This idea of a complete socialistic medical system is a non-starter in our country IMO and Dr. Val has some interesting cultural observations on why this is so . She has the perspective of having lived in the Canadian & UK systems, while practicing here now in the USA. I agree 100% with her observations. If you impose the VA system on everyone (which is already an American micro-economic scale "Universal Health" system of sorts), you're going to have more people with basic coverage (a great thing) with better and more standardized medical records (another great thing), while at the same time alienating both Doctors and patients with the red tape, restrictions, and inflexible cost-containment measures those in the VA system are familiar with.
Dr. Val writes:
If they were served up the Canadian system, they’d scream at the tax rates, and become hysterical at the inability to trade up to a platinum level of care for those who have “earned it.” They would not accept the long lines for care and would immediately start a scheme for off-shoring medicine to circumvent the lines.
If Americans were offered the French system, they’d be immediately annoyed by the inconvenience of the office hours (months of vacation are taken at a time by all members of society, including doctors), they’d never use the preventive health measures (they don’t have time for that stuff), and although they’d be glad to receive home health aides for no more excuse than - “I just had a baby and I’d like a government worker to clean my house” – when they
saw the tax rates it would take to make this available to all, they’d find it unacceptable, especially with such high copays and out of pocket expenses..
But the main problem with Moore's policy solution is that a national health system wouldn't fix one of our health care system's main flaws—one that people really hate—the denial of service. It just changes who decides, so that the government makes the call.
In one heart-wrenching case in the movie, a woman whose husband has kidney cancer is told by the insurance people that they won't allow an experimental treatment that might save his life. But that scene would likely play out just the same way in a nationalized health system. In those systems, cost-effectiveness decisions get made all the time. Care is rationed. That's what happens if you offer something for free—you have to make rules about who is allowed to get it. So, you forbid smokers from having heart bypasses, or, in a more recent debate in the U.K. about a new hay fever medicine, you just say the medicine is too expensive to be used.
So, to do as Moore wants in the United States, you would need to do more than just overcome the insurance industry. You would need to cut the salaries of doctors, reform the legal system, enrage our allies by causing their prescription drug costs to escalate, and accustom patients to a central decision-maker authorized to determine what procedures they are and are not allowed to get. Unless every one of these changes comes together, Moore's new system would end up costing an enormous amount of money.
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Why thank you, Dr. Rob, for your kind comments. I posted a relevant comment about rationing care at www.pandabearmd.com. His post got 81 comments. Here's mine:
"Americans are not willing to judge whose life is or isn’t 'worth' the technologically sophisticated interventions. The result is that both the nearly brain dead nanny with 0 quality of life and the very nice 21 year old above (Christine) whose immune system really screwed up her otherwise normal and full life get equal access to whatever they need. It’s a slippery slope - judging the value of a specific human life, and rationing care. While it may be clear that heroic measures in the stroked out, end-stage patient with no cognitive abilities may not be a worthwhile use of resources, the idea of making a list of conditions or situations that wouldn’t merit resources is not ethically palatable to Americans. We can think of exceptions to the rule, and we’re terrified that our family member (or we) will not get the heroic measures we desire. We’re gamblers by nature - if there’s a 1% chance that doing something medically courageous may return us to a decent quality of life (or perhaps just adds a good year), but costs $500K, we’ll try it.
So, I guess we have to either: 1) accept that we are providing heroic measures to all, which will result in a colossal waste in resources but will sit well with us ethically or 2) begin the process of rationing care, limiting heroic measures in certain circumstances, and praying that we don’t somehow block a Christine from accessing care with our rules."
I have to agree that our nature and the proposed changes per Mr. Moore do not go hand-in-hand. While it may be fiscally responsible to limit heroic measures to the infirm and dying or the barely alive newborns, the general population would not stand for it.
In all of this as well is the problem with taking responsibilty for yourself. What I mean by this is the act of utilizing preventative measures and following instructions and taking one's medicine.
Example: Most of us as physicians have treated more than our share of patients who, having obtained the medicine for their illness free or subsidized, neglected to take it or let the prescription lapse, then have an exacerbation of said illness prompting a very expensive trip to the Emergency Room (or shall I say "night clinic"?) that could cost them their life.
There are ways of reducing cost and providing great health care, but the people as well as the insurance companies and the government need to be on the same page.
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