Open Forum: ‘Socialized medicine,’ huh?
Posted: November 15, 2012
“So, what do you think of ObamaCare?”
This was a question posed to me sarcastically by a patient, an older man, as he settled into his chair next to my desk in the clinic.
This was a couple of years ago, shortly after I began service as a primary care doctor at the VA, and not long after the new national health-care act was passed.
In the two years since, I’ve had a lot of time to read and to think about my patient’s question, and about the shape of the U.S. health care system in general. To some extent, the American people have now answered this question: By reelecting President Obama, our country has chosen to forge ahead to create a national health insurance plan to serve nearly all Americans. The Affordable Care Act — “ObamaCare,” if you like — promises to improve our health status, while saving money spent on care by individuals, businesses, and the country as a whole.
As an American doctor, I am amazed at the technological advances made in modern medicine. The CT scan and MRI, for example, have enabled us to look deep into the body to make accurate diagnoses.
As a result, we are often proud to say that America has the best health-care system in the world.
But do we really? Are all these technical advances available to everybody, or mostly to those with good insurance coverage? Are our citizens healthier on average than those in other countries? And how much do we spend for the health care we do provide?
According to various surveys, the United States spends about 17 percent of our GDP on health care — about twice as much on average as other industrialized countries. Still, our life expectancy ranks no better than 37th in the world. In 2000, a study by the World Health Organization ranked the performance of the U.S. health-care system 37th among 191 nations.
While the methodology of that study has been questioned, a 2010 study by the Commonwealth Fund found that compared with Australia, Canada, Germany, Holland, New Zealand, and the United Kingdom, our health system ranked last in terms of quality, efficiency, access to care, equity, and the ability to promote long, healthy, productive lives — while spending by far the most per citizen.
Currently about 48 million of our fellow Americans lack health care insurance. Under the ACA, it’s estimated 32 million of them will be covered. Not having easy regular access to a doctor greatly restricts one’s ability to get routine and preventive health care that can prevent medical catastrophes.
When a person without medical insurance is brought to any U.S. hospital emergency room for emergency care, the hospital is required by federal law to treat them, regardless of their ability to pay. Valley Health, for instance, loses about $50 million annually by treating uninsured patients, according to a recent Winchester Star article. How then do hospitals recoup these costs? By passing them on to all the rest of us — often in the form of higher hospital fees to individuals and to insurers. Insurers, in turn, pass these costs on to you and me in the form of higher health insurance premiums.
Until the ACA is fully implemented, the United States remains one of the few developed countries to not provide near-universal health care coverage. National health insurance is an idea that has been kicked around in this country since the days of Teddy Roosevelt, but was invariably defeated by a combination of special interests including the insurance industry and, ironically, the American Medical Association. Yet, we managed to create Social Security under the New Deal, and Medicare and Medicaid in the 1960s.
Classically in a free market economy, goods and services will be available to the customer more cheaply and efficiently when providers are allowed to compete. Generally this is true, but it cannot happen in the same way in the health-care arena. The patient often does not have enough information to effectively choose a doctor or a procedure in the same way that you shop for a banjo. Also, in a system where doctors are paid for each procedure, guess what happens — many doctors act like most people in like circumstances, and order more tests and do more procedures to make more money.
Dr. Arnold Relman, former editor of the New England Journal of Medicine, argues that fee-for-service medicine is the primary driving force behind medical cost escalation over the past few decades. I would also contend defensive medicine — that is, the doctor ordering extra tests and procedures so as not to be sued for a missed or delayed diagnosis, even if unlikely — also plays a major role.
“Socialized medicine!?” you may ask in a huff. Well, what are Medicare, Medicaid, or the VA system but forms of socialized medicine?
Through a comprehensive national health care system, we can be sure that almost all citizens have coverage. It should also cut down on the indirect cost-shifting and in this way eventually hold down the wildfire growth of health insurance premiums that threatens to bankrupt businesses while requiring employees to pay an ever-higher percentage of their health care premiums. Under the ACA doctors also will be rewarded to find ways to hold down costs, rather than the other way around.
It has become increasingly clear in my mind that it is morally and ethically right to make sure all our countrymen can see a doctor when they need to — and not have to worry about whether they will have to spend the rest of their lives paying for it. Frankly, it is downright embarrassing that the United States has not established a national health insurance plan until now.
M. Dean Havron Jr. is a physician and a resident of Winchester.