By Milton Hirshberg, M.D.
Cape Cod Times, July 27, 2011
The executive director of a group called Health Care For All had a commentary in your July 8 edition bearing the headline “Creating patient-centered health care.” Long ago, in the town where I grew up, the people already had patient-centered health care. “Creating” is inappropriately used in this heading; “re-creating” would be more accurate.
In my town, my family doctor held office hours and made house calls. He seemed to be as happy working in this occupation as anyone could possibly be. The medical specialists in town were a surgeon and a radiologist. If certain other specialists were needed, they came from Boston to the community-owned hospital when called. The town doctor made rounds twice a day at the county home for the poor and was in his office the rest of the day. There were a school nurse and doctor. Everyone received necessary medical care.
Today we call this a system of Health Care for All, which other prosperous nations still have; but in the United States, it has been disposed of by market forces. Attempts to re-create it in America, through the mobilization of national or state resources under government sponsorship, have been condemned by critics as a socialistic affront to the “free” market ā even though the market is the captive of financiers, is not free, has been tried in health care, and has failed us just as Alan Greenspan, the former Federal Reserve chairman, has acknowledged the market’s failure with regard to the financial crash of 2008.
Our current health system resembles Germany’s; both systems have combined public and private (wellness or insurance) plans with funding from public and private sources at 75 percent public and 25 percent private. But almost all of our private health plans are businesses with the primary purpose of making profits, and the plans in Germany are nonprofit. Germany supports health care at about 11 percent of its economy, while we take 17 percent of our gross domestic product for ours. And the German people spend about $3,700 each for their wellness system, and we spend $6,500 for roughly equivalent health quality.
Obviously we are cheating ourselves, as we pay $1.79 for the same health value that Germans obtain for $1. We know that Germany and the other nations with universal health programs do excel, in terms of program cost/effectiveness, by a great margin over ours.
Why do we persist in this colossal folly and obstinately reject systemic reform after such a comparison? We are the only nation in the world trying to operate a health program by defining health as a commodity, available if a person can pay the market price. And it hasn’t worked, and won’t.
Kenneth Arrow, 1972 recipient of the Nobel Memorial Prize in Economic Sciences, in a 1963 paper published in The American Economic Review, concludes that in the operation of the medical profession “the usual assumptions of the market are to some extent contradicted. The medical profession is only one example, though in many respects an extreme one.”
Health care is not for the market, Arrow concludes. So why are we still trying to invent a different reality that is illogical and doesn’t satisfy the needs of society, especially when there is an alternative available that has already been designed by others, tried by others, and works for others? We Americans already have Medicare, upon which a single-payer national health insurance model can easily be built as has been done in Thailand, South Korea, and Canada. “Know, my son,” said a dying Swedish statesman in the 17th century, “with how little wisdom the world is governed.”
Dr. Milton Hirshberg of South Harwich, Mass., is a retired psychiatrist.
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