It’s a reprint of a 1993 article, and its main points are still valid, in Frontpagemag.com, by Leonard Peikoff:
Just one of the quotable quotes:
…
As with any good or service that is provided by some specific group of men, if you try to make its possession by all a right, you thereby enslave the providers of the service, wreck the service, and end up depriving the very consumers you are supposed to be helping. To call “medical care” a right will merely enslave the doctors and thus destroy the quality of medical care in this country, as socialized medicine has done around the world, wherever it has been tried, including Canada (I was born in Canada and I know a bit about that system first hand).
…
via On The Fence Films.
Update: TrenchDoc links to an audio program from NPR; it’s an hour long, and not much new, except everyone wants a change but cannot agree where we ought to go.
GD, check out the link on my latest post when you have an hour to listen. The Universal Access folks are lining up.
GD, doesn’t it seem that the barber analogy that was given is pretty close to the actual state of our current healthcare system?
I wondered if anyone else would think that.
You’re right, there is not much that is new… but the public in general and a scary number of physicians in particular really don’t even understand the significance of the Univeral Healthcare rhetoric being tossed around these days.
Thanks for the link.
I couldn’t agree more.
Comparing this to entitlement to a barber is absurdist logic — much like a straw man. Why not entitlement to luxury automobiles?
A problem we have already is that medicolegally we already operate as if people have a right to medical care, but we haven’t established that anyone has a right to collect for delivering care.
Aside from those who “cannot afford” health insurance, there are those who can but choose not to buy it — they’re entitled to health care. There are wealthy retirees who absolutely would not consider paying anything more for their care than Medicare pays — they’re entitled.
Health insurance companies make money by denying health care payments — they’re entitled.
Health care providers give care up front, then struggle to get paid — we’re not entitled.
Sure I’m entitled to health insurance, just like I’m entitled to food. I’m entitled to a comfortable home, or at least the mortgage on terms I choose to afford. I’m entitled to use the roads, and o a car to drive on them. Next election, I’m going to vote someone in who will get ’em all for me. It’ll sure beat working.
Speaking from the patient’s perspective, I have spoken at length lately to people about my visit to England. My friend, Helen, whom I stayed with in England spoke very positively about health care there. She has not had a problem with much, but it also depends on your GP because we’ve also a friend there whose GP refuses to give him more than 2 imigran injections at a time for chronic cluster headache – and that’s a joke. He said that our friend shouldn’t need more th an that, but he’s a cluster headache sufferer….the GP just doesn’t want to spend his set budget on imigran, and Glaxo has continued to have a death grip on the product by constantly going for patent updates and changes. Fortunately, Helen’s GP isn’t like that, and if Helen said she needed it, she’d be given 60 imigran injections a month…which she has needed in the past – that is 2 per day, and that is truly what the FDA considers safe use – 2 in 24 hours. Only the insurance companies in the US have put tigher restrictions and claimed they are put there by the FDA, which is a complete lie – I have entire articles saved on this topic. But you’d be hard pressed in America to get more than 6 imitrex injections in a month’s time.
But getting back to where I started here – Helen is someone who has had to rely very heavily on medical care as she has a history of cancer, has cluster headaches, and her 5 year old son was the youngest ever diagnosed sufferer of cluster headaches at age 3 and sees Dr. Peter Goadsby – the world reknowned expert on the topic at Queens Square in London. Helen also just recently had quite a lengthy hospital stay for a new medical problem. So this positive review of the NHS is not done by someone who gets on with very little need for quality health care…
She also has private insurance through her job, but she finds that she does not need to use that much. She recently was going to have an endoscopy (I think…) and her GI doc told her that when considering to go private or not, you have to figure that the physician is required to work so many days (or however it is setup) for the NHS, so the days they can spend on private practice patients is limited. Therefore, you might wait 6-8 weeks for an endoscopy if you use private insurance, but get in for 2-4 weeks in the NHS. I had to wait more than 2-4 weeks for my own endo with my top notch PPO here! Now this is different than Canada’s health system. When I was in junior high, I actually one 1st place in a forensics competition for best speech, and my speech was on comparing health care systems in various countries. At the time, I compared that of the US to Canada, the UK, and Germany. But these days, many things have changed. When I did the speech, Canada’s system was ideal. However, I don’t really know much about their system anymore – only that lots of Canadians have flocked to the US because waiting lists for doctors and procedures and medical care are too long. I don’t think that this is as much of a problem in England.
