“Reform” Health Care? What Then? VA Health Care?

By | May 2, 2019 | 0 Comments

How many times have we heard that the American health-care system is “broken” and needs “reform”? Improvement, yes, but “reform”? This puts health-care providers in the same category as criminals. But if our health-care system needs “reform,” why does it have the best survival rates for most cancers?

Source: The Telegraph

Five year survival rates for common cancers

And how many times have we heard that U.S. life expectancy lags behind that of other developed nations? But if we omit fatal injuries, mainly homicides, we see something quite different – the U.S. has the highest life expectancy. Yes, homicide is a major problem, but health care cannot solve it.

Source: Forbes

Life expectancy in North Dakota ‒ not the best in the U.S. ‒ is 79.5 years, better than any nation. (This includes fatal injuries.) Why? Is there a clinic on every block? Does every town have a medical center? Are there medicines not available elsewhere? No, it is because fewer North Dakotans overdose on illegal drugs or murder one another. Life expectancy is closely related to lifestyle, and health care is only one aspect of lifestyle ‒ often not the most important aspect.

We are told that there are over 40 million Americans without health insurance. Granted, the number includes most of the 10 to 20 million illegal aliens. Granted, the number includes millions of younger Americans who believe they do not need health insurance, and who prefer to spend their money elsewhere. Still, the number is worrisome to anyone with a heart. Those without insurance are less likely to receive optimum care.

The trouble starts when politicians equate having no health insurance with having no health care. This insults my whole professional life. Like millions of other physicians, nurses, paramedics, technicians, and others, I devoted most of my career to caring for patients who could not pay for their care.

I spent my early years in a small North Dakota town where my father was a country doctor, going out in snowstorms to deliver babies. The county sometimes paid him a minimal fee to care for poor patients, of whom there were many. But most of them at least left a sack of potatoes on our back porch. That’s the way people were back then – grateful, not entitled.

I attended the University of California School of Medicine in San Francisco. Our third year was spent at the old San Francisco County Hospital. The building was decrepit, the equipment scanty, but most of us – from lowly students to professors – were dedicated to caring for indigent patients. When I rotated through the emergency room, I helped care for victims of shootings and stabbings, many of whom were alcoholics, and some were criminals themselves.

I completed my training with a fellowship in medical oncology in the Los Angeles County hospital system. At the time, there was little to be done for most patients with advanced cancer. We were the headquarters of a research group trying new treatments. Most of our patients were indigent or working class, but they also included a journalist, a NASA engineer, the fiancée of a police officer, and the brother of one of my medical-school professors. The all got equal care.

After my fellowship, I remained working at Los Angeles County facilities, mainly L.A. County-U.S.C. Medical Center, for 25 years. Our faculty was excellent and included distinguished professors. My first chief went on to become U.S. Surgeon General. I recall an internationally known expert on liver disease, trotting up the stairs late in the evening to see patients – because he had no time to wait for an elevator.

Was everything first class? Of course not. The wards were crowded, the paint drab, and the medical and nursing staffs stretched thin. The Los Angeles Times reported months-long waiting times for elective surgery such as hernia repair, and for referral to specialists. Of course the Times, with its liberal slant, did not compare the waiting times for indigent patients in Los Angeles with the waiting times for all patients in Canada or Great Britain. Surprise! They are roughly similar.

And of course the Times, which favors lax immigration policies, did not make the connection between overcrowded county facilities and the influx of illegal immigrants. As Milton Friedman said, “It’s just obvious you can’t have free immigration and a welfare state.

Drug costs are a burden for the less-than-affluent. Critics condemn the profits made by drug companies. But where do new life-saving drugs come from? Are they delivered by Martians in flying saucers, and drug companies then make huge profits selling them? Drug companies use a major share of their profits to gamble that new drugs will be successful. Drug-company profits play a major role in funding development of new drugs.

Take AZT, the first drug useful for AIDS. How was it developed so fast? It was synthesized by the American Jerome Horowitz, but proved inactive in cancer. It was pulled off the shelf by Burroughs Wellcome, a British drug company that developed several cancer drugs. AZT wasn’t useful for cancer, but there it was on the shelf, ready to try on AIDS. Instead of being grateful for this good fortune, activists condemned Burroughs Wellcome for “profiting from AIDS.”

This is similar to condemning General Motors, Ford, Boeing, and Lockheed for making profits during World War II. Would the critics have preferred that these companies went broke, and Hitler won? Would the critics have preferred that Burroughs Wellcome made no profit, funded no research, and that several years went by before an AIDS drug appeared? Some people hate capitalism more than they hate Nazism or AIDS. Avoid these people – they are dangerous to your health.

In its 74 years of existence, how many new drugs did the Soviet Union develop? None. But “progressives” want to emulate the communists and remove the profit motive from drug development. Roast goose is delicious, but where will we get more golden eggs?

The engine that moves new drug development is made up of American drug companies, and foreign companies that aim at the American market. Americans earn over 60% of the Nobel Prizes in Medicine with 4% of the world’s population. Perhaps there is a lesson here. Locomotives cost more than freight cars, but without them nothing moves forward.

Do we want to continue our excellent system of health care, but improve care of those in need? Do we want to reduce the influx of indigent immigrants, who overburden our health-care system? Or do we want everyone’s health care to be some version of the Department of Veterans Affairs? Do we want to raise the floor, or lower the ceiling? These are legitimate questions.

But what is not legitimate is to claim that the millions without health insurance also are without health care. This is an insult to all those who devote their lives to caring for patients who cannot pay. It is an insult to my father, who went out in snowstorms to treat the indigent. It is an insult to all those − from the gray-haired nurse at Bellevue, to the new intern at Cook County, to the streetwise paramedic in Los Angeles, to the busy private practitioner in Lisbon, North Dakota − who care for the less fortunate among us. These caregivers deserve to be assisted and honored, not ignored and devalued.

Until a few generations ago, our ancestors lived without what we would call health care. Health care is an important component of human well-being, but only one component. Freedom is another important component. We need not give up one to get the other.

“One size fits all” may be adequate for sox, but not where lives are at risk. In our zeal to “reform” health care, let us be sure not to deform it. Those who advocate single payer promise that we will have Medicare for all, but it seems more likely that we will have Veterans Affairs health care for all.

Contact: dstol@prodigy.net. You are welcome to publish or post these articles, provided that you cite the author and website.


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