In view of Dr. Faria's essay, "Is There a Right to Health Care?" in the July/August 1999 issue of the Medical Sentinel,(1) and an editorial which appeared last year in The New England Journal of Medicine,(2) which spoke of a "distributive ethic" akin to corporate socialized medicine, and the collectivist drive toward a right to medical care in America with new proposals for a 28th Amendment to the U.S. Constitution to accomplish such a right,(3) I would like to expound on this issue which is of utmost importance for the survival of the profession and what remains of private medical care.
We are told in Dr. Kassirer's editorial that physicians who agree to the distributive ethic of managed care essentially become agents of the Plan instead of advocates for the patient.(2) According to Kassirer, the fundamental flaw in today's health care environment is the lack of egalitarianism --- nationalized health care (socialized medicine). He tells us that "a system in which there is no equity is, in fact, already unethical."(2) But aside from the fact that ethics is a quality of character that applies only to people not to "systems," his proposed solution of nationalized health care suffers from the very flaw of "population-based" medicine and "distributive ethics," things which the author tells us are very bad. To illustrate the point, we need only change the word "plan" in the author's quote to "government." His quote would then read, "In agreeing to a distributive ethic, are physicians tacitly becoming agents of the [government] instead of agents for their patients?" The answer is a resounding Yes!
Again, we need only look to our Canadian neighbors to see the reality and horrors of government-run, distributive medicine. "Both patients and physicians are jumping ship as the Canadian single-payer system begins to sink."(4) Canadian citizens are now buying personal medical insurance that pays for care in the United States, care that they can't get in their "wonderful" government-controlled system when they need it. Canadian physicians are also leaving Canada in droves, making the already existing shortage of physicians in some areas and in some specialties worse.
Dr. Robert Jackson, who left Toronto several years ago to practice in Dallas, Texas, explained his move by saying that "I don't like being considered the bad guy all the time. Physicians are held responsible for the constant cuts. At the Orthopedic and Arthritic Hospital in Toronto, wards were closed and the staff had to sell pizza to pay for repairing the elevators."(4)
Dr. Jackson also tells us that staff physicians were limited to 25 joint replacements per year. But what do you do if you're the 26th person in line...eh? Government doctors in Canada work long hours for low pay and at times are expected by their government to work for no pay. Most spend on average two hours a day (unpaid labor) filling out government forms. Dr. Jackson's diagnosis? "Pathological Egalitarianism."
There are those who are constantly trying to convince us that egalitarianism is the only moral and ethical choice in a society where people have unequal houses, unequal cars, unequal food, unequal money, and yes, unequal medical care. We are told that the only way to fix this inequality is for Big Government to confiscate the fruits of one's labor and "redistribute" them for the greatest good of the group. But this "distributive ethic" --- From Each According to His Ability and To Each According to His Need --- is actually nothing more than socialism, a concept which has failed miserably everywhere in the world that it has been tried. "Universal coverage" translates to minimalist coverage (as in managed care), delayed access to medical care, and often no access to medical care. All of which begs the question: How is forcing everyone into government-run minimalist coverage and lack of timely access better? As Walter E. Williams observes, "Capitalism isn't popular but it works." It has provided access to more goods and services for more people than any other system in the world. But he observes, capitalism isn't popular because it "is always evaluated against the non-existent utopias of socialism or communism."(5) The key word is "non-existent" --- there is no socialist utopia. Socialism simply doesn't work!
Trying to link human rights to a "right to health care," such as has been done under the Universal Declaration of Human Rights,(6) Article 25 is a truly unAmerican, socialist concept.
Our Constitution is not the UN constitution. Under Article 1, Section 8 of the U.S. Constitution, the powers of Congress are strictly limited. The father of our Constitution, James Madison, gave us stern warning about expanding the role of government "with good intentions." He said, "With respect to the words General Welfare, I have always regarded them as qualified by the detail of powers connected with them. To take them in a literal and unlimited sense would be a metamorphosis of the Constitution into a character which there is a host of proofs was not contemplated by it creators." Indeed, you will not even find the words "health care" in our Constitution. We also note that none of the God-given rights protected by our Constitution involve government taking anything from anyone to satisfy another's "right."
The new globalist (socialist) view of "rights," however, frequently involves government taking from some and giving to others. Although socialists would like to confuse us by trying to convince us that this is charity, it is nothing of the sort. It is what the great French statesman Frederic Bastiat called legalized plunder, and it leads to discontent and destruction of peace in an otherwise peaceful society.
Although egalitarians are always quick to point out inequalities, for some unexplained reason, they never seem to appreciate one of the most glaring inequalities which has brought us to the miserable state of managed care from which we suffer today. There is no tax equity. Because of a peculiar hold-over from World War II, employees buy their medical care with pre-tax dollars, and everyone else has to buy their medical care with after-tax dollars. Totally inequitable and totally unfair. If we had tax fairness and expansion of Medical Savings Accounts (MSAs), we could put power back into the hands of patients, with advice from their physicians where it belongs. In a true free market, prices are controlled via direct interaction of consumer and seller, something that does not exist today in the medical marketplace. Quality is maintained via healthy competition, not via manipulation by managed care or government bureaucrats. Physicians could practice medicine again in the tradition of Hippocrates as opposed to being agents of mangled care or government care, thus regaining the trust of their patients and respect for the profession. To continue down the wrong path toward more "integrated delivery" or worse, government-run medicine is to sacrifice a noble profession on the false altar of egalitarianism.
1. Faria MA Jr. Is there a right to health care? Medical Sentinel 1999;4(4):125-127.
2. Kassirer JP. Managing care - Should we adopt a new ethic? NEJM 1998;339(6)397-398.
3. Davidoff F, Reinecke RD. The 28th amendment. Annals of Internal Medicine, 20 April 1999, 130:292-294.
4. Exodus from Canada. AAPS News, June 1995.
5. Williams W. Capitalism isn't popular but it works. The Post-Journal, September 19, 1997.
6. Consortium for Health and Human Rights. Health and human rights --- A call to action on the 50th anniversary of the Universal Declaration of Human Rights. JAMA 1998;280(5):462-464, 469-470.
Dr. Huntoon is a neurologist in Jamestown, New York, president-elect of the AAPS, and serves on the Editorial Board of the Medical Sentinel.
Originally published in the Medical Sentinel 1999;4(5):177-178. Copyright © 1999 Association of American Physicians and Surgeons (AAPS).