Now one area that I know Dr. Crippen and SHP are extremely unhappy with in the NHS is psychiatric care. So I will also say at this time that Helen has not had a need (knock on wood) to use psychiatric services, so she has not dealt with that profession’s issues in the NHS. That’s one of the few areas she has escaped dealing with in all her troubles! And both Dr. Crippen and SHP are “spot on” about the quality of quite a number of ‘nurse practitioners’ in the UK. That system is not at all what it is in the US. Any nurse can take a 2-day certification course and call themself a nurse specialist – and nurse practitioners there are not at all what they are here. They do not require masters level education and certain amounts of clinical and educational time, supervision, and training. So when they bash nurse practitioners, they are bashing an entirely different group of individuals that we do not have in the United States, do to our more advanced regulating.
Recently I realized that if we’re going to have universal health care coverage in this country – as much as I have always thought that was a good thing – I’m now starting to wonder – would that mean that people like me, who really use their insurance for all it is worth – because they HAVE to – would have to move forward with less coverage and way higher costs so that coverage can be universal? I really would like to see health care be accessible to every person – but I’m starting to wonder if my desire to see that happen might conflict with my own best interests… That’s why I like England’s system where everybody is covered at baseline, and then if you want more, you have to pay for more. But the best thing about the NHS is that it doesn’t leave anybody with nothing. In this country, we have a ton of people with nothing. So how about we give everybody something…at least a little something – and then keep on with private insurance for those who can and wish to pay into it. The problem in countries like England is that they see that as discriminatory because they think that it’s not fair that some people should just have to rely on the NHS but don’t get to reap the benefits of private insurance because they can’t afford it. The grass is always greener, honey – is all I have to say to that. At least those people have the NHS and coverage at all. They could be living in the USA where they wouldn’t even get that much. And besides – the NHS is actually far better than a lot of HMO programs!! I suffered with Aetna HMO for 2 months – and had I lived in England and only had coverage by the NHS, I would not have gone bankrupt and would not have nearly had a nervous breakdown because of the problems with the HMO. I don’t propose that we move to a communist state where everybody must have exactly the same – I don’t see a problem with myself paying part of my salary for excellent coverage and using that coverage because my health (or lack thereof) requires that I use it….but what I do see a problem with is people who are uninsured at all. England’s system is ideal – cover everybody at baseline and then allow those who want more and can afford more to continue to have access to it. At least nobody is left completely uncovered – nobody has to die in England because they cannot afford their beta blocker. And that right there makes it a better system.
(Parts of this is copied and pasted from a comment I typed on another blog yesterday. I’ve messed my wrist up and frankly I like how I said it there!)
I think this issue is going to be HUGE come next election. And all of this I’ve written is from my perspectives as a patient. I don’t know what a national health system would do to me as a nurse or as a future nurse practitioner, but all I know is that as a patient – they’ve got it better. I have less than $1000 in the bank and over $6000 in credit card debt, let alone mentioning educational debt. I make a good salary as an RN – so why is this my problem? I don’t go spending money on fun stuff or stuff I want very often. My medical costs, even with excellent insurance, are through the roof. Someone in England pays like ?6-7 for a 60 day supply of imitrex. Even with excellent insurance, I would be paying about $20 for 6 of them! When I got 5 scripts the other day for $39.50, I exclaimed, “Wow! That’s not bad!” and the pharmacy tech laughed and said that usually we don’t hear people give that reaction. I just expected it to be worse – and I remember it being worse on Aetna HMO – I paid $434 for 18 tabs of Amerge because of a screwup on Aetna’s part, and I have never gotten that money back. The system is hard on docs, but it is killing the patients. Just my .02 and some change…
Take care,
Carrie :)
Health expenses are the largest cause of personal bankruptcies in the U.S.
It’s becoming interesting reading to learn who is opposed to universal health coverage. From the vociferous portestations of a minority of physicians, it appears that those opposed believe that living in gated communities, isolating themselves from the “unwashed” who do not have access to healthcare, and choosing to ignore the suffering of those who don’t have adequate healthcare, and so pay with underemployment and unemployment, with homelessness and with spiraling downward until premature death are enough to keep them from the ravages of communicable disease pandemics.
