Barriers To Health


When a man the size and general girth of S.Q. Lapius gets beside himself there is a lot to contend with.  At the time I didn’t know whether or not to take it seriously, but word had gotten into the newspapers that Lapius had decided to give up his citizenship in the United States and had asked for a visa to go to Russia.  The implication was clear.  He was protesting.  He was going to be the American Solzhenitsyn.


True or not, the item caused a splash, and important people were calling.  The White House sent feelers to find out if the rumor was true.  An agent from the FBI was interviewing neighbors.  The phone rang constantly, and now Lapius was jawboning with a senator, the receiver held tightly to his ear when he wanted to hear something, but when Lapius was shouting he held the mouthpiece of the phone in front of him like a microphone, as if he were addressing the American public.


“I’m not going to tell you anything about my private plans, senator.  Whether or not I renounce my citizenship is a very personal matter.  Why don’t you check with the state department and see if it’s true?  What?  They consider it a confidential matter?  Good for them.  Now don’t get upset, Senator.  One doctor less in America won’t spell the doom of American Medicine.  I’m sure National Health Insurance will get along without me.”


“But trust me, Senator, I won’t leave immediately, not, that is, until I have finished my book.  You didn’t know I was writing a book?  It has a great title.  It will be called the ‘Medical Archipelago’.  The title is reminiscent you say, but what is the book about?”


“The book is about the vast administrative system in which patients, doctors and hospitals disappear into an infinite bureaucratic limbo.  It will describe in detail, the destruction of the system of free enterprise and individual liberty by the government of the United States.  No, I’m not fooling, Senator, I’m deadly serious.  What’s that?  What about the impeachment?  Isn’t that a sign of the vigor of the democracy?”


“Perhaps it is Senator, but in my view it is just window dressing.  The presidency is the last political arena.”


“It was a great show you people put on in the impeachment proceedings, Senator.  Any stranger here would envy us, the way we toss our leaders around, vox populi, town meetings and all that.  But we know better, don’t we, Senator?  You have us strangling in the noose, fashioned by the congress of codes, rules, regulations and legalisms that will ultimately deprive the American people of the best that medicine has to offer.  What do I mean by such outrageous statement?  I’m glad you asked.”


“You are trying to skinflint the public out of decent medical care.  You are worrying yourselves to death about the cost of health to the nation.  Here is the Congress of the United States that has given atomic reactors to Egypt and Israel, that for years paid farmers extraordinary fees to plow under their crops, that has subsidized railroads, trucking and airlines, each in turn, that gives away munitions to friends and enemies alike, that paid 30 billion dollars a year to subsidize an illegal war, that has moth ball fleets of useless ships, graveyards in the desert for outdated tanks and planes, suddenly worried about the cost of health of its own citizens.”


“The government which never to my knowledge had a serious concern about waste, suddenly has become cost conscious when it comes to medical care.  So you have erected a vicious circle of legal barriers that prevents communities from building to their needs.  Suddenly every hospital bed has to be filled; suddenly it is less evil to have patients on stretchers in the hall than to support an empty hospital bed; suddenly it is more serious to have vacancies in the coronary care units than to have a patient die for lack of special care; suddenly you are going to force the patients to buy generic medications instead of trade-name drugs, despite the fact that you don’t have the manpower to police the generic drug makers who will pop up like poppies in Turkey.”


“I am aware of the abuses of unbridled capitalism, but if there has been a successful capitalist industry it is the drug manufacturers who have, by virtue of their research and productions, produced medicines that have saved the lives of millions.  They will surely be dismantled if the results of their research and quality control methods of production can be borrowed gratis by any cluster of businessmen who smell a dollar on the generic market.”


“You are so worried about wasting American dollars on American lives that you have committees that force doctors into conflict, that urge them to discharge patients from the hospitals at the earliest possible moment, yet you don’t permit more hospital beds to be erected even by private investment.  You create monetary incentives for brief hospitalization, and are erecting policing agencies to insure that these policies are being carried out.  You don’t worry about the money you spend on policing medical care as much as you worry about spending it on medical care itself.”


“Suppose there is waste in health care?  What difference does it make?  We should have a surplus of health care, not a deficit.  The nascent ideal of the founding fathers, the credo on which the nation was created, was based on consideration of the individual.  You won’t save the individual by catering to the public at large, but if each individual is properly cared for, the nation as a whole will enjoy good health.”


“In other words, Senator, in your zeal to distribute health at the lowest possible price, you have stifled incentive, imposed a government monopoly, and created a situation where most new medications and innovations in medical instrumentation now originate overseas.  A sad state of affairs for a nation that prides itself on initiative and inventiveness.”


“I don’t disagree with your intention that all Americans should have medical care.  But I am ashamed of your pocketbook considerations.  If you want to distribute health care and subsidize the medical welfare of all of us, then do it.  Damn the expense and full speed ahead.  Since there is nothing else you have to say on the matter, Senator, I think I’ll close off now.”


“What was that all about, Simon?” I asked as if I didn’t know.  “Are you really going to yield your citizenship and move to Russia?”


“Of course not, Harry.  That is a silly rumor.  Besides, there is nothing that Russia can offer me that I haven’t got right here.”