Sunday, February 10, 2008

The problem with Hillarycare

Yesterday I was watching Hillary Clinton give a speech in Maine and the focus was her health care plan. Hillary wants universal health care for all Americans and she wants to pay for it with tax dollars. Under Hillary care, all Americans would have health insurance whether they wanted it or not. Those who opted not to have private insurance would be covered by the government. She thinks this can be done by simply "rolling back" the Bush tax cuts, and if anyone actually believes that they need a heavy dose of reality. The cost of such a system would be astronomical. Look at Australia, which has a similar system, and their citizens pay 50% income tax. So either Hillary is lying or is totally clueless about the facts.

She also said her plan would reduce health care costs by cutting back on ER visits. Again, this is way off the mark. I speak from experience on this issue because I have worked in a government funded socialized medicine system. I can tell you, implementing such a system nationwide would be a disaster for US healthcare. Here's why:

Today, if you get a few cold symptoms like runny nose or sore throat, what do you do? If you're like me you go to the drugstore, pick up the over-the-counter cold medicine of choice and wait it out. Most colds go away in a week or two, and a doctor's visit can be costly. Frankly, it's not worth spending the money to see a doctor about my cold.

The same is said about muscle aches and common pains. We all get the occasional headache from a bad day at work. We all get the occasional achy knee or wrist. It's part of being human. We buy some tylenol and let it get better. Again, no doctor's visit is necessary.

But what if that doctor's visit was free? What if the government picked up the bill? Well, naturally, the number of visits to primary care physicians would increase substantially. Take away the disincentive of paying a bill, and people are much more likely to go see the doctor. This is not opinion, this is fact. Where I worked we did a simple number crunch and found that our patient population averaged just over 6 doctor's visits A YEAR. SIX! And this was a relatively young, healthy, and responsible population. Compare this to the general population and you'll see an astounding difference (I think this number is more like one or two a year). Now, bring in the 47 million uninsured into this system, along with those currently insured but opt to have government coverage instead and what do you think would happen? Naturally, you can imagine the cost involved and the strain on our treasury. Rolling back the Bush tax cuts would cover this for a few days, but that's about it.

In addition, access to primary care would vanish. Even today, you will probably find it difficult to get an appointment with your family doctor within the next few days. But then flood the system with all of these unnecessary government-funded visits, and be ready to wait one or two MONTHS for an appointment. As for those who are sick and need to be seen right now, well they will go to the ER (since there are no appointments available) and ER visits go up, along with costs. This is not alarmism, it's common sense. Folks, when has the government EVER made something more efficient and cost-effective? I can't think of anything. Bureaucracy is expensive. There are a lot of pockets to pad and palms to grease. If you think the pharmaceutical and private insurance industry is corrupt, then look again. They look like seminary students compared to Washington bureaucrats. Yet, Hillary feels the bureaucrats can be trusted more than the private sector.

Just look at Medicare. This is the government's original attempt to dabble in the health care business and it has been a miserable failure. Medicare has become a tremendous financial burden for taxpayers and it gets worse every year, and will continue to get worse as the Boomers ease into that age group. As costs go up, so do restrictions. Bureaucrats implement payment restrictions constantly. How many on Medicare have had trouble getting Medicare to cover a test or a procedure? It's a daily thing. This test is only covered under this circumstance, etc. It's a hassle, and a costly one at that. In addition, payments to physicians get cut. This comes up almost every year. It seems to be the last thing the bureaucrats have left to cut. Do this enough and soon it will be hard to find a doctor willing to accept Medicare. Even today, many physicians LOSE MONEY when they see Medicare patients. And still, the tax burden remains heavy. We've had Medicare for 4+ decades and haven't been able to fix it. We are having trouble providing healthcare to our senior citizens because of bureaucracy, and yet we think we can extend this to every American citizen? The lack of logic and reason is astounding.

So when we have this wonderful universal coverage, and the politicans realize it costs way too much, what will happen? Well, look at Medicare. Restrictions get imposed. Limits on care are implemented. Doctor's payments get cut. And soon, you won't be able to find a doctor to accept this wonderful coverage, all while paying 50+% income tax. Sounds great doesn't it? And when that happens what will the solution be? Well, bureaucrats will do what they have always done, implement more bureaucracy. Universal care would mean full government control, which would mean putting physicians on the payroll as government employees with fixed salaries, no more pay-per-visit. When that happens, access becomes nonexistant. Why would a doctor risk making a mistake seeing thirty patients a day when ten a day is safer and earns him the same paycheck? Ever think you'd see long lines waiting to get in to a doctor? That would likely be a reality.

Call me alarmist, but this is simple truth. When the government subsidizes something it becomes more expensive and less accessible. It's a fact. Our current system isn't perfect, but it's still the best in the world. When people in universal healthcare countries get sick, they want to come to America to be treated. That should tell us something. Folks, once we do this there is no going back. We can't just abolish such a massive government program and have a do-over. Look what happened to Bush when he tried to bring just a little privatization to Medicare. He was slaughtered over it. Once we hang that albatross on our necks, there's no taking it off. Think about it long and hard when you cast your vote this November. We can fix our health care system without government subsidies. Doing otherwise would be a monumental blunder that we will never be able to repair.