Well, wake up. Those that you label as entitled nasty segments of the surplus population denied healthcare will continue to be carriers of disease. You can condemn them, and you can deny them, but you can’t escape the ramifications of their being untreated.
I have worked for either large corporations or government all my life specifically so I will have good health coverage, both now and when I retire.
I could have made a lot more money working for less-stable employers or by being self-employed, but made the choice to stay insured.
People who are crying about lack of insurance have generally made the CHOICE to either be unemployed or work for a place without adequate insurance.
I am sick of everybody wanting something which I work for, given to them for free.
Why are you all harshing so much on Canada’s universal health care? I’ve been chewing this over for a few days since I first saw it in your blog and I’ve finally come up with a rebuttal. Yes, our system may be “wonderfully universal” but it is flawed. It’s also largely provincial which means each province has it’s own problems and therefore it is difficult to lump Canada’s “socialist” healthcare into one category. The bottom line is that yes our doctors are “slaves” – if you consider slavery choosing a profession (I personally believe medicine is an art) practicing your skills and being successful at it while at the same time being compensated with an amount of money form the government instead of an insurance company. I think that before you start harping on universal healthcare and it’s “costs” maybe you should look at the society you are treating as doctors. People who would rather sue you and get rich because they are “entitled” to than get better. You’ve got a society there that lives and breathes the fact that if something happens to them it is someone else’s fault and that person needs, nay, deserves and requires punishment. We are (for the most part at least) not like that in Canada. This is a completely different country.
If you are injured and you need help you can walk into an emergency room and get help without having to go bankrupt. Our system is different but if you need help, you will get it. The system does work (at least here in BC) so stop making assumptions about it that aren’t true! Please!
“It’s becoming interesting reading to learn who is opposed to universal health coverage. From the vociferous portestations of a minority of physicians, it appears that those opposed believe that living in gated communities, isolating themselves from the “unwashed” who do not have access to healthcare, and choosing to ignore the suffering of those who don’t have adequate healthcare, and so pay with underemployment and unemployment, with homelessness and with spiraling downward until premature death are enough to keep them from the ravages of communicable disease pandemics.
Well, wake up. Those that you label as entitled nasty segments of the surplus population denied healthcare will continue to be carriers of disease. You can condemn them, and you can deny them, but you can’t escape the ramifications of their being untreated.”
This is an emergency medicine blog, sir. We see, treat, and retreat these very “unwashed” individuals every day, 12 hours at a time. We do so happily and often with little or no expectation of even a word of thanks, let alone collecting from them so that we may then drive to our mansions and retire to the drawing room in our smoking jackets. You seemingly want to make some assumed elitism-that you would believe all who question universal coverage share-the cornerstone of our collective professional stand on this issue. If this is the case, you are mistaken.
IMHO, we are all just looking for a better way…
Wow. Talk about burning credibility with your readers. And your perspective on health care seemed so insightful before this post.
The COW said….. “People who are crying about lack of insurance have generally made the CHOICE to either be unemployed or work for a place without adequate insurance.
I am sick of everybody wanting something which I work for, given to them for free.”
Just who are you talking to and about? Are you talking about patients on Medicare? If so, wow, do I have a message for you pal! First, get off your high horse and stop looking ignorant. Don’t you know that almost everyone on Medicare has also worked all their life and paid taxes? Don’t you know that all the years they worked and paid those taxes it was for others benefits? Who the hell do you think you are?
You are the difinition of arrogance.
Raffy, maybe you could offer some insight instead of throwing a little snit.
I think I’m like most docs in that I’m conflicted. I really do want everybody to get good medical care, and universal coverage or socialized medicine would probably accomplish that.
Unfortunately, a move to socialized medicine would probably involve a drop in the overall level of medical care to the lowest level deemed acceptable by the government. The barber analogy in the article is appropriate and has already happened to a large extent with respect to medicine.
Finally I am a solo family doc and as such also a businessman. I have four employees who are great and I try to pay them to reflect that. There is no way on God’s green earth the government can run my practice better than I do. It’s like the productivity difference between the Soviet state-run farms and the tiny family farms. When it’s yours you do everything you can to make it succeed, when it’s the state’s you put in your time and go home.
Jennifer,
I’m not ‘harshing’ on Canadian health care; if it works for you great! But, I do not think the same model would work here, for some of the exact reasons you cite.
