Socialized Medicine Means Everyone Gets Care, Regardless of Whether They Have Money
Dave Lindorff
When I was a young man just getting started on my career in journalism, I lived in New York City. My wife, Joyce, a harpsichordist, was herself just starting out as a freelance musician. We had a cheap but rather minimal health insurance plan that didn’t pay for doctor or emergency room visits—only for very costly hospital stays, and then only 80 percent of the total bill. One day, Joyce, who suffers from allergies, had a severe asthma attack—her breathing became increasingly labored. We rushed out of our apartment, hailed a taxi to Roosevelt Hospital, and went into the emergency room entrance.
Joyce was gasping so hard she couldn’t talk, but I was nonetheless questioned at length by an intake nurse about our insurance plan and our finances. It was clear to everyone around us that Joyce was in danger of losing consciousness because the swelling in her throat had constricted her windpipe, but the intake process dragged on as she gasped for breath. The hospital, a private institution, like most hospitals in this country, wanted to make sure it would get paid before it would admit her for treatment!
I lost my temper and began yelling and making a scene. Another nurse came by, saw Joyce’s condition, and, fortunately, brought her in to be seen by a doctor before the financial details were resolved. She was given a drug to reduce the swelling, and she recovered. We ended up paying the hospital $700 for this abusive nightmare.
Today, things have only gotten worse. The nearly 50 million people in America who don’t have health insurance—and that number keeps growing as employers eliminate their insurance plans for workers—have nowhere to turn when they or their families get sick.
Think about that number. There are just over 310 million Americans: nearly one in six is uninsured. Many people with curable ailments have died for lack of care. That’s what happened to a teenage boy brought to a hospital by police in Chicago. He died on the sidewalk as the cops stood by helplessly: the hospital wouldn’t admit him because he had no insurance.
America is the only modern industrial nation in the world that does this to its people. Everywhere else—Japan, Germany, Spain, Italy, Australia, Canada, Taiwan—there is some kind of system through which every single person has easy access not only to emergency care but to doctors and hospitals as well. In most of these countries, the patient receiving care pays nothing or merely a token fee. The cost is borne by the whole population, which finances the system through taxation.
These countries use several different health care models. The United Kingdom has a truly socialist-style National Health Service. In the British system, doctors are on salary from the national government, which also owns the hospitals. Canada’s Medicare system is semi-socialist; the various provinces each pay private hospitals and doctors a set fee for providing care. In Switzerland, the government establishes a basic health insurance plan that all insurance companies must offer to all citizens at a fixed cost. The insurance companies are not allowed to make a profit on these policies, but wealthier citizens are free to buy costlier insurance with better benefits, if they prefer. Amazingly, all of these models cost individuals, families, and society at large far less than health care in the United States.
In the UK, when people get sick—whether with strep throat or AIDS—they don’t have to worry about how they will pay for their care: there is no cost for treatment. In Ontario, Canada, if the son of a top executive at General Motors Canada breaks his leg playing hockey, he is rushed to a hospital, where he is taken care of for free. If the daughter of an unemployed Haitian immigrant in Toronto gets hurt playing soccer, she’ll be treated for free, too, under the same Medicare system. Both kids might even be treated by the same doctor in the same emergency room.
The British, Swiss, and Canadians have better access to primary medical care as well. And because diseases are generally easier to treat and more easily cured when they are diagnosed early, they are able to remain in better health.
But in the American system, only those who have good health insurance plans—generally government workers or staff at large corporations that must offer generous benefits packages in order to attract top-notch employees—can easily afford to go to the doctor whenever they are sick. A doctor’s visit usually costs a nominal fee called a “co-pay”—no more than $20 or $30. When they are sick, they can be treated immediately. If they are becoming seriously or chronically ill, they can be referred to a specialist or sent to the hospital right away, improving their chances of recovery.
