Government in health care? That barn door's been open awhile


Are Medicare, Medicaid and VA care socialized?

They are government-run, large and flawed. They also provide a large percentage of the care delivered in America.

The process is affected by industry lobbyists, who have ensured Medicare can’t negotiate prices with manufacturers. The VA can contain expenses better and it controls medications costs more tightly.

That sounds no less socialized than the Swiss system, which works through insurance companies and which requires everyone be insured. The Swiss restrict insurance company profits for basic care.

That enables them to provide better survival figures than ours or anyone else in the world. They spend 12 percent of GDP, compared with our 17 percent, on health care.

I argue that socialized is a word that implies a degree of government control. It’s hard to be specific and easy for any of us to lead with emotional responses to the label.

Second, what makes medical care good or bad or, possibly, the best in the world? My personal, nonscientific answer involves the doctor-patient relationship.

Medical care should be scientifically sound and honest. If a doctor offers you a cure, pain relief or some other goal, it should be consistent with the research literature and within his/her ability to match those results. Care should also be empathetic. The caregiver should be primarily motivated by the patient’s welfare. Finally, the care has to be available or it’s an aspiration, not an expectation.

From the patient’s standpoint, good care delivers what they came through the door for. Communications have to be clear. I’ve had patients who would trek through fire to improve their chance of cure.

Others seek quality of life and that doesn’t mean the same thing to everybody.

Many patients have wanted my reassurance that their pain would always be controlled, and I offered it within the limits of science. Sadly, many patients are hard to read. They don’t always want the same thing from one day to the next.

Something to bear in mind: Organizations rank a nation’s programs with a different measuring stick than your doctor or politicians who want your vote.

It is in those measures that America does less well than we pretend. For example, our life expectancy runs a year and a half to two years shorter than Great Britain, where the system is single payer and the cost per patient is less than half of what we spend. And that is true, despite what might be considered a death panel being in place.

The disparity between longevity and cost is even greater between the U.S. and Australia.

Study groups look at things like infant mortality, deaths that could have been averted through medical care and other parameters.

These are the measures that put us in 38th place.

Looking at U.S. health in this way has nothing to do with our most innovative procedures. We do some things very well. We might consider pointing an accusatory finger at corndogs and the sugar content of our diet. I’m a sinner when ice cream and chocolate are calling out to me, but I when I walked through the county fair this year, I felt deeply saddened by the gut size of so many young people.

America will be lucky to hold on to 38th place. Many of these kids are headed to hypertension and diabetes, to strokes, kidney failure, and amputated limbs. Each generation’s health problems roll toward the next generation of taxpayers and they’ll be crushed by the size of the looming problem.

Can competition and free enterprise fix things?

American ingenuity produces incredible new products and those generate profits. In some cases, we can offer the world better machines or tastier ears of corn at a lower price.

Consumers have the ability to compare the value of some products, but not others. A sick patient can’t choose treatments intelligently. Few of them could decide whether they should have a pill, a stent in their coronary artery or surgery to bypass an obstruction.

I can say with certainty that doctors in different areas of the country, even within one county, follow different patterns of using technology and the charges vary dramatically.

Patients generally do what their doctor recommends. Many ask for what they saw on television, even though advertisements promote treatments that don’t work better than placebos and others which are more expensive versions of similar products. I’ll cover many of those in coming months.

The public has to understand that quality of care can mean many things. It is not improved by competition that focuses on bigger machines. We need to be reasonable about labels like socialized medicine.

Government is already involved and government decisions are affected by money and the price of elections. Insurers are businesses that run inefficiently and add to the burden of rising costs.

I wanted to write this piece without recommending a specific plan. There are many proposed in the literature. I hope that some readers better understand the terminology and the complex interactions among the players.

I wish you good health. Exercise, eat right, and start your children on good habits from day one. That does make a difference.

Next time, I’ll look at what causes colon cancer, how polyps are involved and the pros and cons of colonoscopy.

Dr. Larry Mulkerin is a retired clinical professor. He can be reached at


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