Oh, and I cannot let this go uncorrected: N=1 states “half of personal bankruptcies are due to medical bills”, and that’s been refuted before, but here are the links:
NRO
Volokh
No, not unless you rope in a lot of other causes under the ‘medical’ heading.
Also, N=1’s entire second paragraph is demagoguery without substance: no-one here has portrayed patients as anything other than players in this dysfunctional system, and never pejoratively. It’s just an attempt to dehumanize those who disagree with you, so we can be dismissed.
There’s a lot to digest here, and thanks to everyone for their comments to both of these threads.
What I cannot comprehend is why any voiced opposition to an as-yet-unspecified single-payor system is met with such derision by our friends, among others, who do not practice medicine. Goatwhacker hit it square; governmental standards are minimum standards in so many industries and arenas. Water quality, foodstuffs content, educational advancement criteria, etc. I believe that this is what we fear for when we express doubts over a socialized/single-payor/universal system. We don’t doubt our current system needs help/overhaul/slate wiped clean and we would serve the needs of our patients and our profession best if we have a leading role in developing its replacement.
EMTALA likely would no longer be an unfunded mandate under single-payor…
those opposed believe that living in gated communities, isolating themselves from the “unwashed” who do not have access to healthcare, and choosing to ignore the suffering of those who don’t have adequate healthcare
So I get done beating one of my servants for missing a spot on the kitchen floor (I make them lick it clean), and find N=1’s post. Who let the cat out of the bag? It was supposed to be a secret that we’re all Marie Antoinette with a stethoscope.
What a load of crap.
You might want to take care of the “unwashed” as I do… with respect, dignity, compassion, and with my best efforts, then walk in here and join the discussion. After reading your post, I’d judge that your opinion is worth less than the homeless man’s vomit I just washed off my shoes.
None of us are arguing that people should be tossed out into the street to die. What an offensive bit of tripe. You can argue all the social justice you want, but I’d advise removing that marxist-driven hate-the-rich chip from your shoulder if you want to be taken seriously.
One thing I would like to point out is that doctors also speak and see things from the patient’s perspective. We need health care and pay for health care insurance, too.
Greg,
While I am not a doctor – this is the reason why I work so hard to share my story and why I keep both sides of my life on my blog. I am a nurse and a patient. I will one day be a nurse practitioner, and I’d like to work in pediatric neurology. However, I also struggle with some major medical problems. I’m not going to hide them away because I think it is important for people to see that nurses (and doctors) are people, too. I’ve always said that nobody is immune from illness – including health care professionals.
Take care,
Carrie :)
I don’t think universal healthcare will come to the US for a long time, it *is* very different from Canada (and I have lived in both countries). I think the blunt fact is that people in the US who have good salaries will not accept sharing the finite resources (doctors, medicine, equipment, etc.) They have the money, they have the political clout, and the attitude that if someone living below the poverty line, who cant find the American dream of making over 100k every year, then they dont deserve to share their healthcare perks.
In Canada and England they believe more in the common good rather than the scramble to the top. Exceptions include English football fans.
They have the money, they have the political clout, and the attitude that if someone living below the poverty line, who cant find the American dream of making over 100k every year, then they dont deserve to share their healthcare perks.
Tim,
I know this is going to get me the “cold-hearted capitalist bastard” label, but if people can pay more, and choose to spend their disposable income on better health coverage, why shouldn’t they be able to get more? Even many countries with “universal” coverage allow people the ability to purchase private insurance with benefits over-and-above the run-of-the-mill govt. insurance.
People that are dependent on the kindness (and financing) of others shouldn’t be left out in the cold, but neither should they expect to have instant gratification (there may be waits for certain things), or coverage with all the frills. It’d be nice to have Cadillac coverage at a Yugo price… but the money has to come from somewhere.
And going off of that last bit there – some of us do not spend disposable income. Read above to see my financial status and I still have opted for the most expensive health care plan the hospital offers. This is because I know that in my situation, good health care is not optional – I have to have it. I tried doing an HMO plan once to save money, and it ended up costing me MORE because of what the plan did not cover – which was my DME home oxygen that I use for cluster headaches, and at least 4 of my meds, including reflux meds and expensive antiseizure drugs that I take for headaches, etc. They also did not cover the dexa scan I needed to get, so I simply didn’t get one. I didn’t get any xrays or MRIs while on it – only waited until after I was back on a PPO because it was so frustrating – and then I found out I had avascular necrosis after getting those scans – if I’d stayed on the HMO, I might not have caught it for an even later amount of time. Those 2 months I was on that were the worst 2 months of my life.
