Monday, December 21, 2020

A wake-up call to those pushing for socialized medicine


Author Tom Knighton has just experienced one of the major advantages of non-socialized medicine, and he's profoundly grateful.

Right now ... my wife [is] resting in a hospital bed. Because I’m self-employed, we don’t have health insurance, either.

My loving wife was having some pain and went to the emergency room about 2:00 Friday morning. After a number of tests, the indications were that it was her gall bladder. No big deal. They wheeled her into surgery a short time later and found out the problem was much, much more severe.

It could have been fatal, actually.

They went ahead and fixed it. Now, she’s recovering. It’s painful, but she’s recovering.

On my way home from the hospital last night, I couldn’t help but think about the debate over healthcare yet again. As I said, we know it’s coming.

Some would believe that considering the bill we’re going to be faced with that it would change my mind about all kinds of things. It doesn’t though. Yes, we’re going to have some serious debt moving forward, but I’d much rather have that than some of the alternatives.

See, I don’t blame the bill on the fact that the insurance companies aren’t even more regulated than they currently are. Quite the contrary.

I blame FDR.

It was his administration that froze wages. Because they were frozen, employers had to find new ways to attract employees, so they started adding benefit packages. That included insurance.

Because people began to be divorced from the cost of their medical decisions. As a result, medical costs began to skyrocket.

. . .

“But single-payer would mean there wouldn’t be any bill,” someone might say. Of course, with single-payer, my wife would be dead.

Take the UK, for example. The average wait time for gall bladder surgery in the UK was about 90 days in 2015. That was too long to wait for what was actually wrong with my wife. She wouldn’t have held on for that long, most likely.

In other words, single-payer would have turned me into a single father.

Hard pass.

. . .

Now, I don’t necessarily think people who want single-payer are evil. I believe the vast majority are horribly misguided. They want something they consider essential and they want it for free.

To be sure, most of us do see healthcare as essential to some degree. However, those of us who oppose any single-payer scheme aren’t monsters for that opposition. We recognize the realities of such a system.

Once something becomes free, becomes a “right,” then people will begin to make use of it for every ache and pain. They’re not going to have to pay for it, even a co-pay, so why not?

. . .

Because of this massive influx of new patients, the system begins to bog down. People don’t try to take care of any issues on their own. They just go to the doctor or hospital and expect treatment as is their “right.”

With that system bogged down, there’s only so much you can do to speed it up. Delays for routine but non-life-threatening surgeries pop up. Longer and longer you have to wait.

And then, some people die because while the surgery they were waiting for wasn’t a life-threatening situation, the doctors would only have been able to tell that the real problem was something else once they started operating.

People like my wife.

There's more at the link.

I've seen this at first hand in the third world.  Medical budgets will only stretch so far, so they're applied to "the greatest good for the greatest number".  Primary medical facilities are provided as widely as possible, to cover people's basic needs.  However, due to the need to spend so much money to provide them, there's not enough left over to offer secondary and tertiary medical care (i.e. advanced surgical facilities, expensive medications, etc.) to everyone who needs them.  As a result, they're rationed.  So much money is available each month, or each year, to provide them.  If you need that sort of care, you have to wait until a doctor can see you to provide it, or the pharmacy has enough of the expensive medication(s) you need to be able to provide them (usually because the person ahead of you in the queue is either dead or cured, and thus no longer needs them).

The upshot is that only the "elite" get the advanced stuff.  Elected representatives and senior bureaucrats will get whatever they need, whenever they need it, because they control the purse strings.  All the rest of the people get by (or, all too often, don't) with what's left over.  That doesn't just happen in the Third World, either.  Remember when President Trump contracted coronavirus?  When Prime Minister Boris Johnson contracted it in the UK?  They got top-flight care, no expense spared, whatever they needed, without delay.  Ordinary citizens with the same disease, at the same time, had to hope that a hospital bed would be available when they needed it.  If it wasn't, they got sent home with a packet of pills and told to wait until there was a vacancy, or until they recovered on their own . . . or until they died, and no longer needed further care.

Socialized medicine, because it relies on central funding and administration, always defaults to the level of the lowest common denominator.  Private medicine, because it can charge according to the actual cost and availability of the care it provides, has a profit motive;  it will provide services to anyone who can pay for them.  Tom may have to pay off his wife's medical debt over several years, perhaps a decade or more, but he still has her.  In a socialized medical system, he probably wouldn't.  You've read how he feels about that.

