You will now decide whether or not you are going
to be a government employee and practice socialized medicine.
In making up your mind, please consider the following:
1. Medicare is part of the Social Security Amendments
of 1965 (HR 6675) and was signed into law as
PI, 89-97 on July 30, 1965.
2. Medicare is socialized medicine for one segment
of the population.
3. This portion of socialized medicine goes into
effect on July 1, 1066.
4. Socialized medicine, stripped of its deceptive
whitewash, is reactionary: it is the imposition of central
power and control over America and Americans
in the false guise of beneficence; it is the opposite of
the American way.
5. Medicare was drafted by politicians and bureaucrats.
Official representatives of the medical profession
were not consulted about the provisions of medicare.
6. Socialized medicine around the world has always
made infinitely worse the very “inadequacies” its
advocates proposed it would cure.
7. Not a single hospital was built in England during
the first ten years of socialized medicine - and
only one in the first thirteen years. For the last ten
years, an average of 400 doctors have left Britain
annually to get away from socialized medicine.
8. This present day socialized medicine is not the
wave of the future - it is not progress; it is a resurrection
of the same ancient, worn out, discredited,
discarded, warmed-over, old world fraud it has always
been.
9. Socialized medicine has always, in every era
and in every location, arrested progress in medical
science through restrictive, burdensome, suffocating
regulation, leading to loss of incentive, stagnation,
and decay.
10. On February 2, 1966 the Belgian government
collapsed because of its free national health service.
The 9000 doctors demanded that it be stopped or they
would withhold their services. They gave as their
reason that “free treatment in the state health service
lowers medical standards. interferes with their freedom
in treating patients, and hurts the country’s
economy” .
11. The Italian Mariotti Project would nationalize
all physicians. Canadian medicine is again the target
of the socialist government. Mexican, Swedish, German,
Czechoslovakian, Hungarian, Libyan, Cuban,
Polish, Bulgarian, Romanian, and Chilean medicine
is socialized, and struggling with difficulties. Russian
socialized medicine is experiencing shortages. Greek
socialized medicine is, this month, plagued by exposure
of corruption, fraud, and abuse.
12. Since socialized medicine is political medicine,
under it quality invariably deteriorates and availability
naturally decreases.
13. It is inevitable that the provider will feel
very little responsibility for and the recipient place
very little importance on E! service that is so valueless
as to be “free”. Thus, bath patients and doctors unavoidably
stand to lose under Medicare.
14. Charity, although dear to the donor, is lightly
regarded by the recipient.
15. People almost never value anything that is
free.
16. Anything that tends to lower the standards
of medical care is evil, Anything that is evil is unethical
and immoral.
17. Socialized medicine has been tyrannically imposed
on civilizations since time immemorial; it was
part of Caesar’s “magnificent society” two thousand
years ago.
18. On the other hand, the practice of private
medicine is tried, proven, and time-honored.
19. America’s private medicine has produced the
healthiest, Longest-living populace in recorded history.
20. Why should physicians now approve of nationalized
medicine when they have long opposed it
on moral, legal, and ethical grounds?
21. Socialized medicine has always proven to be
demoralizing to doctors and patients.
22. Ponder this - would a patient be wise to
place his life in the hands of a doctor who has lost
his self-respect for practicing government medicine?
Then again, perhaps the patient would be even less
wise if that physician were of the type who had not
lost his self-respect for doing so.
23. Admittedly, American physicians have not attained
(and obviously never will attain) their perennial
goal of conquering all disease. But they have
come closer to doing so, and are still more diligently
making more progress in that direction now, than any
other group in the world has done presently or at any
time in the past.
24. By all yardsticks, medical practice in the 17.5.
is the finest in the world because it has not been
socialized.
25. Government produces nothing, therefore it
has nothing to “give” to anyone except what it has
first taken from him or someone eke (minus a sizable
brokerage fee).
26. Medicare is legal plunder. It promises the
possession of someone else (the doctor) ; it promises
something the government does not possess (medical
knowledge).
27. It is a mark of moral bankruptcy for one
group (legislators) to arbitrarily guarantee the professional
ethic of a second group (doctors) to a third
group (the citizens)
28. Only doctors can practice medicine. No one
else is equipped by training and experience to do so.
29. And Jesus answering said unto them “They
that are whole need not a physician, but they that
are sick” (Luke 6 ~ 3 1 ), My Lord said sick people need
a physician - not HEW, not Medicare.