I’m not knocking people who aren’t offered several options for good insurance, but I am going to say that it really bothers me when people have the option for good health insurance and the money to pay for it, and they don’t even get it. Because then when those people get sick, we all end up paying for them, too, and that’s not right. I do think, however, that for those who don’t have disposable income to pay on health insurance, some type of basic universal coverage would be extremely helpful. I would still want to keep my private plan, but I think a universal coverage basic plan might still benefit people even like me who are in the working middle class and have high health care costs…
Take care,
Carrie
As for N=1’s comments;
“medical bills are a contributing factor in just 17 percent of personal bankruptcies and that those affected tend to have incomes closer to poverty level than to middle class. Moreover, for national health insurance to have an impact, it would have to define “medical” expenses in a much broader way than is now typical of either private or government-funded plans.”
“Medical Bankruptcy: Myth Versus Fact”
http://content.healthaffairs.org/cgi/content/abstract/25/2/w74
And while I realize that the following is a worst-case description the fact that it occurred at all is, I think to most Americans, unthinkable.
” By Mark Steyn “America Alone”
http://www.amazon.com/America-Alone-End-World-Know/dp/0895260786
In 2004, Debrah Cornthwaite gave birth to twin boys at the Royal Alexandra Hospital in Edmonton. That’s in Alberta. Mrs. Cornthwaite had begun the big day by going to her local maternity ward at Langley Memorial Hospital. That’s in British Columbia. They told her, yes, your contractions are coming every four minutes, but sorry, we don’t have any beds. And, after they’d checked with the bed-availability helpline “BC Bedline,” they brought her the further good news that there was not a hospital in the province in which she could deliver her babies. There followed seven hours of red tape and paperwork. Then, late in the evening, she was driven to the airport and put on a chartered twin-prop to Edmonton. In the course of the flight, the contractions increased to every two and a half minutes–and most Lamaze classes don’t teach timing your breathing to turbulence over the Rockies.
How many Americans would want to do that on delivery day? You pack your bag and head to your local hospital in Oakland, and they say: Not to worry, we’ve got a bed for you in Denver.”
A friend of mine said it much more elegantly than I can.
“I don’t agree that health care provision is a ‘fundamental right’. A fundamental right isn’t something we provide, it is something that simply exists or, as in the words of the Declaration of Independence, something we are “endowed with by our creator”. We have the right to life, liberty, and the pursuit of happiness. We have the right to keep and bear arms. We have the right of assembly, and the right to worship as we please. Note that these rights do not entail a moral or legal encumberance on the labors of others, they just require that we leave them alone and let them pursue their freedoms.
There are some rights that do require an investment of our labor and monies – the right to a speedy trial and to a trial by jury comes immediately to mind. However, I believe we have an obligation to our freedom to limit the number of such rights to the bare minimum, lest we all make ourselves servants of the government rather than free citizens. As it is, we work about one-third of the year indentured to the government, as that is how much of our labor is consumed by taxes. I do not favor increasing that level of servitude.
I believe that we, as a compassionate people, should extend heath care provision to those in need. This however, is a charity, not a right. We have no obligation to seek out those in need and ensure they have access to health care, other than that obligation our charitable nature imposes upon us.”
Jim, the thing you’re forgetting is that the above occurence is probably the only time that has ever happened. That’s part of the scare tactics that people opposed to expanding health insurance use. They’ll pick a rare occurence and pretend it’s how the system always works. Think of the horror stories that could also be used to talk about how bad the American system is. It doesn’t mean that it always happens.
The stats for waiting times for certain procedures in Canada are on-line and do make interesting reading (waiting times are under the W section).
http://secure.cihi.ca/cihiweb/dispPage.jsp?cw_page=statistics_a_z_e#W
However egregious the taxation system in this country maybe-I can tell you that unless you have lived in a country where there is no or a inadequate tax base, you will never realize how bad it could reaally be. Everything from the 911 system, the highways that one can drive 70mph without (generally) fearing a texas sized pothole (pun intended) to appear out of nowhere, generally uninterrupted electric and water supply are because of the taxes that everybody hates. And that list does not include healthcare….I am not arguing that the govt should tax us more, it could definetely handle and use those taxes better….