ObamaCare plans will exclude top hospitals, such as Memorial-Sloan Kettering Cancer Center in New York, M.D. Anderson Cancer Center in Houston, and Cedars-Sinai Medical Center in Los Angeles.
– News item

British National Health Service will have to close up to 20 hospitals to save itself from financial ruin, while patient care continues to deteriorate.
– News item

Most people on the left are not opposed to freedom. They are just in favor of all sorts of things that are incompatible with freedom.
− Thomas Sowell

The World Health Organization rates U.S. health care as 37th in the world, and Cuba as 39th. But how can any sane person rate our health care as the virtual equal of Cuba’s, where common people can barely get an aspirin? On the contrary, America has the best survival rates in the world for most cancers.

As far as life expectancy is concerned, if you eliminate violent deaths − homicide, suicide, and accidents, for which medical care has the least effect − the U.S. has the longest life expectancy of all nations. I’ll bet you didn’t see that in the “progressive” media.

If we are to believe the World Health Organization and the proponents of socialized medicine, the quality of a nation’s care is judged not by life expectancy, or by survival rates from cancer, or by other indices of quality of care, but by equality or care.

So how can we improve the equality of care? We could improve the care of those now receiving the worst care, as has been our goal for many years. Or we could use the Marxist approach by decreasing the care of those receiving the best care. And this, regrettably, seems to be what “progressives” have in mind.

To improve the U.S. ranking on the World Health Organization scale, we could simply close the top hospitals. And instead of making technology like MRI scans more available in outlying areas, we could make it less available in urban areas. Instead of making expensive drugs and treatments more available to the needy, we could make them less available to the affluent.

But, you say, this is ridiculous, dangerous, even homicidal. Yes, but isn’t all Marxism?

When I first suggested this, I meant it as a cautionary tale. I never thought it would actually come true. But now we learn that that insurance obtained through ObamaCare exchanges will exclude top hospitals like Memorial-Sloan Kettering in New York, M.D. Anderson in Houston, and Cedars-Sinai in Los Angeles. Equality sí, quality no.

Care at top hospitals is more expensive not because they are inefficient, but because they do research, use cutting-edge technology, and often treat patients with complex illnesses. Care in the United States is more expensive than in other countries not because it is inefficient, but for similar reasons. America is responsible for the majority of advances in health care, and over 60% of recent Nobel Prizes in Medicine.

American health care is more expensive for the same reason that a locomotive is more expensive than a freight car – but without it, the train cannot move forward. The rest of the world depends on us for many of its new drugs and new medical technology. Scientists come here to do research, including medical research, because we provide a congenial environment for innovation – or at least we used to.

Starving the top hospitals of revenue will be similar to starving the locomotive of fuel. The train of innovation will slow, causing unnecessary suffering and death. But we will be more equal. Ultimately, we will have “universal coverage” – with six feet of dirt.

If equality is defined the way it was in my youth, it means equality before the law, and equality of opportunity. It means that everyone begins the race at the same starting line. How they finish the race depends on many factors − innate ability, intensity of training, and excellence of coaching. In sports, we all understand this. But in other fields, the idea meets with strong resistance.

But now we define equality as equality of result. Of course, no one does this in sports. No one suggests that an athlete who has short legs, or who slacked off in training, or who has a lousy coach, should start the race several meters in front of the others. That would be seen as unfair, and in addition as insulting to the athlete and to the sport.

Through most of my medical career, what we did was referred to as “medical care.” This seemed reasonable, since it was overseen by physicians. But some felt that this term undervalued the contributions of nurses, technicians, paramedics, and all the others who provide care. So, with some justice, the name was changed to “health care.”

But then the trouble started. The words were condensed to “healthcare.” This was part of a tendency to put combine words into compounds like “backseat” and “backyard,” as if we were speaking German. But that makes me nervous. The modern welfare state was introduced by Bismarck, who is hardly my role model.

The term “healthcare” emphasizes the goal, health, but it also reduces the emphasis on those in charge of achieving that goal, doctors. Doctors were in charge of medical care. But who will be in charge of “healthcare”? Remote, faceless, unelected government bureaucrats, under the orders of people like Kathleen “Let the Girl Die” Sibelius. There, don’t you feel better now?

During the French Revolution, aristocrats and the rich were guillotined – thus removing the “top one percent” so hated by leftists. By the standards of the World Health Organization, this led to greater “equality.” There were just as many poor. Some were even worse off than they had been under the king. But they were more “equal.”

Leftists talk endlessly about doing things for “the people.” But the people they actually want to do something for are themselves. They want to feel altruistic, but feeling altruistic and really helping others are two different things entirely.

The Soviet Union collapsed after 74 years of “building socialism.” They did build socialism, but what else did they build? A huge military and police apparatus, yes, but not much else. How many new drugs did the USSR develop in those 74 years? And how many new medical devices? Not the CAT scan. Not the MRI. Not fiber-optic diagnostic and therapeutic devices. Not treatment for HIV. In fact, aside from a few elite clinics where Communist Party bigwigs received Western-style care, health care in the USSR was often poor or nonexistent.

Leftists do not intend to construct a Soviet-style economy and health-care system in America. But they did not intend to construct them in the USSR, either. They had more lofty goals in mind. They dreamed of universal peace, brotherhood, plenty, and health. But their dream, like the dreams of all totalitarians, turned into a nightmare.

Leftists see economics – erroneously – as a zero-sum game. They believe the poor are poor because the rich are rich. So they aim to redistribute wealth, not to create more for everyone. But leftists are not satisfied with making a mess of the economy. In a colossal display of hubris, they transfer this discredited theory to health care. They believe some people receive poor health care because other people receive good health care. So they aim to redistribute health care, not to improve it for everyone. Marx was a lousy economist, but he would make an even worse physician.

Our goal should be to assure that everyone has at least adequate health care − that is, to raise the floor. If at the same time the ceiling is raised less, then health-care equality will increase. That’s okay with me. But if at the same time the ceiling is raised more − that is, optimum care is raised to a still higher level − then health-care equality will decrease. And that’s also okay with me.

When equality and freedom conflict, we must decide in favor of freedom. When equality and quality of health care conflict, we must come down in favor of quality of health care. In the end, we must recognize that a place already exists where there is equality of health care, equality of income, equality of housing, as well as a guaranteed job. It is called prison.

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