Approximately 2500 years ago Hippocrates, a
physician-philosopher from Greek antiquity, put into
motion one of man's greatest and noblest
achievements--Western Medicine.
The inheritors of Hippocrates’ rational Art--the
physicians of today--are routinely performing such
heroic acts as heart and liver transplants, rapidly
diagnosing and treating heart attacks and safely
treating once lethal infections with an enormous
armamentarium of antibiotics. Even the once
impenetrable realm of the human brain is now the domain
of the neurosurgeon who today removes brain tumors with
his skilled mind and hands.
Because of these and other enormous successes, however,
today Western Medicine is under attack by the very
generations who have reaped her greatest benefits, and
who will also suffer the greatest losses from the
inevitable consequences of this irrationalism.
No rational individual expects government decree to
reverse the earth’s orbit to allow the sun to rise in
the west, to reverse the laws of optics to allow the sky
to turn green, to reverse the laws of gravity to allow a
man to “fall” from the ground up to the Empire State
Building once he has jumped--for government decree to
reverse the law of cause and effect.
Yet in America’s high schools and universities, on
America’s televisions, in government offices, in
Congress and in the White House, the idea that
government decree can somehow reverse the laws of
causality, that government decree can change the
fundamental causal nature of the physician-patient
relationship is portrayed as fact.
The idea is that government, through the use of force,
can fundamentally change the nature of the
physician-patient relationship, can enslave physician
and patient at the point of a gun and, by virtue of a
gun, can produce a health care system that is somehow
superior to the greatest health care system the world
has ever seen.
The fact that the greatest, the best health care system
in the world was not produced at the point of a gun, but
in the context of individual freedom and liberty, this
fact is evaded and ignored.
While dismissing the well known horrors of medicine in
the former communist Soviet Union, the advocates of more
state controls in medicine often portray socialized
health care systems in the mixed economies of Europe as
paradigms of virtue. Nothing could be further from the
truth.
In Great Britain, the concept of state-enforced
“universal coverage” has been a reality since 1946, and
it has been a failure. The cardinal feature of British
medicine, as with any state-controlled health care
system, is the “waiting list.”
A prominent German newspaper in the summer of 1999 had
a telling article titled “On the Waiting List Lurks
Death” (1). The article describes the fate of a 38
year-old reporter and father of two who suffered from
coronary artery disease and died while on the “waiting
list” for seven months for a life saving coronary bypass
operation. In America such a patient would have
undergone his live saving operation within 72 hours.
A chairman of the medical staff at a famous British
hospital has stated that overcrowding in British
Hospitals has led to patient’s dying at home before they
can be admitted to the hospital, of patient’s dying in
the emergency department before receiving a hospital
bed, of cancer patient’s waiting up to six weeks for
treatment while their tumors spread (2).
British orthopedic surgeons have admitted that an
elderly person requiring a hip replacement will probably
die before getting to the top of the “waiting list.”
One major reason that the Labor Party won a majority in
the British Parliament in 1997 was its promise to reduce
the number of patients on the waiting list from over
1,000,000 down to 100,000 (3). To date this campaign
promise is far from met.
In the nationalized health care system in Canada the
government has shut down hospital wards that provided
needed but expensive chemotherapy and radiology
treatment for patients with cancer (4). Even if
patients with cancer are willing to pay for these
services, they are unable to obtain them. If they wish
to live, they must seek health care in the United States
where more freedom in medicine still exists.
Honest physicians in Sweden acknowledge the horrors of
waiting lists under Sweden’s socialized health care
system. “Every Swede can inform a visitor,” says Dr.
Erik Brodin, a Swedish physician, “about the reality of
waiting lists as part of Sweden’s social medicine” (5).
In the famous Swedish University city of Malmo, for
example, the waiting time for plastic surgery is seven
years, for gall bladder operations the wait is three
years. Diabetics in Sweden sometimes go blind while
waiting two years to get an appointment at Swedish eye
clinics (6).
