Universal Health Care

Health care costs in the United States are rising at a rate significantly higher than the rate of inflation. Corporations which provide health care to their employees are hammered by those increases. There is much discussion about how to slow the increase and improve efficiency. The Democratic Party has been pushing for government-run health care since the Clinton administration. Since it a huge agenda item for the Obama administration, let’s look at some of the issues involved.

Let’s start first with the people who actually provide health care. I will talk mostly about physicians but one must remember that in a private practice environment, if the physician makes less money, everyone associated with that physician makes less money also. One of the things which is coming out of the administration spokespeople is that they want to reduce waste, improve efficiency, and reduce payments to physicians. Let’s talk about reducing payments to physicians. I am a physician and I can honestly say that I don’t know a single physician who went in to the practice of medicine exclusively to make a lot of money. That being said, for those readers who might not know what is involved in becoming a practicing physician, let me give you a clue. I spent the requisite twelve years in public school getting good grades. Because my family could not afford to pay for college, I did an enlistment in the Navy to obtain Veterans Administration benefits. Using, those benefits and working full time, I obtained a chemical engineering degree in five years. I spent four years in medical school on a military scholarship and with loans because I could not afford medical school without them. I then spent five years working about 110-120 hours a week with virtually no days off to finish a surgery residency. I spent two more years completing a trauma/critical care fellowship. If you add that up, that is twenty eight total years of education. I paid for the scholarships with years of my life. Is it reasonable to think that after all those years of effort that I should be financially secure? Should I be held in contempt because I expect my efforts to be rewarded? I am not rich by any stretch of the imagination. With all of that education, should I make the same salary as a bank clerk, automobile mechanic, carpet installer, or ice cream vendor? It is an interesting question. In fact, should I be salaried at all or should I be paid by the services I provide? If I am a better surgeon than the guy down the street, should I make more money? I don’t make one tenth of what a professional baseball player makes. Is a baseball player more valuable to society than a surgeon? To place fixed salaries on any profession is to encourage mediocrity. If all baseball players make the same amount of money, there is no reason for anyone to try to become a star. There is no incentive. If you reduce incomes of physicians to the same level as any profession that requires one-year training program or a college degree, where is the incentive for someone to go through what I went through? I love taking care of patients but I am not a financial masochist. It took me sixteen years to pay off my medical school loans. Government-run socialized medicine is a one way ticket to mediocre physicians. Smart people will find something else to do.

What are people entitled to? There is discussion about whether health care is a right. Is everyone entitled to everything at any time? In an ideal world, that would be possible but in a real world with fixed resources, it is not. If it is not possible for everyone to have everything, who decides who gets what? The Democrats want the government to decide. That is happening in England now. They use actuarial tables to decide by your age what health care to which you are entitled. For example, past a certain age, if you having a failing heart valve, the government will not pay for a valve replacement because they have decided that it is a bad investment. It certainly does save costs. They do the same for interventional radiology, transplants, x-ray studies, etc. It is only another small step for the government to decide who lives and dies. It will be like planned obsolescence. You reach a certain age and you will be considered useless to society and we find ourselves cast in Soylent Green. Another government, years ago, went through these logical steps: why spend a lot of money on people who don’t contribute to society; why allow those people with genetic defects or insanity to reproduce; why spend money housing those people who aren’t reproducing anyway; why not terminate those people because their life is worthless and miserable, we would be doing them a favor. They called the science eugenics and it led to millions of deaths. In the current American system, decisions are made with your physician based on your individual story. I make these decisions all the time. A socialized set of rules will lead to philosophical questions. If you are a fifty year old award-winning teacher, do you deserve less care, based on an actuarial table, than a twenty-five year old crack dealer who was shot committing his fifth violent felony? If you are sixty five years old and are an active member of society, you have different options than a sixty-five year old in a skilled nursing facility who is completely unaware of the surroundings and has multiple chronic debilitating diseases. Is that cruel or is it just a better use of resources? While private insurers do limit treatment payments, the individual has a voice in choosing the limits of their coverage by the premiums they chose to pay. In a government run system, the rules will be fixed in concrete and the individual circumstances won’t be considered. The fixed salary, robotic doctors will practice under constraints and algorithms which will take decisions away from the doctor, patient, and family and leave in the hands of government health care administrators. That will lead to a dual system of medicine: a fee for service upscale system for the wealthy and a government-run mediocre system for everyone else. It is another step on the road to mediocrity. The Democrats argue that currently 40 million people have poor health care. They want to make sure everyone has equally bad health care.