I'm not opposed to a certain level of socialized medicine for the indigent and low-income sectors of society.  However, that can only be at a level that is practically affordable.  Once you start saying that everyone is entitled to everything in medicine, you make it impractical and unaffordable except by rationing it - and some of those who don't get a ration this week, or this month, or this year, are going to die because of that.  The bureaucrats administering the system get to play God.  They're trying to provide "the greatest good to the greatest number":  so if they gave primary health care to ten families, but one person died because there was no surgeon available for the life-saving operation she needed, then on balance, the system has worked - at least, as far as the bureaucrats are concerned.

I hope we'll always have private medical care available for those who can afford it, alongside some sort of subsidized medical care for those who can't afford anything else.  That, at least, gives people a choice.

Let's change the subject for a moment.  This doesn't apply to Tom Knighton or his wife, but it will probably, sooner or later, apply to most of us.

We have to accept that, sooner or later, we're all going to die.  I've already talked to my wife about that.  I've had two heart attacks, and I'm partly physically disabled due to a workplace injury in 2004.  I'm at high risk for certain complications, and am more vulnerable than most to some health risks.  Therefore, I've already informed her that if one of those risks should become reality, I'm not going to beggar her through insisting that we pay for the latest and greatest medical care.  Why should I leave my wife a pauper?  If I know I'm going to die sooner or later, and a health crisis suddenly makes that "sooner", that's just the way it is.  I may not like it, but that's not going to alter the situation.

As a pastor, I saw far too many families spend every penny they had, then go into substantial debt, to prolong the life of a loved one for no more than a few months or a couple of years.  Was it worth it?  Some would say yes, but I'm not so sure.  The financial misery left behind by the deceased lasted far longer than the family's regret at their loss.

Even if private health care can provide a slightly longer period of life, is that always a good idea?  Several doctors told me, while I was doing chaplain's rounds in a hospital, that if they were to develop an aggressive, terminal disease, rather than undergo the latest and most rigorous treatments, they'd simply go home with enough palliative care to take care of the pain, and enjoy their last few weeks or months with their families.  They knew the outcome would be inevitable, and all the treatments would do is prolong the agony.

For more information on that subject, try these three articles:



greggBC said...

We need to take Health Insurance back to the basics. It was originally understood that it would pay for major helth issues that would other wise bankrupt the average person/family. Now because primarily of union contract demands insurance has to pay for daily health needs. It was never intended to pay for office visits and precriptions.

deimos said...

I have to disagree on “socialised medicine” when done properly. I worked for decades in the UK health service and its a very professional and caring service, it’s so good that most medics who want to be cutting edge work there voluntarily.

Five years after retirement I caught a bad case of death and they fixed it, upgraded my heart and returned me to my family. All of this went critical ON CHRISTMAS DAY and yet there were enough experts on hand to revive and repair me.

Of course the whole thing cost us nothing and while I don’t recommend it, it was humbling to be on the receiving end of the service.

The Republic of Ireland are our next door neighbours and have a similar tax level and health system. However the UK system is constantly improved whereas the Irish system is stuck in the 1970s. I have seen it first hand and it’s the primary reason we didn’t retire to Ireland.

boron said...

or pay physicians and surgeons $15 per hour (the old adage - you pay for what you get holds true),
or expand the number of doctors (with no selection you get an uncaring butcher),
or require the patient to get through several tiers of assistants, nurses, etc. before reaching the doctor (delaying what might be urgent necessary care),
or total private care with no government or insurance company assistance (allow the patient to build up totally tax-free accounts for solely medical expenses - use them for nonsense or save up for disaster, as the patient wishes).

Mark said...

Sorry, but this is just wrong regarding what you refer to as "socialised medicine". Your experience in the third world may have given you this view, but the experiences in Australia, New Zealand and Europe are completely different.
In Australia, we have universal health care combined with a private health system. It's your choice as to whether you have additional private health insurance or not (there are government incentives to encourage membership).
The majority of the population use the public system and the services provided are world class. There are waiting lists for some procedures, but these are of a non-urgent nature (such as knee and hip replacements, cosmetic surgery and such like). Urgent cases such as that used in your article would receive exactly the same response and receive the treatment he described.
The vast majority of the A&E services are provided by the public system, so if you have an accident in Australia you'll most likely get great care in a "socialised medicine" facility.
It's the same if you want to see a GP. Many GP's directly bill the consultation so that you don't get charged for the visit. Other GP's make a co-charge, so people have a choice as to whether they go to a doctor for free or they can go to a preferred GP and pay a co-payment.
Referrals to pathology or scans are usually free or have a nominal charge for highly specific procedures. Expensive drugs are covered by the Pharmaceutical Benefits Scheme which subsidises their costs. For example, last weekend there was an article about cancer drugs costing $8,000 per month for patients coming under the PBS and thus reducing the cost to a couple hundred of dollars.
People can still choose to use the private system if they wish, and many do. This is mainly done to get procedures in highly specialised areas, scheduled service dates for procedures, choice of medical specialists, guaranteed private rooms etc.
To debunk a few myths, there are no "death panels", there is no additional services for the "elite", care isn't "rationed", life saving or urgent procedures are immediate, you get the same level of care regardless of age or personal circumstances, there are sufficient resources spread across the entire system (although admittedly like all services, this is more difficult to provide in remote regional areas) to provide high levels of care.
Individuals fund the system by contributing 1.5% of their taxable income to the Medicare Levy (an additional 0.5% is levied for the National Disability Scheme). Those wanting to take out private insurance coverage pay about $350 per month for a couple (this varies according to how long you have insurance, the longer your membership, the cheaper it gets).
There are gripes about every health system across the world. The facts are, that our "socialised" health system provides world class care to everyone irrespective of their financial circumstances. It's what a caring society provides.