The health care system in Sweden is often used as a
model of the alleged virtues of nationalized health care
by the most zealous advocates of “health care reform” in
the United States. For obvious reasons, the failures of
the Swedish health care system are evaded.
Between 1986 and 1990 the average five year survival
(medical standard for “cure”) for lung cancer in England
was 6%; that of other European countries with less
socialized health care systems was 10.5%; that of the
United States which still has the freest health care
system was 14.5%, more than double that of England. The
same trend is evident for bowl, lung and breast cancer
(7).
The correlation is clear: the freer (less government
controls) the health care system, the higher the quality
of care. Yet, these data are evaded and never reported
by those who demand more regulation of the health care
industry in America.
Waiting lines are the inescapable sign of price
controls, in health care as well as in any other
industry. A cardinal feature of any socialized health
care system is that health care becomes a rationed
commodity, and medical “waiting lists” are one of the
earliest indications that the state’s regulation of
health care is bankrupt, morally and financially.
Medical services go to those willing to wait the longest
or those with the most political pull. In a free market
system, health care goes to those who value them the
most (8).
A major motive of those who cry out for “universal
coverage” is not the quality and availability of health
care. If the quality and availability of health care
were their concern, then an honest look at reality would
end their advocacy of a system that has proven to
produce the exact opposite of what they claim to be
advocating.
A fundamental motive of those who demand more government
intervention in medicine is the re-distribution of
wealth. It is an attempt to sacrifice the productive to
the non-productive, the healthy to the non-healthy. The
chronically ill, the hypochondriac, the unproductive
worker take out far more than they put in. The young,
the healthy, and the productive worker bear the brunt of
taxes (9).
The inefficiency of government bureaucracy has been
proven time and time again, and medicine is certainly no
exception. Yet the cry for more government intervention
in the health care industry continues.
The moral basis of the
physician-patient relationship is that value is traded
for value, with the standard being the physician’s and
patient’s best self-interest. Replacing the physician’s
and patient’s self-interest with the use or threat of
government force destroys the moral foundation of the
physician-patient relationship and ultimately destroys
medicine. The only one who derives any short term
benefit from this situation is whoever is applying the
use of force.
One of the most tragic effects of state controlled
health care is the phenomena of “brain drain.” No young
bright individual, no dedicated physician who has spent
years mercilessly studying and mastering his art wishes
to be a slave to the government. For a competent
individual, the prospect of sacrificing his talents and
hard earned skill to a bureaucrat who’s only
qualification to rule him is a gun placed in his hand by
politicians is a moral outrage. Such an individual will
never enter the field but will choose a career where
more freedom exists, or, if the state begins controlling
medicine after he has already started a medical career,
such an individual will continue to work in the medical
field until early retirement is possible or has acquired
sufficient skills for another field where more freedom
exists. Ultimately the medical field is left to
individuals who are less and less competent and less
concerned with what happens to their patients.
The phenomena of “brain drain” and the extremely low
morale of physicians has been well documented in the
socialized health care system of England (10). As more
and more physicians leave in disgust, the care delivered
becomes worse and worse.
Today Americans do not even have to look to Europe to
see what a miserable failure government regulated and
controlled medicine represents. American Indians have
had “National Health Insurance” since the 1920’s (11).
The poor quality of health care delivered under this
program is legendary.
In Oklahoma the Indian Health Service can provide care
for only about one half of Native Americans in one area,
clinics are decrepit and dirty and open only 9 to 5,
five days a week, even for emergency care. All this
despite spending $1,800 per individual per year in the
late 1970s--the average figure for all Americans during
this time was approximately $740.
Medicaid and Medicare provide another example of the
failure of socialized medicine in America. Despite
projecting a much slower rate of increase, the
government spent $24.9 billion dollars for medicaid/medicare
in 1970 and $280 billion dollars in 1990. This is one
of many examples of how unrealistic spending projections
by the government really are.
Despite such enormous increases in spending, the
rationing of services under medicare/medicaid has
already begun. Typical reimbursement for medicaid/medicare
is currently 80%. There is mounting evidence that
medicare/medicaid rationing has lead to increases in
patient mortality rates (12).
