Only Congress has the Constitutional authority to declare war on a foreign power.

Hillary Rodham Clinton has declared war on American medicine: ``If the forces arrayed against [health care] reform want a real battle in which their self interest is exposed and their real agenda made public, they will get it'' (NY Times 11/9/93).

Antinuclear activists have portrayed the grisly effects of nuclear war against an unprepared society (and grotesquely exaggerated them). Medical care would be unavailable, they say. Worse, nuclear war would be the ``end of civilization as we know it.''

It is increasingly probable that the best medical care in history will be destroyed without a single nuclear explosion. The deployment of HRC's ideas would have an effect equivalent to that of a neutron bomb, leaving the infrastructure of medicine intact while killing its human aspects. (Note the diagrammatic portrayals of the ``system'' in her plan: large buildings dominate the picture, and a few uniform, stereotyped humanoid silhouettes are added as ``input'' and ``output.'')

The neutron bomb might be delivered by the equivalent of a ballistic missile. Or the components might arrive in suitcases or fishing vessels to be assembled later.

Medical services are now available in abundance in the United States. One-seventh of the economy is related to medical care, and the medical industry provides one out of every seven jobs.

How could such a powerful industry be ruined?

Triggering a fusion reaction in a hydrogen bomb requires fission.

The medical industry is undergoing fission, with its various parts warring against each other. And all of them are to be placed in a pressure vessel, whose walls are made of price controls. (These might be called a Resource-Based Relative Value Scale, expenditure targets, a global budget, a ban on balance billing, or premium caps, but they are all the functional equivalent of price controls.)

Throughout forty centuries of human history, price controls have invariably driven goods and services off the market or degraded their quality, while instigating corruption and civil unrest.

Other controls are contemplated, including ``practice guidelines,'' ``technology assessment'' (meaning restrictions on access to new technology similar to FDA restrictions on access to new drugs), quotas for training programs in medical specialties, economic credentialing of physicians, and new criminal penalties for attempting to influence the delivery of medical care (fines of $50,000 and prison terms of 5 years, 10 years, or life).

Injected into this explosive mixture are elements that are as poisonous as fission products: the politics of envy, the demonization of certain interest groups, and calls for emergency action that short-circuits the normal deliberative process.

In situations of war, emergency, or severe shortages, triage must occur.

Under traditional Western ethics, triage is based on the principle of saving as many lives as possible. Those in imminent peril to life, who yet have a chance of being saved, have first priority. The walking wounded wait.

This ethic is grounded on a belief in the sanctity of every individual human life. Such a belief is a moral absolute that is reflected in the Oath of Hippocrates. The Oath took the radical stand (for its time) that the role of the healer and that of the killer must not be commingled.

With the deconstruction of the Hippocratic ethic, a new triage principle is arising: achieving the greatest good for Society, with the greatest good being defined by a political process. The result is that the healthy, the productive, and the politically favored go first. Others may die on the waiting list.

One defense for this policy is that the nation is purportedly being bankrupted by the nearly $1 trillion spent for medical care.

In fact, the nation is not being bankrupted by medical expenditures, just as it is not being bankrupted by the $400 billion annual expenditure for soft drinks.

There is one and only one reason for bankruptcy: debt that cannot be repaid.

The rationing of medical care is neither necessary, sufficient, nor efficacious for retiring the national debt. Redistributing expenditures (both public and private) from the care of the sick and the injured into programs designed to benefit or at least please the healthy will not bring fiscal solvency.

Many special interests obviously have a stake in the outcome of health care reform. The interests include physicians, nurses, hospitals, nursing homes, pharmaceutical companies, and all others who supply goods and services for the care of the sick and the injured and the health needs of all. At risk is not only their ability to earn a livelihood or profit from their investments. Far more serious is the threat to their freedom. Caregivers in the Brave New World may actually be punished for practicing by the Oath of Hippocrates for the benefit of their individual patients (not that of ``Society''), according to the best of their knowledge and judgment (rather than according to the dictates of a third party). But the ``providers'' are not the ones who will be hurt the most.

The group that will suffer the most from misdirected reform includes anyone who ever becomes a patient. Next in order of sacrifice will be those forced to bear the brunt of the inflated costs that will surely accompany centrally planned medicine.

Could anyone profit from the destruction of American medicine? Could anyone benefit from the use of a nuclear weapon?

If anyone expects to profit, it is most likely to be those who have written or paid for the production of a proposal. As Hillary Rodham Clinton wants to know the agenda of the opponents of reform, others would like to know the identity and the agenda of its advocates. Whether the public will have access to that information is an issue that will be decided in federal court in the case styled as Association of American Physicians and Surgeons, et al. v. Hillary Rodham Clinton, et al.

At present, the answer to cui bono? has to be inferred from a careful reading of the various reform proposals.

Careful study is also the answer to the question of whether this newsletter is indulging in the hyperbole characteristic of Physicians for Social Responsibility.

If reform would mean the destruction of medicine, then such reform would mean disaster. The potential is so serious that every American needs to become informed about the problem, to study the differential diagnosis, and to weigh the possible modes of therapy. A wealth of material is available. We can supply the Clinton Administration's proposal as it stands in November, 1993, in WordPerfect format on a high-density, 3.5 inch floppy disk, for $5 (it is more than 1300 pp. of text, 1.45 megabytes). We can also supply information on a free-market approach to insurance problems, the abridged Patient Power by John Goodman and Gerald Musgrave, published by the Cato Institute, for $5. (DDP does not take a position on pending legislation.)

Like access to medical care, access to energy is crucial to avoid disaster.

For your information, we enclose a copy of the November issue of the newsletter published by Petr Beckmann for twenty years. This newsletter is a critical national resource, filled with dependable scientific information otherwise available only with strenuous effort. The new editor is Arthur Robinson, Ph.D., who also serves on the Board of Directors of DDP. Subscriptions are only $25 per year. Write AtE, PO Box 1250, Cave Junction, OR 97523.