Free...But the Patient Doesn’t Get Well

by Lawrence W. Reed

       If government ever does to health care what it has done to the Postal Service, we will be well down the road to contracting the national illness known as “socialized medicine.” With so many regulations already, it’s arguable that we’re halfway there now. We’ll know we’ve reached the end of the road when doctors become federal employees and medical care is “free.”
       What’s wrong with socialized medicine? A friend of mine put it more concisely than I’ve ever heard it put before. His name is Dr. Roberto Calderon—he is a radiologist in Managua, Nicaragua.
       Dr. Calderon didn’t just answer the question with exotic theories. His insight is derived from a decade of experience, from a time when the Marxist Sandinistas ran his country and tried to put the state’s bureaucracy in charge of almost everything. He saw socialized medicine from the inside and argues forcefully that it doesn’t work for the following five reasons:
       1. The patient can’t choose the doctor. The bureaucratic process makes the important assignment of which physician shall treat the patient. After all, he who pays the piper calls the tune. There’s little room for free choice—for shopping around—for switching from one doctor to another—when medicine has “to go by the book.” Too much freedom for the patient makes life difficult for the bureaucrats—they already have more than enough paperwork with which to deal.
       2. The doctor can’t choose the patient. Assignments are assignments under socialized medicine. Referring a patient to another doctor is an unnecessary complication—an evasion of responsibility—and it screws up the system. Because medical services are made “free” by the state, demand for them goes up, which means that every doctor quickly becomes overbooked and overworked. So, doctors receive their order: just get the job done whether you like the patient or not and whether or not you are suitable for him.
       3. The doctor gets paid at the end of the month regardless of what or how well he did. Even an eighth-grader understands why this is a prescription for high cost and poor performance. What in the world makes socialists think that people work harder and better for some faceless bureaucracy than they work for themselves?
       4. The patient doesn’t get consoled. Dr. Calderon told me that it was common in Sandinista Nicaragua for patients to complain that “the doctor hardly speaks to me; he just says to sit there and be quiet.” Ever since the Hippocratic oath was written, it has been regarded as an important, even vital, role of the healer to provide comfort, reassurance and a positive mental attitude to the sick. This gets lost when doctors, in effect, become short-order cooks in an uncompetitive, state-run, medical soup-kitchen.
       5. The patient doesn’t get well. That’s exactly the way Dr. Calderon put it, but he really meant that far too many patients under socialized medicine are “chronically sick” as a direct consequence of the previous four points.
       Moreover, socialized medicine inevitably means that the right equipment—and medicines—and physicians—aren’t available at all or are simply not at the right place at the right time. People go on waiting lists to have operations performed, and many of them die before they ever get to the head of the line.
       The only consolation the patient gets from all of this is that he won’t get a bill in the mail. His taxes—and the taxes of everybody else—pick up the tab. All of this misery and agony is for “free.”
       All things considered, I’d rather rely on freedom, not government, to cure the ailments of medical care.

Chapter 7
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