by David Alway, MD
In thinking about socialism and medicine in the United States let’s adopt socialist point of view and ponder some logical conclusions.
Injustice Exists
The socialist notices that some people are starving, don’t have adequate shelter, or are relatively uneducated. He also observes that others are very well off, having access to the finest meals, enough money to buy grand homes and are well-educated. This state of affairs, he concludes, is unjust. After all, many of these people are in bad circumstances through no fault of their own or are in good circumstances through no effort or merit on their part. Why should there be such injustice?
So what are we to do about it? The socialist view is that we should we try to evenly distribute everyone’s money and assets – so that each adult has the same or similar amounts.
Consequences
The most ominous issue relates to what kind of government we must have to be able to count and redistribute everyone’s wealth.
What if some people resist this grand undertaking, deciding that they wish to keep their wealth? This, of course, will have to be treated as criminal activity, lest others get the same idea. Jails, police and investigators will be needed to keep these tendencies in check.
And who can be trusted to have control over an entire nation’s wealth? Won’t those in charge do as they will with the money, find ways to keep more of it for themselves, or even run the country as their personal fiefdom?
And what of the total wealth of a nation? In our socialist scenario, people who take no risks and who do not work hard will be given the same as those who do. So what is the motivation to take risks or to work hard? What is to prevent them from slowly reducing their output, their motivation, and their interest in productivity?
And what shall we do with people of ability and drive who decide to leave the country? Aren’t they depriving the country of ‘justice’, since they are taking the wealth that would result from their productive abilities out of the country? Will emigration become illegal?
This simple idea of attempting to ‘correct’ perceived injustices in the world has resulted in some unfortunate consequences. We have an autocratic government with great power over poorly motivated people and a poor rate of production.
So Let’s Rethink This
This whole set of results could have been avoided had we thought more deeply about the problem in the first place. Yes, there are injustices in the world, but systematic injustice on a massive scale is created by attempting to redistribute wealth, without regard to merit. And it creates a dangerous concentration of power in the government. In addition, we have attempted to redistribute something (wealth) the source of which we really did not understand.
In the end, we killed the very source of wealth: the individual who is seeking his own wealth and happiness.
The system that allows individuals to be free and to keep their own property is called capitalism. Capitalism has an unmatched ability to create wealth and improve everyone’s standard of living. The capitalist recognizes that people are not psychologically like ants, selflessly sacrificing themselves (like drones) for the state or state leader (a stand-in for the queen of the colony). People can become motivated, though, to actualize their potential and become inventive and spectacularly productive.
What About Health Care?
Keep in mind, many people do not understand that health care in the United States is already dominated by governmental controls and government purchasing of health care. At the local, state, and federal levels, there already exist massive controls over physicians, laboratories, medical devices, drugs, hospitals, clinics, storage of patient information with the government itself responsible for 50 percent of all health care spending in the country.
The degree to which the government becomes involved in providing goods and services is the degree to which further socialism is being instituted in medicine. Every bit of money the government spends on health care is money taken from someone else. Government health care is a massive form of wealth redistribution.
In the socialist’s view, no matter how much you paid into the system, you don’t ‘deserve’ any more of it than any other person in the country. But you don’t deserve any less of it either, for bad personal habits like smoking or becoming obese.
If you speak to a socialist, he will probably consider health care to be a right – with the consequence that others (including physicians, hospitals, nurses, etc.) have no right NOT to provide these services. This creation of slaves in medicine will (and has) inevitably lead to health care workers exiting the field or people deciding not to train for it in the first place.
And who will increasingly have power in this system? Not the individual, for his desires are being crowded out. Those with real
power will be government bureaucrats and politicians.
Conclusion
So in the current health care debate, pay attention both to the details of the proposals and to the overarching arguments. If you listen closely you will notice that those pushing for more government involvement are not actually saying that their proposals will work, that the proposals can be paid for, or even that they have read them in detail. They say, instead, that it is simply the ‘right’ thing to do.
There is a choice to be made. One road leads to greater individual rights, freedom, productivity, good doctor-patient relations, further advances in health care, and better lives. The other leads to statism, government control of the individual, falling levels of productivity, a lack of innovation in medicine, drone-like doctors and nurses, and ultimately, more death.
