- Clinical Professor of Neurosurgery (ret.) and Adjunct Professor of Medical History (ret.), Mercer University School of Medicine; President, www.haciendapub.com, Macon, Georgia, USA
Miguel A. Faria
Clinical Professor of Neurosurgery (ret.) and Adjunct Professor of Medical History (ret.), Mercer University School of Medicine; President, www.haciendapub.com, Macon, Georgia, USA
DOI:10.4103/2152-7806.184580Copyright: © 2016 Surgical Neurology International This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.
How to cite this article: Faria MA. Free market or socialized medicine for the future of US health care?. Surg Neurol Int 23-Jun-2016;7:68
How to cite this URL: Faria MA. Free market or socialized medicine for the future of US health care?. Surg Neurol Int 23-Jun-2016;7:68. Available from: http://surgicalneurologyint.com/surgicalint_articles/free-market-or-socialized-medicine-for-the-future-of-us-health-care/
This is a commentary written in response to an article published in Surgical Neurology International and penned by the retiring neurosurgeon Dr. Clinton Frederick Miller that was highly critical of American medicine. He opines that a major overhaul, or rather overturn, of the American health care is necessary to correct the myriad of alleged abuses he perceives in the system. In his quest for reform, Dr. Miller also made a pitch toward supporting ObamaCare as a stepping stone in the implementation of socialized medicine in the US.[
My friend and colleague Dr. Russell L. Blaylock has already written an excellent rebuttal as far as moral and political implications in Dr. Miller's treatise to the effect “While some of the observations in the article may be correct, the type of liberal/left proposals to solve the problems are harmful.”[
Third party payers (insurance companies as well as the government) are problems because the system is perceived and, in fact, mishandled as if somebody else other than the patient is paying the medical bills. In other words, patients act as if they are spending somebody else's money when they seek medical care. This also makes the system terribly expensive. In the present milieu in the US health care system, the invisible hand of the free market is hampered. I need not mention the cost of defensive medicine because of the adversarial litigious climate in which physicians practice.[
As to the specifics, Dr. Miller alludes to over-diagnosis and over-treatment of breast and prostate cancer, and goes to mention that 85% of men over the age of 60 at autopsy harbored microscopic evidence of in situ prostate cancer, suggesting that this is a benign condition requiring no treatment.[
Dr. Miller then goes on to lambast over-treatment in neurosurgery, and opines, based on a 2007 New England Journal of Medicine study, that conservative treatment of lumbar radiculopathy is as good as surgical treatment with microdiscectomy.[
Returning to more general concerns, Dr. Miller mentions Hippocrates and the Oath, and I am happy that he does.[
Over-treatment and alleged unnecessary medical care, too much surgery, heroic care, all of this happens—but they do not all mean greed and the implied (immoral) profit motive, as ascribed by Dr. Miller, but also the penchant of Americans to live longer sometimes without considering quality of life—after all, somebody else (government or insurance companies) is paying the medical bills! It is not always the doctors’ fault, but the imprecisions of the art and science of medicine and our way of life and our way of thinking. And the American way is not always wrong.[
Modern liberals, who frequently prefer to call themselves progressives (and in the US usually resent the term socialists with the notable exception of Democrat Presidential candidate Senator Bernie Sanders), have also a predilection to compare the US with other industrialized nations when it is deemed politically convenient. Immediately, two items come to mind: The purported statistics of health care and gun violence. Let me state from the outset that selection bias has no place in scientific methodology, and the usage of numbers that usually accompany these discussions brings in a method of science, statistics, that abhors biases. Second, why should the rest of the world be ignored as if they were no part of the community of nations, nations made up of human beings with aspirations, yearning to live in peace, and with the same natural rights as anybody else? I have already discussed the issue of guns and freedom in terms of the history and culture of America and the rest of the world.[
I do not wish to offend our European friends and colleagues. After all, the US is only the culmination of European (Western) civilization. But Western Europe has a largely stagnant, and in some countries, an aging population that has difficulty sustaining itself. Until recently, Europeans have been able to ration health care very efficiently with socialized medicine because of the much more homogenous population and culture it serves. This situation would be very difficult to accomplish in America without establishing an authoritarian government, curtailing freedom, regimenting, and changing the American way of life—very likely for the worse. Scandinavia has had a long tradition of socialistic Nordic tribal welfare that is time-honored, and thus, frequently not abused, serving its temporary purposes (e.g., socioeconomic and moral support) until the afflicted persons get back on their feet. In the US, welfare services are abused as they are largely politically motivated, rather than time-honored social and traditional mores.
