Nightmare at 1600 Pennsylvania Ave: Socialized medicine! (it works well)

Rep. Ron Paul, who wants to be president, made a speech recently on the floor of the House of Representatives where he suggested that Americans are mad at their government because the government tries to do stuff for them that they’d rather do themselves. Having recently spent two nights in the medical brig, I immediately thought that Paul is completely out of his mind — who in their right mind would want to do their own health care?

(Old joke: You know what they told the guy who wanted to do his own appendectomy? His doctor said, “Whatever! Suture self!”)

It seems to me people are upset because they can’t get health care at reasonable cost, and the government is doing absolutely nothing to fix most of those problems.

Then I read somewhere that Karl Rove urged his clients to bring up the bogey word “socialized” to describe programs their opponents advocate, since everybody hates anything that is socialized? Oh, yeah? You mean like people hate socialized roads, socialized water delivery systems, socialized sewer systems, and socialized airports?

So I was ready when Jim Wallis’s e-mail hit my in box this morning. His story about his experience with “socialized medicine” in London — a horror story that George Bush will use in his next State of the Union?

It’s a nightmare for sure — for the critics of “socialized medicine.” Read it for yourself, below the fold.

Here’s the usual, Republican view of “socialized medicine” (click on thumbnail for a larger view:

Government Optical

Pretty funny, eh? It’s totally groundless. Think about the government’s program of eye care for soldiers. Pilots and sharpshooters need great eye care. They get the best. They also get stylish glasses. And, though budgeted, you can get some style on Medicare and Medicaid, too — lots of styles, not just one. Our government operated eye care is socialized almost not at all in the classic, socialism definition of its being a planned output and planned outcomes system. Neither output nor outcomes are planned.

Socialized medicine really works. It’s a nightmare for the crowd that thinks bad health care or no health care is cheap, and the socialized medicine can’t work. Read Jim Wallis’s story, below the fold:

My Encounter with [Insert Scary Music] … Socialized Medicine!
by Jim Wallis

My foot had been sore for a couple of weeks and it wasn’t getting better. I usually would ignore that, but we were about to leave on a two week vacation with my wife Joy’s parents to celebrate both of our big anniversaries (their 50th and our 10th). Then I have to fly to Singapore for the World Vision triennial conference. So I wouldn’t be back home for many weeks and my Washington, D.C., health care provider (over the phone) strongly urged me to see a doctor in London before we left.

I realized then that I was about to have my first encounter with SOCIALIZED MEDICINE! Now it’s one thing to advocate health care reform in America and even to be politically sympathetic to the idea of a single-payer government-supported system like they have in most of the world’s developed and civilized countries (such as Canada, Germany, and Great Britain). But it was another thing to actually go to the emergency room (or ER, but in the U.K. they call it Accident and Emergency) of a hospital in the British National Health Service. After all, I had heard the horror stories—long waits in incompetent, dirty, and substandard medical facilities; bad doctors and faulty diagnoses; and, of course, incredible bureaucracies like everything in “socialist systems.” Rush Limbaugh and every other conservative pundit have warned us all in America about the horrific practices of British socialized medicine.

So I prepared myself. I brought a big novel to read, along with my eyeglasses, a bottle of water (no telling what they would not have in socialized medicine), and emotionally steeled myself for the ordeal. Ann Stevens, the Anglican vicar with whom we stay in London (she’s my son Luke’s godmother and Joy’s old pal) took me to St. George’s hospital, dropped me off at “A and E,” and wished me luck at 9 a.m. Hoping I would be home that night for dinner, I took a deep breath, walked across the street, and made my way into socialized medicine.

The waiting room was actually quite peaceful and not crowded, I noticed, as I walked up to reception. The woman at the reception desk smiled. I didn’t expect that. “Can I help you?” “Yes,” I replied, “you see, I am an American—I guess you can tell—and I’m visiting family here—my wife is British—and we’re staying with our friend the vicar, and I have a sore foot, which I normally wouldn’t worry about but we’re going away for several weeks on vacation, and I called my health care provider in the U.S., and they told me to come in here, and thought I should get an X-ray or something.” (I wondered for a moment if it would help to tell them that I was a friend of the prime minister, but decided not.) “What do you need from me?” I asked hesitantly. “Just your name and address,” she replied with another smile. “Oh …OK.” She told me it would be about 10 minutes to see the nurse. “Yeah right,” I thought to myself.

