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| On "Universal" Health Care | | Date Created: Jan 16, 2005, 09:46 AM |
On "Universal Health Care"
The following is an essay or opinion piece in response to the presentation of a family practice doctor at Coal Creek Rotary, Louisville/Lafayette Colorado on 3/18/04 regarding his desire for a "single payer" or "universal" health care system in the US. It is solely my opinion.
This family practice physician has the experience to be concerned about health care delivery in this country. As a family physician, he has been in the front lines of health care delivery for years. He is intelligent, passionate about the subject, and appears well informed. I can personally vouch for the integrity and compassionate nature of Dr. ____ and his idea of a universal health care movement. There are certainly many reasons to decry the state of health care delivery in our country. I grieves me that one so compassionate and caring can look at our current mess of a health care "system" and come to a mostly wrong conclusion and base it on exactly the wrong reasons and assumptions.
But why should my opinion or viewpoint be any more valid than his or even as valid? I'm one of those sub-specialty doctors, a surgeon, a Plastic Surgeon no less. I don't even accept medical insurance anymore. Aren't I part of the problem?
The reality is that plastic surgeons have a unique perspective on US health care delivery because we do emergency and acute medical care, elective reconstructive (medically necessary -- "insurance covered") surgical care, and elective cosmetic (not medically necessary, not insurance covered) care. The latter is the last bastion of traditional fee-for-service medical care in the US. Plastic surgeons my age or older have seen how things used to be. That is, both systems of government run or quasi-government care and fee-for-service or free market, competitive care. Additionally, I can compare to some real-world, US systems that you know rather than highly suspect comparisons to Canadian, European, and Third World systems you don't know.
So why is Dr. ____ partially right but for the wrong reasons? The simplest answer is that a just and humane society does need a safety net to provide basic health care and acute care for those who can't or are unwilling to pay for this service themselves. Training of doctors, nurses, and health care personnel needs a safety net as well -- so does medical research and public health. Actually we did have this before the federal government got involved. They were called charity or public hospitals. They were often run by (horrors!) faith based organizations and they did a great job of caring for those who truly needed it. They also helped train doctors and other health personnel and provided epidemiological and other health research data. What happened to them? Some, like the Shriner's hospitals still exist. But as with many other areas where the federal government gets involved, they were supplanted by federal run or regulated welfare programs like Medicare, Medicaid, and government run or heavily regulated but protected insurance programs. There is also the VA system to compare to.
But let's bet back to basic assumptions and how we got where we are. The real reason that the socialist thinking that is behind universal health care is wrong is that health care is not a right. Rights are not granted by kings or governments and they are not provided by universal health care systems or central planning committees of the dictatorship. Rights are inherent in human beings. Some would argue that they are God-given. The people then authorize a government to protect those rights, not given them to the people. These rights were enumerated in a famous document. They are things like life, liberty, and the pursuit of happiness, but they are not food, shelter, wealth, health care, or true enlightenment. If health care is a right and should be provided to everyone, who's going to pay for it? Food should be as basic a right as health care shouldn't it? So you should be able to go down to King Soopers and take whatever you "need" and not have to pay for it, right?
Rights are something the government should not be able to take away from you, not something it has to provide. Government has no way to provide anything. It only has the power to take from someone and give it to someone else. It's supposed to be a limited government controlled by a Constitution and the consent of the governed. It's not supposed to be a powerful central authority that would promise to provide everything that someone politically privileged wanted or thought they needed by taking it away from someone else.
People once expected to have the opportunity to provide for their own needs of food, shelter, and health care and to provide for their families and even for those in their community who are in need. They didn't expect the government to do it for them.
The second fundamental problem with the universal health care program is that Dr. ____ can say "it's not socialized medicine" but it looks like it, acts like it, sounds like it, and even smells like it. It's fundamentally federal government welfare and a central command economy system. You can argue what the definition of "is" is and try to define your way around it by saying doctors and well-intentioned people will be running it, but if it has the force of government behind it and it gets its money by taxation, it's a price fixing, central planning, government welfare operation.
And if we learned anything from history and sober analysis of reality (and there's little evidence that we have), it's that socialistic government-run systems never work and certainly never work better than free enterprise and individual choice systems. In a free society people make their own choices, take responsibility for their own choices and actions (including helping others), and use the power of competition to control prices. The power of profit incentive to generate services and technology serves what people want. That's how we got to be the world's wealthiest nation and the "best health care" in the world. We don't have that now and precisely for the reasons that single payer/universal health care advocates want to use to solve the problem.
