God Save the Mean

As a long-time, dedicated critic of Medicare and all other forms of central planning health care, it is amusing to see some of the presidential candidates swirling about a core dedication to single-payer health.  And make no mistake, that is precisely the goal of any and all enlargements, enhancements, amplifications, and spreading of Medicare and Medicaid.  It’s disheartening (and amusing) that so many very intelligent, successful people I know will brook no attack on LBJ’s master vote bribe, and they refuse to acknowledge the structural faults, and economic future that is plain for all to see.  Both major parties are to blame for pandering, as are the recipients who will not allow actual reform.

But if you won’t seek reform, might it seek you?  We have all seen numerous CMS innovations from DRG’s, to the SGR, core measures, and ICD/CPT/EHR idiocies, all designed not to improve care or efficiency, but to try to limit expenditures.  And every attempt thus far has been an utter failure.

The United Kingdom still holds some predictive value for us on occasion, and we have had several decades to witness the great success of the British model.  They have run short of physicians, ambulances remain backed up in ER parking lots, and they have started allowing nurses to do “routine” surgeries (they might argue that any routine surgery is one you survive, but pick your own definition).  And still, the Brits are running out of money.

So now the cagey cockneys plan to have the National Health Service “ration 34 everyday tests and treatments deemed ‘unnecessary’ in a drive to save money and relieve pressure on the overburdened health service.”  Certain routine x-rays, screening blood tests, arthroscopies, and CT/MRI scans will be deferred or disallowed in favor of physiotherapy or pain killers (that is gonna be so much fun to watch over here, just as the latest dumb War On Drugs is getting ramped up).  Certain hernia repairs, as well as cataract removals that don’t meet certain NHS thresholds will also be prohibited.  As we have seen a great deal already here, a third party – government or Big Insurance – is acting as the physician in determining which treatment approach would be best. This is the case in Canada, Britain, and increasingly here.

Let’s not lose sight of the goal, which is to save money.  One might hope that if we save Medicare dollars in more common areas, we might “save” more seniors in the long haul.

Which is impossible.

What neither the NHS or Medicare can confront is the combination of infinite demand and finite resources.  Recipients will demand more and more, and when physicians aren’t available, they will go to the nearest ER for trivial complaints (they already do).  The government might refuse to pay the bill, and does so frequently, but this only makes things tougher on those doing an increasing amount of work with decreasing means.  The NHS can ration what it likes, but it will not ultimately reform the problem.  We here in the US can gin up a “no pay” list, but administrative costs, and medical price inflation will continue, as will the level of demand from a growing population of complicated elderly patients.  Even CMS’s ludicrous “quality” initiatives that purport to increase longevity will only increase long-term cost projections all the more.

Centralized planning for health care can be a success for cookie-cutter, common approaches, diagnoses, and interventions.  Even then it will be a horribly expensive, temporary success, which will one day collapse.

Centralized health care has been and will remain a failure for individual patients who want their care directed by a competent physician invested in them.  What they will get are glasses that will not compensate for cataracts that cannot be removed, leaving them with two blind spots.

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Pat Conrad MD

Pat Conrad is a full-time rural ER doc on the Florida Gulf Coast. After serving as a carrier naval flight officer, he graduated from the University of Florida College of Medicine, and the Tallahassee Family Medicine residency program. His commentary has appeared in Medical Economics and at AuthenticMedicine.com . Conrad’s work stresses individual freedom and autonomy as the crucial foundation for medical excellence, is wary of all collective solutions, and recognizes that the vast majority of poisonous snakebites are concurrent with alcohol consumption.

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1 Response

  1. Seneca says:

    Well put, Dr. Conrad. So how do we get there from here? One concept actually proposed by a politician was Joseph Lieberman’s suggestion that we eliminate secondary insurance from existence for Medicare. When people actually have to pay, even at 20%, market forces can at least begin to shape the heath care curve. Like you, I’m not optimistic. The likely end game is complete failure of the publicly financed insurance schemes with a parallel system for the wealthy who can pay.

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