by Rose M. Rohloff

Across the country I have asked various parents, teachers, grade school and high school students an elementary question: "What form of government is the United States?"
Being the most basic of query, the universal response of “A Democracy” took me by surprise. The next request was for each person to quote the Pledge of Allegiance. Some did not know it clearly, while others did recite ... United States of America, and to the Republic for which it stands ... followed by, "Oh, so what."; "It is a democratic republic which is the same as a democracy." One male in his twenties from Chicago (who stated he attended the best high school in the city) responded, "Well, we need a combination democracy, socialist, communist government because people are too stupid to think for themselves." My final statement to this person was to point out that these are three opposing ideologies that cannot exist together.
The question begs to be asked, "How can voters function as responsible citizens and make reasoned, insightful judgment when voting, if they do not know or understand what form of government exists in the United States?"
It is interesting to compare the intelligence of writing for grade school children from the 1800s with the readings of today. Children in the 1800s were educated in civics starting at young ages, because parents and grandparents fought to obtain and secure for them the new form of government - a Republic governed by a national Constitution.  

The comparison of "new" (incorrect)  teaching is important, because Democracy intentionally does not appear anywhere in the Declaration of  Independence or the Constitution. [Cato Institute: On Democracy Versus Liberty, By Steve H. Hanke, Feb 2011] The founders studied history in depth with types of governments, and specifically did not create a democracy to avoid mob rule.
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The public today is often bombarded with reports, news (non-news) - an overabundance of opinions regarding important issues. Without the basic understanding of the U.S. Republic, individuals have been conditioned to react with and vote based on emotion, as opposed to thoughtful reasoning; the breaking down of issues with intelligent discourse based on Constitutional understanding.
Authors have broken down a differentiation of a democracy in the simplest term as a majority dictating issues. When a majority of persons are swayed with emotion, it is ‘mob rule’. This distinction is important, as more and more voters are craving socialism, with groups such as ANTIFA and #xyzMOVEMENTS continuing to form. The Founding Fathers researched all the various forms of governments thoroughly before specifically establishing a Republic instead of a Democracy (as reviewed in the link video, discussing the rule of law versus the majority).

James Madison reviews the downfalls of a large democracy in the Federalist Paper, No. 10: The Utility of the Union as a Safeguard Against Domestic Faction and Insurrection. 

A great deal of emphasis has been placed on the importance of the 2018 mid-term elections, and the tide of ‘Red’ versus ‘Blue’ control at State and Federal levels. In Arizona, two candidates posted the following in the election overview of candidates:

• Steve Gaynor (Republican) for AZ Secretary of State: “… bedrock of our democracy …”
• Katie Hobbs (Democrat) for State Senator: “… foundation of our democracy …”   

These statements reflect poorly of our country if: (1) The actual candidates for representing the people either do not know themselves the form of government they are being selected to be representative within; or (2) Those in or running for government intentionally wish to perpetuate the ignorance of voters, especially with emotion versus thoughtfulness, and incorrect propaganda.
Taking the importance to the Nth degree for properly educating and understanding the foundations and ideologies of a Republic versus a Democracy: A democracy may vote in socialism; the U.S. Republic cannot, because representatives must abide by the guaranteed protections within the Constitution, especially our Rights.

 Veterans are the citizens who have the Right to free healthcare through the Veterans Affairs (VA), for wounds or illnesses sustained in the protection of the country. The inefficiency of the VA system as a government run entity has sadly been well documented over the last two decades, and requires separate coverage of its own.
The concept of a Right given by the government is an oxymoron, being the very essence of Unconstitutional. Rights define our freedom from the government. When Rights are given to, allowed control by the government, it is socialism. And, Socialism is defined in Merriam-Webster as:
economic and political theories advocating collective or governmental ownership and administration of the means of production and distribution of goods (and services); there is no private property; a system which the means of production are owned and controlled by the state; a stage of society in Marxist theory transitional between capitalism and communism.
There is currently a growing trend calling for a single healthcare payer: That single payer is the government. Giving full, nonmilitary healthcare control over to the government is contrary to having Rights, often called socialized medicine, which is in actuality what I term healthcare socialism.  

The American system has been based upon freedom, the free market, at its very core. Healthcare is included with the exception of the Veterans Affairs (VA) system, and the formation of Medicare, and now the expansion of Medicaid. A growing trend in the country is a call for a single payer healthcare system.

Recent articles have cited a high percent (up to 40%) of medical students wanting a single payer. This year, Medical students bring the AMA into the single payer dialogue AMA House of Delegates 2018 Annual Meeting, June 9-13, 2018

Well, who is that payer? The answer is the government. What would be the single payer system - VA, Medicare, Medicaid? I suggest we not use the term single payer system, and instead delineate the true description, what I refer to as healthcare socialism. 
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As discussed in Part I of this series, the Federal Government was designed for protection of the Constitution, and to be effective with limited power, operating with efficiency. Government run healthcare has proven to not have limited power, to be costly with decreased quality, and to be inefficient.

