"And for Other Purposes"
APRIL 01, 1960 by GORDON B. LEITCH M.D.
Dr. Leitch is a practicing physician and surgeon in Portland, Oregon, and a former member of the editorial staff of Northwest Medicine.
On December 17, 1959, the Wall Street Journal carried a special article by Paul Duke which stated: "Suddenly and unexpectedly, chances are growing that 1960′s election year Congress will approve some form of compulsory health insurance plan for the aged under the Social Security program. The Eisenhower administration, after long opposition to the idea, is debating whether to propose such a bitterly controversial step."
Thus, in accordance with politics’ foremost axiom—that every event must be resolved into increased power for the political apparatus—the Eisenhower administration weighs the political advantages, in an election year, in advocating a course it long opposed for sound, logical reasons. And thus, with the Forand Bill type of legislation already in the congressional hopper (H. R. 4700 in the House, a companion bill in the Senate), Americans are confronted, for the second time in less than two decades, with deciding whether to reject this latest socialized medicine assault or to lose by default another and most significant segment of their freedom.
Most Americans over the years have tended to regard socialized medicine as something of a bogey. It might happen, perhaps, given the general socialized trend and the continued erosion of that freedom which has enabled America to reach its position unique in the history of the world. But it would be a last phase sort of thing, perhaps accompanying the nationalization of industry.
This judgment, however, failed to recognize the significance of the growing Social Security system. A few courageous people pointed out from the beginning the political implications of the mistakenly called Social Security Act with its assumption of government responsibility for individual welfare (not the general welfare specified in the Constitution) and its device of compulsory "savings" through payroll deductions. But the warnings went unheeded.
Meanwhile, many doctors had been warning that Social Security carried the seeds of socialized medicine, requiring only a declaration of government responsibility for "health," with a corresponding increase in forced "savings" through payroll taxes. Both steps are advocated in the current legislation already cited.
Why Doctors Oppose
It is common knowledge that physicians, almost to a man, are opposed to socialized medicine. But the reasons for their opposition go much deeper than the popular but mistaken belief that doctors are merely pursuing their own selfish interests.
As American citizens, they question the moral, economic, political, and legal propriety of government action to supply individual needs or desires for any marketable item, whether it be food, lodging, medical care, automobiles, entertainment, or what not. In short, are such actions a legitimate function of government as constituted in the United States?
As physicians, they know things about socialized medicine that most others do not; but there are two schools of thought on what to do about it. The first holds that physicians have neither the time nor the facilities to acquaint people with the unpleasant facts of government controlled medical care. Let people learn the hard way, they say, for the record shows that most Americans are unwilling to learn from the experience of others, but insist on finding out for themselves. Advocates of this position contend that it took eighteen years for people to learn about the evils of prohibition, and that after several decades of financial binge they remain unaware that they can’t tax-spend themselves rich.
The second school of thought holds that the people at least should be warned, whether or not they choose to heed the warnings. What are some of the things that doctors know about socialized medicine?1
The Patients Lose Most
First, they know the fallacy of the popular idea that doctors are somehow "punished" under a system of government medicine while patients are not. A good doctor can get ahead under any system of medicine; by his competency he makes or arranges his own security. The poor doctor is better off under government medicine because his livelihood is assured him, and his working conditions are improved. When a socialized doctor puts in his 40-hour week, he is through; he can spend the weekend with his family without giving a thought to patients. Furthermore, doctors retain the great advantage, no matter what the system of medicine, of assurance that diagnosis and care always will be available to themselves and members of their immediate family. Because it is impossible to socialize doctors without simultaneously socializing patients, doctors know that it is the patients who get the worst of the "bargain" in socialized medicine.
A Political Affair
Next, and most significantly, doctors know that socialized medicine is neither a scientific nor a medical affair. It is strictly political.
Other considerations vanish when a politician scents votes; and socialized medicine means votes simply because medical expenses are among the costs that people have trouble meeting. Medical costs are high for two reasons. Many procedures necessary in modern medical care are technical and costly. And today’s prices are greatly inflated, primarily because government—through unnecessary taxes, spending programs, and related policies—takes too large a proportion of people’s earnings.
Doctors, aware that medical costs can be reduced only by deflation and by increased medical efficiency, know that socialized medicine necessarily decreases medical efficiency. Consequently, they know that political promises of reduced medical costs are phoney.
Doctors know, too, that since socialized medicine is neither medical nor scientific, but strictly political, demand for medical attention of all types mounts under such conditions. The system becomes loaded—and overloaded—so that the mechanism for delivering medical care breaks down, thus doubly assuring the poor quality of such care.
In private practice, a physician might see as many as 20 or 25 patients in the course of a full day. But once the system becomes afflicted with politics, the unlimited demand for "free" medical care would require that he see 120 or more patients in the same period of time. To meet such quantitative demand obviously must dilute the doctor’s time and skill if everyone is to receive his share of attention. Thus there occurs an inevitable loss of quality, and medical care becomes mediocre.
But quantity is no substitute for quality. Assembly-line medical attention merely stimulates the patients who are necessarily shortchanged to demand the full treatment they think they need. Thus, demand for additional physician services and related facilities continues to mount, adding to the tax load and the total cost. So, there is initiated and perpetuated a vicious circle of "free" medical care, increased utilization, breakdown of quality, demand for additional facilities, rising costs, more "free" medical care, and so on, without visible termination.
