In vetoing the recent legislation to expand federal health coverage to children, President George Bush explained that this was a first step toward socialized medicine. That term--"socialized medicine"--evokes a knee-jerk response in just about everyone. It smacks of government interference in our lives, government selection of our doctors, and an inefficient bureaucratic system resulting in poor care for all.
The facts are to the contrary. Our present health care system is neither cheap nor non-bureaucratic. As University of Washington teacher and emergency room physician Stephen Bezruchka pointed out, we spend more dollars per capita on health care in this country than others do anywhere in the world--by some estimates accounting for half of all money spent on health care worldwide. Yet, by almost all measures of society's health, this country lags far behind--that is, except for spending money for health care.
Our system could hardly be more bureaucratic. Health care insurers insist that we be treated by "panel" doctors. Those same doctors and their administrative staffs spend much of their time trying to persuade health insurance companies to authorize treatment that the doctors deem necessary, or to pay for treatment that was already given. People with long-term illnesses have nightmarish stories to tell about their dealings with the health insurance bureaucracy. Doctors and hospitals complain that they cannot make any money due to inadequate levels of reimbursement by health insurance companies. It is not unusual to see the health insurer pay only 25 percent of a hospital's bill. A recent article in the Los Angeles Times revealed that numerous hospitals in the Los Angeles area were in financial difficulty.
It gets worse. Surveys show that 50 percent of the personal bankruptcies in this country are the direct result of medical expenses. That says nothing of the massive numbers of people who are impoverished because of health care bills or struggling to meet health insurance premiums that rival a second mortgage payment.
It gets worse. In the 1950s, the United States ranked among the top five countries in the world in a variety of indicators of health, such as infant and maternal mortality. Now we know, however, that our health care system is not delivering a healthy society. By nearly every measure of health, the United States population ranks in roughly the bottom quarter of developed countries of the earth. We are the 41st county in life expectancy alone. A child born in the United States has less chance of a long, healthy life than one born in nearly any industrialized country on earth that has a "socialized" system.
It gets worse. Barbara Starfield, a leading researcher and medical doctor at Johns Hopkins University--which houses arguably the best medical school in the country--writes in the November/December 2005 issue of the Boston Review, "Several studies have shown that the third leading cause of death in the United States, after heart disease and cancer, is medical intervention, including both tests and therapies . A conservative estimate of the percentage of deaths in the United States that result from adverse effects of medical treatment is 10 percent. In other words, an estimated 275,000 of the total 2.5 million deaths that are annually attributed to specific diseases, are really the result of harm from medical interventions."
Dr. Starfield was not talking about medical negligence, but about the people who would be alive today but for proper medical intervention.
In short, we are spending much more money than anyone for something (health), and we are getting less of it. What do we have for this payment? A very profitable business: the business of providing health care.
It is undeniable that nearly all of the industrialized countries that rank ahead of us in health statistics have health care systems that President Bush would call socialized medicine.
Our one truly "socialized" system--that is, Medicare--has about a 3 percent administrative overhead, whereas an administrative bite from the health care taken by health insurance companies and large corporate health care providers is 25 percent or above. Critics of socialized systems, such as those in Canada and Great Britain, point out that there are often long waits for elective procedures such as total knee replacements and total hip replacements. On the other hand, no one, regardless of their financial status in those countries, must wait for acute care no matter what the cost, and no one in those countries has to worry about being bankrupted if they contract a catastrophic illness. Health statistics prove that those systems, despite their flaws, deliver healthier populations. In other countries--such as Spain, France, Germany, Japan, and even Cuba--critics cannot point to long delays for elective procedures. Imagine what these countries could do if they could spend the per capita dollars on health care that is spent in the United States.
The health care system in the United States is blessed with the best doctors, medical institutions, research facilities, and the like. We have the best medical schools, as evidenced by the desire of foreign students to be trained here to take their skills back home. Yet there is no question that we are stuck with this expensive, inefficient, and ultimately failing system because of the political clout of the health insurance and other health establishments. Because of the money that these interests have, it is not surprising that no one has challenged Mr. Bush on this assertion. Neither the press nor the pundits seem prepared to challenge this basic assumption that a socialized system is somehow evil.
Imagine a system where doctors could exercise their art and science on behalf of their patients without having to hire large administrative staffs whose job it is to tussle with an insurance company over each recommended treatment. Sure, in such a system most doctors would be salaried employees of some government agency or some nonprofit clinic or foundation. The upside of such a system is that the doctors, presuming that they are adequately compensated, would then not have to spend large chunks of their time waiting on hold to get permission from some nurse who works for a health insurance company to provide treatment.
Certainly it is time to take a serious look at alternatives. Our present system, despite the enormous costs, is delivering neither health care nor health to our society.
James Duenow is a semi-retired trial lawyer with 25 years of experience with medical malpractice cases. Send comments to firstname.lastname@example.org.