Category: Steve Karp

Breaking Up the Legal Industrial Complex


In 1918, Britain’s Hilaire Belloc published a book entitled The Free Press.  Buried within was his commentary on the two large guilds in British society, those of doctors and lawyers.  Though strong, the medical guild was no match for the legal guild, due to the latter’s administrative, legislative, executive and governing power.  And as it went in Britain, so it would go in America.

Today nearly all our interactions, whether direct, or indirect, are controlled by the law, with the law controlled by lawyers.  Our law is divided into constitutional, statutory and administrative branches, with approximately 20 sub-branches.  Due to hundreds of years of mounting bureaucracy, and with the usurpation of power by the legal guild, the law and our lives have become what lawyers wish it to be.

Reform of our law will never occur if lawyers remain the sole gatekeepers of it.  The chance to change this is in greater pressure on the legal guild, starting from outside and boring within.  The outsider with the greatest chance to accomplish this is its old nemeses, the medical guild, through greater knowledge of the law.

A friend once said to me: “Any physician can become a lawyer but few lawyers can become physicians.”  This anecdote was recently confirmed during my own discussion with a law school’s screening admission advisor. “You will have no problem being admitted.” “Why, I asked?” “Because you are a physician and can think logically.” 

‘The ability to think logically;’ but practice medicine is much more.  And that is why few lawyers become physicians. So the question is: ‘should more, or all, physicians become lawyers, or something of a hybrid, and why?’

The practice, standards, and accountability required of a physician, are unlike any other profession.  It is claimed that physicians possess a unique fund of knowledge; however to many of us, it resembles the Sword of Damocles.  That sword dangles in the form of second guessing, use of ‘retro- spectacles,’ Monday morning quarterbacking, and a disproportionate responsibility for unforeseen or poor outcomes.

So if physicians possess a unique fund of knowledge, don’t lawyers as well?  And don’t lawyers possess a unique fund of knowledge that just happens to regulate society?  Can these two unique funds of knowledge somehow be combined for the protection of physicians, patients and society?  I believe it’s possible and will propose why it should be considered.

The medical school curriculum currently runs over four years.  The first two years, with a bit of clinical observation thrown in, encompass the basic sciences, the scientific foundation of medical education.  The third-year curriculum consists of clerkships, which are rotations of two-to-three months, through five specialties, that include general surgery, medicine, OB/GYN, pediatrics and psychiatry.  The fourth year is a combination of additional course requirements and electives.

Law school in comparison is currently spread over three years.  The first year is devoted to the foundations of law and includes civil procedure, contracts, torts, criminal, property, and constitutional law.  The second and third years essentially hone the basic knowledge acquired in year one.

So is it possible to produce, en masse, medical students with a foundation in the law, while maintaining their medical ability?  I believe it is since the majority of physicians today train to become clinicians rather than enter a physician/scientist track as designed for MD/PhD candidates.   My proposal will therefore apply to the majority of practicing physicians, and is as follows:

First, several medical school courses can be taken during college.  As is, there are too many science majors entering medical school, and there is ample proof that even a lowly history major can bring excellent care to a community, especially rural areas spurned by former biology majors.  Next, delete the summer vacations of the first two years since that’s a relic of less advanced education.  Finally, since the fourth year of medical school often consists of three or four months of requirements, with the rest of the year being electives, much time can be freed up but still allow time for an elective or two, if needed.

My proposal reduces the medical school curriculum to three years, but what to do with the fourth year?  It’s called the first year of law school and it can actually be interspersed with the third-year clerkships, and thus combined, be integrated into the last two years of medical school.  So now, every physician obtains the basic knowledge of the law that is the essence of a lawyer. But to what end, you ask?

First, medical malpractice lawsuits will be substantially reduced once physicians apply the legal knowledge they acquired in medical school.  This will occur because physicians, now versed in another “unique fund of knowledge,” will understand the legal ramifications of their medical acts and better protect themselves and their patients through improved documentation.

Lawyers will be much more cautious in tangling with a medical profession that is not only expert in medical care but also has the same foundation of legal education that they do. Medical malpractice insurers will see a decline in inquiries, less need to mount a defense of their insureds, or force unjust settlements on physicians.  A resultant downward trend in physician malpractice premiums will ensue.

Physicians with a greater understanding of the law will be in a position to head off the legal misadventures inflicted on their profession such as: mandated child abuse courses for maintenance of professional licensure, required even of physicians who don’t treat children; mandated drug abuse courses for physicians who don’t prescribe controlled substances; query of medication databanks to play mommy and daddy for drug seekers.  The latter is especially egregious since alcohol is purchased without a prescription and recreational marijuana is becoming legally sanctioned by leaps and bounds.