I settled into the waiting room chair, looked around at all the people who didn’t seem to be in any distress, and opened my book for a good long read. It was five minutes before the nurse called me in to a little office adjacent to the waiting area, which seemed to be an intake room. She was pleasant and professional as she asked me what was wrong, and how long I had felt the soreness. She gently examined my foot and then told me I would be called in to see a doctor in about 10 minutes. “Sure thing,” I thought. So I went back out to the waiting room and settled in again to read my novel.

It was five minutes before a young woman appeared and called my name, “Mr. Wallis?” She was a young Asian doctor named Dr. Gillian Kyei. She was also very pleasant and professional, taking time to ask me lots of questions about how I might have hurt my foot, etc. She examined the injured foot carefully, told me that it didn’t necessarily look broken, but that we should get an X-ray to make sure. I waited in her examining room for a couple of minutes while she called down to the X-ray department to say that I was on the way. Then she came back and escorted me herself.

When I got to X-Ray, I checked in by just saying my name and took a seat in the waiting area. Finally, I was going to get to read my book! But five minutes later, the technician came out to bring me in. She took her time with me, taking several different angles of my foot. When I was done, she sent me back to my young doctor, with another smile.

This time the wait was a full ten minutes because, I later learned, Dr. Kyei was reading the results of my X-ray, which had already been sent to her computer. She showed me what looked to her like a fracture of my fourth metatarsal bone, but said she wanted to consult with the orthopedic specialist. I waited about ten minutes more while she did that and so got a few more pages read.

Dr. Kyei then came back with the definitive diagnosis—my fourth metatarsal bone was indeed fractured. She went over their preferred treatments and my options with me. Normally, if this injury had just happened, they would put me in a cast to hold the broken bone in place and give me crutches. They were still happy to do that now. But since I had been already walking on it for over a week and the bone was still in the right place, I could also have the option to just using a therapeutic soft boot to keep the weight on my heel and off my fourth and fifth metatarsals. While the fracture was at the base of the fourth metatarsal, as she carefully explained and showed me on the X-ray, the pain was being felt lower down—across both my fourth and fifth metatarsals area. If I chose the boot, I could still swim with my kids and get around a little easier, but I would have to really try to keep my weight off the injured area. I chose the boot and she told me she would be back in a minute.

It was actually about two minutes before she got back, and I was getting nowhere with this novel. She handed me a very stylish black boot (so much better than other colors for fashion coordination), and gave me my final instructions—be very cautious about the foot, try to stay off it as much as possible but keep it mobile and flex it so the blood circulates, get another X-ray as soon as I get home and, of course, then consult with my home physician. Then she wrote me a nice long letter for my home doctor, describing their diagnosis and treatment. Dr. Gillian Kyei then wished me the best of luck, hoped I would have a great vacation despite my foot, smiled, and sent me back to the front desk.

“How can I call a cab?” I asked. “Oh, I’ll do that for you,” she said. “Just take a seat over their and the cab will be here in about 10 minutes.” As I sat there, I realized something. Nobody had ever asked me to pay. Everything was FREE, including my nice new boot. How about that? They think health care is a right for all citizens, and even foreign visitors like me. Amazing.

The cab came in 5 minutes. I thought I would tell him some horror stories about my experiences in the American health care system, but decided not to. I was back at Ann’s in just over an hour from when I left—with my letter, my boot, and my tale of smiling, pleasant, and efficient health care workers. And somehow I began to believe that back in America we weren’t being given the whole truth. And guess what? Ann tells me that David Beckham and Wayne Rooney, the biggest British soccer (football) stars, have had metatarsal bone fractures, just like mine. In about six weeks, I too will be back on the field, thanks to socialized medicine! And in the meantime, I will keep my foot up … and maybe get that novel read.

posted by God’s Politics @ 5:00 PM

You may leave comments here, certainly, or also at Jim Wallis’s blog site.

Update August 20, 2007:  Health care in France also works well, despite it’s being “socialized,” according to some sources.  See this post at SuperFrenchie, based on this Boston Globe opinion piece.

17 Responses to Nightmare at 1600 Pennsylvania Ave: Socialized medicine! (it works well)

  1. martygrn says:

    “Private enterprise probably knows exactly what the public needs and wants, especially with insurance — but the interests of the insurance companies in America cut the opposite way. Figure out how to make the private entrepreneurs advocate for the public needs instead of against them, and we could get some serious progress.”