Our health care "system" is breaking down because it's a system. It's because of (mostly) federal government welfare systems, because of government control of the health care "industry", and because of federal regulatory abuse that we're in our current mess. And you think more of this will solve the problem? The War on Poverty, the War on Drugs, our welfare systems -- they all just need more money and power and we'll really solve those problems. Even Dr. ____ admits that "money doesn't solve it".
Of course there are a myriad of reasons why health care costs are out of control. The US tort litigation (malpractice law) system is a big contributor. And interestingly, plaintiff attorneys are big contributors to the Democrats. But even here the power of the government is behind it. Plaintiff attorneys use the power of our court system to make money, big money, off of the excuse that they are helping people and policing doctors. Even a cursory look at what's going on will show you that people aren't helped, many are hurt, doctors aren't "policed", and the only winners are the lawyers while we all pay for that "malpractice insurance" that is skyrocketing. It's the worst of the free enterprise system (predatory profit making) combined with the coercive power of the court system. The "special interests" control of the legislative government system (Big Law) is as important to the Democratic party as labor unions and the teacher's unions and many plaintiff attorneys use the wealth generated by their tort system to lobby politicians to keep the system going. No federal welfare health care system will even begin to work unless the attorney's predatory, legalized extortion, government backed tort liability system is ended.
The other fundamental reason why we are in the current mess we are in and social medicine advocates can use the "43 million Americans are uninsured" statistic as an accusation, is that insurance and insurance companies are not now and never were a good way to provide for basic needs like health care. Our own Rotarian medical insurance broker who sells health insurance for a living will tell you this. You can figure it yourself. Imagine if you used an insurance company to pay for your basic food needs -- your groceries. The company that provides that service needs to make a profit, so right off the bat you're going to pay more for groceries than you would have if you paid for them yourself. And before long that grocery insurance company would be telling you what grocery store you can go to, what you can buy, and how much. And not long after you'd be getting in disputes over what you "need" versus what is just because you want it. And the government will step in to control that the the grocery insurance companies have to provide certain foods and you can't negotiate with the insurers over what they can charge you and how much they reimburse. Then your grocery insurance premiums will be rising but you feel like you're paying more and getting less for it. Some people will have no way to pay these inflated premiums and soon "grocery care" becomes a right to those with a socialist view of the world.
Insurance, like government, is a good way to hide costs. It got started during the price fixing, rationing, and central planned economy of WWII and the New Deal. Employers couldn't determine wages to be paid employees because of wage controls so they started providing benefits outside of wages for needed employees. One of these benefits to get around wage controls was health care insurance. This continued to look as if the health care insurance was "free" or just a "benefit" and worked reasonably for awhile as long as the insurance industry wasn't too heavily government controlled and protected, people had some other choices, charity hospitals were available, the malpractice industry hadn't started, and government and it's special interest, big money form of representational democracy wasn't so big and powerful. None of those things hold today. But the problem remains that government control of something people want and need is the cause of the problem, not the solution, and insurance is not a good way to fund health care needs (It is a good way to provide for unexpected or catastrophic needs though).
Three examples of systems you know in the US and in your own experience will illustrate how such things really work. The first is dental care. And if you don't believe me, ask the dentist and orthodontist in our group. Dental care isn't quite as essential, generally, as health care, but it's similar. Why isn't universal dental care a right? Why don't we have a dental care crisis? Why isn't our dental care "system" broken? There are more than 43 million Americans without dental insurance. There are certainly people going without proper dental care. Why no outcry? The answer is that dentists never got seriously involved with insurance as a means to pay for dental care needs and wants. It's still mostly fee-for-service. You can choose who you want to see, how much you're willing to pay, and whether you want it at all. It's readily available. There are even ways to get it free or at reduced cost if you're willing to wait and/or see dentists in training. There's also a minimum of governmental regulatory abuse and malpractice insurance needs. The worst dentists have had to put up with is the scare tactics of the anti-fluoridation crazies, the mercury in dental fillings nuts, and the regulatory excess caused by the AIDS scare (which turned out to be based on the intentional actions of a dentist rather than by standard dental practice).
