Universal Health Coverage --- Call It Socialized Medicine
Lawrence R. Huntoon, MD, PhD
One of the biggest myths being propogated today is the absurd notion that "people can't see a doctor without having insurance." The truth is office visits are relatively cheap, well within the means of most people. The problem is most people don't budget anything for their annual medical care. And, then when a problem arises, any expense greater than zero "isn't in the budget."
The other problem is that insurance really isn't insurance anymore. It is pre-paid health care. True insurance is intended to prevent financial disaster in the face of an unlikely event. Most people, however, have come to expect first dollar coverage for everything including very common and likely events like routine doctor office visits. "Covered'' employees don't realize it's their money going to pay for this "wonderful" non-bargain of first dollar coverage. It's not a "free" benefit provided by their employer as most employees believe. These costs are essentially hidden from employees. Money their employer wastes in purchasing first dollar coverage or inferior managed care coverage for the employee is money which would have been the employee's salary to spend as they choose.
The reason most people obtain their health insurance from their employer is because of tax discrimination. During World War II, our government enacted wage and price controls. Employers couldn't attract better workers by offering higher wages, but were allowed to offer health insurance as an untaxed benefit. Although World War II ended 54 years ago, this same tax discrimination policy remains in effect today. This atrocious policy discriminates against the working poor, part-time employees, employees working for small businesses that don't offer health insurance, and the self-employed. Those who obtain their health insurance through their employer, purchase their coverage with pre-tax dollars. On the other hand, those who purchase their health insurance on their own, purchase it with after-tax dollars --- a huge difference. In fact, the uninsured actually end up paying what amounts to a tax penalty for being uninsured.(1) It is estimated that "a family in the bottom fifth of the income distribution pays about $450 more in taxes than insured families at the same income level. For families in the top fifth of the income distribution, the tax penalty is $1,780."(1) The analysis goes on to say that "on the average, uninsured families pay about $1,018 more in federal taxes each year because they do not have employer-provided insurance. Collectively, the uninsured pay about $17.1 billion in extra taxes each year because they do not receive the same tax break as insured people with similar income. If state and local taxes are included, the extra taxes paid by the uninsured exceed $19 billion per year."(1)
Where, we must ask, is the compassion for these overtaxed, hard-working people? This is clearly a government-created problem. What we don't need is more government (nationalized health care) to "fix it." What we need is to get government out of our wallets so people can have their own money needed to purchase and own their own health insurance. The other thing the pro-socialist "crisis mongers" fail to tell people is that only one-third of the uninsured are chronically uninsured.2 For the other two-thirds, it is only a short, temporary condition, "half of all uninsured spells will last less than six-months. Three-fourths of them will be insured within 12 months. Only 18 percent of all last for more than two years."(2)
Those who brandish the "crisis" of the uninsured to promote socialized medicine also often fail to tell people that uninsured doesn't necessarily mean poor. In fact, the National Center for Policy Analysis (NCPA) tells us that "a third of the uninsured households earn more than $30,000 a year and 10 percent earn more than $50,000."(2) That's at least 40 percent of the so-called "uninsured" that could well afford a $45 office visit or health insurance.(2) We need to get away from the concept that "someone else," big government or insurance, needs to take care of our every need.
The other adverse consequence of this tax discrimination is that it led to cost inflation of medical care. Everyone came to believe that we were spending "other peoples' money" (OPM). And, when you're spending OPM, the sky is the limit. Patients have been told that they are getting "free" insurance from their employer and quite naturally came to expect everything they wanted or desired, whether of marginal benefit or not, would be "fully covered." Likewise, the physician who "participated" in insurance and was paid directly by the insurance company for everything with OPM, had no disincentive to hold down costs. The patients came to view these "participating" physicians as "good" and "compassionate" because the physicians would accept their insurance and the patient would have to pay little or nothing out of pocket, not realizing that OPM was actually their money all along.
Both patient and participating physician, therefore, contributed to this disrupted market where both buyer and seller were insulated from costs thus leading to uncontrollable cost inflation. The problem of cost inflation was further compounded by the cost of government regulation. Government mandates increase the costs of health insurance tremendously, and the mandates are often for things that most people don't want or need. Yet, they are forced to pay for the "coverage." "These mandated benefits included wigs for bald-headed women (Minnesota), pastoral marital counseling (Vermont), and community sperm bank services (Massachusetts).(3) In New York state, most health insurance premiums doubled as a result of state-mandated community rating. This has made health insurance especially hard to afford for the young and healthy who are, in effect, punished by the state for being young and healthy and for not engaging in unhealthy behavior. State mandates, which were purportedly instituted to "help" people, have thus had the effect of pricing many people out of the health insurance market. This, however, is predictably what happens when we look to big government to "help" us.