HMOs are government controlled and subsidized entities
and provide the latest example of what happens when the
state attempts to nationalize the health care industry.
As is currently occurring with HMOs, the typical mode of
operation of those who cry out for increased government
control is to first destroy capitalism and replace it
with a government controlled and subsidized entity
(HMOs, Managed Care, medicaid/medicare). Once the
inevitable failure of these state controlled entities
becomes too obvious to continue to evade, their
advocates begin to cry that they are actually examples
of the failure of capitalism and demand more controls,
more servitude and slavery, more government “oversight”
(13).
This is precisely what is now occurring with HMOs under
so called “HMO reform” and with medicaid/medicare under
so called “medicare reform."
HMOs are increasingly denying claims and have attempted
to restrict patient choices by imposing “gag rules” on
physicians which prohibit physicians from even
mentioning possible alternative treatments that are
deemed “too expensive” (14).
The real function of HMOs, as with the bureaucracies
controlling and implementing socialized medicine in
Europe and the former Soviet Union, is the rationing of
health care. As with any system that promises to
deliver a “free” good or service, socialized medicine
initially causes an explosion in demand with the
government ultimately rationing the good or service.
This is the point in the evolution of socialized
medicine that America currently is in.
Bureaucrats working for such government agencies as HCFA,
COBRA, FDA, DHHS, Medicare and Medicaid, HMOs etc. have
and continue to replace freedom in medicine with complex
and unintelligible statistical models attempting to
determine the “true medical needs” of present and future
generations of Americans (15). The government
controlled and sponsored entity that is to implement all
these controls is to be the HMO, the latest Trojan Horse
for socialized medicine.
The present health care system in the United States is a
far cry from what it was in the late 19th and early 20th
century. This period in American history was marked by
unprecedented freedom, in medicine and across all
industries. During this period anesthesia was
discovered, opening the door for modern surgery.
Medical giants such as Drs. Osler and Halsted
established the American system of training the best
physicians in the World, Dr. Harvey Cushing pioneered
modern brain surgery and two physician brothers moved to
untamed land in central Minnesota and in a few years
built the Mayo Clinic, one of the best medical centers
in the World.
American physicians today no longer enjoy the freedom of
physicians one generation ago before Medicaid and
Medicare opened the door for socializing America’s
health care system. The physicians of one and two
generations ago developed antibiotics, eradicated
smallpox, pioneered open heart surgery, organ
transplantation, and so the list goes on. America’s
present health care system has suffered a great deal
from the incremental socialization of medicine and the
degree to which this incremental assault on medicine is
suffocating innovation and progress is immeasurable.
Under “managed care” (HMOs, PPOs, etc.) the late 19th
and early-mid 20th century physician-scientist-medical
pioneer is slowly being replaced by bureaucrats who’s
sole purpose is to “cut costs”, to ration medical care,
to ensure “compliance,” to literally stifle and destroy
innovation.
The original American concept of freedom does not mean
the freedom to enslave physicians, to loot, to take by
force the productive efforts of others. The moral
foundation of America is the principle of individual
rights, which includes the individual rights of
physicians. As the producers of health care, physicians
have the moral right to practice medicine freely,
without government coercion or force. They have the
right to practice medicine on their own terms without
the constant threat of coercion, the constant threat of
the loss of their right to life, liberty and the pursuit
of happiness. Health care is not a right (16). To claim
that one man has a right to the products, to the goods
and services of another is to simultaneously hold that
it is moral to enslave the individual who produces that
good or service. It is the erosion of the concept of
individual rights—the individual rights of
physicians—that is responsible for the decline in the
availability and quality of health care today.
In a moral inversion, Washington has recently declared
open season on physicians (17). The justice department
and the FBI have joined ranks in prosecuting physicians
under the draconian criminal provisions of the Kennedy-Kassebaum
Bill passed in 1996. It has become politically
fashionable to blame physicians for the gross failure of
socialized medicine under medicare/medicaid.
