Wednesday, February 11, 2015

In the Healthcare Debate, Remember the Doctors

[Below is my reply to a comment posted on Paul Mulshine’s column My generation is kidding itself about Medicare]

Since Medicare is far more efficient and cost effective than private health insurance, the answer to the problem of controlling health care costs is absurdly simple. Universal health care for all. Expand Medicare to cover everybody and pay for it through payroll taxes. By including 300+ million Americans into the same insurance pool, the cost of providing health care would be dramatically reduced. Such a huge pool of insured backed by the power of the federal government could negotiate the best terms for medicines and fees for service. Since everyone would be paying into the system there would be no free ride for anyone while the basic social contract to provide care to citizens would be upheld. And the government would not be getting between the patient and their doctor. Rather, Medicare would simply be involved in paying for services while the patient chooses which doctors to see. No more of the in-network restrictions, arbitrary wait times for medications or reams of forms to fill out to give private companies the opportunity to take your premium and then deny coverage. All that would be ended. Doctors would even have to compete with each other to be more efficient to win the finite supply of Medicare dollars. The doctors and hospitals would come crawling to the consumer for a change.

Obviously, I couldn’t answer every point spewed out by VoiceofDemocracy. That would have taken a chapter. Instead, I chose to focus on VoiceofDemocracy’s callous final sentence regarding doctors in my reply:

“The doctors and hospitals would come crawling to the consumer for a change.”

Funny: I never thought of doctors and hospitals as someone I “crawled” to when I’m sick. A few years ago, I had major hernia surgery. Thanks to my talented surgeon, it was done laparoscopically, enabling me to return to work in a few days, rather than spend weeks of a painful recovery. I was always grateful that there were people who went through the grueling process of becoming doctors and other healthcare professionals. When my grandson was diagnosed with Crohns disease—a once-upon-a-time life-threatening ailment—I was grateful that treatments and doctors were available to put him into remission, enabling him to live an essentially normal life.

It’s bad enough that you would corral everyone into a one-size-fits-all healthcare straightjacket, placing everyone into a position of being forced to pay for everyone else’s healthcare, but not being responsible for his own. This is utterly character-destroying. Much worse is your utter contempt for the very people your whole scheme depends on—the doctors, whose careers would be placed under state control. Leaving aside your “slavery is freedom” diatribe, your hateful disdain for doctors reminds me of an observation by Doctor Hendricks, a character in Atlas Shrugged:

[I]n all the discussions that preceded the enslavement of medicine, men discussed everything — except the desires of the doctors. Men considered only the ‘welfare’ of the patients, with no thought for those who were to provide it. That a doctor should have any right, desire or choice in the matter, was regarded as irrelevant selfishness; his is not to choose, they said, but ‘to serve.’ That a man’s willing to work under compulsion is too dangerous a brute to entrust with a job in the stockyards — never occurred to those who proposed to help the sick by making life impossible for the healthy. I have often wondered at the smugness at which people assert their right to enslave me, to control my work, to force my will, to violate my conscience, to stifle my mind — yet what is it they expect to depend on, when they lie on an operating table under my hands?

Of course, getting customers is not a problem for most doctors under any socialized, single-payer scheme. Only in a free market do doctors actually have to compete. The problem under single payer is being overwhelmed. Once healthcare becomes “free,” people flock to doctors on any whim. Why not? Cost is no object—to the consumer. But it is to the government, which will have to control costs. And it will, using its monopsony power. As the only legal buyer as a “single payer,” government officials won’t have to “negotiate” with anyone. It can simply dictate. Doctors wouldn’t have to “crawl to the consumer”: They’d have to grovel before the government.

Related Reading:

The Forgotten Man of Socialized Medicine: The Doctor, Part 1, Part 2, Part 3, Part 4—Leonard Peikoff

Atlas Shrugged—Ayn Rand

How Not To Fight Against Socialized Medicine—Ayn Rand

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