Indeed, "universal coverage," nationalized
health care, or socialized medicine, regardless of what you choose to call
it, is not the same as medical care. All of the citizens of Canada, for
instance, have "universal coverage." What they often don't have,
however, is the medical care that they need when they need it. That
is why we see Canadians crossing the border into the United States in droves
to obtain the health care that they can't get when they need it in their
own country. Their government rations access to health care and thus attempts
to control costs by making MRI scans, radiation oncology, bypass surgeries
and many other health services largely unavailable to their own people.
Is this the egalitarian's view of compassion and social justice?
We Get More of What the Government
Government programs also breed highly destructive dependence. How destructive? Well, I once took care of an alcoholic patient who bragged that his government disability checks allowed him to purchase better quality whiskey than he could afford to buy when he wasn't considered disabled because of his alcoholism. The government thus subsidized his alcoholism.
During his hospital stay, I pointed out his government subsidized habit had damaged his liver, his pancreas and his brain. He was slowly but surely killing himself with alcohol, bought and paid for by the government. After much discussion with the patient, I convinced him to give up alcohol, but there was a problem. Although the patient was willing to give up alcohol, he wasn't willing to give up the government checks. You see, if he gave up alcohol, he would lose his disability status, and would have to do something drastic like work to obtain money. But, he reasoned, why work when the government will give him the money to spend doing something that he liked to do? This spontaneous "experiment" in addiction medicine proved one thing beyond a shadow of a doubt. As powerful as addiction to alcohol is, it pales in comparison to the addiction to government money.
Yes, we need health care reform, but it needs to be based upon the principles of individual freedom and individual responsibility. And, there are many options out there. Most people could purchase a high deductible indemnity insurance policy at a lower price than they would pay for monthly managed care premiums. That's right --- a much higher quality of health care at a lower price! Imagine, having the freedom to choose the doctor or hospital you want to go to, being able to go to specialists without denials, delays, and gatekeepers. And, the money saved by purchasing a high-deductible catastrophic policy could be set aside in a special savings account to pay for deductibles. The money saved by purchasing a high-deductible policy could also be used to pay for the insurance premiums.
Medical Savings Accounts (MSAs) allow people to put money aside and take a tax deduction for keeping and controlling their own money. The MSA earns interest year after year tax free and if not spent by retirement age can be converted into a pension fund. Think of all the money you and your employer have turned over to insurance companies since you started working, and how much a young worker would have accumulated after 45 years of investment in a MSA. Those in favor of nationalized health care, of course, don't want to give you control of your own money. Government elites feel that they can better spend your money for you. This is the real message that they don't want you to hear.
And, last but not least, there is charity. No hospital ever turns any patient away because of lack of funds. Hospitals and the physicians on call at those hospitals are required by law to treat all patients presenting to the emergency department irrespective of ability to pay. And we do it all the time. It's a total myth that you can't come to the hospital because you "don't have insurance" or "can't pay." Charity is something that should involve churches, not big government. What big government does, confiscating money from all, including the minimum wage earner, and redistributing it based upon some social engineering scheme, isn't charity. It's legalized plunder. True charity comes from the heart, not from forced "contributions." Most churches and charitable agencies understand the dependency trap of big government programs. They understand that it does no good in the long run to give a man fish for his dinner. This does not help him. To help a man, you must teach him to fish. The goal should be to help a man back to his feet so he can support himself and his family, not to trap them in a cycle of dependency. That is what dignity and self-esteem are all about. That is what true compassion is all about. The Amish don't have "insurance coverage," yet they have existed for centuries via a charitable tradition of voluntarily sharing others' burdens and medical expenses. This same concept has been implemented via other churches and religious organizations in conjunction with MSAs and has been proven by AAPS members like Dr. Alieta Eck and associates to be a much more affordable alternative to traditional health insurance.
I find it very sad in a country where men and women have died fighting to preserve our freedom and have died fighting off socialism and communism that some are now considering socialized medicine as a solution to improving access to health care.
Lenin once said that "medicine is the keystone
in the arch of socialism,'' and I believe those who are promoting "universal
coverage" via government-run and government-controlled medicine know
this. What they hope is that the public won't find out the truth. There
is nothing compassionate about socialism. This is why the AAPS gives a high
priority to educating other physicians and the public about the truth of
socialized medicine. That is why AAPS should be joined and supported by
1. Are the uninsured freeloaders? National Center
for Policy Analysis, Brief Analysis No. 120, August 10, 1994.
2. Goodman JC, Musgrave G. Patient Power. Excerpted from: Problem: The rising number of people who lack health insurance. National Center for Policy Analysis, 1992.
3. Printz D. We need MSAs now! Medical Sentinel 1996;1(2):5.
Lawrence R. Huntoon, MD, PhD is president of AAPS and a practicing neurologist in Jamestown, New York.
Originally published in the Medical Sentinel 2000;5(4):134-136.
Copyright ©2000 Association of American Physicians and Surgeons.