The boogeyman of Socialized Medicine is being dragged onto the field of rhetorical combat to block the move toward anything smacking of Single Payer Health Care in the United States. The argument is old and hoary by now, that adopting a system like that available in Canada or the United Kingdom would lead to a collapse of American health care. Somehow the fact that expenses might be shared and disbursed through the government will render the world’s best health care system somehow crippled inside a generation is not seriously questioned by most people. Because most people don’t know.
You can find case after case of anecdotal evidence to support the notion that British health care is worse than ours. Someone knows someone who, as the argument goes. And there is something to that. The waiting periods alone, the pigeonholing of treatment—horror stories abound which we glimpsed here when HMOs were instituted and accountants seemed to be in charge of medicine.
There is, in fact, too much information for the average American to digest much less make sense of.
Technologically, the United States has an extraordinary medical system. Unmatched in the world, despite some annoyingly negative statistics. That we achieve what we do in a country peopled by citizens who do the least for their own health than in any other country comparably empowered is amazing.
Americans eat too much. Medicine can only do so much against a rising tide of obesity related illnesses. The tradition of the doctor giving you a physical and then telling you to eat right and get some exercise is not a quaint leftover from an age that didn’t know as much as we do—that is sound advice and more than half the battle in maintaining good health. The explosion of Type 2 diabetes in children has been alarming, and this can be tied directly to diet and exercise.
We also work longer hours under higher stress than almost anywhere else in the developed world. The need for vacations and long weekends is acute. This may sound sarcastic, but the link between stress and several major illnesses is no joke.
We are also a violent society. If one looks at emergency room statistics, it becomes quickly clear that we are a people who like to beat, stab, and shoot each other at higher levels than almost anywhere else.
What makes all these factors so overwhelming is that we have the means to do all this. Because a certain percentage, a significant percentage, of the population can afford to go to the doctor and have the consequences of all these lifestyle disasters “taken care of.”
I put all this out front because the one factor that is muted in the national debate over the rising cost of health care is the fact that we are, collectively, idiots. We do not do, statistically, the simplest things to avert the need for medical intervention.
The last detail in this litany has nothing to do with idiocy but with sentiment and perspective. It has been said for decades and it is true—80% of individual health expense in this country is spent in the last two years of life. We are, as a people, loathe to die and we will direct our health services to do absolutely everything to give us another day.
In Europe, such people are told to go home and die.
That sounds cold, I know, and I’m sure there are people in France and Germany and Italy with the resources to reject this advice.
But the nations as a whole are not expected to pay for it. Here, we are.
Through health insurance.
Back in the 1950s, the insurance industry, seeking to cash in on the post war boom like everyone else, found some novel ways to increase the sale of policies. At a time when an individual could actually afford to pay for most medical care out of pocket—for a number of reasons, but almost all related to overhead expenses in the health care industry—health insurance was sold according to what was known as Community Standards. Which meant that everyone got roughly the same policy for the same price. This spread the expense over the broadest base of payers. But young people didn’t buy health insurance for the most part. So the industry began creating categories. You could get a discount if you didn’t smoke or drink. If you had no history of certain illnesses, that would reduce the price, too. (Race played into this, too, and where you lived, and what you did for a living.)
The trouble with this came later when business got involved by offering health policies as employee perks. Now suddenly you had a huge pool of people taking advantage of a health insurance system that had not grown to meet the demand.
And then technology got involved, through incredible improvements in available care. Illnesses that could never be treated became treatable, but along with that the expense went up.
At some point everyone began to believe it was their right to have perfect medical care and to be guaranteed a long, healthy life.
And the bubble began to grow. More doctors and hospitals started being sued when previously excusable mistakes or the simple untreatability of a condition prompted the disgruntled patient or family to pursue compensation.
This was all good for the insurance industry because now they could offer policies to cover doctors and hospitals in the event of suits.
But at some point, it grew all out of proportion to what the system could handle, and premiums skyrocketed. Doctors were leaving the field as well or they were specializing so much that the old General Practitioner was getting thin on the ground—and we all know that specialists are more expensive than generalists.
And side by side with this marched the destruction of reasonable life styles and reasonable expectations. An industry was being called upon to treat the ailments of an increasingly unhealthy population with fewer and fewer practitioners who, to cover themselves legally, began doing more and more tests, conducting more and more procedures, the whole thing escalating absurdly—and often obscenely—into the realm of the ridiculous.