30. The Bauer Amendment adopted by the AMA
House of Delegates in 1961 puts it this way “The
medical profession is the only group which can render
medical care under any system”.
31. Wilbur Mills, author of Medicare, states that
it will not work without the willing cooperation of
doctors.
32. Therefore only doctors can impose socialization
on the medical profession: by being a party to
it - by participating.
33. On the other hand, now that PL 89-97 has
been enacted, only doctors can prevent the socialization
of medicine: by declining to be a party to it -
by not participating.
34. If physicians permit medicare for those over
65 to operate now by participating, it is only a matter
of a short time until all patients and all doctors are
totally nationalized.
35. If doctors don’t firmly stand on principle
now, they will be pitifully, ignominiously begging
HEW for a few more pennies per visit in the near
future. Socialized medicine in Japan offers an indelible
example.
36. Those over 65 are being led to believe all
services will be provided under Medicare. But Part A
and Part B of Title XVIII provide only limited services.
For instance, annual check-ups, the first $40
under Part A, the first $50 under Part B, vaccinations,
etc. are not covered.
37. There are approximately 18.5 million persons
in the USA 65 and over.
38. All over 65 (except certain criminals) are
eligible to receive benefits under Part A of Title
XVIII of PL 89-97. This includes an estimated six
million over 65 who have never been under Social
Security and thus have paid no Social Security “taxes”.
For this six million, Part A of Medicare is pure
charity.
39. Private insurance companies estimate Part B
will cost $10 per month. So 70% of Part B is pure
public charity, the funds coming from general revenues.
Yet Part B is called “insurance”, the $3 is
called a “premium”, and anyone 65 or over may
sign up.
40. In the main, Medicare is public charity.
41. Physicians should be suspicious of and fear
there is deception in an inconsistent system of “social
security” that on the one hand (Part A) ceases to
collect fluctuating “premiums” and begins to pay
changeable benefits at age 65: but on the other hand
(Part B) begins to collect fluctuating “premiums” at
age 65 for unsure, changeable benefits in the unknown
future,
42. Under Title XIX, all recipients of welfare,
regardless of age, will be eligible for Medicare by
1970. There are in excess of 200,000 on welfare in
Mississippi alone. It is estimated that Title XIX of
the present law, without amendment, will cover forty
million people by 1975.
43. And. of course, all of this is only the beginning.
On February 25. 1966 Senator Harrison A. Williams
D-NJ introduced S 2953, and Representative
John E. Fogarty (D., R.1.) introduced HR 12976 which
would provide presently uncovered diagnostic services,
and for all persons over 50.
44. On March 1, 1966 the President asked for
six to eight Billion dollars for a hospital modernization
program outside of Hill-Burton to provide the anticipated
increase in facilities which will be required by
Medicare.
45. While money is squandered by the bureaucrats
in administering medicare, doctors participating
in medicare will be required to be economical.
Cheap treatments and cheap prescriptions are to be given
preference, HEW employed referees will set the
standards - not the patient’s doctor.
46. If you participate in Medicare, any praise or
commendation will go to the bureaucrats, but its failures
will be blamed on YOU.
47. When the public becomes disgruntled with
the poor quality and lack of availability of care under
socialized medicine, it will vent its wrath on DOCTORS,
not Wilbur Cohen or HEW.
48. HEW, the Liberals, the bureaucrats, and other
socialists will never admit the inherent fraud of socialism
or their own guilt in perpetrating it, but will,
instead, divert the blame to DOCTORS for the predictable
shortcomings of socialized medicine.
49. Non-participation is not a strike against
patients. A strike is the withdrawal of services. Non-
participating physicians will individually continue in
the future, as they always have in the past, to expend
every effort on behaIf of all individuals who seek
their services.
50. Non-Participation is not a strike against
Medicare. Section 1802 specifically states that doctors
may choose not to “undertake to provide , . . services”
under PL 89-97, In other words, you do not
have to practice under Medicare.
51. Section 1801 of PL 89-97 prohibits the imposition
of Medicare on a doctor who declines to be
a participant.
52. The 13th Amendment to the U.S. Constitution
prohibits involuntary servitude.
53. In Article I, Section 8 of the U.S. Constitution
the central government is granted no authority
by the citizens through their states to engage in the
business of medical care or insurance.
54. The only portion of L 89-97 that is involuntarily
imposed on physicians is compulsory inclusion in
Social Security and the mandatory payment of Social
Security taxes.
55. The socialization of medicine in the United
States is not intended as an end in itself. It is planned
as a means to an end - the total socialization of
America.
