Free Medicine Can Make You Sick; C. G. Jones, M.D.

One of the most glaring facts is that government mediDr. Jones is a surgeon in Grove City, Pennsylvania. [260 ] cal care invariably costs more than had been expected. During the first four years of socialized medicine in Great Britain, the demands for free service and for costly though often unnecessary medically related items re sulted in trebling the yearly budget. The taxpayer-who still has to foot the bill-had his annual tax burden in creased by 12 per cent. This on top of already heavy taxes makes the system almost prohibitive. The deleterious effects of the system are to be noted everywhere. There are so many free dental patients that dentists no longer have time for their customary work with school children. Obviously, this condition need per sist for very few years to affect seriously the dental health of the kingdom. Waiting lists for admission to hospitals become staggering. The increased volume of patients invites second-rate care for many instead of first-rate care for the truly ill. The burdensome cost of caring for those who are ill, plus those who pretend, leaves no funds for research or preventive medicine. Along with these and other details of administration, there is the problem of selecting from the long lists the patient who needs imme diate or emergency care. The system not only involves huge cost, but it also constitutes a menace rather than a means to health. In other words, "You cannot buy good health."

The Voluntary Way Even though the American system is still voluntary, in that hospital and health insurance can be selected at [261 ] will, some of these evils are beginning to make them selves known in an insidious way. If our health insur ance were to become compulsory, it is easy to see how these defects might multiply and actually jeopardize the health of the nation. A system of socialized medicine tends to weaken one's reasons for being well. A struggle for livelihood is no longer required. If a leg is broken, the State pays medi cal, hospital, and operation costs, and advances adequate funds for living until the bone is healed. But there is the rub. If a man suffers no material disadvantage from sickness, there is no material incentive for him to recover rapidly. But if loss of income goes with the broken leg, he will be anxious to have it heal so that he can get back to work as soon as possible. And doubly so, if he pays his own hospital and surgical bills. Doctors know that a broken leg heals very slowly in a Welfare State. And for the same reason, the recovery of most patients ~'pro tected financially" by insurance companies proceeds slowly and painfully.

Mrs. A and Mrs. B underwent operations for benign fibroid tumors of the uterus on the same day; they were in the same semiprivate room, were about the same age, and had almost identical operative procedures. But from the very first postoperative day, any similarity between the two women ended abruptly. Mrs. A recovered rapidly and was eager to get home to her family and her work. Mrs. B seemed to revel in her long recovery because her husband had told her that the whole thing was covered by insurance and she should stay in the hospital as long [262 ] as she wanted. "Don't let them send you home too soon," he said. Mrs. A went home on her sixth postoperative day, which was routine for her operation; but Mrs. B com plained and stayed four days longer, until she "was good and ready." Though her bill exceeded Mrs. Ks by more than sixty dollars, the insurance company paid for all but a few extras.

A routine office visit one month later revealed that Mrs. A had been doing her house work and other chores for almost a week. Mrs. B was not able to climb stairs and had attempted no work beyond drying some dishes the previous day. The prolongation of her recovery, in my opinion, must be attributed to insurance coverage. Recovery Postponed There are many examples of comparative amputees, showing that the one obliged to pay his own bill and earn a living recovers faster and learns to use a prosthetic device earlier than the one who is waiting for an insur ance settlement. This sort of thing happens far too often to be pure coincidence. An individual can become ill by just imagining he is ill, or, he may be a malingerer from the very beginning. The psychiatrist will tell you that the incentive for either is the thought of increased recompense for being ill. At any rate such persons manage to bring misery upon themselves and to all about them.

Socialized medicine includes government care of the [263 ] sick and support for the family as well. If this support amounts to approximately the same as the man can eam from his own daily labor, he is tempted to be sick con tinuously. The temptation would be the greatest for people in low income brackets, illness actually being preferable to good health. This may sound strange, but doctors can observe the fact in their daily practice. Many people want to be sick, or sicker than they actually are, because material advantages in the form of compensa tions and liability payments are involved. Less Joke than Reality In accident cases where the recovery period is un usually long, the question of insurance liability and pos sibly future litigation is likely to be present. When referring to the man who has been limping unnecessarily for several months, doctors sometimes jokingly say that John has nothing the matter with him that a prompt and substantial settlement wouldn't cure. But it occurs so often that it is less joke than reality. Patients who are waiting eagerly and selfishly for the settlement of their claim recover slowly in spite of all treatment. And usually their complete recovery coincides with the final settle ment of the claim. It is easy to see why there are so many cases for the compensation lawyers, referees, and juries. Just imagine the job of sorting all of these malin gerers from the real needy if socialized medicine were availablel The advocates of government in medicine point to our [264 ] overcrowded hospitals as though they have in mind a solution for the problem. But the fact is that much over crowding is traceable to increased voluntary insurance benefits, a situation that would only be aggravated if all beds were l:l:free." The waiting lists for the hospitals of England and Germany· are so long that many patients finally gain admittance only to have forgotten why they applied.