David Alway is a neurologist.
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If free life-saving care is to be provided in the emergency room then it should be for everyone. If I am taken to the ER unconscious, why should I have to pay a large bill when someone else gets it free? I didn’t consent to care.
evinx,
i was not referring to the baucus proposal. the system we have right now is way too expensive; as a conservative individual, it is appalling to me to spend nearly 1/5 of our gdp on a single service industry item. if it is not fixed, the cost of health care services will keep going up because the new technology is not getting any cheaper. even what you are suggesting would require a reform. however way we need to contain cost.
‘Wow! We’ve really forgotten our roots when someone can ask this question. Can you honestly not imagine health care being delivered independent of the government?’ yeah, we had it and it worked so well that we ended up with the current system! in those days we had the snake oil salesmen posing as doctors, doctors were getting paid by eggs and chickens, and we had no standards of practices and patient protection.
Ayse,
Everyone would like less to be spent. That is the easy part.
What evidence is there that a govt reform plan as proposed (either HR3200 or Baucus) would lower costs?
One has to look at how do you lower costs? In the private sector, more competition and innovation force increases in productivity which ultimately lower costs. So now, what govt program has actually lowered costs? I would hope you would agree that simply lowering dr + hospital reimbursement rates is not a viable, long term solution.
ALL OTHER ENTITLEMENT PROGRAMS ARE OUT OF CONTROL! Why would adding or expanding health care lead one to believe it will lower costs? Where is an example? some evidence, please.
Great Article! I couldn’t agree with you more that capitalism is the proper moral system. It is the only system that truely protects the individual to FREELY trade with other individuals and gives every individual no matter what there situation is in life rich or poor the opportunity to a better life. I would much rather live under a system where I am in full control over my own life and being than to have someone else who I didn’t choose make decisions about my life. Important decisions about my health care for example should be between me and the doctor of my choosing not bureaucrats in Washington.
Without the availability of pricing for any and all services & proceedures we will not have this utopia of capitalistic health care that anti-reformers are touting. Provide us with a health care equivalent of the Mulrooney sticker and we might have half a chance. When I go to buy a refrigerator I have more information available to me about the cost and when I will get it than I do going to the doctor for a simple check-up. And if the refrigerator arrives damaged I can return it for another–if the doctor messes up (unless it is a serious and grievous error) I just have to see another doctor and pay even more money to fix the mistake-where is the market place in effect there. If you are in the health care industry are you willing to put your money where your mouth is–how about some time guarantees? How about some refund system when a surgery or procedure doesn’t work? You want true competition–then have true competition-not this smoke and mirrors system you have now.
evanx:
i totally agree that lowering dr./hospital reimbursements would not come even close to solving our rising health care cost – that would be a very ineffective and possibly harmful bandaid, especially if the current system of reimbursement is left unchanged. what i don’t agree with is that seeing gov’t as an evil in the reform discussion. some people blame the gov programs such as medicare and medicaid for the current health care cost mess. i think this is a knee-jerk reaction for it does not address the root of the problem. even in a perfect market environment, the prices would still go up because of the consumer attitudes. in many developed countries, the cost of care is lower not because the services are rationed (because some still have the option to purchase these services out-of-pocket) but the citizens of these countries in general have different expectations from their medical services.
i am not saying that i am in favor of a total gov’t run health care but i believe there should be some form of gov mediation. historically, a perfect-market system did not work well for the medical profession and the patients. what individual physician has the time and money to market him/herself? i personally like a system similar to what david goldhill was offering as an idea in his article in atlantic http://www.theatlantic.com/doc/200909/health-care.
Q: How does Robinson Crusoe enforce his supposed “right to health care (or food or housing or a secure retirement or …)”?
In the socialist system proposed, wouldn’t it be considered unpatriotic to smoke or become obese? Just thinking…
A picture is worth a thousand words:
http://www.sinkers.org/posters/capitalismworksbest/capitalismworksbest.jpg
I don’t think many of the people screaming “Socialism!” at any attempts to fix our system would be happy in a true free market capitalist system. Gone would be government subsidies for medical insurance, medical and pharmaceutical research, and medical education, the fruits of which our doctor caste are allowed to sell back to us at monopoly prices. Gone also would be prescriptions, medical licensing and any other government-imposed restrictions of the free exchange of medical products and services which protect the monopoly rents which are the primary drivers of medical cost in this and every other country, including those with “socialized” medical care. Back in the days when there was no evil “socialism,” doctors earned scarcely more money than housepainters and had to hustle their butts from house to house to generate revenue.