But many Americans, even those who have some kind of health insurance plan, don’t have adequate access to health care. Instead, they might be responsible for paying perhaps the first $1,000 of their medical bills out of their own pocket before any insurance reimbursements kick in. That poses a terrible dilemma for a family in such a situation. If you feel a sore throat coming on, do you go to the doctor and pay perhaps $75 or $100 for an office visit? Or do you wait to see if it goes away on its own because you need that money to buy groceries? If you decide to wait and you have not a cold but strep throat, not only do you become very sick, but your family may get sick, too.
I was in that kind of situation when I was thirty-six and my daughter was a baby. She had a condition called febrile seizure syndrome. If she got sick and ran a high fever, she’d have a seizure and stop breathing, sometimes for as long as two minutes. It was horrifying to see. Her little body would stiffen and turn blue, and her eyes would roll back in her head. Once we learned about her condition, we would always rush her to the pediatrician at the first sign of a higher than normal temperature.
But each of those visits cost us $75, and my wife and I didn’t have much money at the time. Sometimes, when she got sick, I remember thinking, “Oh, maybe this is just a flu, and visiting the pediatrician won’t help. I’ll just give her Tylenol and try to keep her cool with a wet washcloth so she doesn’t have a seizure.” Then I’d start to feel guilty: “But what if this is a bacterial infection, and the doctor could treat it?” Usually we’d relent and take her to the doctor—and spend $75 to find out that it was just a cold. Parents should never have to consider money in such situations. And in a society with socialized medical care, they wouldn’t have to.
In a socialist society, a parent with a sick baby could go straight to the doctor, or in an emergency, to the hospital. The baby wouldn’t be at risk of suffering through something potentially life-threatening, and the parents wouldn’t have to face the financial anxiety of deciding to see a doctor—or suffer the guilt of not seeing one.
For those fifty million Americans with no insurance, the situation is worse still. They are usually poor, and therefore often choose not to see a doctor when they are sick. Doctors in America are private businesspeople, and most of them demand payment before they’ll see a patient no matter how sick that person is. So poor people often wait until they are so sick that they must go to a hospital emergency room. Such facilities are generally required by law to admit anyone who needs treatment.
But many American hospitals have eliminated their emergency rooms, so that they don’t have to accept patients who walk in off the street. Such hospitals only admit those referred by a private doctor. So the uninsured must find a hospital with a public emergency room; in rural areas, that can mean a drive of over fifty miles. Even these hospitals sometimes turn uninsured sick or injured people away. Stories of people dying after being sent away from hospital emergency rooms are legion.
To address the soaring number of uninsured Americans, the administration of President Barack Obama introduced, and Congress passed, the Affordable Care Act of 2010, dubbed “Obamacare” by its critics, a name subsequently adopted by the administration itself. Starting in 2014, health insurance companies must sell policies to anyone who can afford them, business owners with more than fifty employees must provide minimal health insurance for them or pay a fine, and those who do not receive insurance through their workplace must buy it on their own or be fined at tax time.
But the available plans will be costly (the law’s price controls are minimal), and the insurance will be bare-bones, covering some hospital costs, for example, but not doctor visits or much preventative care. And most private insurance plans do not pay for treatment from doctors, medical labs, or hospitals that are not in their network of approved doctors or facilities.
Obamacare leaves health care in the hands of private, for-profit insurance companies, and it will do little to reduce health costs. Whether measured by the cost per person or as a percentage of total expenditures, the United States currently spends nearly twice as much on health care as does Switzerland, whose costs are second only to the United States’.
Ironically, we already have a kind of socialized medicine in America: Medicare. But you must be permanently disabled or over the age of sixty-five to qualify for it. Older Americans can go to almost any doctor or hospital, and the government pays the bill. It’s not a perfect system, and there are holes in its coverage, but it works much the way the socialized health system works in neighboring Canada.
Does this make sense? Why do we have socialized medicine for our elderly, but not for everyone? The answer is that a lot of large corporations—hospital companies, insurance companies, drug companies, as well as many doctors and specialists—have a financial stake in the status quo. That’s what we must all work hard to change.
To learn more about the fight for a humane, fair, and cost-effective national health care system in the United States, visit www.pnhp.org, the Web site of Physicians for a National Health Program, a group of thousands of health care professionals fed up with the existing system.