I’m one of those rare individuals in America who wants more than simply "health care reform"; I want something called SOCIALIZED MEDICINE. That means that I want a health care system that looks a lot like England’s National Health Service. I didn’t always feel this way, not until I took an economics course in graduate school on comparative health care systems. After noticing the perverse incentives that our private health care system perpetuates, I realized that the only way it is possible to control costs while at the same time optimizing the quality of care that Americans receive is to (A) put physicians on a salary (top 5%-10% of all income earners), and then (B) put them [collectively] in charge of the health care system.
But I didn’t write this essay to address that topic [at least not directly] but rather to address the #1 Hysterical Complaint About Socialized Medicine that Republicans like to voice in the political arena : the long wait times associated with 'Socialized Medicine.'
There is a reason why we don’t see the same long waiting lists in America that we see in many single-payer countries (like England and Canada): in America, millions of people who cannot afford the cost of the surgery [or who do not have good enough insurance] do not have their names on any lists. Of course, the ‘list’ of those who need the care still exists, it’s just that poorer folks cannot afford to be placed on any ‘official’ lists. Incredibly, the Republicans like to trumpet the fact that we do not have long waiting lists as alleged evidence of the superiority of America’s private system. In truth, it is a fact that only shames us.
Once countries turn to the single-payer approach, the long waiting lists begin to appear, because suddenly those who could not previously afford to wait in line now can One part of the solution to this problem is to simply stop underfunding the health care system; spend more money on more doctors, dentists, facilities, equipment. England’s National Health Service has longer wait times than are actually necessary because the Conservatives in Parliament have consistently fought to underfund the system (= ‘control costs’). Why? Because they don’t want their rich people to have to pay more in taxes. Sound familiar?
Due in large part to these efforts to ‘control costs’, England spends a far smaller share of their national income on health care than Americans do. In spite of roughly equal "health outcomes" (OECD), America’s private health care system costs Americans more than twice as much as the NHS costs the citizens of the UK. In 2002, UK citizens spent only about 8% of their GDP on health care ($2,160 per citizen). This compares to the approximately 15% of GDP that Americans spent on health care that year ($5,267 per citizen). If England were to start spending the same percentage of their GDP on health care as Americans do, they’d be able to shrink their waiting times dramatically. (Also note: they get the same results at half the cost because their government-run health care system is far more efficient than our profit-motive health care system is.)
Now there is little doubt that England’s NHS would be able to reduce their wait times significantly if they were to double the amount of money they spend on their supply of services. Ultimately, however, there is always a point when scarcity raises its ugly head. It is a fundamental fact of economic life: there are currently not enough hospitals, clinics, physicians, dentists, MRI scanners for everyone to enjoy the services they desire without waiting. But even if we were to increase spending significantly, there would still be a limited number of the 'best’ doctors and facilities, the most technologically-advanced equipment, etc. That is why every health care system must find some way to ration scarce services. In America, we simply price the poorest citizens out of the ‘best services’ market. But I believe there is a better way.
I propose an alternative approach to rationing that just might make most parties relatively happy. First, go ahead and set up a ‘socialized’ health care system that grants every citizen a ‘first come, first serve’ right to the scarcest of elective services. If nothing else were done, this type of system would force the richest citizens in the country to wait in line just like everyone else. (That is, of course, precisely the nightmare that most rich people fear would be their fate if Socialized Medicine were to come to America.) But might there not be a way we can use the marketplace to fix this little problem?
Here is my proposal: Have the 'list managers' create a market that gives those with high positions on a list (those with the shortest waiting times) an opportunity to trade their places in line with those who are lower on the list for some kind of mutually agreed upon compensation. If I'm rather poor and have only a week to wait for my knee replacement surgery, I might be willing to trade my position in line with a very wealthy citizen who might otherwise have to wait for 6 months if she can offer me some amount of money that would adequately compensate me for enduring the additional months of pain.
Other health care ‘privileges’ that could be auctioned off: the next available kidney, becoming the next patient of one of the best doctors in the country, etc. I suspect some kind of internet-based bidding system could be set up that would be a bit more dignified than Ebay. Understand that when it comes to emergency services, the financial resources of the patient are usually a secondary consideration (not a variable usually considered during triage decisions). We consider seriously wounded people to have an equal right to the best care that is immediately available. My proposal would simply extend that kind of moral reasoning to the provision of scarce non-emergency medical services.
And so we would finally have a health care system that is fair. My prediction, however, is that we would still end up with essentially the same result that we have today: the wealthiest members of society would still obtain the best medical care on the planet; they’d just be paying a bit more expensive premium for the privilege. The big difference, of course, is that the poor would get compensated directly for accepting poorer quality medical care, instead of simply being relegated to that fate by an uncaring society.
The good thing about this approach is that it recognizes that every single human life---on the most fundamental level---possesses equal worth and is equally deserving of the best care available. But once each individual has been granted that fundamental moral right, individuals would then be free to use the resources available to them to negotiate a better overall situation for themselves. Generally speaking, poorer folks will probably be willing to 'settle for' treatment by an intern instead of by a ‘celebrity physician’ if they are offered compensation they consider sufficiently generous, but each of them would still have the right to refuse all offers and enjoy the ‘best’ and ‘most prompt’ non-emergency care available if that is their desire.
It is not possible in this life to provide ‘true economic equality’ for all members of society, because it will never be possible to eliminate scarcity re: the most desirable goods/services/‘experiences’ in this life (there is only so much beachfront property). Some people are going to be able to experience the scarcest of desirable ‘experiences’ that most people will never be able to experience. Those people would be society’s richest citizens. But on at least one level of human experience, we can do the right thing and grant every poor slob out there an equal right to the health care resources that society is able to provide. If we do this, we Americans will have finally earned the right to see ourselves as an essentially virtuous people.