56. The socialization of America will complete
the socialization of the world.
57, Total world socialism is the avowed aim of
the communist conspiracy.
58. Lenin stated that the keystone in the arch
of the socialist state is socialized medicine,
59. “Liberals”, “moderates”, “intellectuals”, New
Dealers, Fair Dealers, New Frontiersmen, Great Societiers,
socialists, the Scholars, one-worlder's, communist
dupes, communist fronters, communists ; and all
leftist organizations including the ADA, CFR, AFL-CIO,
UN, UNESCO, CPUSA, etc. foster socialism,
including socialized medicine.
60. many advocates of socialism today vow they
are anti-communists.
61. In 1883, when Chancellor Otto von Bismarck
initiated the first “national compulsory health insurance”,
he adopted communism “to fight communism”.
And since then, sixty-four countries have done the
same.
62. America is daily being forced to adopt more
and more communism - and each time we are told
that the reason is “to fight communism”.
63. Some persons (including some doctors) cooperate
in socialism because they accept the solemnly
made statement “it is inevitable”, The truth, however,
is that this oft-repeated untruth is, in reality,
propaganda conceived and promoted by the socialists
themselves to get otherwise good people to be accomplices
in the socialist destruction of the market
economy which originally was America.
64. Some will participate in medicare because
they abhor the thought of being considered out of
step with modern times, or of being old-fashioned, or
of opposing the majority. Paul the Apostle, by Divine
inspiration, wrote in Romans 12:2 ‘I. . . . be not
conformed to this world”.
65. In early 1948, 84% of the doctors in England
voted 9:l against socialized medicine, but in the next
few months threats, abuse, misrepresentation, and
accusations caused them to surrender.
66. After World War II, when the Labor Government
of Australia imposed socialized medicine, 90%
of the doctors refused to participate. As a result the
Labor Government was defeated and the law never
went into effect.
67. So, you see, socialized medicine is NOT inevitable.
68. This controversy over socialized medicine is
only one, but a most important, battle in the war
by the socialists to collectivize America and thus the
world.
69. Social schemes are instigated by a small group
of grasping men for base purposes - not humanitarian
love of neighbor or the welfare and health of the
nation, as deceitfully claimed.
70. Contrary to what we have been told all of
our lives, it does not take two to make a fight, Doctors
(and all Americans) are having war waged
against them unilaterally. A war not of their choosing,
which they have not provoked, and in which they
have not volunteered to fight - but a war for their
(and their country’s) enslavement, nevertheless. The
socialists are the aggressors. Repeatedly they have
slapped our face and bloodied our nose by insulting us
with accusations that we are not practicing good
medicine. They have put shackles on us legislatively.
Come July 1, they will tie our hands behind out back
with restrictions. And still many doctors refuse to
realize or admit that THEY are in a fight,
71. Doctors (and all Americans) must realize
this war of aggression for their enslavement IS going
on - and if they wish for themselves and their children
to be free - THEY MUST FIGHT TO WIN NOW.
72. Medicare, though it is called such, is not
insurance. There is no contract. There is no policy
wherein the provisions are stated, It is whatever “the
Secretary (of HEW) may direct” at any given
moment .
73. Section 1803 provides that persons participating
or not participating in Medicare may have other
health “insurance”. This provision is necessary to
give lip service to the basic doctrine of freedom of
contract. But the action by many insurance companies
(undoubtedly at the behest of HEW) cancelling their
health policies as of midnight June 30, 1966 threatens
to give that forbidden monopoly in this area to the
social planners of Medicare anyway - through intentionally
staged default.
74. In some instances, these are “non-cancellable”
policies! But the fine print allows the company to do
so since all policies in the group are being cancelled.
75. These companies are thus assisting HEW
to coerce eligible persons to sign-up for Medicare. This
is irresponsible and immoral collusion with evil.
76. By this action the insurance companies (with
certain notabIe exceptions) have forced those 65 and
over to sign up for medicare or face the prospct of
having no health protection. Was the collusion voluntary
or involuntary on the part of the insurance cornpanies?
If involuntary, I can find no provision in
PL 89-97 authorizing the government to issue such a
regulation. If voluntary, did the insurance companies
conspire with the government (1) in exchange for the
plum of being appointed fiscal agent for Part A or
Part B; and/or (2) to get rid of their burdensome
poor risk of old folks?
77. That insurance companies are acting as co-conspirators
in their own (and their country’s) demise
is reprehensible since through their holdings of stocks,
bonds, mortgages, and loans insurance companies
constitute the backbone of the country’s financial
integrity.