The second and greater effect will be on society.  The idea is not to create more lawyers but rather to have more citizens with a greater knowledge of our basic law.  With physicians now trained in the law, legislatures on the state and local level, disproportionately represented by lawyers, will be put on notice.  With their knowledge base now not held in exclusivity, they will be more wary of, and take greater care, in enacting and attempting to enforce unwise and unconstitutional laws. 

Fear is a great motivator to prevent misadventure.  Perhaps some of what is needed today is for the legal realm to acquire some of that.  My solution is to distribute the knowledge base that has been within the exclusive domain of the legal profession.  Physicians are in quantity and aptitude well positioned to add balance to what has been monopolized for too long by the legal guild.

  

 

 

 

 

 

In 1918, Britain’s Hilaire Belloc published a book entitled The Free Press.  Buried within was his commentary on the two large guilds in British society, those of doctors and lawyers.  Though strong, the medical guild was no match for the legal guild, due to the latter’s administrative, legislative, executive and governing power.  And as it went in Britain, so it would go in America.

Today nearly all our interactions, whether direct, or indirect, are controlled by the law, with the law controlled by lawyers.  Our law is divided into constitutional, statutory and administrative branches, with approximately 20 sub-branches.  Due to hundreds of years of mounting bureaucracy, and with the usurpation of power by the legal guild, the law and our lives have become what lawyers wish it to be.

Reform of our law will never occur if lawyers remain the sole gatekeepers of it.  The chance to change this is in greater pressure on the legal guild, starting from outside and boring within.  The outsider with the greatest chance to accomplish this is its old nemeses, the medical guild, through greater knowledge of the law.

A friend once said to me: “Any physician can become a lawyer but few lawyers can become physicians.”  This anecdote was recently confirmed during my own discussion with a law school’s screening admission advisor. “You will have no problem being admitted.” “Why, I asked?” “Because you are a physician and can think logically.” 

‘The ability to think logically;’ but practice medicine is much more.  And that is why few lawyers become physicians. So the question is: ‘should more, or all, physicians become lawyers, or something of a hybrid, and why?’

The practice, standards, and accountability required of a physician, are unlike any other profession.  It is claimed that physicians possess a unique fund of knowledge; however to many of us, it resembles the Sword of Damocles.  That sword dangles in the form of second guessing, use of ‘retro- spectacles,’ Monday morning quarterbacking, and a disproportionate responsibility for unforeseen or poor outcomes.

So if physicians possess a unique fund of knowledge, don’t lawyers as well?  And don’t lawyers possess a unique fund of knowledge that just happens to regulate society?  Can these two unique funds of knowledge somehow be combined for the protection of physicians, patients and society?  I believe it’s possible and will propose why it should be considered.

The medical school curriculum currently runs over four years.  The first two years, with a bit of clinical observation thrown in, encompass the basic sciences, the scientific foundation of medical education.  The third-year curriculum consists of clerkships, which are rotations of two-to-three months, through five specialties, that include general surgery, medicine, OB/GYN, pediatrics and psychiatry.  The fourth year is a combination of additional course requirements and electives.

Law school in comparison is currently spread over three years.  The first year is devoted to the foundations of law and includes civil procedure, contracts, torts, criminal, property, and constitutional law.  The second and third years essentially hone the basic knowledge acquired in year one.

So is it possible to produce, en masse, medical students with a foundation in the law, while maintaining their medical ability?  I believe it is since the majority of physicians today train to become clinicians rather than enter a physician/scientist track as designed for MD/PhD candidates.   My proposal will therefore apply to the majority of practicing physicians, and is as follows:

First, several medical school courses can be taken during college.  As is, there are too many science majors entering medical school, and there is ample proof that even a lowly history major can bring excellent care to a community, especially rural areas spurned by former biology majors.  Next, delete the summer vacations of the first two years since that’s a relic of less advanced education.  Finally, since the fourth year of medical school often consists of three or four months of requirements, with the rest of the year being electives, much time can be freed up but still allow time for an elective or two, if needed.

My proposal reduces the medical school curriculum to three years, but what to do with the fourth year?  It’s called the first year of law school and it can actually be interspersed with the third-year clerkships, and thus combined, be integrated into the last two years of medical school.  So now, every physician obtains the basic knowledge of the law that is the essence of a lawyer. But to what end, you ask?