In Spain, Greece, France, and the rest, the economies are sinking because of their uncontrolled spending in social (including medical) services they can no longer afford.[
It is worth reiterating that despite the shortcomings, drawbacks, and alleged abuses of the American medical care system, that fee-for-service American medicine is still the best in the world. This is particularly true given our unique cultural situation, the growing and heterogenous population that it serves, rampant immigration, popular expectations, and other political and cultural considerations.
The pharmaceutical industry has also been attacked elsewhere and not always unjustifiably so. The abusive high-price of US drugs has also been cited as a shortcoming of the American “free-market” medical care. But pharmaceutical companies will gradually be paying the price in lost market share, as many Americans who pay for their own medications will buy them abroad via the internet at a fraction of the cost. Further competition from abroad with the development and mass production of high quality, generic drugs will become a pharmaceutical bonanza for patients. People paying for medical care (fee-for-service) and medications from their own pockets will shop for the best prices, which is the free market at work, but education and freedom of choice are essential for the free market to function.[
Third party payers, as mentioned, are a major problem and my concerns are worth repeating: The system is perceived as if somebody else other than the patient is paying the medical bills; thus the free market is hampered. It is abused on all sides and these abuses escalate. Even insurance companies are getting ripped off, but they easily pass the costs to the enrollees, ultimately the patients. This is a problem that, like the other shortcomings mentioned, needs addressing. But ObamaCare is not the answer.[
Socialized medicine in other countries is frequently lauded even by citizens, as in Canada and Great Britain. Why? Because it has become, for many, a national symbol of pride as well as a false measure of security. Only 4% of people are sick enough to need the system at any one time, and when they do they find queues to see specialists, waiting lists for radiographic studies, and surgery, restrictions of services, and various forms of rationing.[
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2. Blaylock RLLast accessed on 2016 Jan 29. Available at: http://www.haciendapub.com/articles/regimentation-medicine-and-death-cre .
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W Jost Michelsen
Posted December 24, 2016, 3:10 pm
I think to discuss this situation as socialist vs capitalist is infantile at best. Just remember that Universal health care began in 1861 with Bismark as well as Social Security, in Germany and still works well. Having experienced the health care system in the U.S. for over 70 years first at my father’s feet and then my own, I think your “free” market stuff has been tested and failed.
Dr. Miguel A. Faria
Posted January 1, 2017, 2:54 pm
I must admit Michelsen’s allegations to my article are concise and loaded propositions, but let’s take analyze those statements logically.
1. Consider his statement alleging that “socialist vs capitalist is infantile at best.” The statement falls flat on its face: Most of the world is dismantling socialism, acknowledging its failures — except for Western Europe that is learning the hard way and has tried but has been unable to throw away this unproductive system because its addicted population clings to it despite failure and bankruptcy!
The rest of the world, except for a few die-hard communist countries, such as North Korea, China (in theory) and Cuba, are going for free market capitalism, including Russia! Michelsen’s blanket statement falls well within several logical fallacy categories, including Braggadocio, Fallacy of Fallacy, and Over-generalization.
2. Consider the generalization, “Universal health care and social security worked in Germany since Bismarck in 1861.” So far, yes, it has worked imperfectly in that nation. Germany has been an orderly, over-regimented nation that until recently has also been a homogenous population ethnically and culturally, so that using it as a model for the rest of the world is what is “infantile” at best or deceitful at worse. I alluded to this in this article.The comparison of Germany, then with the rest of the world, except Scandinavia, is like comparing apples and oranges. This attempted comparison falls within the logical fallacy category of Inappropriate Comparison of Division and Composition fallacy.
3. Consider the next statement: “Having experienced the health care system in the U.S… the free” market stuff has been tested and failed.” Obviously Michelsen has not only based his opinion on his own limits experience; but he also might have read but ignored my arguments or dismissed them altogether without even attempting to rebut them point by point as I did with Dr. Miller. His arguments here fall within the logical fallacy categories of Anecdotal Generalizations, and Failure to honor his Burden of Proof in ignoring or dismissing my previously stated arguments without answering.
The “infantile” remark (Ad Hominem fallacy, incidentally) falls within Michelsen’s end, not mine!