Socialized Medicine
By Dan Smoot
Reprinted in 2000 from The Freeman, April, 1960,
with the permission of the Foundation for Economic Education,
Irvington-on-Hudson, NY 10533
IN 1884, Prince Otto von Bismarck, Chancellor of Germany, instituted the first modern program of socialized medicine. It was called compulsory national health insurance.
Bismarck hated communism. His motive in introducing socialized medicine in Germany was to buy the loyalty of the German masses as a means of keeping them from becoming communists. Bismarck adopted "nationalistic socialism to end international socialism"-to use his own words. To use other words, Bismarck was the first leader of a great nation to fight communism by adopting communism.
The German citizens paid more for their national compulsory health insurance than they had paid for private insurance before Bismarck came along-and they got less in return.
Bismarck's scheme failed miserably to provide better medical care for the people of Germany; but it did become an important feature of the German militaristic state; it helped pave the way for Hitler a generation later; and it furnished a pattern with which practically every other nation in the West-including America-has experimented.
British Experience
England first started experimenting with socialized medicine in 1911. The experiments were a failure, as they always have been everywhere.
But government never retrenches. When government seizes power and money from the people in order to promote their welfare and then makes matters worse for them, government always argues that it didn't have enough power and money to do enough promoting.
In England, for example, when Lloyd George's rather moderate experiment in the Bismarckian type of national health insurance was abandoned, the nation went all the way into communized medicine.
The National Health Program which became the law of England in July 1948 is modeled on the Soviet system created by Lenin.
In less than two years, there were more than half a million people on the waiting lists for hospitalization, while some forty thousand hospital beds were out of service because of a nurse shortage. The hospital shortage in Britain has become so acute that many mentally deficient and helpless, aged people are unable to secure institutional care. The only effective means of easing the shortage is to deny hospital admission to the old and chronically ill who cannot be discharged once they are admitted.
In industrial centers, some British doctors have as many as 4,000 registered patients each. Such doctors can give each patient only three minutes per call-three minutes overall, for consultation, diagnosis, prescription, filling out official forms, and maintaining proper records for governmental inspectors.
Twelve per cent of all British taxes go into the national health program. Thus the wretchedly inadequate "free" medical services in Britain actually cost the average Englishman considerably more than an American pays for the most expensive private health insurance and hospitalization. [NOTE: this was written before Medicare was enacted in 1965 -- Ed.]
Over and above what the British themselves have put into socialized medicine, one must consider also the billions of dollars which America has pumped into the British economy as loans and outright gifts. And still the thing is a failure. Why?
Whenever government enters a field of private activity, that field becomes a political battleground. Whenever you mix politics with medicine, doctoring becomes a political instead of a medical activity.
"Something for Nothing"
But the primary reasons for the inevitable failure of socialized medicine can be found in the patients themselves. When people are forced to pay for something, whether they want it or not, they are inclined to use as much of it as they can in order to get their money's worth.
There are endless stories about Englishmen who trade their government-issued eyeglasses, wigs, and even false teeth, for beer. There are housewives who trade government-issued medicine for perfume and cigarettes. And there are some who pick up extra money by selling the gold fillings out of their teeth-getting them replaced by government dentists and then selling them again.
Malingerers are people who pretend to be sick in order to get sick pay, social security benefits, free hospitalization, or a rest at government expense. Hypochondriacs are people who think they are sick, but aren't. There are countless thousands of such people. No system has ever been devised for definitely identifying them, for weeding out the unnecessary or unreasonable or dishonest demands made upon the medical care services-no system, that is, except the one existing in a free society where a person must pay his own doctor bill or is controlled by provisions of an insurance policy which he himself has bought. No compulsory health insurance program has found a means to discourage racketeers or petty complainers who make useless trips to the doctor and monopolize professional time that should be spent on people really needing care.
| Written By: Robert J. Cihak, M.D. | |
For decades, Canadians have cast pitying glances at us poor American neighbors who actually have to pay for our medical care while they get theirs for "free."
Yet the major candidates in Canada's recent national election both agreed the country's health care system is failing. They made the usual socialist diagnosis of "not enough money." None of the candidates mentioned government control as what ails the Canadian system.
On this side of the border, Senator Edward Kennedy (D-Massachusetts), with presidential candidate Senator John Kerry, also from Massachusetts, in tow, promotes Canadian health care to U.S. voters, in the hope we too can have "free" medical care.
High Costs, Low Quality
A July 2004 study by the Vancouver-based Fraser Institute, Paying, More, Getting Less, concluded that after years of government control, the Canadian medical system is badly injured and bleeding citizens' hard-earned tax dollars. The institute compared health care systems in the industrialized countries in the Organization for Economic Cooperation and Development (OECD) and found Canada currently spends the most, yet ranks among the lowest on such indicators as access to physicians, quality of medical equipment, and key health outcomes.
One of the major reasons for this discrepancy is that, unlike the countries in the study that outperformed Canada--Sweden, Japan, Australia, and France, for example--Canada outlaws most private health care.
If the Canadian government says it provides a particular medical service, it is illegal for a Canadian citizen to pay for and obtain that service privately. At the same time, the Canadian government bureaucracy rations medical services. According to another Fraser Institute survey, Waiting Your Turn: Hospital Waiting Lists in Canada (13th edition, October 2003), a Canadian health care patient, on average, must wait 17.7 weeks for hospital treatment. Those who live in Saskatchewan waited an average of 30 weeks, those in Ontario a relatively expeditious 14 weeks.
Dying in Queues
In 1999, Dr. Richard F. Davies, a cardiologist at the University of Ottawa Heart Institute and professor of medicine at the University of Ottawa, described in remarks for the Canadian Institute for Health Information how delays affected Ontario heart patients scheduled for coronary artery bypass graft surgery. In a single year, for this one operation, the doctor said, "71 Ontario patients died before surgery, 121 were removed from the list permanently because they had become medically unfit for surgery," and 44 left the province to have the surgery, many having gone to the United States for the operation. (According to the Canadian Institute for Health Information, 33 Canadian hospitals performed approximately 22,500 bypass surgeries in 1998-99.)
In other words, 192 people either died or became too sick to have surgery before they could work their way to the front of the line.
In a May/June 2004 article in the journal Health Affairs, researcher Robert Blendon and colleagues described the results of a survey of hospital administrators in Australia, New Zealand, Great Britain, the United States, and Canada. Fifty percent of the Canadian hospital administrators said the average waiting time for a 65-year-old man requiring a routine hip replacement was more than six months. Not one American hospital administrator reported waiting periods that long. Eighty-six percent of American hospital administrators said the average waiting time was shorter than three weeks; only 3 percent of Canadian hospital administrators said their patients had this brief a wait.
Bare-Bones Health Care
Barring epidemics and other disasters, fewer than one out of 10 people in prosperous societies will face a major medical crisis in any one year. Those suffering people, however, are the ones who need help the most, and the aging of the baby boomers in the United States makes it likely more serious illnesses will afflict more Americans in the next couple of decades. The kind of minor health care services the Canadian system provides well are not what America's aging Baby Boomers will need most urgently in years to come.
America's health care system already includes too much Canadian-style bureaucratic delay and inefficiency. For example, the slow acceptance by Medicare and Medicaid of medical innovation, their exacting paperwork requirements, delayed and low payments of claims, and the threat of overzealous prosecution by health care bureaucrats are driving doctors out of business and giving patients fewer medical options.
Fixing those flaws would seem to be a much more promising prospect than a further move down the road Canada has followed to high costs and low quality of health care.
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