78. That Medicare will destroy private insurance
and private medicine should come as a surprise to no
one. It was planned and promoted for just those
reasons. That is its purpose!
79. So our advice to our patients should be: “If
you have private health insurance, keep it; if you do
not have private health insurance, buy it; if your
company has cancelled your policy (many companies
have), demand that they reinstate it (several companies
have) ; if you have not signed up for Medicare,
don’t; and if you have signed up for Medicare, withdraw”.
80. Patriotic Constitutionaliets oppose socialism
in all its forms.
81. Non-Participation in socialized medicine is
legal, at long last agreed to by the AMA.
82. Even Wilbur Cohen (Undersecretary of HEW)
on August 7, 1965 stated non-Participation is legal.
83. Non-Participation is ethical. Section 5 of the
AMA Principles of Medical Ethics states “A physician
may choose whom he will serve”.
84. Section 6 of the Principles of Medical Ethics
of the AMA advocates Non-Participation: “A physician
should not dispose of his service under terms or
conditions which tend to interfere with or impair the
free and complete exercise of his medical judgment and
skill or tend to cause a deteriortation of the quality of
medical care.”
85. Non-Participation is honorable. By not participating
in Medicare a physician is upholding the Constitution,
preventing the communization of the world,
and proudly maintaining the integrity of his profession.
86. The AMA's Bauer Resolution of 1961, and reaffirmed,
advocates Non-Participation : “The medical
profession . . . will not be a willing party to implementing
any system which we believe to be detrimental
to the public welfare”.
87. Thus a physician who declines to participate
in socialized medicine is acting in the highest traditions
of the noblest of the professions.
88, Participating will be easy. It will be supinely
"going along” and it will assure that physician of
“getting along”.
89. On the contrary, not participating will be
hard, It will take courage, conviction, stamina, and
dedication. All manner of pressures and hindrances
will be imposed on the non-participant to “whip him
into line.”
90. It is legal for an individual to advocate Non-
Participation.
91. It is legal for an organization to advocate
voluntary Non-Participation. Several county medical
societies and at least five state medical associations
have endorsed non-participation,
92. PL 89-97 gives the appointed Secretary of
HEW and his designees almost unlimited authority
over participants (doctors, patients, hospitals, etc.)
in Medicare.
93. Do you believe that any jackleg bureaucrat,
any egghead social planner, any compromising politician,
any pay-off appointee, with no medical training
and bound by no code, knows more about medicine
or how to care for patients than doctors who are
Bona-fide professionals with seven to nine years of qualifying
training?
94. George Washington said “Government is not
reason; it is not eloquence; it is force! Like fire, it is
a dangerous servant and a fearful master”.
95. Under Medicare the good doctor will be equalized
with the mediocre doctor. There wilf be less
incentive to be the best doctor pcxssible.
96. Under socialized medicine, the Department
of HEW has patients and the Department of HEW
has doctors. But doctors do not have patients; and
patients do not have doctors.
97. The medicare doctor will merely be acting as
an agent for the Department of HEW.
98. By participating in socialized medicine, physicians
unilaterally become hired clerks - employees
of appointed political bureaucrats.
99. All of the above is only a drop in the bucket
of what will come to those who participate in Medicare.
Doctor Philip R. Lee of the Palo Alto Clinic,
the new Assistant Secretary of HEW, says that to
take care of the increased number of patients expected
when Medicare gos into effect on July 1 “Doctors are
just going to have to work harder”. He also favors
“allowing a nurse or a technician to go directly into
the first or second year of medial school”.
100, By the end of 1965, 57% of those eligible
for Part B of Medicare had not enrolled. The bureaucrats
frantically put on an all-out propaganda drive
of deceit. Threats of the deadline of March 31 were
utilized. Most agencies of the government, entertainment
stars, governors, and many others participated.
101. On January 31, eight million people - that‘s
46% of those eligible had not enrolled.
1.1 million had actually signified they do not want to enroll -
God bless ’em. Efforts by the social planners were
intensified.
102. It has been admitted that at least $2.5
million has been spent through the Office of Economic
Opportunity to pay “volunteers” to personalIy call on
those over 65 to persuade them to sign up. For instance,
the rate of pay “credit” set by the QEC for
these Medicare salesmen in Waldo County, Maine was
$11 per hour for physicians, $9 per hour for dentists,
$8 per hour for attorneys, $5 per hour for accountants,
$3 per hour for secondary school teachers, $2.50 per
hour for elementary school teachers, and $2 per hour
for horses - yes, that’s right - HORSES.
