Socialism Sucks in Healthcare as Well
Jeffrey I. Barke, M.D.
My brother Ron is an eye surgeon in Dallas, Texas. He performs a wide variety of procedures including vision correction surgery commonly known as “Lasix.” This type of surgery was discovered by accident in 1974 in Russia. There, prominent eye surgeon, Dr. Svyatoslav Fydorov, was treating a severely nearsighted young boy who had fallen and gotten shards of glass stuck in his eye.
Fortunately, the damage was minimal even though a sliver had penetrated the boy’s cornea – the clear tissue that forms a protective layer over the eye itself. But the boy noticed a vast improvement in his vision after the accident. Dr. Fyodorov examined the child’s eyes again and discovered that the tiny cuts made by the glass had actually reshaped the cornea and changed the focus of the child’s eye.
The doctor became intrigued with this discovery. He continued to study the matter and eventually published his findings. A few American doctors became aware of Fyodorov’s work and determined to do their own research into the effects of the accidental results. In this manner, the original All Laser LASIK vision correction procedure eventually came into wide use. In the earliest days, the surgeons used a scalpel to create the cornea cuts. They called the procedure Radial Keratotomy. Ultimately, the scalpel was replaced with the cutting precision produced by a beam of focused light - the laser.
Over the years there have been further advances in vision correction surgery while the cost of these procedures has been steadily reduced. I believe that this has occurred, in part, because vision correction surgery is not covered by medical health insurance.
Without the restrictions usually imposed by insurance companies and government regulations, an open marketplace of competition and consumer demand have improved the quality of the end product and lowered the cost of LASIK.
There are many other examples of improvements driven and developed by free markets in healthcare fields:
Breast augmentation and rhinoplasty
Weight loss surgery
Dental implants and teeth whitening to name just a few.
Even the advent of concierge primary care — the area where I practice medicine — was created out of patient demand. They indicated a willingness to pay a premium for a closer relationship with a doctor that would also avoid the delays common to overcrowded group practices at the time.
But most of healthcare is not subject to free market forces. As a result, we have been unable to duplicate the progress achieved by vision correction surgery and some other areas of medicine. As a result, without the positive effects of competition and pricing freedom, the cost of health insurance and medical care itself has skyrocketed over the past several decades. This has occurred despite the government's best regulatory efforts to halt the escalation with a range of interventions and mandates. They haven’t worked.
Moreover, senior bureaucrats in the government, know-it-alls in the media, and intelligentsia pontificating from academia love to romanticize the socialized medical systems of Canada and the United Kingdom. They are hell-bent on looking at them as a model for American medicine. Big mistake.
O Canada…
In Canada, every citizen is covered by the government healthcare system at an enormous cost. As a result, Canada has some of the highest taxes in the western world. It is also not uncommon to wait months and sometimes years for routine, non-life-threatening procedures, operations and tests such as an MRI, joint replacement surgery or cataract removal. Many medications available in the United States are not available in Canada. There is a reason, then, why many affluent Canadians travel to the United States to get medical treatment borne of a desire to escape delayed care and poor service.
Push back against the Canadian system began in 2005 when the Supreme Court of Canada struck down provincial laws that banned private health insurance. The court found that having people die while on wait lists violated Quebec’s Charter of Human Rights and Freedoms. For technical reasons, this ruling did not apply outside of the province. Nevertheless, private healthcare began growing in Canada as more citizens became impatient with and discouraged by their system.
Why would Americans want to emulate the Canadian healthcare system?
According to David Gratzer: “Socialized medicine has meant rationed care and lack of innovation. Small wonder Canadians are looking to the market for solutions.”
The system in the United Kingdom is not much better. If you have money you can purchase private insurance and access private physicians. For the rest of the country, the National Health Service (NHS) offers coverage through a government-run system paid for by the taxpayers.
The NHS requires registration with a local GP (general practitioner) in order to access all levels of care within the UK system - much like an HMO in the United States. A patient’s local GP is crucial to the medical care in the UK. Only GP’s can refer patients to a specialist and/or authorize sophisticated testing.
The idea of a GP as gatekeeper was to prevent abuse of the system with unnecessary tests demanded by pushy patients rather than ordered by dispassionate professionals. Unfortunately, this results in excessive waiting times for even routine tests. In the US, HMOs are falling out of favor for some of the same good reasons.
The NHS has its own hospitals and clinics to service the vast majority of the population. A private system in the UK competes directly with this system. Many doctors work both sides of the street. The UK is a good example of how a two-tiered system of haves and have nots arises. Routine surgeries and procedures are performed at NHS hospitals and clinics for the poor and wealthy alike; when specialty surgery is needed— an open-heart procedure, cancer cell removal, hip replacement — the Brits move over to private providers for treatment. It isn’t that the rich necessarily get better treatment in the UK; they just get what they need on a more timely basis. Think about someone waiting 6 months or longer for a hip replacement: Constant discomfort with the realization that medical care delayed is no care at all.
If we were to design a healthcare system from scratch, we probably would not choose the UK or Canadian systems as models. One reason is that neither takes advantage of the efficiencies of a free market system. If government-run healthcare is so superior to what the private sector can produce, why not have government-run supermarkets, restaurants, or clothing stores as well? Ask Cuba, China, Vietnam or any of the other Soviet-style socialist economies. They all eventually allowed private businesses to operate next to state-run stores to get better products, services and pricing.
We currently have three examples of government run healthcare in the US and they are all in trouble:
The VA Healthcare system is notorious for its long waits and inefficiencies – veterans literally died while waiting for proper attention.
Medicare is slowly going bankrupt and is seeing more and more physicians opt out of participating in that program;
and the Indian Health Service is both corrupt and ineffective.
If we cannot put our own socialized systems right, why would we want to expand them to include all those medical providers who are not now caught in the U.S. government’s web?
In 2014, Dr. Keith Smith created the Free Market Medical Association as part of his effort to bring transparency and free market principles to healthcare. “We founded the FMMA so that the nation could learn how we did this. We have offered total and complete transparency over our competitors, and we showed that this was a viable business model.”
Dr. Smith is but one innovator trying to create a free market in American healthcare. In 2003, I co-founded PersonalCare Physicians, the first primary care concierge practice in California. Concierge medicine is now a growing free market movement where patients pay a membership fee to join a medical practice. This membership fee allows doctors to take care of a smaller cohort of patients and therefore provide a much higher level of personalized medical care.
There are other models being put forward in response to the demand and frustration of the typical American patient experience: One Health, Forward Health, MDVID and a variety of telemedicine services are some of these other models. If American healthcare is to remain the best in the world we must allow free market forces to act to bring down costs, improve quality and innovate as only America has proven it can do.
I hope my brother, Ron, keeps innovating his techniques in eye care in his private practice - I may need his vision correction surgery services soon!