The physician-patient relationship is one that is based
on the principle of mutually beneficial trade between
physician and patient. This requires that the producer
of medicine—the physician—exercise his natural right to
act independently and freely in accordance with his own
best judgment. This requires that the patient exercise
his right to seek health care in accordance with his
best judgment. The moral foundation of this
relationship is the principle of trading value for
value.
The principle cause of this
relationship is not the patient’s need, but the skill
and ability of the physician. Socialized medicine and
its various acronyms (HMO’s, managed care, PPOs, etc.)
destroys the causal nature of the physician-patient
relationship by attempting to enslave physician and
patient.
An individual can only act in accordance with his
nature. By waving a gun in the air and decreeing that
the laws of nature are to reverse, the government cannot
change the fundamental nature of the physician-patient
relationship—it can only destroy this relationship and
ultimately destroy medicine.
Such free market “reforms” as Medical Savings Accounts
and 100% tax-deductibility for medical expenses and
insurance premiums offer America a practical and moral
means of improving the quality and availability of
health care. These free market reforms hold the promise
of restoring the integrity of the physician-patient
relationship and improving the quality and availability
of health care for all Americans.
REFERENCES
1) “On the Waiting List Lurks Death,”
Frankfurter Allgemeine Zeitung, Christian Schubert,
September 1, 1999.
2) “The Health Hazards of Government-Controlled
Medicine,” The Intellectual Activist, Llewellyn H.
Rockwell, Jr., volume I, number 10, March 1, 1980.
3) “On the Waiting List Lurks Death,”
Frankfurter Allgemeine Zeitung, Christian Schubert,
September 1, 1999.
4) “The Health Hazards of Government-Controlled
Medicine,” The Intellectual Activist, Llewellyn H.
Rockwell, Jr., volume I, number 8, February 1, 1980.
5) Ibid.
6) Ibid.
7) “On the Waiting List Lurks Death,”
Frankfurter Allgemeine Zeitung, Christian Schubert,
September 1, 1999.
8) “The Health Hazards of Government-Controlled
Medicine,” The Intellectual Activist, Llewellyn H.
Rockwell, Jr., volume I, number 8, February 1, 1980.
9) “The Health Hazards of Government-Controlled
Medicine,” The Intellectual Activist, Llewellyn H.
Rockwell, Jr., volume I, number 10, March 1, 1980.
10) “The Health Hazards of Government-Controlled
Medicine,” The Intellectual Activist, Llewellyn H.
Rockwell, Jr., volume I, number 10, March 1, 1980.
11) “The Health Hazards of Government-Controlled
Medicine,” The Intellectual Activist, Llewellyn H.
Rockwell, Jr., volume I, number 8, February 1, 1980.
12) “Quality and Equity in Dialysis and Renal
Transplantation,” The New England Journal of Medicine,
Norman G. Levinsky, M.D., volume 341, number 23,
December 2, 1999.
13) Ibid.
14) “While Rome Burns: The Immolation of
Medicine,” The Intellectual Activist, Paul Blair, volume
10, number 1, January 1996.
15) “The New Health Planners,” The Intellectual
Activist, volume I, number 19, August 1, 1980.
16) “Health Care is Not a Right,” Leonard
Peikoff, pamphlet published by Americans for Free Choice
in Medicine, 1994: http://www.afcm.org/hcinar.html.
17) “While Rome Burns,” The Intellectual
Activist, volume 10, number 1, January 1996.
Dr. Richard Parker, a
practicing emergency physician in the Dallas, Texas
area, is a senior writer for the Ayn Rand Institute in
Marina del Rey, Calif. The Institute promotes the
philosophy of Ayn Rand, author of Atlas Shrugged and The
Fountainhead. He is also a writer and editor for
Objective Medicine, an site devoted to presenting
intellectual fuel to doctors and other rational
individuals who wish to contribute to reversing the
destructive nationalization of medical endeavors. You
can visit Objective Medicine at
http://www.objectivemedicine.org.
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