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.”