First, medical malpractice lawsuits will be substantially reduced once physicians apply the legal knowledge they acquired in medical school.  This will occur because physicians, now versed in another “unique fund of knowledge,” will understand the legal ramifications of their medical acts and better protect themselves and their patients through improved documentation.

Lawyers will be much more cautious in tangling with a medical profession that is not only expert in medical care but also has the same foundation of legal education that they do. Medical malpractice insurers will see a decline in inquiries, less need to mount a defense of their insureds, or force unjust settlements on physicians.  A resultant downward trend in physician malpractice premiums will ensue.

Physicians with a greater understanding of the law will be in a position to head off the legal misadventures inflicted on their profession such as: mandated child abuse courses for maintenance of professional licensure, required even of physicians who don’t treat children; mandated drug abuse courses for physicians who don’t prescribe controlled substances; query of medication databanks to play mommy and daddy for drug seekers.  The latter is especially egregious since alcohol is purchased without a prescription and recreational marijuana is becoming legally sanctioned by leaps and bounds.

The second and greater effect will be on society.  The idea is not to create more lawyers but rather to have more citizens with a greater knowledge of our basic law.  With physicians now trained in the law, legislatures on the state and local level, disproportionately represented by lawyers, will be put on notice.  With their knowledge base now not held in exclusivity, they will be more wary of, and take greater care, in enacting and attempting to enforce unwise and unconstitutional laws. 

Fear is a great motivator to prevent misadventure.  Perhaps some of what is needed today is for the legal realm to acquire some of that.  My solution is to distribute the knowledge base that has been within the exclusive domain of the legal profession.  Physicians are in quantity and aptitude well positioned to add balance to what has been monopolized for too long by the legal guild.

  

 

 

 

 

 



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Health Insurance or Medical Care?


The terms health insurance and medical care are often used interchangeably. They are, however, quite different concepts, and once understood, who benefits or loses becomes apparent.

For decades, Americans have been fed a lie that health insurance ensures receiving medical care. The truth is that there are many obstacles in our way when that care is needed. With the passage of the Affordable Care Act (ObamaCare), the old lie was advanced, not just in name but in deed. Under active debate is its repeal, hybridization or replacement. But are these just false choices?

Insurance is a product sold based on risk. While it can protect me from myself, it can also serve to protect me from you or you from me. So, what is health insurance protecting?

If, as the name implies. it insured health, then it would be selling preventative services for injury or illness. The problem is that injury is often unanticipated and there are few ways to prevent illness. The old adage that you don’t see a doctor when you are well by and large has more than a grain of truth.

So perhaps what we have is a misnomer and what pays our medical bills when we are injured or ill is actually medical insurance. The question though, no matter what it’s called, is how is it working out for us?

Part of the basic definition of insurance is an “agreement by which a person pays a company and the company promises to pay money if the person becomes injured.” ObamaCare requires that most of us purchase a health insurance policy or pay a ‘penalty’ for what we may not want, use, or find financially beneficial. So, what’s the motivation for requiring us to possess health insurance?

To understand human motivation is to acknowledge the role of money and power. Once that’s accepted, the question becomes “who stands to gain in forcing every citizen to have a health insurance policy, with its numerous exclusions, many of which can’t be anticipated, and which benefits mostly the underwriter, not the insured?”

The punchline is: not the average Joe. Though the list of who benefits is relatively short, those on it are quite powerful and from that power flows a stream of monetary gain. It arises from the creation of a law that’s purposely ill defined, nearly impossible to understand, and requires from here to eternity to clarify, thus ensuring job security. Its culmination is the creation of companies in support of its mandates. The list of those benefitting includes: politicians, lawyers, the judiciary, the press, and CEOs of health insurance companies, hospitals and government mandated medical organizations.

Now having clarified the scam that is health insurance, what does it have to do with medical care? Unlike health insurance, medical care is what patients actually benefit from. So how will medical care be obtained without Obamacare? Though not comprehensive, here is a broad outline.

The poor will always be with us. The truly poor will always have some form of government assistance. For the elderly, Medicare should continue but be phased out over time, with younger generations hopefully making better life choices, taking better care of themselves, and limiting the effects of their choices on society. Over time, most people can be reconditioned to pay for what is routine, such as they pay for food, housing and clothing. Catastrophic plans can and should be recommended and marketed for children and most adults. Situations like the VA and certain public employees can perhaps be approached with a different lens, that of a quid pro quo.