Old NFO said...

Concierge medicine is coming...

Unknown said...

a large part of the problem is that the list prices for medical care is skyrocketing because insurance companies have people who's only job is to negotiate bigger discounts from the medical providers (note, bigger discounts, not lower prices), so the medical providers just jack up the list price and give bigger discounts.

I've been saying for years that if I could pay what the insurance companies pay, I wouldn't need insurance (except for extreme cases)

I've seen a bank of medical tests listed at list price of $1000 where they amount they were actually paid was $10. But if I didn't have insurance, I would have been on the hook for the full $1000

Besides the Price Transparency that Trump has been pushing for, we also need a 'cash is king' bill that says that if we pay at the time of service/discharge, we can't be billed more than 1.5-2x what the medical provider would accept from the cheapest (non-government) insurance provider.

That would still leave some room for discounts when they are appropriate, but would eliminate the 10x-100x inflation of list prices.

David Lang

John in Indy said...

Concierge medecine is already here, BUT, FedGov is using Medic/are/aid reimbursement inbthe same way they use student loans as a control mechanism. If you or any student takes ANY student loan money, Feds control all your policies.
In medecine, if a doctor takes K ess from a cash patient, Medicare uses that lower amount as the price from which they discount payments by 75%.
Glad her surgery was successful.
And no, you don't get to stop writing, even if you are dead. You have too many series goingbthat I am waiting for the next book in, and too much imagination and research competence not to start MOAR books!
John Sage

HMS Defiant said...

Back when I was a citizen of California the state used to pay out the nose to give heart transplants to men sentenced to life in jail. The highest paid gov employee was a prison psychologist who was getting $975,000 per year. At the time most of the men in my command were prison employees with mini14s and a will and readiness to shoot said prisoners. CA had a lot of them.

MadMcAl said...

Sorry to say so but the gall bladder surgery argument is pure straw man. If the condition is critical then it will be taken care of as soon as possible and necessary (I have heard about cases were a relative small regional hospital actually flew in a specialist surgeon per life flight helicopter for emergencies). But a gall bladder stones, while painful are not immediately deadly.

Also, as has been mentioned before, there are hybrid systems.
Here, in Germany we have on one side the governmental regulated health insurances (several of them, the government limits what the insurance can take from the insured as an percentage of the income and what it has to pay for at a minimum). Then there are private insurances. The privates are actually cheaper for a single, but more expensive for a family (the government ones have the same price for the single or the family while the privates insure every family member separately) and have a better service. It is not cheap (but cheaper than what I heard about US insurances) but it works.
One thing though is that the government regulates how much the doctors and hospitals can take for necessary visits and procedures. We pay through the nose for voluntary things, but anything that is live saving or even necessary for mental health it is paid for by the insurance.

Bob Gibson said...

To those singing the praises of socialized medicine, tell it to Charlie Gard and Alfie Evans. Oh, wait, you can't because they're dead due to your system. They *might* have died anyway, but thanks to your medical 'gods' they never had a chance.

Mauser said...

MadMacAl clearly doesn't read too closely. Sure, if they had been gallstones, maybe she could have waited, in pain. But the ACTUAL ailment was a perforated ulcer, which was only found because she was able to get prompt medical attention. If she had had to wait for rationed gall bladder surgery, she would have died.

I had a friend under the Canadian system who was put off for his abdominal pain over and over for 6 months, until FINALLY they checked him, and found out he had advanced pancreatic cancer. 6 months of treatment opportunity lost. Probably could have saved him.