The following cases are only a few of the major healthcare fraud cases over the last few years:

• 301 National take down in healthcare fraud results in approximately $900 million in false billing1
• Three charged in $1B Medicare fraud scheme2
• 412, including doctors, in $1.3 Billion Health Fraud3
• Woman defrauds Medicaid of $1 Million4

Healthcare socialism includes physicians as employees of the hospitals, ergo employees of the government. Under the current government payer system, Hospital-employed physicians drain Medicare By Alex Kacik|November 14, 2017
1 National Health Care Fraud Takedown Results in Charges against 301 Individuals for Approximately $900 Million in False Billing, Department of Justice, June 22, 2016, https://www.justice.gov/opa/pr/national-health-care-fraud-takedown-results-charges-against-301-individuals-approximately-900
2 Justice Department charges three in $1 billion Medicare fraud scheme, The Wall Street Journal, July 22, 2016, http://www.foxnews.com/politics/2016/07/22/justice-department-charges-three-in-1-billion-medicare-fraud-scheme.html
3 U.S. Charges 412, Including Doctors, in $1.3 Billion Health Fraud, The New York Times, July 13, 2017, https://www.nytimes.com/2017/07/13/us/politics/health-care-fraud.html
4 Beverly Woman Defrauded State Of $1 Million From Medicaid: Prosecutors, DNAinfo, October 14, 2017, https://www.dnainfo.com/chicago/20171018/beverly/santila-terry-speech-therapy-clinic-theft-charges-docbarbie-hair-boutique/

• A 49% increase in hospital-employed physicians between 2012 and 2015 led to a $3.1 billion increase in Medicare costs related to four specific procedures in cardiology, orthopedics and gastroenterology, according to analysis from consulting firm Avalere Health.
• Medicare paid $2.7 billion more for diagnostic cardiac catheterizations, echocardiograms, arthrocentesis and colonoscopies delivered in hospital outpatient settings than it would for treatment in independent facilities, while beneficiaries footed a $411 million higher bill.
• Hospital-employed physicians performed more services in costlier hospital outpatient settings, resulting in up to 27% higher costs for Medicare and 21% for patients.

Putting aside for a moment the short and long term legal (giving away of Rights), ethical, efficiency, quality and moral arguments of a government socialist system, let's ask an essential feasibility question:
    How would it be funded initially as there is no long term sustainability.

The existing Federal Total revenue as of 2018 is only $3.654 trillion (T)

Right now, the country cannot fund social security or existing Medicare (and Medicaid which is not included or considered). The Forbes July 9, 2018 article reviewed the additional cost projections of a single payer system:

• An independent analysis of Sanders's plan conducted by the left-leaning Urban Institute estimated that it would cost $32 trillion over 10 years.
• And those are just the financial costs. Socialized medicine's human costs are even greater. Single-payer systems, the world over, ration care and force patients to wait for treatment.
• The United States can barely afford its existing healthcare obligations. In 2017, the federal government spent more than $700 billion on Medicare -- a 65 percent increase over just 10 years.

It is important to read all three sections of this series to appreciate under Healthcare Socialism, the individual gives up their Rights because the government dictates: what is to be done, the services to be given, lack of financial responsibility with a non-sustainable system, and who is to do what job where and when – which is covered in the next section.   

 A major factor that is never discussed in healthcare socialism (since it is referred to as ‘single payer’) is the education of clinician staff - the doctors, nurses, etc. which is not covered regarding cost and decreased quality.
New York University (NYU) just announced they now have a tuition free medical school. In response, Elisabeth Rosenthal, MD, editor-in-chief of Kaiser Health News, explains why NYU got it wrong.

In an op-ed for The New York Times, Dr. Rosenthal, a former emergency room physician, cites research that shows medical school debt often discourages students from pursuing lower-paying specialties or from practicing in areas where the majority of patients are on Medicaid.
Instead, students are more likely to pursue more highly paid specialties, like neurosurgery or orthopedic surgery.

By eliminating tuition … She claims most physicians who enter higher-paying specialties are able to quickly pay off their student loans; the physicians that have trouble doing so are those who opt to take lower salaries as primary care physicians …"Instead of making medical school free for everyone, NYU — and all medical schools — should waive tuition only for those students who commit to work where they are needed most," she wrote. (See Title V of the ACA tax law passed under Obama.)

ACA, Page 1309, Title V SEC. 5207. FUNDING FOR NATIONAL HEALTH SERVICE
… authorized to be appropriated, out of any funds in the Treasury not otherwise appropriated, the following:
‘‘(1) For fiscal year 2010, $320,461,632.
‘‘(2) For fiscal year 2011, $414,095,394.
‘‘(3) For fiscal year 2012, $535,087,442.
‘‘(4) For fiscal year 2013, $691,431,432.
‘‘(5) For fiscal year 2014, $893,456,433.
‘‘(6) For fiscal year 2015, $1,154,510,336.
‘‘(7) For fiscal year 2016, and each subsequent fiscal year, the amount appropriated for the pre-ceding fiscal year adjusted by the product of ‘‘(A) one plus the average percentage increase in the costs of health professions education during the prior fiscal year; and ‘‘(B) one plus the average percentage change in the number of individuals residing in health professions shortage areas designated under section 333 during the prior fiscal year, relative to the number of individuals residing in such areas during the previous fiscal year.”
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In summary, $BBs funneling out without oversight or budgeting and funding of bodies through schools without quality education, and then dictating who must work where and when. 
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The ACA is predominately discussed in regards to healthcare coverage for uninsured, some $17M people, because people choose to not make the time to actually read the whole Tax Law. As Title V reflects, monies being spent have nothing to do with coverage, and is shows spending with no accountability, and we are seeing negative outcomes with the reduced training and preparedness as clinicians – clinical time and sciences replaced with diversity, global health issues, nursing theory. Last year, I was interviewed by a university with a ‘leading nursing college’, asking me if people who would make good nurses are prevented from becoming nurses because they cannot pass basic sciences, so we just need to reduce more of the sciences as “they don’t use that knowledge anyways, right?”