Dr. Schwartz, who lives in Scarsdale, N.Y., has been writing an editorial column on important people and events in medicine for Private Practice magazine for more than eight years. Reprinted from Private Practice, May 1988.
The problems associated with socialized medicine can be symbolized by the fate of two children, David Barber and Matthew Collier, who died in early 1988 in the British city of Birmingham.
Both children needed heart transplants to survive. Their parents became so desperate that they sued Britain’s National Health Service to force the NHS to provide the necessary medical care. Their efforts were in vain: Neither child got the operation, and neither child is alive today.
The point is not that those who run socialized healthcare systems would rather see children die than give them the care they need to survive. Rather, the point is that all socialized systems lack one thing: enough money to provide quality medical care and to take full advantage of modern medical technology.
In other words, the propagandists are stretching the truth a long way when they insist that socialized medicine provides a bountiful distribution of all the medical care people could want or need. In reality, medical care is rationed in socialized systems. Managers must decide which patients will be sacrificed because the total amount of care provided is based on the total amount of money available.
J. Enoch Powell, a former British cabinet member who ran the NHS for three years, summed up the situation when he said that the demand for free medical care is infinite and cannot be satisfied by a country’s limited resources. David Barber and Matthew Collier are two depressing examples of what can happen when the demand for care outstrips the supply of money.
Britain is not the only country plagued by the pitfalls of socialized medicine. Until recently, the Soviet Union’s medical system was praised to the skies by Soviet propaganda and by naive Americans who were taken in by that propaganda.
But now that the current Soviet ruler, Mikhail S. Gorbachev, has called for open and honest discussion of his country’s problems, the truth has emerged: Russia’s health-care system is—d has long been—a disaster. Basic medicines are in short supply, while equipment to treat serious illnesses such as kidney disease is virtually unavailable.
For instance, the Soviet media have revealed that the country’s infant-mortality rate in recent years has been two-and-a-half to three times greater than that of the United States. The death rate for all Soviet citizens actually is rising, and many hospitals lack even basic supplies and equipment. These revelations explain why, for most of the past two decades, the Soviet Union hasn’t bothered to report statistics on its infant mortality and death rates.
As more and more of American medicine is socialized through the Medicare program for senior citizens and the Medicaid program for the poor, rationing—the denial of care to save money for the government is becoming evident here, too.
For example, in Oregon, legislators recently decided that the state would not finance heart and liver transplants. Instead, they made more money available for preventive activities such as prenatal care. As a result, a number of Oregon citizens whose lives could have been saved by transplants were told, in effect, to go ahead and die because the Oregon Medicaid program would not help them.
Diagnosis Related Groups
The chief method of rationing care in the Medicare program is the system of diagnosis related groups, under which hospitals are paid a fixed amount to treat beneficiaries. The reimbursements are based on each patient’s initial diagnosis. As a result, hospitals try to discharge senior citizens as quickly as possible because the less time they stay in the hospital, the more profit the hospital makes.
Medicare managers already are trying to introduce a much more radical method of rationing health care by getting as many senior citizens as they can to enroll in health maintenance organizations.
If this effort to boost HMO enrollment is successful, the government will save money because HMOs will receive a fixed amount annually for each member, regardless of how much medical care that member receives. This means that HMOs have an incentive to give as little care as possible. The less care provided, the more money HMOs will make.
One or two generations ago, many people dreamed that socialized medicine would provide every citizen with all the health care he needed or wanted. But history has proved irrefutably that socialized medicine is simply a means of imposing Procrustean rationing on the entire population. In other words, some citizens receive care and live, while others are denied care and are permitted to die as quickly as possible.