Another example most people know is government-run medicine already here in the US. If you've seen Medicare in practice, you've seen government-run medicine. Unfair? Inadequate? Doomed? Inefficient? Too slow? Too bureaucratic? You ain't seen nothing. Try applying it to everyone in the US. Or try VA medicine. I've been there. Government jobs and pushing paper are the most important things at the VA. The patients are incidental, a nuisance as it were. And the "not socialized medicine" folks think single payer universal health care won't be like this socialized medicine? It will be run by caring government individuals commonly known as bureaucrats with government jobs. Think IRS. If it's paid for by coercive taxes, centrally planned and run, and has the power of government behind it, it will be VA medicine. And who runs the government today? Bureaucrats, lawyers, and politicians, some of whom are more than one of these.
And one other comparison to a US institution before moving on to why universal healthcare is partially correct for the wrong reasons -- the US public schools. Education is not a right either. We know that it's desirable for citizens of a country to be educated and most parents want their children to get an education if they possibly can. Those of us who don't have kids or whose kids are already out of school are even willing to help pay for the education of others children. We once had the best education system in the world too. What happened?
There are a lot of similarities between the US public school system's bloated, ineffective, and politically correct "education" and that of health care delivery. The main difference is the costs and controls weren't hidden through insurance coverage. They're hidden in government taxation. Also education doesn't have a malpractice insurance crisis from lawyer predation. Instead we have the teacher's unions and entrenched bureaucracies of education -- another major "special interest" constituency of the Democratic party. In fact the worst problems of our public schools are in the inner cities of our major metro areas and those cities have been run by Democratic politicians and political machines for decades. It's hard to think of one that isn't. Kansas City's experience proved that unlimited funds couldn't solve the problem. Why does public education seem to be getting worse all the time?
Well we did rather well with local funding and control of public schools but we lost it when the parents gave up control to the big city politicians, the career teachers, the PC fads in teaching, and particularly to the feds. The answer? Give control back to the parents. That means vouchers and private schools. Vouchers are not the best answer. The money still has to be taxed and wasted by government before it's given back, but that's the only way for the "poor and minorities" to be able to break out of the government schools and choose the education they want.
The same is true in the US medical care system. Uninsured doesn't mean no health care or even no access to health care. The so-called deaths caused by this are statistical manipulation scare tactics like various claims of the number of medical mistakes. People make poor decisions that affect their health adversely all the time. Victimology is what the single payers are preaching. You're just a victim of corporate greed. You're too dumb to make your own choices. The "government" or someone owes you quality health care for whatever that entity thinks you need. And if you get fat, smoking disease, alcohol disease, or suffer a medical mishap, real or imagined, you can make millions by suing (or someone will make millions). And where does that money come from by the way?
So yes, we need a safety net of government-run medicine that appears to be free. It will help with the crisis in medical school and residency medical and surgical training (a crisis that hasn't hit the media yet). It will help government-run research if they're willing to engage in real scientific research rather than politically correct research (as we saw in the AIDS epidemic). It will be about as good as VA medicine or the Canadian system or the European system but it won't be as good as the old charity hospitals and certainly not as good as free enterprise, fee-for-service, people chosen and paid for competitive medicine. The latter will have to develop as a second tier of medical care. The profit drive is necessary but is controlled by individuals, not by government. Profit driven companies can do well providing disaster insurance or even running hospitals and clinics -- the Mayo Clinic comes to mind -- as long as they're controlled by the free market rather than the government. The key is that individual people have to make their own choices and decide what they're willing to pay for what services. If you want to go to the government hospital and appear to pay nothing, fine. If you want what you want, when you want it, and how you want it, it can be provided but you'll have to pay for that yourself just like cosmetic surgery. The government system becomes another competing hospital just like public schools compared to private schools.
Not happy that you're already paying for government medicine through your taxes? Too bad. You're already paying for public education, such as it is, too. But don't worry, the Democrats are all for raising those taxes and they've done such a great job running our big city education systems and Medicare/Medicaid/VA medicine. Currently it appears that Republicans will cut the taxes and raise the spending. More money and government control should solve the problem wouldn't you say?. And not to worry about government power and control either. Just like in the vouchers fight, the government and the universalists won't let there be free enterprise medicine. It's too important to be left up to individual people's choices. The federal government will fight a two tier system at every turn. It already does. I'm just lucky I can provide at least cosmetic medical/surgical care under a competitive, fee-for-service system.
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