From: kenr@orleans.storage.tandem.com (Ken Rose)
Newsgroups: alt.california
Subject: Re: Paradise lost and Medi-Cal...
Date: 20 Aug 92 16:53:20 GMT
Organization: Tandem Computers Inc, Cupertino CA

In article <1992Aug20.091514.21888@gdr.bath.ac.uk>, mascdb@gdr.bath.ac.uk (C D Burdorf) writes:
> Get a clue man!  The amount of money spent on Health care in the
> US far exceeds that of any country with socialized medicine.  The
> reason for that is there is no profit motive in medicine in 
> countries with socialized medicine.  Thus, you don't have the
> problems of doctors overcharging to pad their wallets and you
> don't have the problem of them operating on people when it
> isn't necessary (which happened to my sister in California).  
> 
> You pay for medical care one way or the other.  In a socialized
> system you pay through taxes.  In a private system you pay through
> your salary.  You pay one way or the other.  The advantage of a
> socialized system is THERE IS NO PROFIT MOTIVE IN MEDICINE, SO 
> YOU DON'T HAVE GREEDY CORRUPT PEOPLE PERFORMING OPERATIONS TO
> MAKE BUCKS. AS A RESULT, YOU DON'T HAVE NEARLY THE SAME AMOUNT
> OF MALPRACTICE PROBLEMS.  If you look at it rationally instead
> of ideologically, you pay less for medical care in a socialized
> system than you do in a private system in the following ways:
> 
> 1. Less Cost
> 2. Less Malpractice
> 3. Less worry about greedy doctors doing unnessary operations.
> 

C.D. makes some good points about the flaws of the present system.
Although he didn`t mention them, there are studies that show things
like doctors with their own pharmacies tend to prescribe more drugs,
high-cost procedures are done more often in fee-for-service practices
than HMO's, etc.  And hospitals compete with each other to buy
high-priced diagnostic equipment, the result being some areas have
too many things like MRI scanners, so the bills of all patients are
inflated to help pay for this excess.

But that doesn`t mean we should jump immediately to option B,
socialized medicine.  For although C.D. points out some advantages
of socialized medicine, he hasn`t mentioned some of the drawbacks
or even the restrictions necessary to achieve the benefits.

Take less cost, for example.  Some of the lower cost can be attributed
to rationing health care.  I don't know the age (C.D. in England
should be able to tell us), but patients with kidney failure after
a certain age are simply not treated with dialysis.  That's a death
sentence.  And lets not ignore the possibilty of politics rearing
its ugly head.  Patrick Buchanan, for example, views homosexuality
as a sin.  If he was in office, do you think the national health
service (which as head of the executive branch he would run) would
fund health care for AIDS patients?  Or might it be rationed like
other care already is under socialized medicine?  Private insurers
offer an alternative to the government today, an alternative that
would disappear with socialized medicine.

As for less malpractice, C.D. is probably right that there are 
doctors that perform unneccessary operations, sometimes motivated
consciously or unconsciously by profit.  However that does not
explain most or even much malpractice.  Studies have show that
certain operations are common or rare in adjoining counties or even
adjoining hospitals.  Medicine is an art, not the exact science
people expect.  Not all doctors are trained or follow the best
standards for treatment.  The point is by singling out malpractice
as a profit-motivated problem, the expectation is created that when
doctors no longer have profit as a drive that malpractice will
disappear.

A point not addressed by C.D. is where profit can benefit patients.
Many technological advances in medicine have been led by companies
motivated by hopes of profit.  Non-invasive diagnostic techniques,
bio-engineered drugs, etc. are brought to market by firms hoping to
do so at a profit.  Again, this is not a case of black and white;
you could reasonably argue that rare diseases are ignored by
drug companies, that tools cost too much, etc.  

And in quality of care, the case isn`t so clear cut in favor of
socialized medicine.  The Federal government runs the VA hospitals
in this country, and they aren`t a model of well-run or effective
medical care.  The real world of government run activities includes
drawbacks like restrictive civil service rules, strong unions 
interested more in advancing the interests of their members than
the customers, etc.  Until someone explains why socialized medicine
for the entire country will work better than the part already run
by the government (the VA and military system) we ought to be wary.
I recall reading a book by a doctor about his training and practice,
and he told an anecdote about a patient with a stroke who needed
a diagnostic test right away.  Unfortunately the patient picked
around 5pm to get ill at a VA hospital, and with a cheery
"F*ck you, doc" the technician took off for the day.

Another drawback to socialized medicine (and that applies to many
insured plans,too) is the lack of a tie between using costly resources
and having to pay for them.  This means, for example, that people
with minor problems don`t go to a low-cost or free clinic (where
they would face a cost, namely time waiting) but drop in at the
emergency room if things get worse. It is well known that
emergency rooms are the least cost-effective way of delivering
routine health care, yet many people routinely use them as their
main source of health care.  This drives total costs through the
roof, and yet the big selling point people use in advocating
socialized medicine is that visits will be "free".   

____________________________________________________________________
Ken Rose    (kenr@storage.tandem.com)
The Usual Disclaimer:  Any opinions expressed above are mine alone, not
those of my employer (who is kind enough to allow me Usenet access).