Next, doctors know that in spite of its mediocre quality, government-supported medicine is anything but low in cost.
Under the prevailing market procedure, the patient pays only for the health services he chooses to utilize. But with government controlled and politically dominated medicine, everyone must pay(unless specifically exempted as proposed for certain people in the current Forand-type legislation), whether or not they utilize the services. This is true regardless of any "free" label or other effort to distort the fact.
The intrusion of government or coercion into any market place activity always must be more costly than when the same venture is conducted voluntarily. And the people will have to pay, both directly and indirectly, and go on paying more and more.
People will pay first through increased taxes which cannot be avoided: increased withholding taxes (the Forand-type legislation amends the Internal Revenue Code to scale upward the Social Security taxes over and above the increases already scheduled by law), increased income taxes, and increased hidden or other taxes.
However, taxes are never high enough to cover the costs of something-for-nothing. So people can expect to pay, over and above increased taxes, a supplemental "use" or "service" charge at the time of incurring service or medical attention, as Britishers found necessary, to their chagrin, with regard to prescriptions and appliances.
Then there are the vagaries of human nature which lead to further costs. Whereas a person carrying fire insurance on his house will rarely think of burning down the structure simply "to get his money back," the same person has few qualms about periodically declaring himself sick in order to "collect" on his contributions. Under the impression that medical services are "free," he periodically feels obliged to get his share of this "something-for-nothing." All this burdens the system with extra costs.
Finally, there is still another inescapable cost: the "brokerage" cost of government, the handling charge, necessitated whenever government builds a regulatory fence around any segment of the economy.
Physicians know that high quality medical care, such as Americans now enjoy, is no accident. It results only when two conditions exist: the freedom of both patients and doctors to accept or reject, and the sacred and inviolate nature of a patient’s confidential disclosures to his doctor.
They also know that under any system of government-supported medicine, both these essentials are lost, all "safeguards" and "reassurances" to the contrary notwithstanding. Socialized medicine can exist only when backed by compulsion and regimentation.
Finally, and in some respects the most disturbing to physicians, is their knowledge that the push for government controlled medicine in America comes, not from American sources, but from dedicated collectivists abroad working to attain world-wide socialism through the International Labour Organization with headquarters in Geneva, Switzerland. A hangover from the old League of Nations, it is "affiliated" with, but not a direct part of, the United Nations. It conducts its affairs independently, somewhat in the role of a world super government which turns its grandiose "plans" over to its own member nations, or to the United Nations, for implementation.
The Forand Bill
Against this general background let us examine specifically H. R. 4700, the Forand Bill, typical of efforts to fasten socialized medicine on the United States as a part of the Social Security system.
First, H. R. 4700 is a revenue measure, which amends the Internal Revenue (Income Tax) Code to levy increased taxes on employees, employers, and the self-employed.
Second, it is a clear-cut bid for medical services supported and controlled by the federal government. That, initially, it is limited to so-called annuitants of the Social Security system, and that it proposes to subsidize only hospital, nursing home, and surgical services for this small segment of oldsters, is immaterial. The important point is that, stripped of semantic covering, this Forand-type legislation spells out state medicine—medical care by grace of governmental bureaucracy.
Finally, with disarming honesty, the Bill’s preamble concludes with the significant phrase, "and for other purposes," that blank check provision beloved of all bureaucracies on the march.
While this bill does not go the whole distance now, in keeping with the grand strategy of the Geneva planners and their American cohorts, no one reading the 700 pages of congressional hearings held on the bill during July 1959 can retain the slightest doubt of the eventual goal.
Costs and Other Questions
The one-step-at-a-time strategy is also followed in the matter of raising taxes. No one, including sponsors of the legislation, has any idea what the program would cost. In his 1957 version, Representative Forand guessed it might require an increase of one per cent in withholding taxes as a start. The lower figure specified in the current bill is probably a judgment on the part of sponsors that Congress would rather add to the Social Security "Trust" Fund’s mounting deficits than to further increase the withholding tax in an election year.
Confining the program to Social Security annuitants, and offering restricted medical care only, are likewise proposals "moderate" enough to be politically realistic, that is, not likely to arouse too much opposition. But the death blow to market-place medical care is there, nevertheless.
If the medical needs of a small segment of older people (not all oldsters are under Social Security by any means) is properly a government responsibility, why not the health of those below retirement age? Say those aged 64—or 60—or 58—or 50—or 42—or 35? Why not the health of everybody?
In summary, physicians know what ex-Governor Thomas E. Dewey of New York stated when summarizing the report of a commission which he had named to study the matter: "Socialized medicine is no good. It never was any good. And it never will be any good."
The matter of government controlled medicine, instead of private practice in the market place, is important in its own right as it affects quality and costs. But even more important is this: What happens to America? Where do we go from here?
Freedom or Force?
At stake is the role of the individual in America. Is he willing, as the Founding Fathers envisaged, to accept some responsibility for his own future and that of his family? Is he willing to take the initiative to solve his own problems and join with others in solving those of mutual concern? Or will he pass the buck to the impersonal forces of government? Will he work to improve present medical, business, and government practices? Or will he scrap them all and substitute a system which submerges his own identity to the status of a number in a gigantic bureaucracy, in an impersonal, faceless society of conformists? The physical, economic, and spiritual health of America, perhaps even of the world, depends upon the answer to this question.