It Didn’t Work – Let’s Do it Again! by Pat Conrad MD

sweden

In 1628, the King of Sweden Gustavus Adolphus commissioned the construction of a massive warship, the Vasa, to contend for control of the Baltic against rivals in Poland and Denmark. Like many government initiatives, it was heavy in force – 64 large bronze cannon – and top-heavy with useless imperial ornamentation. In fact it was so top heavy that 1,400 yards into its maiden voyage, a heavy gust rolled her open gun ports into the sea, and she sank in full view of the celebrants on the dock. Undeterred by this example of poor foundational logic, Crazy Bernie Sanders is gearing up for his primary swan song with a lot of coverage and a lot of moony-eyed followers over his love for nationalized health care. In this “House of God,” bad gomer ideas just won’t die…no matter how may times they are refuted.

In 2012, Britain started to emulate Sweden in privatizing hospitals. The state began outsourcing to private equity firms, which boomed as private firms introduced “competition into what had been one of the world’s most ‘socialized’ medical systems.” A former Swedish civil servant in the health service compared his country with Britain: “The difference between Sweden and England is that privatization of a hospital was only considered when you had big financial problems.” It wasn’t his point, but it begs the question: if the socialized approach is so good, why switch to the private approach to bail it out? And why not start with capitalism instead of work your way to it?

The managing firm, Capio, bragged to the Brits about their St Göran hospital: “Emergency patients see a doctor within half an hour, compared with waits of up to four hours in the NHS. We took [a] department that dealt with 35,000 patients a year and now treats 75,000.” Capio also proclaims “low levels of hospital-acquired infections, and patient surveys record high levels of public satisfaction. It has also produced year-on-year productivity gains – something the state cannot match.” The company president tells us “the profit motive works in healthcare” and companies run on “capitalism, not altruism.” And he’s right! No, I’m not taken in by an administrator gleefully waving around patient satisfactions scores, and I wonder whether the staff satisfaction scores were not inversely proportional. Still…

Don’t try to sell capitalism to The New York Times. Their economics writer Robert Frank wrote a year after the Brits became envious of the Swedes that, “Another important difference is that, unlike many American health insurance providers, the government groups that manage Swedish health care are nonprofit entities. Because their charge is to provide quality care for all citizens, they don’t face the same incentive to withhold care that for-profit organizations do.” (And really focus on this next line,) “Because of pervasive market failures in private health care markets, this may be the sector that benefits most from collective action.” The same collective action that the Brits are trying to get out from under? The same collective action that has Swedes cheering capitalism and Canadians getting new hips in Ohio? Let’s zoom back to Sweden to hear from Christina Rigert. The 62 year-old Rigert was a hospital administrator who “resigned on principle” when it was privatized a decade ago. Now back as a patient after gastric band surgery, she says: “The experience was very good. I had no complaints. There’s less waiting than other hospitals. I still do not think there should be private hospitals in Sweden but it’s happening.” So she had a good experience, which she is against.

To sum: collective action and altruism may be demonstrated to be less effective, but nicer and more popular. Capitalism works better despite its flaws, which apparently include demanding more productivity out of government employees whose satisfaction with the status quo is adequately camouflaged by their public compassion. A not insignificant portion of the U.S. electorate – abetted by a cadre of numbskull physicians who regard noblesse oblige as data – is now pushing to adopt the discredited ideas from Europe.

Douglas Farrago MD

Douglas Farrago MD is a full-time practicing family doc in Forest, Va. He started Forest Direct Primary Care where he takes no insurance and bills patients a monthly fee. He is board certified in the specialty of Family Practice. He is the inventor of a product called the Knee Saver which is currently in the Baseball Hall of Fame. The Knee Saver and its knock-offs are worn by many major league baseball catchers. He is also the inventor of the CryoHelmet used by athletes for head injuries as well as migraine sufferers. Dr. Farrago is the author of four books, two of which are the top two most popular DPC books. From 2001 – 2011, Dr. Farrago was the editor and creator of the Placebo Journal which ran for 10 full years. Described as the Mad Magazine for doctors, he and the Placebo Journal were featured in the Washington Post, US News and World Report, the AP, and the NY Times. Dr. Farrago is also the editor of the blog Authentic Medicine which was born out of concern about where the direction of healthcare is heading and the belief that the wrong people are in charge. This blog has been going daily for more than 15 years Article about Dr. Farrago in Doximity Email Dr. Farrago – [email protected] 

  6 comments for “It Didn’t Work – Let’s Do it Again! by Pat Conrad MD

  1. Sigmund Derman
    March 7, 2016 at 10:09 am

    “It didn’t work” and/or “It doesn’t work” is most fittingly applied to the United States healthcare “system.” Regarding the Canadian, British, and various European systems, I believe that the most fair assessment would be that they work rather well. They are not 100% socialized and I do not think that a general national healthcare system needs to be absolutely devoid of opportunities to give and receive healthcare privately. But most citizens of Canada, England, France, and German are highly satisfied with their healthcare system. Most doctors are satisfied as well. We cannot just copy some other country’s system because healthcare needs to be adapted to each particularly country. But we are similar enough to Canada that I would be very surprised if something similar to the Canadian system would not work quite well for us in the USA.

  2. politovski
    March 6, 2016 at 10:52 pm

    so, what sort of system are we proposing? i would say that our experience here has effectively invalidated our system, ie “capitalism”. i suppose if we were to go purely cash and having set fees for all the cpt’s would perhaps be the most equitable non socialized way. but, even so, how are the patient’s without means going to have access to care? is this our version of the British culling the Irish population back in the 19th century? that certainly does not seem to be commensurate with the Hippocratic oath……

    • Pat
      March 7, 2016 at 10:15 am

      The Hippocratic Oath is constantly misused as a justification to insure universal access. The Oath says nothing about guaranteeing car for anyone; it only prescribes proper physician behavior once he has elected to see a patient. Trying to relate bad British economic policies to a misappropriation of an ancient Greek oath is as non-sensical as using more government to solve a problem originally created by government.

      Moreover, we haven’t tried “capitalism” here; Medicare and Medicaid drove up prices artificially, as did crony corporatism with insurance companies.

      • Politovski
        March 8, 2016 at 4:26 pm

        Perhaps you forget the time before Government assistance existed? Things were so bad that Medicare and Medicaid were formed, leaving us in the mess we are currently in. As for the Hippocratic oath, it states that we should do no harm. Advocating for something other than decent health care is doing harm seems like a logical Equation to me.

  3. Steve O'
    March 6, 2016 at 10:06 am

    I’d say that all three have bad instincts and guilty behavior.

    To compare the three, we see fairly similar European-style countries which have agreed that the politics of the means of production are central to the government and its people.

    Poisoned trees yield bitter fruit, but each of different shapes and sizes. The strangling bureaucracy of the NHS, the horrible mess of US Healthcare, and modestly less-horrible Swedish cultures have brought varying degrees of impediments on their own healthcare. The argument of “medical insurance companies” is trivial, in light of the question – “which societies have human beings at the core of their purpose?” None of the three – but Sweden perhaps a little more so, and US/Britain similar in severity, but different in style.

    This Weberian mess is bigger than just geography.

  4. Eugene Frank
    March 6, 2016 at 8:12 am

    What constructive purpose is provided by medical insurance companies? They serve their owners by minimizing expenses and avoiding costly patient populations.

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