But how do we address the cost of medical care? I believe we will be pleasantly surprised at how the cost of care declines once needless middlemen are removed and entrepreneurs resume their rightful role. At one time physicians were involved as such, but with the takeover of our society by the legal guild, decades of their societal intervention essentially strangled private medical practice.

There certainly is room for participation by pharmaceutical companies, devise manufacturers, hospitals, etc. Regarding hospitals, they need to be restricted to a core mission of maintaining an emergency room for emergencies, operating rooms for inpatient surgery, and hospital beds for inpatients only. Since most hospitals are financially propped up by taxpayer-paid government subsidies, once their unnecessary expansion into the medical marketplace is reversed, physicians along with the nursing profession can resume their role in patient advocacy and care.

Medical care is available though it’s strangled through the bureaucracy of the politician’s creation and their business associates involvement. Once health insurance is outed for what and for whom it actually benefits, we can focus on what we actually need: medical care.

The terms health insurance and medical care are often used interchangeably. They are, however, quite different concepts, and once understood, who benefits or loses becomes apparent.

For decades, Americans have been fed a lie that health insurance ensures receiving medical care. The truth is that there are many obstacles in our way when that care is needed. With the passage of the Affordable Care Act (ObamaCare), the old lie was advanced, not just in name but in deed. Under active debate is its repeal, hybridization or replacement. But are these just false choices?

Insurance is a product sold based on risk. While it can protect me from myself, it can also serve to protect me from you or you from me. So, what is health insurance protecting?

If, as the name implies. it insured health, then it would be selling preventative services for injury or illness. The problem is that injury is often unanticipated and there are few ways to prevent illness. The old adage that you don’t see a doctor when you are well by and large has more than a grain of truth.

So perhaps what we have is a misnomer and what pays our medical bills when we are injured or ill is actually medical insurance. The question though, no matter what it’s called, is how is it working out for us?

Part of the basic definition of insurance is an “agreement by which a person pays a company and the company promises to pay money if the person becomes injured.” ObamaCare requires that most of us purchase a health insurance policy or pay a ‘penalty’ for what we may not want, use, or find financially beneficial. So, what’s the motivation for requiring us to possess health insurance?

To understand human motivation is to acknowledge the role of money and power. Once that’s accepted, the question becomes “who stands to gain in forcing every citizen to have a health insurance policy, with its numerous exclusions, many of which can’t be anticipated, and which benefits mostly the underwriter, not the insured?”

The punchline is: not the average Joe. Though the list of who benefits is relatively short, those on it are quite powerful and from that power flows a stream of monetary gain. It arises from the creation of a law that’s purposely ill defined, nearly impossible to understand, and requires from here to eternity to clarify, thus ensuring job security. Its culmination is the creation of companies in support of its mandates. The list of those benefitting includes: politicians, lawyers, the judiciary, the press, and CEOs of health insurance companies, hospitals and government mandated medical organizations.

Now having clarified the scam that is health insurance, what does it have to do with medical care? Unlike health insurance, medical care is what patients actually benefit from. So how will medical care be obtained without Obamacare? Though not comprehensive, here is a broad outline.

The poor will always be with us. The truly poor will always have some form of government assistance. For the elderly, Medicare should continue but be phased out over time, with younger generations hopefully making better life choices, taking better care of themselves, and limiting the effects of their choices on society. Over time, most people can be reconditioned to pay for what is routine, such as they pay for food, housing and clothing. Catastrophic plans can and should be recommended and marketed for children and most adults. Situations like the VA and certain public employees can perhaps be approached with a different lens, that of a quid pro quo.

But how do we address the cost of medical care? I believe we will be pleasantly surprised at how the cost of care declines once needless middlemen are removed and entrepreneurs resume their rightful role. At one time physicians were involved as such, but with the takeover of our society by the legal guild, decades of their societal intervention essentially strangled private medical practice.

There certainly is room for participation by pharmaceutical companies, devise manufacturers, hospitals, etc. Regarding hospitals, they need to be restricted to a core mission of maintaining an emergency room for emergencies, operating rooms for inpatient surgery, and hospital beds for inpatients only. Since most hospitals are financially propped up by taxpayer-paid government subsidies, once their unnecessary expansion into the medical marketplace is reversed, physicians along with the nursing profession can resume their role in patient advocacy and care.

Medical care is available though it’s strangled through the bureaucracy of the politician’s creation and their business associates involvement. Once health insurance is outed for what and for whom it actually benefits, we can focus on what we actually need: medical care.



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