    I cannot make the argument for how to make exactly this happen as well as Ms. Herzlinger does in her book, but I will attempt to do so. The current system rewards insurance companies for soing things the way they do. What would they do if health insurance became another true ‘product’ like most every other product in the marketplace? What would happen if every individual made their own decisions about their purchasing health insurance? What has happened in the retail sector as individuals have exerted more and more of their influence? Why not open the insurance industry enough to allow visionary people of the ilk of Sam Walton, Michael Dell or Bill Gates to reinvent the industry? These people did it with retail, computers and software, why not create a system whereby the same transformation would be able to happen in the insurance industry. Auto, life and home insurance are competitively priced and respond to the needs of consumers. Why can health insurance not follow a similar model? We need simply to change the laws to make this a reality. I will posting on my blog within the next few weeks how to make this happen. It is taking me a bit of time to try to do justice to a plan that took a book to lay out, but am working on it. I believe a system that REMOVES government involvement is a much better than the alternative which INCREASES government involvement. I currently work in health care and can say, beyond a shadow of a doubt, that the government programs are the absolute worst out there.


  2. Ed Darrell says:

    One of the serious issues would be how to convert our hospitals to for-profit, private ownership. While I don’t think that’s an inherent barrier to private insurance universally carried, it’s a huge one now. Socialized medicine on the Swiss, private/for-profit provider model would require a much more dramatic re-engineering than the Canadian model.

    The first step should be universal health coverage. As you note, there also should be no inherent barrier to getting that, with private insurance. However, insurance companies oppose it. That suggests there are serious structural differences between the U.S. and Switzerland that also impinge on a Swiss-style solution in America. It makes no sense for insurance companies to oppose adding millions of people to their customer base — and yet they do oppose it, on business grounds. They claim it would cost them too much.

    It wasn’t the SEC that put Arthur Andersen out of business, it was the courts.

    Private enterprise probably knows exactly what the public needs and wants, especially with insurance — but the interests of the insurance companies in America cut the opposite way. Figure out how to make the private entrepreneurs advocate for the public needs instead of against them, and we could get some serious progress.

    Absent that, socialized medicine along the English or Canadian models appears a much better way to go, to me.


  3. martygrn says:

    Hospitals in Switzerland are private, FOR-profit entities, however, with government mandated transparancy. I understand that the Enron, etc. issue could be used against the workings of the SEC, however because of the Enron issue, Authur Anderson is basically out of business. Exactly the same kind of market control needed in health care. As for for-profit vs. non-profit, who will know better how to supply what the public needs and wants? The current monopolistic non-profits who think they know what we need better than we do or a for-profit, competitive marketplace where they need to prove their value to the public everyday?


  4. Ed Darrell says:

    Employee retirement support is significantly reduced. Many companies that formerly offered pension plans offer no match at all for 401Ks — which means they offer no support at all.

    I’d like to see the statistics on 401Ks. Got a link?

    Nor have we gotten to the 401Ks that are screwed up by the employers, like those at Enron.

    If our intent was to increase income for senior citizens, I’m not sure we succeeded — certainly not on the scale that the cost-of-living increases in Social Security did in pulling people out of poverty. If our intent was to make retirement coverage broader, I think we failed. If our intent was to improve retirement conditions for senior citizens, I think we failed. 401Ks are a huge success for the top 20% of income earners, but they have discouraged pension plans for the other 80%. That’s a financial problem for our nation, especially for our children — but it’s a moral failing, too.

    Back to Switzerland: Who builds hospitals there? Are they government entities, or private non-profits?


  5. martygrn says:

    True, they got out of providing ‘traditional pensions’, but many offer employer matches for 401k contributions. All is invested tax free. Also, many small businesses (the backbone of the US economy) are able to offer a 401K but could never have offered a traditional pension. Statistics show that, due to 401K’s, many more people have retirement savings now than ever would have had it under the old pension plans. Employers did not drop out of providing retirement benefits, it’s just the form of the benefit that changed. And, a 401K is much less expensive for an employer to provide, does not have the administrative overhead, etc. that traditional pensions do. And they are much more secure than a pension. IF an employer goes bankrupt, your 401K money is safe. It is not in the employers hands and they can not get to it. Unless, of course, you have ignored all investment advice and invested in your employers stock. And the best is that YOU decide how to invest YOUR money, how much risk to take, what to invest in, etc. In a traditional pension, all those decisions lie with the employer. Exactly the way health insurance is now. Who do you think can decide best for you what coverages you need in health insurance? Your employer, the government or yourself? I vote for making my own decision based on my and my families needs.