I'm leaving this up for a while because I want as many eyes to read this as possible. Spread it around. I am a physician with experience in socialized medicine. It's not the answer.



Dr. J.W.

Aren't you being too logical? A rational post has limited appeal.
Let's get wild.

We Want "Free" Medicine regardless
of its cost! It's all part of the
Vast Left-Wing Dependency Strategy.

Force-feed the general public (the "great unwashed"), to a more malleble Open Society, Open Borders, Happyness pills, Free
Love Groupies, all manner of good things the Vast Right-Wing Rejects.

Autobahns everywhere. The sky's the limit. To hell with Rules Governing Conduct. Who needs rules?
Down with Gubmunt! reb

Anonymous said...

Yeah, yeah!

Down with Traffic Signals,
and Speed Limits. Let's
have some excitement.

Cops eat square donuts!

Oh yaaa...Vote Ron Paul.
Yeah, that's the ticket!

"Loony Tunes"

Allisoni Balloni said...

I'm currently living in Spain and talk to my host parents often about the health care system here. They have payed income taxes throughout all of their working years, and during that time, when they got a prescription, a large part of the cost was already covered. Now that they are retired, all of their medications are free. Ambulance services are also free, as well as home visits from doctors 24 hours a day. My host father is having a problem with one of his legs and yesterday wasn't able to get out of bed, and even on a Sunday they were able to call a medic and she came over and helped him. They have nothing but good things to say about the system. I know that that doesn't cover all aspects of the system, but they have lived with it for a long time and don't have any complaints. It's interesting to observe first hand, as I know you have as well.
Have you seen SICKO? I'm sure that you would just be too disgusted to even consider watching it, but I'd like to know what you thought it if you have seen it, because I thought it did a good job of trying to disprove the seemingly good aspects of a universal system, and in the end it still appeared to be the best solution.

BB-Idaho said...

Poor Spain. We are so lucky with our wonderful free market health care. We are old and on medicare.
Last year we spent $6000 on that,
Part D and supplement insurance.
Did not see a doctor once. Without the Medicare, I figure not seeing a doctor would have cost me
$8500 a year. I agree that government adds needless regs and inefficiencies, but I submit that
government does not pay their CEOs
millions. Nor is the US particularly high in the parameters which measure a healthy population, despite being far and away the most costly system. Small wonder it's a major issue
in current politics.

John Washburn said...

Allison, I think it's difficult to compare the citizens of Spain or other universal care nations with Americans. Forgive me, but Americans tend to be a bit greedy. We have an entitlement mentality and when there is something free available we tend to milk it dry. Universal care in America would be abused just like all other entitlement programs. That is what makes it too expensive. If we were responsible citizens and acted frugal with the tax payers money, then I'd be more apt to support it.

Anonymous said...

Hello, Dr. Washburn,

This is my first time reading your blog. I am interested in this post because I too worked in a similar medical setting you said you had worked in: I worked in a large urban for-profit tertiary hospital in California that also was mostly funded by government programs and our local agency. Because it was founded in the 19th C as the County Infirmary for Native Americans, blacks, other minorities and indigents, the other hospitals in the area would send us all their "undesirables" and they took only the "good" healthy patients with no serious pre-existing conditions and who had private insurance. We were always over-whelmed, but the care was exceptional what with affiliation with one of the nation's top medical schools. All our chiefs had dual roles at the medical school and at our teaching facility.

I agree with you that universal healthcare would be a nightmare with all the abuses it would generate. At our hospital we had some people come in almost every week for every pain in the butt they got or just to "chat" with the doctor who found they had no problem! As it is now, too many Americans abuse their health with drugs, overeating, smoking, sedentery lifestyles, etc. and end up with hard to manage chronic diseases. The American public needs to be educated in proper nutrition and exercise.

I've been to Europe and those people don't have the rates of diabetes and high cholesterol problems despite the fact that they indulge in quite a bit of wine and coffee. They prefer eating fresh food in season and they walk alot. They don't snack between meals on junk food. I didn't see the obesity we have here. Most seemed to be the proper weight for their height.

I think it is OK to have a health safety net for the very young for preventive care, innoculations, screening for public health concerns, congenital conditions, etc. and for the very old who can no longer work. Anyone between the ages of 18 and 65 should be able to work and put something aside for medical emergencies and/or for insurance premiums. We had sliding scale payment programs that were affordable for the working poor, and those people were proud to pay their way according to their incomes. Many were not willing to accept charity.

I think a sliding scale program such as the one I mentioned would be OK, don't you, instead of a completely free ticket that fosters dependency and abuse.

Emilie Garcia
Port Orchard, WA