Old truths still evident. I posted this about 6 years ago (December 7, 2006). It’s still relevant.
To Socialize or Not to Socialize — Gee, I’m Glad I’m a Doctor!
I have been reading through some of the news articles about health care and all the trends towards socialization. It’s very interesting to me, now that I’ve been working in health care and learning about Medicaid and private insurance. My viewpoints are biased by the fact that so many physicians I work with have come here from other countries because they couldn’t stand how socialization limited their treatment options — for both their patients and their families.
Socialism (everyone pays taxes, the government decides how the tax money is spent for your health):
PROS: Everyone gets healthcare.
CONS: The government doles out health care, which means that it will decide what it will spend money on and what it won’t. If it saves money to ban junk food, the government will ban junk food. If it saves money to euthanize retarded people, it will (see the Netherlands). If the government saves money to ban trans fats, it will (see New York City).
Capitalism (people pay for what they want, if they have the money to afford it):
PROS: If you want to save your 499.5g baby, and you have $4 million dollars to pay for the nitric oxide and high-frequency oscillator ventilation, go for it! (In France, any neonate less than 500g is dead.) If you have polycystic kidneys, and want to stay alive on dialysis for months, nay years, and can afford it, go for it! If your child has spina bifida, and you want a Mitrofanoff procedure for her, go for it!
CONS: If you can’t afford it, it doesn’t happen.
The best place is always that fine middle ground between having choices in your health care and having public policy in place to help those who are less fortunate, without bleeding the government (and thus the taxpayers) dry.
An example is trying to save one 22-week NICU baby, versus using the $4 million Medicaid dollars to protect hundreds of thousands of other children from meningitis. Personal choice (“It’s *my* baby!”) versus public policy (“Your baby is legally dead.”). If thousands of taxpayers are paying to keep *your* baby alive, versus getting *their* babies immunized, you will lose.
A lot of people operate under the assumption that the government is always the answer when it comes to obtaining money to help the poor and the less fortunate. That money, though, comes from some place. And that place is me. If I’m paying taxes to treat an overweight kid for his type 2 diabetes (Does anyone remember how much it costs for daily Glucophage for a 9 year old boy?) — I’m going to want a say in what kind of food he puts in his mouth. Socialization breeds public policy. (See upcoming ban on TV junk food advertising.)
I smell a ban on junk food entirely in the near future.
Medicaid is a socialized medicine of sorts. The only requirement for Medicaid is that you fit below a certain income bracket, and that you have the wherewithal to make sure you renew it. (Which sure beats my deal of actually having to work > 8 hours a day and get my income subtracted to pay for medical insurance for myself and my family, in addition to the taxes that go towards paying for others’ Medicaid bills. So it beats me all to heck, why mothers can’t remember to renew their children’s Medicaid. Perhaps it has something to do with why they’re on Medicaid in the first place.) Plus, with Medicaid, I am fortunate in that I don’t always have to choose between treating one child, or letting 4 others die. Medicaid lets me treat a child for pneumonia, and still have money to treat 4 others.
In other countries, doctors must decide if it’s worth it to treat a child for pneumonia, or to use that money to buy vaccines for the others who aren’t sick.
I know this matters little to people who are involved in the day to day details of working and making a living. But, public policy is encroaching more and more on individual freedoms in health care. And it’s just a matter of time before more and more laws are passed for our common good.
I feel public policy has its place. I admire the advocacy that went into the ban on lead paint. I also love the recommendations for universal vaccinations. (I have never seen HiB meningitis as a result of the HiB vaccination. I have seen one non-typable Hi, but not HiB.) But the debate on junk food adverstisements is a tad disturbing to me. I see less and less accountability by parents, and more of a “doctors know best” attitude. And I’ll be the first to admit, doctors don’t know everything. And having a doctor decide what is junk food and what is not seems awfully totalitarian to me.
It’s enough to make me adopt a pro-Pringle attitude, envisioning posters with toddlers gripping a Pringle with the captions: from my cold, dead heads.
Doctors don’t always know best. I mean, for years, people advocated taking antioxidants — vitamin A and vitamin E. You didn’t hear about the study that showed that mega-doses of vitamin A actually increased lung cancer? (Could it be because the body’s immune system actually *uses* free-radicals to kill foreign cells? — Immunology 101, people.)
Or the big egg debate. . . . “Don’t eat too much eggs.” And now eggs are okay.
“Medical knowledge has a half-life of about 4 years,” one of my attendings said. And it’s true. What is common knowledge now, will be disproved in 4 years. And statistics can always be skewed, because with humans, n-values can’t always be significant. You can only do so much blood work on a 2.5 kilogram kid before you exsanguinate him — so repeated blood tests are not ethically practical.
The good thing about public health, though, is that it promotes research to back treatment modalities. The bad thing is that public policy doesn’t do anything about the money needed to implement treatments.