National Health Care - my take

I just finished my rotation in family medicine in a small community outside Portland where I had some interesting discussions about health care reform. The big issue that sets doctors one side of the political fence is national health care. Historically the medical community in the US has been strongly opposed to it, priding itself on freedom and innovation that comes with a more free-market approach. Of course, we do have government-run health care in the US (medicare, medicaid, the VA, and health plans for government employees), but we refuse to extend membership into these systems to the public at large. Obviously many political and economic interests are at stake in keeping the system largely private for the majority of citizens.

My own personal opinion on the matter is that national health care (single-payer system) is the way to go, although I do not profess to really understand all the complicated aspects of health care and policy relevant to the issue. I also recognize that the free-market approach has some obvious advantages, the most admired probably is technological innovation. Nevertheless this is my reasoning, briefly.

1. Health care is not a product like cars or computers and so we cannot expect the free-market to provide the most efficient, high-quality, and cost-effective system the way it does for consumer goods. There are many ways in which health care is really not a regular consumer good. Here's one example: we understand that the profit motive is key to delivering excellent products, and so we are more than willing to accept that some people are going to get very, very rich if they make a really good product. Yet the public has mixed feelings when the same logic is applied to doctors and biotech. Frankly, we find it repellent that somebody is getting rich off of people suffering. Another example of the difference is that in a free-market the consumer drives product development (demand). This principle applied to health care would mean that more and more of our resources will be targeted to the aging baby boomers - those with money. Such as system, however, will divert resources from children, which is a far more rational investment of health care resources from a public health stand point.
2. Fortunately we live in a world with several wealthy, developed countries, each with their own type of health care system. The vast majority are socialized systems - our fee-for-service, free market approach is actually the exception. We should embrace American ingenuity by all means, but a thinking person who has done a little reading cannot but come to the conclusion that socialized systems are better in terms of overall health markers (longevity, infant mortality, etc.) and resource use per capita than ours is. We spend more than twice that of the next developed country (Switzerland) per person on health care and still leave 20% of the population without practical access to a doctor. Indeed, the US system is excellent at providing top-tier, high-tech medicine to patients who can afford it. But comparatively speaking it performs poorly from a public health stand point. This may be a logical consequence of privatized medicine, or it may be an unfortunate perversion of the free market. Regardless, the statistics speak for themselves.

Being a patient in the US is like being a diner in a city that only has high-end restaurants. Of course you are going to get great food, but it will break your budget, and a lot of people won't be able to eat out at all, ever. The analogy of a socialized medicine would be a city with no high-end restaurants but a lot of low- and mid-range options that guarantees everyone will be able to afford some place to eat out, but at the cost of having no gourmet options.

American doctors and patients like to berate the Canadian (or other socialized) system because of things like the amount of time it takes to get a procedure done, or the fact that you might have to travel to a large city to get a brain MRI scan. "If our system is so bad, why does everyone come here for their surgery?" I have heard over and over. Sure, if you have money, why not come to the US and get a great operation when you want? A large obstacle to radical health care reform - going to a single-payer system - is our attitude that health care is like a car when it should be thought of as something like national security. We don't let private interests fight our wars because we believe that national security is an interest of the public collective not of individuals - and health care should be the same.