Free Medicine Can Make You Sick
The following essay was published in Essays on Liberty, Volume V., by The Foundation for Economic Education, Inc. in 1958.
Free Medicine Can Make You Sick, by Charles G. Jones, M.D.
Among the socialistic wedges being driven into the hear of our openly competitive society is government controlled medicine. Its advocates describe it in glowing colors. "It is the moral obligation of a civilized nation," they maintain, "to care for the indigent, aged, infirm, physically handicapped, and mentally ill." The talk as if only the State could discharge this obligation. In my belief, government medical care unwittingly prolongs the suffering of those already ill, and even cases illness to develop.
A widespread public complacency reflects lack of serious thought as to the possible consequences of socialized medicine in the United States. Many are lulled by a false sense of security because they hear so much about the benefits and so little, if anything, about the costs - the price to be paid. Experiences from other countries which have tried socialized medicine are depressing and alarming and ought to guide us away from similar mistakes.
One of the most glaring facts is that government medical care invariably costs more than had been expected. During the first four years of socialized medicine in Great Britain, the demands for free service and for costly though often unnecessary medically related items resulted in trebling the yearly budget. The taxpayer - who still has to foot the bill - had his annual tax burden increased by 12 per cent. This on top of already heavy taxes makes the system almost prohibitive.
The deleterious effects of the system are to be noted everywhere. There are so many free dental patients that dentists no longer have time for their customary work with school children. Obviously, this condition need persist for very few years to affect seriously the dental health of the kingdom. Waiting lists for admission to hospitals become staggering. The increased volume of patients invites second-rate care for many instead of first-rate care for the truly ill. The burdensome cost of caring for those who are ill, plus those who pretend, leaves no funds for research or preventive medicine. Along these and other details of administration, there is the problem of selecting from the long lists the patient who needs immediate or emergency care. The system not only involves huge cost, but it also constitutes a menace rather than a means to health. In other words, "You cannot buy good health."
The Voluntary Way
Even though the American system is still voluntary, in that hospital and health insurance can be selected at will, some of these evils are beginning to make themselves known in an insidious way. If our health insurance were to become compulsory, it is easy to see how these defects might multiply and actually jeopardize the health of the nation.
A system of socialized medicine tends to weaken one's reasons for being well. A struggle for livelihood is no longer required. If a leg is broken, the State pays medical, hospital, and operation costs, and advances adequate funds for living until the bone is healed. But there is the rub. If a man suffers no material disadvantage from sickness, there is no material incentive for him to recover rapidly. But if loss of income goes with the broken leg, he will be anxious to have it heal so that he can get back to work as soon as possible. And doubly so, if he pays his own hospital and surgical bills. Doctors know that a broken leg heals very slowly in a Welfare State. And for the same reason, the recovery of most patients "protected financially" by insurance companies proceeds slowly and painfully.
Mrs. A and Mrs. B underwent operations for benign fibroid tumors of the uterus on the same day; they were in the same semiprivate room, were about the same age, and had almost identical operative procedures. But from the very first postoperative day, any similarity between the two women ended abruptly. Mrs. A recovered rapidly and was eager to get home to her family and to her work. Mrs. B seemed to revel in her long recovery because her husband had told her that the whole thing was covered by insurance and she should stay in the hospital as long as she wanted. "Don't let them send you home too soon," he said.
Mrs. A went home on her sixth postoperative day, which was routine for her operation; but Mrs. B complained and stayed four days longer, until she was "good and ready." Though her bill exceeded Mrs. A's by more than sixty dollars, the insurance company paid for all but a few extras.
A routine office visit one month later revealed that Mrs. A had been doing her house work and other chores for almost a week. Mrs. B was not able to climb stairs and had attempted no work beyond drying some dishes the previous day. The prolongation of her recovery, in my opinion, must be attributed to insurance coverage.
There are many examples of comparative amputees, showing that the one obliged to pay his own bill and earn a living recovers faster and learns to use a prosthetic device earlier than the one who is waiting for an insurance settlement. This sort of thing happens far too often to be pure coincidence.
An individual can become ill by just imagining he is ill, or, he may be a malingerer from the very beginning. The psychiatrist will tell you that the incentive for either is the thought of increased recompense for being ill. At any rate such persons manage to bring misery upon themselves and to all about them.
Socialized medicine includes government care of the sick and support for the family as well. If this support amounts to approximately the same as the man can earn from his own daily labor, he is tempted to be sick continuously. The temptation would be greatest for people in low income brackets, illness actually being preferable to good health. This may sound strange, but doctors can observe the fact in their daily practice. Many people want to be sick, or sicker than they actually are, because material advantages in the form of compensation and liability payments are involved.