The hue and cry of overcrowded hospitals is a twisted statistic, for the beds are overburdened with people who are not really sick. The third party in the fonn of health insurance has entered the picture. But the present sad picture, with only part of our population voluntarily in sured, would surely be magnified if health insurance coverage were made universal and compulsory. Experience with socialized medicine shows hospitals so overcrowded that the situation becomes near impos sible, doctors so overworked that their patients get less and less real treatment, the cost of drugs reaching astro nomical figures, the total cost of the social system soar ing, and the government calling for investigations. The doctors are accused of high-handed methods, the drug gists are accused of charging too much for the pills, the people themselves are accused of being too sick. So finally, more and more there creeps into the picture police controls-l:l:the last refuge of self-bankrupting, socialist planning."!

With the obvious increase in the number of insured 1 Palyi, Melchior, cCHow Sick Is Socialized Medicine?" in The Free man, June 1952. [265 ] persons who are demanding medical care and hospital ization, a "doctor shortage" becomes more or less inevi table. Doctors are overwhelmed with the demands of people who feel that their insurance is wasted if they don't use it. Minor and even imaginary ills demand im mediate attention. If doctors could only confine their attention to patients who are really ill, the present quota of doctors should have ample time for leisure. If there were the same insurance coverage for plumbing services as for health and accidents, I am convinced that there would be a plumber shortage before the signatures were dry on the policies. Loss of Inspiration Socialized medicine tends to overwork and tire the doctors until they lose interest in the welfare of their patients and are no longer inspired by their original dedication to ideals. When this situation arises, there may be some patients· who never get to see their doctor and finally recover because they have no recourse. This leads some persons to ask, ~~If this condition persists, will not socialized medicine, at least in part, cure some of its own ills?" There may be some merit to this idea on the surface, but when we digest it, we find that it involves quite an expensive cure for people who would get well without help. At the same time, some would die for lack of treatment and others would suffer for lack of the medicine they need. So the self-correcting features of socialized medicine are really no excuse for [266 ] its adoption. It should be remembered that under our present system, most patients may call one or more of several doctors in their community; but the "beneficiary"

of socialized medicine waits for the doctor to whom he has been assigned. Why Doctors Prefer Freedom There are many reasons why doctors cry out against socialized medicine. First, as individuals, they abhor the regimentation which is inevitable under socialism. Sec ond, they feel that initiative, research, and humane care of the ill will gradually be replaced by robot dispensing, complacency, and the treatment of a number rather than a human being. Third, they have always thought that giving inferior drugs to increase their pro:fit, or perform ing less than their best because the pay was predeter mined was beneath their professional dignity. All of these shortcomings exist in all of the presently function ing systems of socialized medicine. If the loss of the hardy physical and mental attributes of the pioneer-to make of us weak and dependent wards of the State-is an incurable disease, then our fate is inevitable. If our youth are to be deprived of the in centive to dedicate their lives to the healing art, and devote their years to learning their profession, then our diseases will be treated by automatons and our health will deteriorate. If the important work of doctors, nurses, technicians, and allied skills is to be minimized and even denied by political charlatans, then these same youths [267 ] will refuse to enter this noblest of professions except by edict. If we eventually accept all of these proven evils as a system of government and a way of life, then we can blame ourselves for inferior physical and mental health and weak protoplasm. To maintain our health and strength, we had best insist on our present high quality of training, zealous research, and devotion to the preven tion and cure of diseases of body and of mind.

[268 ] SACRED COWS AND BRUISED SHINS MANY libertarians have scars on their shins, suffered from trying-in a certain way-':to kick around some popular socialist sacred cows. Experience is one way to learn how to avoid some of the bruises, but we may also learn from the experience of others. The libertarian is not a complacent soul, happy with things just as they are. Once he has grasped the concept of a society of free me~, he sees vividly many imperfec tions in the contempor~ry scene. He sees liberty being violated on every hand, and is incensed when others bow down before idols of socialist design. The situation is urgent, it seems, and so he is likely to become a crusading idealist. Finally, a golden opportunity arrives for the freshman libertarian. The local club invites him to be its speaker. Hurrah! The club will first have its feast, then transact some business and indulge in some levities, and finally listen to his speech. He will be allowed fifteen minutes for his Dr. Harper is a member of the staff of the Foundation for Eco nomic Education.