  6. Ed Darrell says:

    Did employers stop providing retirement benefits because the 401K put the investment decisions in the individual employee’s hands?

    Yes, especially for hourly-wage employees, and for employees below executive level. Employers not only got out of providing retirement benefits, many of them gutted the retirement plans to add to the bottom line.

    I hope that’s not a sample of what would happen.


  7. martygrn says:

    Sorry for the second post, but forgot to make one important point. If you really look at the Swiss system, it is almost totally privatized. The insurance being sold, the providers, etc. are all private, for-profit businesses. A key to the entire system is to take what an employer and employee put in to health insurance now, and give it to the employee to purchase insurance on their own. A key is to give this money the same tax-free status that employer provided insurance has now. Many people say employers would just drop insurance money as a benefit. This, among many other arguments, are exactly what the arguments over creating 401K retirement plans were. Did employers stop providing retirement benefits because the 401K put the investment decisions in the individual employee’s hands? Look at the world, 401K’s are almost required as an employment benefit these days. The same type of sheltered account for health care money could be created and left to the individual to purchase the plan that works best for them individually and has the exact coverages they need. The insurance companies would respond by changing the way they do business and offering reasonably priced plans that people want. Exactly what the securities industry did when 401K’s were introduced. This money would be kept in a similar account that could only be used for health care purposes.


  8. martygrn says:

    Agreed, universal coverage is the key. As for the government being involved in quality, what Ms. Herzlinger proposes in the book is a system more along the lines of the securities industry. Mandate transparency in the industry. Make hospitals, doctors, clinics, etc. release their performance data to the public. What are their success rates with certain conditions, etc. Also make health care providers provide their ‘price lists’ up-front so consumers know what they are being charged. The government involvement would be limited to an agency similar to the what the SEC is to the securities industry. To enforce compliance with the release of the data and the accuracy of it. Then allow the market to reward the successes and ‘punish’ those who do not measure up. Also to deregulate the hospital industry and allow for true competition. There is a way, using a risk-adjustment’ model of insurance reimbursement to make this totally work. I cannot explain it all in detail in a single post as it took an entire book to explain it all, but am hitting the high points. The book goes in to much more of the gritty details.


  9. Ed Darrell says:

    One of the keys to the Swiss system’s success is universal coverage. That’s what the CHIP programs President Bush opposes are designed to do. Can you tell Bush about Switzerland?

    A second key is a high degree of government intervention to assure quality of delivery. Generally, when that is suggested in the U.S. conservatives cry “socialized medicine!”

    I think universal coverage is the keystone. We’re a long way from that.


  10. martygrn says:

    Everyone who is arguing FOR government controlled, single-payer healthcare is using the WHO ranking of countries health care systems where the US is ranked 37th. What most argue is the fact that Canada, Great Britian, etc. are ahead of us on that measure. Why don’t we instead focus on who is number ONE on that ranking? Of course, it is a country that has government run, single-payer health care, right? WRONG!! The number one, best health care system in the world is Switzerland, with a CONSUMER driven health care system. The government provides no direct insurance at all, insurance companies still exist (altough much different than our insurance system), and providers are still private enterprises. Why does this work better than any other system? Because it puts the individual CONSUMER in charge of the system. What could be better than you and I deciding for ourselves what we do and don’t need? Can this system work here? YES, yes and yes. For details on how, read the book “Who Killed Health Care?” by Regina Herzlinger. This book lays out how to make our system the best it can be. I am going to try to work with Ms. Herzlinger to break her plan down to something that can be presented in an online post/blog, but until then, check out the book.


  11. Ed Darrell says:

    Marty, why do you think only the U.S. government is incompetent? Government involvement in healthcare works well in France, in Canada, in England, in the military — what makes our government uniquely incompetent to do what the French and Israelis do?

    One of the key drawbacks of the U.S. system is private involvement as gatekeeper. Fully 25% of every dollar we spend on health care goes to private insurance companies for the sole function of keeping out of the health care system anyone who is not insured. For the amount of money we spend trying to keep them out, we could buy every uninsured person a gold-plated policy from the most expensive insurance company in the nation.

    The cheapest health care is preventive, keeping people healthy. To do that, we need to encourage people to see physicians, to get small problems treated early. Our present system discourages that. We know that also drives up costs.