103. The cost of mailings to those over 65 urging
(even threatening) their acceptance of Medicare is in
excess of $1.5 million.
104. With all of this, by March 8, 1966, only
79% of eligible persons had signed up for Medicare.
105. Much to the consternation of HEW officials,
and in spite of all efforts, one week prior to the original
deadline to sign up for Part B of Medicare (March
31, 1966), four million of the eighteen and a half
million eligible persons had still not signed up.
106. So, the cry for the socialization of medicine
comes not from the “neglected”, “needy”, “mistreated”
citizens at large, genuinely in need of help, but from
the socialists in and out of medicine, It is not for the
succor of the destitute, but to sucker us all into
collectivism.
107. The politicians and the bureaucrats desire
the nationalization of medicine. The people are not
demanding it.
108. Socialized medicine, being the opposite climate
from that in which American medicine has
reached such heights, is, thus, a regression for America,
not an advance.
109. With its unswerving history of having always
arrested advances in medicine, socialization has
only condemnation and failure to offer as its credentials,
110. Those physicians advocating non-participation
are not opposed to progress, as accused. On the
contrary, since socialized medicine is a retrogression,
the non-participant is in the forefront of medical
progress,
111. The practice of medicine involves only two
people - the patient and his physician. Any third
party is an intruder that dilutes and divides the loyalties
and responsibilities inherent in patient-physician
obligations. By not participating in Medicare a physician
is simply adhering to and operating under this
maxim.
112. For a physician to practice under Medicare
he must comply with the regulations of the Secretary
of HEW and work within the limitations of the
prescribed utilization review (utilization committee).
Thus he must forfeit his loyalty and responsibility to
his individual patient and transfer these to the impersonal
government. In so doing he betrays the
trust of his patient and violates medical ethics.
113. A doctor who chooses not to participate in
socialized medicine will not be turning his patients
away. On the contrary it will be the bureaucracy
which, in violation of the Consitution, denies the
patient the services of his doctor.
114. So, the time to say “NO” is now, when only
a minor portion of the physicians’ practice will be
involved and when there will be the loss of only a
small, insignificant portion of potential income. That
risk and sacrifice now will be the most effective and
the least costly. Such action by physicians now will
cause government medicine to collapse for lack of
participants .
115. Later, when all the population is included,
the major portion of the physician’s practice will be
involved and choosing not to participate then will
reduce his income to almost nothing. He will either
have to leave the practice of his chosen profession
to make a living, or starve. It will be too late. No
amount of personal sacrifice for principle then will
be effective.
116. Non-Participation by physicians is in the best
long-range interest of their patients, themselves, and
good medical care,
117. The Oath of Hipocrates says “I will prescribe
regimen for the good of my patients according to
my abiIity and my judgment and never do harm to
anyone”.
118. All evidences point to the conclusion that to
participate is not in the best interest of patients.
119. Robert Louis Stevenson wrote in his EULOGY
OF THE DOCTOR “. , . . above the common
heard . . . . the physician almost as a rule . . . in
history he will be thought to have most notably exhibited
the virtues of the race”.
120. The above should make it crystal clear to
all physicians that if they participate in Medicare
they will be party to the socialization (destruction)
of the practice of private medicine because of which
Americans enjoy the finest medical care in history.
121. What the future holds for you, your profession,
the health of your patients, and the very survival
of the Republic rest in your hands,
122. For the American miracle to continue we
must have less government and more individual
responsibility.
Based on these principles and determined to help
reestablish and then preserve this independent representative
Constitutional Republic of Law , I decided years ago, after
praying for guidance, that I would not violate my moral and
ethical beliefs and render a disservice to my patients, my
country, and myself as an accomplice in the enslavement of
mankind by being a party to the setting of its keystone -
socialized medicine.
Now you will make the decision - perhaps the most
important decision you have ever male. There is no middle
or "neutral" ground.
Are you saying to yourself as King Agrippa said to
Paul in Acts 2 6 : 2 8 - "Almost thou persuadeth me", but . . . .
but . .... ? Do not let as yet unresolved conflicts and
unanswered questions deter you.
TAKE YOUR STAND NOW ON PRINCIPLE.
You can work out the details of implementation
as the necessity arises,
Joshua 24:15.
"Choose you this day whom ye will serve" - Joshua 24:15.
Fraternally,
Curtis W. Caine, M.D.
CWC/abf
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