Then people started falling off the insurance rolls. This was a calamity because by then the basic costs—manageable way back before this spiral took off—were no longer supportable by individuals out of pocket. If you didn’t have health insurance, you had two choices—no medical care at all and hope for the best or you use emergency room care, which is massively expensive. Hospitals are over a barrel with this—they cannot legally refuse care. A good deal of the cost for this has been assuaged through government programs, but now we have a fiscal shortfall.
The basic facts now are that health care in this country is unaffordable. We’re robbing peter now to pay paul.
So how does this play into the debate over Single Payer?
The insurance industry is one of the next financial sectors due to take a nose dive. The truth is, they cannot afford to take a cut in revenues. They have locked themselves into policies that demand funding at certain levels and any one thing that threatens a source of money will probably pull the last stone out of the foundation and set them plummeting. Single Payer means they will lose revenue.
They have to. The general population cannot afford to pay. Likewise we as a nation cannot afford to continue carrying the uninsured. Fifty million Americans have no insurance, which means they living on luck or through the unacknowledged largesse of the Medicare and Medicaid systems, both of which are nearing collapse.
And American business—the functioning of the country, in this instance—cannot survive epidemics that will destroy productivity.
Like it or not, this is a Social Issue—capitalized in this instance to make a point. The concern is that we are becoming Socialistic. Yet it is clear that the Market—that much vaunted moronic system—cannot provide a solution to this problem that is acceptable.
I say acceptable because it can provide a solution. What it will do is see the system collapse entirely because it doesn’t work and allow hundreds of thousands if not millions of people to suddenly and completely go without health care of any kind. No emergency room care, no free clinic care, nothing. The market will proclaim such services no longer viable and the money will dry up and the system will go away. It may then rebuild itself from the ruins, but for a time there will only be health care for those who can pay for it out of pocket.
But I wish to bring your attention back to the start of this piece. A good part of the problem is the American lifestyle itself. We can debate the billing structure of various insurance systems, the efficacy of every single hospital everywhere offering ALL the same services (is it really necessary that all hospitals have an MRI?), we can argue over the R & D expense of pharmaceuticals, we can come to blows over Single Payer vs. Free Market, but at the end of it all we have to stop making ourselves sick.
Which means we also have to stop expecting miracles—miracles that, if we don’t get one, we’ll sue someone because we think they’ve cheated us out of our due.
There are some fundamental problems with our health care system that need to be met.
There is a shortage of General Practitioners. GPs don’t make the big bucks, it is less glamorous work than surgery. (Yes, we have a shortage of nurses, too, but solving this may solve that.) The issue over money is not a matter of greed but a question of debt. The expense of training a doctor is enormous. Students come out of medical school with a debt load that Atlas couldn’t shoulder without help. I would propose creating a system whereby the cost of training GPs is fixed and paid for by the public. Repayment can be offset in a variety of ways, one of which is that the GP pays a higher tax, which would also go toward a national malpractice insurance system. Oversight can be managed through this system. This would accomplish two things immediately—more GPs would become available to provide basic services to communities, most especially so-called well baby care. This would begin a trend toward prevention at the family level that over time would begin to reduce long term medical costs. Secondly, it would draw more doctors to serve at this less expensive, more immediate, basic level, freeing up time for specialists to do their jobs better. It would also over time reduce the expense of late life illness by simply producing a generally healthier population.
Secondly, we need to stop obligating our doctors to prolong life indefinitely. That’s a philosophical issue, but it becomes a resource issue. Some things can’t be fixed.
Thirdly, I would require school curricula at the grade school level to include basic self health courses. People need to understand their own bodies before they can make any kind of judgment, sound or otherwise, about health decisions.
Fourth, I would mandate basic health care coverage and limit escalators. The simple arithmetic says that if fifty million people can participate in a viable health care system, money will not be an issue. But they can’t if all the policies are based on special categories.
There are probably some areas that should not be open for taking profits. Holding people hostage for their health just because of bottom line concerns is immoral.
If we introduce a public option, the insurance industry will hurt. They can either raise premiums then on the customers they still have or they can figure out how to undercut the government. No one is suggesting they have to go out of business, though some will, but this situation has become intolerable. It may just be that for once someone will have to say, publicly, “Yes, you can make money here—just not as much as you used to.”
But it will also be a total package. If Americans want a health care system that will fix any and all problems without any regard to lifestyle, then we are soon to be without. If the health industry is unwilling to address the fact that as it currently stands their services are simply unaffordable to most people, then the country will collapse under the weight of its impoverished sick and soon they will collapse as well. And if politicians and pundits do not stop playing the Socialism card any time a constituent bleats that a program will cut into profits, then all we have to look forward to is higher and higher costs until no one can have anything.
All, it seems to me, we’re currently doing is arguing over who will bury the body once the patient has died.