    I’m not convinced that government involvement is worse than profiteer involvement. The English example Rev. Wallis offered seems to make a case that it can work. I refuse to believe U.S. people are that much stupider than the English.


  12. martygrn says:

    Interesting that so many people advocate the government getting more involved in healthcare. What was the system like in the US 50 years ago? Most everyone had health insurance through their employer, it was reasonable in cost, covered most everything and health care itself was reasonably priced. What changed? Let’s see: medicare was expanded, medicaid was created, government price controls went in to effect. Also, we went from ‘traditional’ health insurance to the HMO model. Who created this change? The HMO model for insurance, whereby insurance executives were now in charge of what is right for you medically, was made legal during Carter’s administration. The HMO model was also the basis for ‘Hillary-care’.

    The moral of the story? Government becoming more involved in health care is what caused the current breakdown in the system. Why does anyone think that even more government involvement will fix it?


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  14. Michael says:

    Just a quick point to Waldron.

    My girlfriend is a Medical Doctor and many of my friends are too. They don’t make as much as you think they do. Once you factor in Medical Malpractice insurance, you wonder if 10 years of schooling was worth it. The doctors that make the most money are the ones who specialize in a certain field. That means after their residency program they do another 2-4 years specializing in a narrowed down field. This puts their time schooling/residency upwards of 14 years (Residence make under 50K per year depending on the program) Not to mention the 300K+ in student loans they have to pay off.

    Try not to blame the Doctors, they are doing their best with a bad situation. You’re probably not surprised to know that many doctors end up quitting medicine and going to work for the insurance companies and pharmaceutical companies so they can make a decent wage.


  15. Michael says:

    A big part of what Ron Paul is stating is that the medical system is broken. I think we can all agree on that. However, what caused the decline of our health care system? Insurance companies? Pharmaceutical companies? The FDA? All the subsidies and lobbyist money that floods most politicians offices and especially D.C. A large contributing factor to the decline of medicine was when the government started playing a bigger role in it. The VA care, Medicaid and Social Security is nothing to brag about. The entitlements just keep on growing…

    Ron Paul is very in tune to the inadequacies of the Health care industry. He is a Medical Doctor by trade. Everyone should understand the fundamental problem is our mismanaged government and policies. It’s perpetuated by rising law suits and medical malpractice claims. The Doctors and Hospitals are forced to run every test under the sun “just to cover their asses” so they don’t get sued. Then you have the insurance companies turn down claim after claim, forcing the doctors and hospitals to raise their prices ($50 band-aid anyone?)

    The government has created an environment for big insurance companies to thrive and become the monsters that they are today. Our society has forced us into a corner and most of the story is unknown or not understood by John Q. Public.

    Now I’m torn on this issue because I believe there should be some sort of health care for everyone. However, I’m not happy about paying more taxes to accomplish this. The entire system is broken and if we (the American people) want to have anything in the future we need a fundamental change in government and the way it does business. Ron Paul wants to in fact change policies that are plaguing us all. He follows a very simple “Cause and Effect” approach. We owe it to ourselves to look more at the root of the problem, than just throwing money or new policies at them.

    Here are a couple of things you should watch and forward to people that are also concerned about where the money goes in Washington.


    An uninsured American


  16. Mike O'Risal says:

    But it’s a slippery slope. If we get socialized medicine, the next thing you know we’ll be drinking tea and allowing gay marriages. Before long, we’ll see marijuana decriminalized and then, while nobody’s looking… BANG! The Queen takes over and we’ll be back living under a monarchy. Surely Americans must stand up against creeping Monarchism lest we be forced to boil our meat!


  17. waldron says:

    i want socialized healthcare for this country also! of course, i’ve heard horror stories from canada and britain (ironically), but france has a great healthcare system. essentially, whether independent or socialized, healthcare is bound to have it’s snags, it’s unpleasant encounters.
    what i love about socialized healthcare is that you don’t go to a convenience store cash register and see a can with a little girl’s face on it, claiming pictured girl needs a liver transplant and any donations are welcome. you don’t have the poor elderly going without necessary medication, you don’t have college students who are trying to work their way through school having to “tough out” the flu, because they don’t have insurance.
    i have a feeling it won’t ever work in America. We emphasize independence too much in our culture, doctors who make above average salaries would like to keep it that way, and their are many many people in the insurance business who would be out of a job.
    craft post!


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