And I Thought Their Food Was Lousy ? by Pat Conrad MD

While physicists assure us that a perpetual motion mechanism cannot exist, they clearly have never met the proponents of single-payer government health care.  Contrary to all empirical evidence and good sense, the proponents of herd health keep coming.

Sally Pipes does a good job of detailing the joys of the British National Health System, another of the bad ideas rapidly sinking the Sceptred Isle that should scream warnings to their trans-Atlantic cousins.

Now typical of the NHS:

  • 12 hour ER waits.
  • Cancer treatments delayed for over 2 months.
  • 4.3 million on waiting lists for surgery (“Adjusting for population, that would be like having everyone in the state of Florida on waiting lists.”  I live in Florida, and when I need it, I don’t want to wait.)
  • “In Scotland, fewer than 80 percent of patients receive needed diagnostic tests — endoscopies, MRIs, CT, scans and the like — within three months.”
  • “…almost 30,00o died in the past year while waiting for treatment — an increase of 57 percent compared to 2013.”

The U.K. has severe – and worsening – shortages of physicians and nurses.  Their post-op survival rates are significantly worse than in the U.S.  Despite funding increases well in excess of inflation, advocates continue to blame a lack of adequate funding.  Pipes reiterates a point I have tried to make for many years:  the salient feature of government care is unrestrained demand.  This invariably, rapidly leads to over-utilization, cost overruns, price inflation, budget shortfalls, attempts at cutbacks, rationing, reduced payments, scarcity, and finally loss of access and the disappearance of services.  We have already seen this in Medicare, Medicaid, and in the VA.

  1.  And so the never-ending proponents for single-payer care keep coming, and what are their arguments?
  2. “It will be more efficient.”  While Big Insurance is currently no model of efficiency, it at least has the potential for competition, if we would quit empowering government to prop it up in crony corporatist arrangements.  Any system that has already devised nine different ICD-10 codes for turtle-related injuries cannot be a demonstration of preferable efficiency.  Any all-powerful bureaucracy that can mandate massive private business expenditures in unproven, unwanted IT systems is by definition, inefficient.
  3. “It will be cheaper.”  New York’s Ocasio-Cortez, congressional candidate and the human embodiment of the word “blithering” favors such a system that by her own statements would cost a new $32 trillion.  Cut that figure in half, and it is still hilarious.
  4. “It will be higher quality.”  As has been amply demonstrated on this blog, there is no objective, reproducible definition of “quality.”  Quality measurements are arbitrarily conjured and disseminated by third-party payers on pain of financial loss, and the only value they have ever demonstrated is the utility with which they are used to deny payment for work already done.  To paraphrase John D. MacDonald, when the man says “quality,” you can already see him reaching into his pocket for three walnut shells and a rubber pea.
  5. “Most of the industrialized world already has it.”  At one point most of the industrialized world had markedly higher syphilis rates, too.  The economic impact on Britain has been a negative one, and likewise in Canada.  I have read some cogent commentaries defending the German system, but it still brings restrictions more demanding U.S. voters (and their lawyers) are unlikely to suffer.  At best, the worldwide jury is still out, and the argument is not conclusive.  The herd is not always the safest place.
  6. “It makes economic sense.”  Sure, and that’s why nations with single-payer care have GDP growth rates so much higher, and unemployment rates so much lower, than ours.  Check out the comparative tax rates, and get back to me.  Nothing about a single-payer system will make our economy more robust or give us a leg up on our competitors.
  7. It will be more “fair.”  The moral club underlies the majority of the do-gooder arguments for single-payer.  Their assertions are that everyone has a right to basic care, and that providing such is a moral imperative.  The insinuation is that everyone will have the same level of care and same access to MRI’s, advanced transplant surgery, cosmetic plastics, and cutting edge chemo, which is of course nonsense.  The connected will have better access, and better care.  The wealthy will go and buy it, somewhere.  The hoi polloi will have free amoxicillin and flu shots, and plenty of highly controlled opioids to control the metastatic pain.  Health care will be as fair as the housing spectrum back in the USSR, where the best leaders got a dacha, but everyone had some sort of shelter.  If you want to see a do-gooder writhe on a stick, ask them to define the term “fairness.”

