Pros & Cons of Socialized Medicine


S.Q. Lapius said “no” for the last time, and punctuated the finality of his mood, by slamming down the phone.


I was busy stirring the fire and getting the new log positioned, and really hadn’t followed the conversation that Lapius had just terminated so vigorously.  I might have asked him what that was all about, but it turned out to be unnecessary.


Lapius sidled over to watch me work, and said, “You will never guess what that was all about.”


“Tell me who you were talking to and I’ll take a shot at it.”


“Ok.  I was talking to Crabgrass.”


“He wanted you to sign another petition to have the Congress repeal  Medicare,” I said, searching for the wildest improbability.


Lapius stared wide-eyed, “How did you know that?” he asked.  “Did you know Crabgrass was going to call me?”


“No.  But I know Crabgrass.  He ran the hammer and sickle up on his flagpole the day Medicare was passed.”


“Yes,” agreed Lapius.  “It figures.  One of the most advanced minds of the middle ages.” 


“But you do agree that government interference does have a stifling effect on the medical profession, don’t you, Simon?”


“Of course I do.  But that doesn’t mean they should scrap programs that help pay for medical care.  It is the way that they do it that should be changed.  After all, we physicians gladly accepted government subsidies to research, hospitals, training of doctors, and medical schools.  We can’t complain about those programs.  They have given tremendous impetus to the entire medical profession.  The medical profession, in effect, has accepted areas of socialization.”


“Are you in favor of socialized medicine?”


“I am in favor of the government picking up the bill for health care, and against any program that disrupts the doctor-patient relationship.”          


“Terrific.  You favor two irreconcilable positions.  In the first place, the bill for health is open-ended.  There is no limit to how much a government can spend for the health of its people.”


“True.  But what else are governments for, or at least our government, anyway, but to insure its citizen’s life, liberty and the pursuit of happiness.  Certainly it follows that to assure these qualities, our government must invest in health, education, and housing, and create the healthiest environment possible for its citizens.  After all, that is what a family does, that is what a community tries to do.  The federal government is simply a higher plane of social organization that should be helpful in these matters.”


“Then why shouldn’t you favor socialized medicine?”


“Because I don’t think it will be necessarily helpful.”


“Why not?  You are being inconsistent.”


“Because it may destroy the medical profession in the process, and without the medical profession, the noble aims cannot be fulfilled.  The first generation of socialization seems to work fairly well because the doctors who have been in private practice are swept into it and apply the principles of service they had applied in their private practice.  But eventually a different type of person goes into medicine, one who is willing to sacrifice some individuality, to make medicine a routine 9 to 5 job.  Personal interest is lost, and as a result the patients suffer.  Medical care becomes mechanical.  The profession tends to become debased over the years.  Treatment becomes administered by codes and statute instead of remaining individualized.”


“How can the doctor-patient relationship be preserved if government is going to institutionalize medicine?”


Lapius shook his head.  “I don’t really know.  Perhaps the best compromise would be an extension of the Medicaid system.


Set a realistic fee for services, and have the doctor submit the bill for services on a monthly basis as he does today.  This will allow patients free choice of doctors, and permit the physician to govern the medical problems of patients, choose appropriate specialists and so forth.”   


“It could be expensive.”


“Everything is expensive.  But they could save money by eliminating the very expensive watchdog bureaucracy that monitors fees and services and utilization.”


“Be realistic, Simon.  No government is going to spend money without finding out where it goes and how it is being spent.”


“They did with Lockheed and the Penn Central.  To make the system work the government will have to trust the doctors more than it does and to trust the hospitals.  Sure there will be some cheating.  But the loss to cheating will not be as expensive as the cost of supervising every iota of medical care.  If you think your patient needs something you will be able to order it, without the concern that some clerk miles away may deem it unnecessary and interfere with the care of your patient by canceling the order.  The systems must be built on faith and trust, and this is where the government has erred.  They have set up a policing system which, frankly, in my opinion, runs counter to the spirit of the constitution, and the precepts on which the nation was founded.  After all, volunteerism is as American as apple pie.  Communities can be depended on to develop volunteer police and fire departments.  Volunteer rescue squads sprout all over the place and do a terrific job.  The spirit of volunteerism must be built into any government system to make it work, and this is being excluded.”


“You favor volunteerism, I take it.”


“Of course,” said Lapius.


“So why do I always have to build the fire?”


“You volunteered, my boy.  You volunteered.”  Lapius said, warming his hands over the curling yellow flames.


“I volunteered?”


“I recall you saying “It’s chilly. Why don’t we have a fire.”