April 13, 2024

Medicine in the Era of Big Government

My wife is having surgery today.  She’s chosen her doctors as best she can with the limited information available regarding their abilities, which is to say word-of-mouth, and we’ll soon be off to the relatively new facility in Bryan, Texas for her operation.

It’s a relatively minor procedure, but I have to admit to being a little afraid for her.  There’s nothing like putting your life – or that of a loved one – in the hands of a stranger to make you appreciate a country in which one can choose who the man or woman holding the scalpel will be.  That freedom is essential.  But will it still exist if a national health care plan is implemented?

I don’t think continued freedom of choice is a given, although it certainly should be.  No government-run medical plan can be considered legitimate if patients are forced to have their health care administered a small set of state-appointed doctors.  Choice is mandatory if consumers are to avoid being forced into substandard treatment situations.

Fans of Tom Clancy will no doubt recall a chilling scene in a recent novel of his – I forget which one, sorry – in which Caroline Ryan becomes incensed after witnessing British surgeons drinking at lunch only hours before a scheduled operation. 

I’m not saying that nationalized health care will lead to drunks in the operating room.  I’m really not.

But I am saying is that a patient’s freedom to choose his or her own doctor is essential and must be preserved in a system in which medical malpractice will likely not be discouraged with the same vigor with which it’s pursued now.

Moreover, a national system will be motivated to cut costs in the same manner as the current regional HMOs have – by controlling doctors’ salaries, employing fewer doctors and keeping them “fully utilized”, and denying access to specialists by using general practitioners as gatekeepers.

Other national healthcare plans have been observed to create cost efficiencies in this manner with the inevitable result that access to non-rudimentary healthcare is delayed, often for months, with patients suffering as they move their way up the waiting list.

That’s a horrific outcome for a society in which we’ve had immediate access to the best healthcare system in the world.  Yet it seems inevitable given the incompatible goals of national healthcare:  universal access unfettered by economics and reduced costs.

There’s also a problem with the G.P.-as-gatekeeper strategy that may not have been taken into account:  Almost half of U.S. primary care physicians would change professions if they had an alternative.

Some of the oft-cited reasons for this malaise are the over-abundance of government-mandated paperwork and low profit margins on an increasing number of government-funded patients. 

Notice anything in common about these complaints?

Barack Obama claimed during the presidential campaign that he would not tamper with existing healthcare plans.  Indeed, he stated quite clearly that we could all keep our existing coverages.

Unfortunately this is not true.  While his plan, if it is passed, would probably not do away with existing employer-provided plans, it would remove the need for employers to provide healthcare coverage as an enticement to employees.

Employers compete for the best workers using a variety of tools, one of which is fringe benefits.  Medical coverage could be considered one such, although at the rate of over $1000 per month for family coverage, it’s hardly a fringe issue.

Question:  Which employers will continue to pay a 24% premium on the total compensation package for a typical $50K/year accountant or sales representative? 

Answer:  None that want to stay in business.

The inevitable outcome of a national healthcare plan is that it will absorb all but the most exclusive of existing health plans, making participation in it effectively mandatory.  This brings us back around to the choice issue.

Patients and their families don’t care which bean-counters process their claims.  We care only about whether we like and trust the doctors handling our cases and that we get needed healthcare in a timely fashion. 

The architects of America’s proposed national healthcare plan would do well to remember that. 


Marc is a software developer, writer, and part-time political know-it-all who currently resides in Texas in the good ol' U.S.A.

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