Friday, October 24, 2008


By : Dr. J. Emmett Billings, M.D., M.B.A., Chairman, American Physicians-in-Commerce League (APICL)

In poll after poll, Americans consistently rank health care as a pressing political issue. In this year’s election, voters will ask the candidates to repair the system. Americans worry about rising medical costs and prescription medication prices. With the employment market shrinking, more and more Americans find themselves without health insurance. And more and more Americans lament the fact that insurance companies increasingly dictate their care by refusing to cover visits to doctors outside their networks. In short, many Americans find it reprehensible that the wealthiest Nation in the world allows so many to fall through the cracks in our health care system.

But America’s health care system is not broken. We need do nothing to change it. Rather, America’s health care system represents the pinnacle of innovation and free market enterprise in a free market country. No other country on earth provides such lucrative incentives to pharmaceutical companies to develop life-saving new medications as the United States. If there were no money in health care, why would chemists toil their lives away searching for cancer cures and cholesterol thinners? And if there were no money in health care, why would doctors spend every waking hour on call? Humanity has nothing to do with it. Just ask a radiologist whether he cares more about your X-ray or the $950,000 base salary he earns. There is nothing wrong in this, because money is what we need to attract the best and brightest minds into health care.

If we take money out of health care, we face medical ruin. This is what the critics do not understand. Many such critics point to European Nations such as England and Germany, where the government provides universal health care at no cost. They even point to our northern neighbor Canada for the proposition that government can care for all its citizens. But those Nations provide shoddy, negligent care. In Canada, patients die in waiting rooms and transplant applicants must wait up to 76.2 years for a kidney. Similarly, prescription medications in Canada—while cheaper—do not even approach the quality standards American medications must meet. True, an average Canadian can always walk into a hospital and receive care, but he will wait interminable hours on a cold bench, receive substandard care and adulterated medications. The same goes for the British, Germans, Spanish, French, Russians, Italians and Cubans. Nationalized health care means bad health care for all. Considering the poor level of care in these Nations, it would be better to be uninsured in America than covered in England.

America provides top-notch care. Our patients receive superior treatment from world-renowned physicians in superior medical institutions all over the country—provided they can pay for it. Our medical equipment is first rate. We produce only wholesome and unadulterated medications that actually cure diseases, not cause them. In short, the American system heals—and it heals quickly. In America, patients receive treatment in due course. There are no lines or interminable delays. Why? Because there is money to be made in our system, and no company makes money by selling bad products or providing substandard services. In America, doctors know you could choose another hospital for your care. That is why they strive to outdo the competition and win your business. When doctors compete, you win.

America’s health care system is not just innovative. It also cultivates responsibility. In our Nation, there is no free lunch. No one can realistically expect to receive state-of-the-art professional services without paying for them. America’s health care system thrives because patients pay their bills. The miracles of medical science do not come cheap, and a responsible patient knows that. Responsible patients know in advance they might one day require medical services, and that is why they purchase health insurance. If they do not purchase health insurance, they must pay their bills. That is the way the system works. Just as it would be foolish to assume that you could walk off the sales floor with a car without paying for it, so too is it foolish to assume that you can walk into a hospital without paying for the service you receive there.

Health care is not a right. It is a commodity. It is no different from any other product for retail sale. To that end, we can only guarantee further medical breakthroughs and first-class medical treatment if every patient pays his way. There is nothing “unique” about health care, nor should we be constrained by notions of “humanity” when sober economic judgment should be our only guide.

America’s health care system works because it reflects a “tough-love” approach to care. Other countries take pride in the fact that they pay to treat every beggar who steps through a hospital door. But this is not charity; it is irrationality. Our system works because we allow beggars to die on the street, just as we refuse care to any uninsured person. We must resist appeals to institute “universal health care” in this country. We must insist on credit checks on all prospective patients to ensure that their assets will cover care. If patients obtain care without paying for it, we must prosecute them for fraud and theft. Furthermore, we must influence Congress to authorize the use of force in the collection of medical debts. These are fair and reasonable things to do. The critics must understand that our system reached its strength through its commitment to free market ideals, not humanity. And in the free market, everybody pays. If you can’t pay, you don’t get care. That’s the end of the story.

In this year’s election, we are confident that intelligent American voters will recognize that our health care system needs no overhaul. If health insurance is expensive, we trust that Americans will exercise their historical resourcefulness to find an alternative. By the same token, we trust that Americans will not whine when they find themselves rejected from medical care because they have no insurance. A responsible person accepts the consequences of his actions, and rejection from medical care is the consequence that flows from irresponsibly failing to obtain health insurance. Americans stoically bear their misfortune. We are confident that uninsured Americans will not take it personally when hospitals refuse to treat them for financial reasons. If death results, all we can say is: “You should have bought health insurance.”

In sum, let us remember that America’s health care system is a business. In order to maintain the highest level of innovation, profitability and care in the health business, we must resist every attempt to inject a “human” element into health care decisions. True, some will not be able to purchase health care services in America. Some Americans will always be unemployed and uninsured. They will not be able to access the fabulous wonders that medical science has unlocked. But this is a free market system: You can’t play if you don’t pay, and fairness is not the goal.

Fight for innovation. Do not change the way that health care does business in America.


SteveW said...

Too much to try to discuss in a comment but I'll try. American health care is not private - it's almost 50% run by the government, so the notion that we don't have national health care is almost half false. That is not to mention that private insurance companies are among the most highly regulated private entities. Further, the vast majority of new medicines are developed here because (gasp) companies can make money here. In fact, they can overcharge the private sector because our government and the governments around the world negotiate low rates and private Americans foot the bill.

Americans are not dying untreated in hospitals - most hospitals are giving away up to 20% of their services. If you go to an emergency room, you will get treated.

I'm not saying America's health care system isn't broken. It is. But the notion that we have a private system is false. Also, the idea that superior outcomes somewhere else show the superiority of public over private is a reach beyond the available evidence.

We have not seen a private-public comparison yet. The US is not private, and the other countries are currently subsidized by us through the private American citizen paying the research bills for the world. Also, many other countries have super-payer systems where people buy better care than that provided by the national health care system. Also, some of the other countries are failing in glaring ways in some areas (e.g. dental care in the UK)

Tell me where the obvious logic is that health care is so much different than other retail services. People die without food, and they can't work without cars (in many circumstances) leading to a drastic reduction in quality of life. What am I missing here that this point is not obvious to me?

How will you ever get past the dilemma that doctors will sell their services out privately to the rich and not make their services available to the national health care system? You will be forced into a double dilemma - either conscripting people to the national health care system or having incrementally less health care available under a national system than under a private system (since they cannot sell their services out on the free market at the price the system would otherwise bear).

Just some things to think about - there is a reason that the system has not been fixed even though the solution seems "obvious." That's because the world is not that simple.

Balthazar Oesterhoudt said...

Thanks for the comments. It is true that the American system is neither completely private nor completely public. All I aim to do in my satires is to reveal some glaring problems through obvious exaggeration. Taken at face value, these exaggerations are ridiculous. But they conceal deeper dilemmas, and I am glad that you pick up on them and give them the detailed attention they deserve.