None of this is any defense of our thoroughly corrupt Big Insurance industry.  But it was made worse by the influence of government health care, and still worse by the sleazy giveaways at the core of the ACA.  Will even MORE government fix these problems?

Not even a little bit.


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] 

  10 comments for “And I Thought Their Food Was Lousy ? by Pat Conrad MD

  1. Gerald A. Shubs, M.D.
    October 10, 2018 at 8:09 pm

    Dr. Farrago,
    I have been your fan since The Placebo Journal. I retired (quit, actually) 4 1/2 years ago. DPC, clearly is the “old fashioned medical care,” most of us used to enjoy. Despite your criticism of a single-payer system, what do you recommend? Insurance companies in their present form, along with their minions need very strict regulation or dismantling. We physicians abdicated our influence years ago (instead of refusing to cooperate).

  2. Gerald A. Shubs, M.D.
    October 10, 2018 at 7:54 pm

    Dr. Farrago,
    I remain a staunch fan of yours, since the Placebo Journal. I retired (quit, actually) 4 1/2 years ago. Direct Patient Care (aka: old-fashioned medicine) clearly is the way-to-go for effective and rewarding medical care. That said, considering my hatred of insurance companies, as they are now, and HMOs, etc., how do we cleanse ourselves of them? A single payer plan or strict regulation of “decision-makers” or simple extermination of the nest are possible solutions. How would you proceed, when you are king?

    • Doug Farrago
      October 10, 2018 at 8:43 pm

      DPC works. The health sharing ministry model works as it just acts as a catastrophic plan. Their prices are low. Combine the two and you have a free market system forcing patients to shop around. Americans are great shoppers….ask Amazon. Then watch the prices of healthcare drop.

  3. JRDO
    October 6, 2018 at 12:02 pm

    In the realm of bicycle manufacturing Keith Bontrager is often quoted for saying, “stronger, lighter, cheaper, pick two”.

    I think the situation in healthcare is similar.
    Universal coverage, quality, affordability, pick two.
    Which one of the three is least important?

  4. PW
    October 6, 2018 at 10:02 am

    “In Scotland, fewer than 80 percent of patients receive needed diagnostic tests — endoscopies, MRIs, CT, scans and the like — within three months.”

    Looks like the Scots need another Braveheart and Robert the Bruce.

    • Drphil
      October 12, 2018 at 12:32 am

      On the other hand – the 80% in the US won’t be on the wait list in the first place because they can’t afford the cost or the copay and simply go without.

      The problem with nationalised medicine is government interference.

      The problem Americans seem to have is rationing based on anything other than the ability to pay.

      • Drphil
        October 12, 2018 at 12:36 am

        Sorry the over 20% who have to wait.
        I misread the original quote.

  5. Bill Ameen, MD
    October 6, 2018 at 9:32 am

    Dr. Doug, This is the conundrum of our times. I trained briefly in med school in England. I remember a friendly guy awaiting a cardiac workup who waited so long he built a ship model on the ward. Whatever role the guv’mint has, we have to get the damned thieving insurance companies out of the mix. My healthy wife turns 65 next month…bringing to an end the monthly extortion from BC/BS of $1,100 with a $6,000 deductible. Like paying the Mob not to break your store windows. Thank goodness for Medicare…which we have already paid for for decades. Socialized medicine! A great idea in 1965 when doctors’ office visits costs $3 and people died around the age of 65 before there were CT’s and MRI’s and ambulances were hearses back then!

    • Susan
      October 6, 2018 at 5:32 pm

      Problem with Medicare is that it pays physicians so little that it’s usualkt less than the cost of providing care. Many physicians are not accepting Medicare anymore.

      • Steve O'
        October 6, 2018 at 6:01 pm

        Voilá! The way to prevent the expenditure of money is to price it down so nobody will do it. At a certain price, the cost falls off to zero.
        I’m all for socialized medicine when the car dealerships and grocery stores offer doctors 90% discounts as well.
        If Medicaid pays me 10¢ on the dollar, why can’t I pass that on?

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