Any government program has inherent flaws. The first is trying to write rules that apply to 300 million people and address all circumstances is impossible. Whenever it is tried, like in the tax code, it leads to tens of thousands of exceptions that no one can understand. It never works. Another generic problem with the way the United States government works is the way that money is handled. In private industry, the people who do the work own the money. Private industry will invest money in order to save money or improve efficiency any time they see a chance to do so. It is those investments and improvements which drive the economy and fill market niches. In the government, the people who own the money and the people who use it are separate. The government puts that system in place to try to control expenditures. The problem with that system is that the people who dole out the money don’t understand the work being accomplished and the only way that they can look good is to spend less money. Therefore, every year the money people have the goal of restricting spending no matter the outcome. There is no better example than the military supply system. It is onerous and unwieldy and the deck plate workers can’t understand the system or find what they need. Anyone who has ever worked in a government program knows that the program always asks for more than they expect to use. They also save money until the end of the fiscal year in case something comes up. If they spend less than their budget, the budget will be reduced the following year. Therefore, the left over money at the end of the year is always spent on something, no matter how redundant or unnecessary. If you plotted spending by month, you would find every government agency spends huge sums in September before the close of the fiscal year. It is built into the system. It wastes vast sums of taxpayer money. Universal government-run health care will be inefficient and wasteful. All government programs are. Any one who says differently has no experience with the government.

Pharmaceutical companies, medical equipment companies, medical service companies, and health care in general, is better in the United States than anywhere else in the world. I have heard the arguments using statistics about longevity and birth rates deaths, etc. But sensible people vote with their wallets. Does anyone leave the United States for anywhere on the Earth looking for higher quality care? People go all the time for cheaper care but not for better care. Pharmaceutical companies and medical equipment companies are not altruistic. They are in business to make a profit. Most of the advances in medicine, prosthetics, and equipment are developed in the United States and marketed around the world. If you take away the profit motive, those developments will slow to a crawl. The only reason that pharmaceutical companies invest so heavily in research and development is that they stand to make profits when successful drugs are marketed. If that profit potential is taken away, only government research, funded by tax money, will continue.

The very basis of the success of the United States is the market system. It is the best system ever developed to provide incentive for hard work and new ideas. The fact that the individual who works hard or develops a better product receives the benefits of his/her hard work or ingenuity is the thrust behind the success. People do not work hard when there is no incentive to do so. It is the reason communism and socialism always produce poor economies. If I work twice as hard and receive the same benefits, it is only a matter of time before I work down to the lowest level which allows me to keep my job. It brings up more philosophical questions. If I have been a producer, worked hard my entire life, and contributed to society in good behavior and tax revenues to the government, am I entitled to more benefits than the person who did not work and lived off the government (my earnings)? If the Democrats answer is no, why would anyone work? If everyone gets the same thing no matter whether they work hard or not, welcome to the Soviet Union. Some people will say it isn’t fair to have some with more benefits than others. I believe it isn’t fair to those who work hard and produce to be restricted in their benefits to the same level as those who don’t. At the same time I say that, I also say that there is clearly some base line level of care that all citizens should be receiving. Notice I said citizens. No one who is in the country illegally is entitled to a dime of publicly funded health care. It is insane to provide that kind of incentive to people to sneak into the country.

In summary, universal government-run health care will lead to poorer quality physicians, lesser paid assistants, rationing of health care based on broad-based rules not on individual needs, less new products and medications, and inevitable inefficiency and waste. It is a terrible idea and flies in the face of the very system that made the country great.