By Gerard J. Gianoli, M.D., of the Association of American Physicians and Surgeons
"What about the poor?" is inevitably asked of people who promote free enterprise in medicine. Good question. Let's look at actual results, not sentiment or good intentions.
In the U.S., Medicaid is generally the means for payment for medical services for the poor. The services are, however, the same regardless of the payment method (Medicaid or private). In socialized systems, the payment method is the same for rich and poor, and service is provided by government-salaried workers. As is typical of socialism, more money does not buy you more or better services, but political influence often does.
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Many decry favoritism for the politically influential in socialized systems. Consequently, it was big news when the former director of the NHS died in 2011. Margaret Hutchon died in her own hospital, located in the town where she was mayor. Emergency surgery was to be done in June the preceding year, but was canceled and delayed four times over the course of almost 10 months. In the U.K., when it comes to hospitals and the NHS, there were probably very few people with more political influence than Hutchon. The fact that even she was subject to such delays highlights the inefficiencies of socialized medical systems.
The surprising thing about Ms. Hutchon's medical horror story is not the four delays in her emergency surgery. It's that she did not come to the U.S. to have her surgery sooner, as other politicians in socialized systems do. Fidel Castro left Cuba, Michael Moore's "socialist health-care paradise," for a private hospital in Spain when he needed life-sustaining surgery. Similarly, Canadian Prime Minister Danny Williams came to the U.S. (just as 40,000 Canadian citizens do every year) for heart surgery. Unlike Hutchon, Castro and Williams are still alive.
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As bad as socialized systems work when you are politically connected, they're even worse when you are not.
Hutchon's experience is not unusual. My patients relay similar stories or worse. A recent study by the Fraser Institute revealed that, in Canada, the median wait time from referral by a primary care doctor until treatment by a specialist was 18.3 weeks. The 13.6-week wait in Saskatchewan was the shortest, and the nearly yearlong wait (43.1 weeks) in Prince Edward Island was the longest. If the primary care doctor referred a patient to the wrong specialist, care could be delayed for more than a year.
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In the United States, while we have problems regarding costs, even the most destitute of our citizens do not face such long wait times. Any hospital or physician who has delayed treatment for an emergent medical condition would be subject to civil and potentially criminal prosecution. But not so in the socialized systems, as long as the paperwork has been filled out.
Our own version of socialized medicine is the Veterans Administration system. The VA delay scandal of 2014 demonstrated how the VA has operated for years – delays in medical treatment and cover-ups of the inadequacy of the system. A probe revealed 40 veterans who died waiting for care at one VA Hospital in Phoenix, while an internal VA audit of 40 VA facilities revealed that 120,000 veterans were left waiting or never got care, while schedulers used a system designed to hide this problem. This was not new for the VA – a 2002 VA report demonstrated 300,000 veterans waiting more than six months for appointments. The problem continues to this day. Even indigent patients on Medicaid receive care more promptly.
But veterans have an escape route. They can opt to seek care outside of the VA, where they can receive private care almost immediately. And they don't need to leave the country.
Medicaid patients have better access to health care in the U.S. than the politically connected in socialized systems. Yes, the poor need a "safety net." But note that the U.S., which still has private medicine, is the safety net for people trapped in socialized medicine.