Tuesday, May 24, 2005

Sharin' the Hate (of socialized medicine)

The following two stories from across the pond got me thinking about how much I dread and despise the notion of universal, government health care. (Thanks, Scrivener) There are many links, since I wanted to provide some background. I'm not just playing Dixie out my hindquarters on this one.

Here are recent, inciting outrages: "A nine-year-old boy has died after an operation to treat his severe epilepsy was cancelled because Britain's top children's hospital had run out of money." AND "The National Health Service should not have to give life- prolonging treatment to every patient who demands it because that would mean a crippling waste of resources, the Government said yesterday."

These reminded me of another story announcing the Swedish prime minister delayed his hip surgery for 8 months in order to demonstrate solidarity with the common Swede who pays taxes for the privilege of waiting in line for medical aid. Of course, when the press release touting the P.M.'s egalitarianism was announced, no one mentioned how the pain and impediment might affect the quality of the job he was supposed to be doing for his constituents (or that living with treatable pain isn't a humane burden to inflict on anyone in the name of "care"). Here's a Canadian couple who, instead of waiting for the wheels of their system to grind, flew to Belgium and (gasp) paid for their own surgeries by refinancing their mortgage. They call it "the best investment they've ever made."

People gripe and huff about American Big Pharma, portraying the industry as an evil cabal seeking to gouge the sick and vulnerable out of their last dimes. This spin exists despite the fact that drug spending as a portion of health care hasn't increased since 1960 and pharmaceutical management of medical conditions often reduces the need for more drastic and expensive treatments later. Another fact many don't consider is that new drugs or devices can take 15 years of expensive investment before getting to market while many in development never make it at all. Also, since generic drugs can legally be manufactured 7 years after the original is marketed, there is a limited window of time for corporations to recoup their initial investment and make the profits required to fund new research.

Glaxo Smith-Kline wants you to know that Pharma profit margins aren't higher than other American industries who aren't simliarly resented. GSK also posts their own argument as to why price controls stifle innovation and reduce quality of care. But many simply assume that scientists working for corporations, as opposed to universally benevolent institutions like academia or the government, don't care whether their work helps humanity, and these unethical Frankensteins let their money-grubbing bosses' agendas overwhelm their attachment to reason and their vocations.

However, a BIG factor in this debate which I don't see covered enough is that another reason for the high price of American pharma is that we actually SUBSIDIZE socialized medicine abroad! Our Congress has actually passed international trade agreements that mean American pharma can't negotiate decent prices for their products in countries with centralized health spending. If you weren't aware of it, read this Senate policy paper stating, "Many of today’s industrialized countries impose strict price controls on pharmaceuticals despite their developed economies. These price-control policies inhibit fair and equal market access between the United States and its trading partners, causing U.S. consumers to shoulder a disproportionate share of the increased worldwide spending on pharmaceuticals." We've been propping up other countries' still-collapsing, shoddy medical services with Cadillac drugs sold to them at Yugo prices. And that means the prices are higher here in the free market to compensate for the inequity elsewhere.

My takeways:
1) If I'm ill, I don't want any bureau dictating which treatments I'm able to consider. I don't want anyone deciding for me whether I have adequate quality of life to merit its continuance. If I'm willing to pay, and to waive my right to punitive litigatory claims should any unorthodox decisions bring me harm, I want access to whatever I think I need. As we've seen, case-by-case decision-making is not easily accomodated by Central Control. But no one is more alone than in suffering, and it's a time when individual cases and desires must reign paramount.

2) If all medical payment comes from a single piggy bank, bureaucratic inefficiency and corruption become endemic and one-size-fits-all treatment plans are a necessity. Citizens begin to lose touch with the direct cost for health, feeling that health is the gov't's concern alone, taking less and less responsibility for their own choices. Haven't we all seen people take something they didn't want just because it was free? When people spend from their own wallets directly, they tend to make more careful determinations, reducing wasteful expenditures and shopping for bargains on essential components. Individuals across various professions can negotiate trade-in-kind with health care providers, and are more likely to feel the spirit to support private health initiatives and charities which can provide customized health care to those in need.

3) Universal Health Coverage would require a national ID and centralized recordkeeping. For many who say they support the idea, these obvious consequences don't seem important, though I keep hearing them yell about the Patriot Act which doesn't yet reach this level of invasiveness. I don't want anyone who can hack a single database to have access to all my personal data and medical history. I don't want some obscure gov't agency to decide behind closed doors that they can include my information in studies without my knowledge. I don't want them to decide to publish my information to someone who they believe (though I may disagree) has a compelling reason to want it. That could be incredibly corrosive to individual liberty and the much-vaunted, though elusive "Right to Privacy."