As a chronic pain patient, in a true free market system I could pay $10 bucks for an online consultation with a doctor in India and then order my medications without a prescription from wherever for a fraction of the cost I’d pay here, so why the hell would I spend thousands of dollars for abuse, humiliation, ass-covering, scare-mongering and no treatment which is what I get from the capitalist-induced kleptocratic monopoly system in this country?
Suddenly, if you doctors wanted my business, you’d have to actually be competent and treat me with respect. Now, you can be incompetent, indifferent and abusive, because you have me, and millions of other Americans, by the short-rabbits due to your monopoly over medical care and drugs.
So you want free market? Yeah, this anarchist says bring it on, baby. As the old saying goes, be careful what you wish for, as you may get what you deserve.
“Q: How does Robinson Crusoe enforce his supposed “right to health care (or food or housing or a secure retirement or …)”?”
Robinson Crusoe has the right to everything that exists on his Island right up to the point some capitalist shows up with “men with guns” to claim “ownership” over his island. Up to then, he can sleep anywhere he wants, eat whatever he picks, and freely use whatever medicinal plants he find on the island. He is subject only to the limits imposed by nature, his own abilities, and the technology he has at hand.
Once the capitalist comes along, Crusoe no longer has any “rights” to anything, but the right to work for the capitalist, who claims ownership over the whole isand and all its resources, including all the fish, coconuts, medicinal plants, and real estate. If Crusoe wants to eat a fish, he has to catch at least 6 more to pay the “owner” for the right. If we wants to sleep, he has to pay rent on whatever place he places his head down. The medicinal plants that grow freely on the island are definitely off-limits, and he will have to pay with his labor for the right to use the plants and be severely restricted in their use, as over-indulgence makes him a less-productive worker bee and the capitalist will not allow this.
So that’s how Crusoe exercises his rights, and how he loses them.
Actually that description fits what a socialist would do not a capitalist. You are forgetting two very important concepts that are part of a pure capitalistic society called “property rights” and “individual rights”. Yes between the new individual and Robinson Crusoe they would have to come to some kind of agreement as to what portion of the island they can each have. Once they each have there own portion of the island they are each free to pursue there own livelihood and happiness based on there own ability like getting as much fish, coconuts, medical plants etc. They are also free to trade with one another or not deal with one another at all. If the new individual has a knowledge of medicine and wants to spend his time investigating the medical plants available on the island to help with his own health and Robinson Crusoe he can now offer his services to Robinson Crusoe in exchange for additional fish.
Paynehertz,
Your views on socialism are off the mark, in my opinion, but your views about the current medical system, while hyperbolic, point out many real flaws with the system that should be corrected. You talk about the physicians’ monopoly – we’ll I’m against this as well. I’m ready to eliminate the barriers to a true free market and to take the consequences. I believe this physician monopoly may also underlie why you seem to be getting such poor service for your particular pain problem. (That, combined with a DEA that arbitrarily prosecutes physicians for ‘overprescribing narcotics’, the whole war on drugs mentality, and the lack of objective measures of pain).
In my opinion, it should be legal for you to obtain whatever drug someone else wishes to sell you – with the physician acting solely as adviser (not controller) of such drugs (and that, only if you wanted him/her to be involved).
Did you miss the point regarding Robinson Crusoe? It was pointing out the parasitic view of rights inherent in those who speak of a right to health care.
The point is that rights are meant to be freedoms of action, not guarantees of results. You are supposed to have the right to take actions to preserve your life, to get and keep property, to pursue your own happiness. No result is guaranteed. Happiness is not guaranteed. Those who claim the ‘right’ to having health care provided to them (instead of the right simply to pursue their own health care by voluntary trade with others), are actually claiming the right to force others to provide it for them – at the point of a gun if necessary. So in the end, a ‘right’ to have health care provided to you is a fundamental violation of the rights of everyone. It pits man against man in deep conflict. Not exactly leading to the harmony we are all trying to achieve.
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