Healthcare: Not Black and White

First and foremost, thank you for a magazine that presents issues important to us on many levels.

Your articles on socialized medicine [including one by Faigy Grunfeld] point to the success of such systems in countries other than the United States. What they fail to point out are the drawbacks. First, it is the government and not the marketplace that determines what medical care is available, to whom, when, and under which circumstances.

It is the government, under socialized medicine, which decides which hospital will have which medical equipment such as MRI and CT machines, thereby limiting accessibility to MRI and CT scanning. This can result in waitlists which deny seriously ill patients treatment in a timely fashion. The number and specialties of doctors per hospital is likewise controlled by the government and needed procedures like heart valve bypass/replacement surgery often require long waits. What is done here in a day or two must often be delayed, perhaps putting the very life of the patient at risk.

Then the question becomes, who determines a person’s place in the queue for a lifesaving procedure? Who determines not to allow procedures and to which patients? What happens to choice of doctors? These and other questions must be answered.

Do cost-cutting plans protect the citizens or put their protection at risk?

All these questions do not seem to be addressed by the hoopla of “Medicare for All.’’ They should be.

Mrs. I. Rosenblatt

Author’s Response:

Thank you for your letter. This article was building upon the assumption that people are familiar with the general pros and cons of socialized healthcare, and was really an in-depth exploration of the 2020 presidential candidate proposals. The examples you mention are legitimate concerns about what happens when governments ration care because of the expense, which is why I specifically interviewed Dr. Moffit at the Heritage Foundation, in order to provide the free-market position on healthcare. (He did not delve into the examples you mention, but argues for robust competition which will enhance care.)

Just as an interesting point, sometimes governments provide better care than insurance companies.

For example, patients with psoriasis over large parts of the body can go straight to biologics like Humira, Remicade, Cosentyx and Taltz, which are all very expensive, if they receive care at the V.A. Patients on private insurance are first required to try a steroid cream, then they can try methotrexate, a very cheap chemotherapy option, before insurance would consider paying for biologics. This is one small example. You can find hundreds in both directions, where government plans outdo private plans and vice versa.

So concerns about governments rationing care are real, but there is also the concern of profit-driven insurance companies rationing care in order to spare their bottom line, which was one of the inspirations for the ACA in the first place.

As usual, there is no perfect solution to this messy, complex topic.