Less Joke Than Reality
In accident cases where the recovery period is unusually long, the question of insurance liability and possibly future litigation is likely to be present. When referring to the man who has been limping unnecessarily for several months, doctors sometime jokingly say that John has nothing the matter with him that a prompt and substantial settlement wouldn't cure. But it occurs so often that it is less joke than reality. Patients who are waiting eagerly and selfishly for the settlement of their claim recover slowly in spite of all treatment. And usually their complete recovery coincides with the final settlement of the claim. It is easy to see why there are so many cases for the compensation lawyers, referees, and juries. Just imagine the job of sorting all of these malingerers from the real needy if socialized medicine were available!
The advocates of government in medicine point to our overcrowded hospitals as though they have in mind a solution for the problem. But the fact is that much overcrowding is traceable to increased voluntary insurance benefits, a situation that would only be aggravated if all beds were "free." The waiting lists for the hospitals of England and Germany are so long that many patients finally gain admittance only to have forgotten why they have applied.
The hue and cry of overcrowded hospitals is a twisted statistic, for the beds are overburdened with people who are not really sick. The third party in the form of health insurance has entered the picture. But the present sad picture, with only part of our population voluntarily insured, would surely be magnified if health insurance coverage were made universal and compulsory.
Experience with socialized medicine shows hospitals so overcrowded that the situation becomes near impossible, doctors so overworked that their patients get less and less real treatment, the cost of drugs reaching astronomical figures, the total cost of the social system soaring, and the government calling for investigations. The doctors are accused of high-handed methods, the druggists are accused of charging too much for the pills, the people themselves are accused of being too sick. So finally, more and more there creeps into the picture police controls - "the last refuge of self-bankrupting, socialist planning." 1.
With the obvious increase in the number of insured persons who are demanding medical care and hospitalization, a "doctor shortage" becomes more or less inevitable. Doctors are overwhelmed with the demands of people who feel that their insurance is wasted if they don't use it. Minor and even imaginary ills demand immediate attention. If doctors could only confine their attention to patients who are really ill, the present quota of doctors should have ample time for leisure. If there were the same insurance coverage for plumbing services as for health and accidents, I am convinced that there would be a plumber shortage before the signatures were dry on the policies.
Loss of Inspiration
Socialized medicine tends to overwork and tire the doctors until they lose interest in the welfare of their patients and are no longer inspired by their original dedication to ideals. When this situation arises, there may be some patients who never get to see their doctor and finally recover because they have to recourse. This leads some persons to ask, "If this condition persists, will not socialized medicine, at least in part, cure some of its own ills?" There may be some merit to this idea on the surface, but when we digest it, we find that it involves quite an expensive cure for people who would get well without help. At the same time, some would die for lack of treatment and others would suffer for lack of the medicine they need. So the self-correcting features of socialized medicine are really no excuse for its adoption. It should be remembered that under our present system, most patients may call one or more of several doctors in their community; but the "beneficiary" of socialized medicine waits for the doctor to whom he has been assigned.
Why Doctors Prefer Freedom
There are many reasons why doctors cry out against socialized medicine. First, as individuals, they abhor the regimentation which is inevitable under socialism. Second, they feel that initiative, research, and humane care of the ill will gradually be replaced by robot dispensing, complacency, and the treatment of a number rather than a human being. Third, they have always thought that giving inferior drugs to increase their profit, or performing less than their best because the pay was predetermined was beneath their professional dignity. All of these shortcomings exist in all of the presently functioning systems of socialized medicine.
If the loss of the hardy physical and mental attributes of the pioneer - to make of us weak and dependent wards of the State - is an incurable disease, then our fate is inevitable. If our youth are to be deprived of the incentive to dedicate their lives to the healing art, and devote their years to learning their profession, then our diseases will be treated by automatons and our health will deteriorate. If the important work of doctors, nurses, technicians, and allied skills is to be minimized and even denied by political charlatans, then these same youths will refuse to enter this noblest of professions except by edict. If we eventually accept all these proven evils as a system of government and a way of life, then we can blame ourselves for inferior physical and mental health and weak protoplasm. To maintain our health and strength, we had best insist on our present high quality of training, zealous research, and devotion to the prevention and cure of diseases of body and mind.
1. Palyi, Melchior, "How Sick Is Socialized Medicine?" in The Freeman, June 1952.