In every house where I come I will enter only for the good of my patients, keeping myself far from all intentional ill-doing.
(from the Hippocratic Oath)
As you go, proclaim the good news: “The kingdom of heaven is at hand!” Cure the sick… as you received without payment; give without payment.
A couple of days ago I was on the phone with my Mother. She had recently undergone cataract surgery for both her eyes – a series of operations that has brightened her outlook, both figuratively and literally. My mother has been on a pretty fixed income for the past several years, but because of a program in the city in which she resides (a program designed to benefit those on a scale from “pretty fixed” to “no” income), the procedures were very nearly free. During our conversation I made the comment, “Hooray for socialized medicine!”
Mother, a lifelong Libertarian and congenital contrarian, was quick to chide me. “This is not socialized medicine,” she insisted. “Socialized medicine would be terrible!”
This is what I would call a typical conversation between my Mother and me on such subjects. It is a disagreement we have had for decades. For her, the Market (always with a capital-‘M‘) is the Answer (again, you can almost hear the capital-‘A’) to all problems – be they social or personal (and all those potentially-unhygienic crevices in-between). Anything, therefore, that would supplant or interfere with the unfettered workings of the Market is bad.
I am inclined to disagree.
I was in mind of this conversation, over the past several days, as I came across the following two anecdotes, related to me by friends of mine:
First, one friend, just recently returned from a pre-Olympic visit of five weeks in China, told of getting a cut on her ankle, which then got badly infected. After a couple days of just trying to let it heal on its own, the wound began turning blackish, and so she went to see a Chinese physician. She mentioned that she was slightly frightened to take that step, as she had – like many of us – been raised on the horror stories surrounding anything non-American that relates to medical practice.
She was in for a pleasant surprise. At the Chinese clinic she was immediately seen by a (female) doctor, who examined the wound, made a treatment decision, and relayed instructions to the (male) nurse. The nurse, in turn, cleaned the wound and bandaged it properly. The infection was treated with antibiotics and is now fully healed.
The surprise did not end there. Total time in the clinic? Less than an hour (with a translator, no less). Total cost of the antibiotics? $1.50. Total cost for the visit itself? Fifty cents, American.
The second story, slightly less rosy, involves a graduate school colleague of mine, who has just been given formal permission to take part of the next year off for medical leave. The leave is officially sanctioned, remember; it is recognized by the University and is, in effect, simply a “pause” in her studies. In other words, she is still a student.
Despite this very clear fact, however, she was recently informed, by the administrator of the school’s insurance plan, that she would not be considered eligible for school medical insurance while she was on school medical leave. Never mind that (to quote the Book of Esther) it was for such a time as this that medical insurance was invented in the first place; my friend has been caught up in a bureaucracy with its own illogical logic.
While I am not privy to all the details of the discussion that followed, I am reasonably certain that my colleague noted the frank absurdity of this situation to the administrator.
Given the above, I wish to make the following points:
1) As much as I may dislike the practices of the People’s Republic of China on issues of liberty, I cannot fault them for having an inexpensive health care system that seems, at least on my limited knowledge of it, relayed to me by my friends who have been there, to work. That is to say, the usual argument against China’s “human rights record” shifts somewhat if we expand our imagining of “human rights” to include effective, affordable health care.
2) The argument often made against a program of socialized health care for our nation – by my Mother and those of her mindset – is that such a system would be mired in bureaucracy and inefficiency, such that those who need care might not get it at the time they most need it. What I have observed, however, in my own health care and that of others, is precisely this sort of bloated inefficiency already at work here in America – with the added insult of an obscene price tag.
My evidence, I admit, is scant, and consists at this point of hearsay and anecdote. And yet the sheer preponderance is certainly indicative. Consider, for example, doctors who insist on putting human beings ahead of profits. I am friends with physicians who are idealistic and truly concerned for the full health and wellbeing of their patients, and each one of them in the past ten years has been encouraged by the partners in their practices to leave because such care is not serving the ultimate goal of profit (One friend now works, interestingly enough, as a major administrator for the public health establishment).
Contrariwise, I have been acquainted with other doctors, who are, in more typical fashion, concerned chiefly with dollar signs. One such soul, while diversifying his portfolio into real estate, was recently involved in callously dispossessing my wife and I of our apartment with less than a month’s notice when it became profitable to turn them into condominiums (So, let the reader be aware, I do have some personal bias, if not animus, in these discussions. Caveat emptor).
“Health care for profit” is not simply an oxymoron or an ethical dilemma – it is a blasphemy. Mention of the phrase makes me mindful of another image – this time of a college classmate, some years ago, weeping openly on her graduation day.
She wept, not for joy, but because she suffered from both youth-onset diabetes and rheumatoid arthritis, and had not yet secured a job, and had therefore no access to affordable job-related insurance to replace the school’s plan (a plan by which she would no longer be covered upon graduating). She wept because, despite all the high talk of the “Market” and its “forces,” and of that mythic abundance that supposedly abounds when supply meets demand, she was, quite simply, uninsurable. Even if she could have afforded to pay the premiums, private insurance would have refused to cover the very conditions for which she most needed insurance.
Those who disagree with my outrage at this will speak here of “complexities.” I am aware that this is a complex issue, and I am aware that the answer is not simple (or at least not simple-minded) charity. After all, even the Nazis gave bread to the poor, at least at first. The Nazi example chastens us that we should always look deeply into the motives and methods of any model of charity we might endorse.
But the situation I have just described, regarding my college friend and many more like her, is simply, patently, perversely unreasonable. There must be a point at which reason – and reasonable kindness – prevails, mustn’t there?
Frankly, at this point, I do not care what it is called – whether it goes by the name “socialized medicine” or by some other, less offending moniker – but the fact remains that there are countries all over the globe, of every stripe of politics and resource, that are delivering efficient and affordable, if not free, health care options to their citizens. The quality of this care, moreover, often beats the best that the American medical market seems to provide; in fact, we’re pretty low on the totem pole when it comes to the effectiveness (total or partial) of our care system.
So, to be blunt, call it what you will, but I am tired of waiting. Health care, by my lights, should be readily available, highly effective, and free. I have little interest in discussing anything short of that anymore. Nor am I interested in discussing or rehearsing the reasons given as to why we can’t do it. Such reasons are simple lies, and should be named as such. Like the other countries that are doing it, we can do it. The fact that we Americans aren’t amounts to little more than simple foolishness and petty jingoism.
Too often, human beings are made to suffer so that the comforting word choice of a few powerful individuals can remain untarnished, or for some idiocy of ideological gluttony. Systems are put in place to preserve the systems themselves, and not the lives put in their care. Why do we (who with all our talk of affluence and education relative to those “less fortunate,” should certainly know better) allow such gluttony to continue?
We will be judged, I am told, by how we have cared for the “least of these” among us. Let us, for once, be honest: The least among us deserve better – better, certainly, than we have offered them thus far.