4) Most people grit their teeth every time they have to suffer through the horrors of governmental administration. IRS, DMV, and passports are all painful, and sometimes unjust, hassles. People who are currently collecting from welfare, Medicaid, and unemployment make legitimate complaints abouts inefficiencies, inability to redress errors, inconsistency and poor quality among the government employees who simply ride out their tenures to retirement, immune to the personal accountability and performance evaluation common in the private sector. Now, we should put our lives in their hands?

If you want more and more health care news and commentary regarding the benefits of the free market and private health care versus centralization, look at Andrew K. Dart's Socialized Medicine page.

6 comments:

Anonymous said...

Couldn't have said it better myself. Having spent 8 years as a physician in the military (USAF) I have been in the "belly of the beast" as a healthcare provider. All I can say is, if you like what the Feds have done for mail delivery (Post Office) you'll love what they can do for healthcare (Socialized Medicine).

Henway Twingo said...

The part of the many-stomached beast I occupied was within Big Pharma where the corporate and governmental absurdities exceeded the usual quotient of a Vonnegut novel. It's great to get another perspective from the literal (not literary) trenches.

Flightfire said...

What I don't understand about the argument against socialized health care is the fact that we already HAVE it in the United States. People who argue against it don't realize that everyone in our country gets treated, regardless of ability to pay. This occurs in the ER most of the time, because no other doctors are required to take them. In order to have a truly free-market system, you have to be able to deny care for people who can't pay.

As anybody who has been to the ER knows, it is outrageously expensive. They charge about $700 just to walk in the door, and then ER docs usually have to cover their asses so they order a bunch of expensive tests, just to make sure the patient isn't going to die of something really rare when they walk out the door.

Wouldn't it be easier to just assume those costs with preventitive care for everybody, instead of hemmoraging money for poor people who come into the ER. Those costs eventually get passed on to you in the form of higher health care premiums and more expensive medical procedures.

OBloodyHell said...

> Wouldn't it be easier to just assume those costs with preventitive care for everybody, instead of hemmoraging money for poor people who come into the ER

Because there is a clearly defined limit to how much care an ER has to provide. If you need a long course of treatment (either drugs, rehab, or surgeries like heart transplants) those don't get "covered" by an ER's requirements.

Since the sum total expense of all those performed in the US is much greater than the ER expense, it allows the whole system to be fairly humane without being bankruptingly so.

I've been diagnosed with a semi-important heart condition, as a result of the "I be poor without health insurance" ER response to another problem. I don't get the drug treatments for it, because I generally can't afford it (I could, I suppose, but I don't think the life that results from putting literally *all* my money into dealing with that problem would be worth it).

I'm not dying, I'm just more likely to have a heart attack than average. BFD. I'm already well past life expectancy for someone just 100 years ago.

It's my choice (somewhat) and I live with it. I don't blame the medical community for not letting me sponge off them (I'd happily do so, but I don't demand it of them).

Part of the problem with modern life is that all too many people these days are blinkered to the fact that, one way or another, other people don't owe you a portion of their life for your purposes.

If you don't have anything to give them in return, then anything they choose to give you is pure charity, and you have no right whatsoever to demand any of it from them if they choose not to give freely.

Money is someone's *life* -- minutes, hours, days -- in negotiable form.

You get it in return for pieces of your life.

To demand that anyone give up their life for your purposes without recompense is either slavery or murder -- even if it's only a matter of a minute or two.

You have stolen the life from that person, and they will never get it back.

Henway Twingo said...

Nick that's an interesting perspective with a libertarian bent that I can groove to. As to charity, I think it's the most efficient way to provide certain kinds of aid.

Flightfire- Although ER's will treat, many poor communities' ERs close to due financial strain and ambulances are turned away from others. In our system, under catastrophe, you will get care, but it may not be the closest or best. And the ongoing check ups, vaccines, eye and dental, and lifetime medication which are part of most people's idea of comprehensive socialized healthcare are missing here. I don't love the idea of mandating people's behaviors "for their own good." I'd rather provide a better marketplace where they can privately budget whatever level of healthcare they prioritize for themselves, and let people do as they please. In fact, I bet if we offered a full boat of 100% health coverage with the single catch that participants adhered to strict health guidelines, I bet the only ones who'd sign up would be people with regimented health behaviors already, not our enrollment targets. Under those conditions, I think we'd see the uninsured would prefer to remain uncovered and unrestricted.

April said...

Universal Health Coverage would require a national ID and centralized recordkeeping.

Ummmm...this already exists, it's called your social security card and number. You already are in a centralised database. Several, in fact.

I'm all for socialised medicine. Bring it on...healthcare should be a right, not a priviledge.

As someone who was dropped from a health insurance plan (BC/BS) for having the temerity to develop MS, As someone who has been denied healthcare for having a major illness, and then had to go without healthcare for months, while my condition worsened, all I can say is BOOYEAH! for national health.

why do we pay more for drugs developed here than people in other countries do for the same drugs? Big Pharma might not be an evil cabal, but they're damn close. They gotta gouge somebody, right?