In the upcoming election this November the question of socialized medicine is likely to play a big role. This issue has been visited and revisited innumerable times in the past, but with the rise of the socialist agenda in this country this concept needs to be reassessed once more. While there is clearly a need for some form of universal health care, that does not mean that universal Medicare or socialized medicine controlled by the government is the right way to go for all of us. In fact, it is probably the worst way to go. Dealing with a huge monolithic organization such as Medicare and expanding it in order to be able to cover all persons in the country would add a gigantic financial burden to our economy. There is no “free lunch” here or anywhere else. Someone has to pay, and that would be the taxpayer one way or the other. By the way Medicare, Medicaid and even the VA for that matter can all be considered forms of socialized medicine. Medicaid is a state run health care program for people with low income. It is funded by the state and subsidized by the federal government as well. The VA Health System is for our veterans and paid for in large part by the federal government though depending on income criteria, whether the illness or injury was service related and other factors, the veteran may be responsible for some costs and co-pays. So as a nation we have already had experience with some forms of “socialized medicine,” and that experience has not always been good.

We all contribute to Medicare during our working lives. Upon reaching age 65 we begin to receive the benefits of the contributions we have made to the Medicare program during our working years. This is the medical insurance program designed to provide health care coverage as most of us start to reach retirement age and will no longer be the beneficiaries of our employment health insurance program. Medicare for all of its faults is an essential program for our elderly population. Without it the great majority of our retired elderly population would have no health coverage at all.

However, the bureaucracy of Medicare is enormous, and a Medicare for All program would complicate this bureaucracy even further. It would also lead to even greater financial deficits and more wasted dollars for a program that is already financially strapped yet crucial to the care of our elderly. More importantly the quality of medical care would likely suffer. In Canada and Great Britain each of which has its own form of socialized medicine, it may be relatively easy to see a family practitioner or nurse practitioner for a simple problem. This may account for some of the popularity of these programs, but for serious problems it could take weeks to get to see a specialist, have the proper testing or procedure done. So it may be a matter of the healthy getting good care or perhaps unnecessary care expeditiously, but the not so healthy getting not so good care. In a study done by the congressional budget office a few years ago comparing U.S. health care to Canadian, a number of interesting things were found. For example, the proportion of middle aged Canadian women who had never had a mammogram was twice that of the U.S. rate. Three times as many Canadian women had never had a Pap test. Less than 20% of Canadian men had ever been tested for prostate cancer compared to 50% in the U.S., and only 10% of Canadian adults had a screening colonoscopy compared to 30% of U.S. adults. This might account for the higher mortality rates in Canada for breast, prostate and colon cancer. From my own personal experience practicing at a major New York City medical center for many years, I saw many patients coming from Canada, Europe and elsewhere for treatment that they could not get in their own countries in a timely fashion.

In a study done by the Fraser Institute in 2016, 63,000 Canadians left their country in 2016 to have surgery done elsewhere. A study published in the New England Journal of Medicine showed that in Canada, despite it’s universal health care system, socioeconomic status had pronounced effects on access to specialized cardiac services. Another study showed that high-profile patients enjoyed quicker access to specialized care.  Moreover, among the nonelderly white population, low-income Canadians were found to be 22% more likely to be in poor health compared to their U.S. counterparts.

I have singled out Great Britain and Canada as examples of socialized medicine with less than desirable results, but most other forms of socialized medicine are similar.

Apart from the statistics what are the real issues as to why socialized medicine is may be bad medicine? Let’s take a closer at some basic points from a patient’s point of view.

• First, although it is great to not have to pay for health care, at least not directly, we as patients always pay a price one way or the other. As I said before “free health care” is not free. Some one has to pay the piper, and we as patients will pay through increased taxes.
• Second, socialized medicine will likely lead to rationing of health care. The bond between you, the patient, and your doctor will be weakened. Your doctor may act as your advocate against the behemoth of socialized medicine, but his effectiveness will be weak. There will only be one game in town, the socialized game. It’s hard to fight the government.
• Third, the government will try to placate you by giving you free eye glasses and gym memberships with the mantra that preventive health care is great, and it is. However, you will be short changed on big ticket items which are more important such as your permitted length of stay in the hospital; your allowed rehabilitation days; what diagnostic tests you can get; which procedures you are allowed to get; which medications and so forth.
• Fourth, your choice of doctors and hospitals will be limited.
• Fifth, and perhaps most importantly, your ability to contest anything about how you are medically treated will be essentially eliminated. The bureaucracy will overwhelm you. What other choices will you have? The answer is none. It will be a one provider system. There will be no competition for your health care dollars. It all goes to the government.

Now let’s take a look how socialized medicine will affect practitioners.

• First, practitioners will essentially become government employees. While socialized medicine may try to instill a sense that the practitioner will still be independent, this will most definitely not be the case. The practitioner may be working for the government as an “independent contractor,” but once again there will be no other game in town. So if you as a practitioner do not like the way care is being rendered to your patients, you have no options.
• Second, medical care will become more impersonal. It will become an issue of quantity over quality. Arbitrary “guidelines” will be established dictating how many patients should be seen an hour. Fail to met the quota and your salary will be affected.
• Third, more errors will be made because time constraints will prevent more thorough evaluations and follow up, but don’t worry malpractice insurance will be covered by the government. The problem with that is that it may be cheaper for the government to pay off a case than defend you against a wrongful accusation.
• Fourth, professional satisfaction will diminish. Being a medical practitioner will no longer be a profession but rather a job and will be treated as such by the practitioner.
• Fifth, like most government run programs practitioners will be overwhelmed by tons of unnecessary paperwork which will only serve to distract the practitioner from the real work at hand which should be to take care of patients’ needs.

So having said all of this, how do we get around the problem of providing good quality care without skyrocketing costs for those of us who have so called “private insurance” and perhaps also for those of us on Medicare, Medicaid or in the VA system? How do we take good care of patients in a way that is fair, sensible, effective, and less expensive than what we are paying for now? How do we do this in a way that is also good for practitioners most of whom at this point are frustrated and demoralized by the complexities, inconsistencies and hardships of practicing in the current systems of healthcare delivery?

More thoughts about how we can set up a health care system or systems that will do just that in following blogs.