For the past six years I have worked full-time as a Registered Nurse. In that time, I have found the industry to be full of genuinely good people with big hearts who seek nothing but to ease suffering and make the world a better place. So when self-proclaimed Socialists campaign on the promise to create a single-payer healthcare system I listen intently because nothing has ever been improved by adding more government control. And those of us on the front lines of healthcare have an informed and realistic understanding of the industry’s logistics, and the government’s previous failed attempts to reform the system, so to hear politicians explain why the system is a failure is like listening to a drunk driver explain how someone else crashed his car – even though he is still in the driver’s seat. So, here are a few reasons why Medicare-for-All (MFA) is just another horrible, big-government idea.
First, because politicians lie. On Jan. 11th 2020 in Davenport, Iowa Sen. Bernie Sanders (I., Vt.) said: “In America today, unbelievably, we are seeing a decline in life expectancy. Did you all know that? Instead of living longer lives, we are actually as a people living shorter lives.” (https://www.nytimes.com/interactive/2020/01/31/us/politics/bernie-sanders-campaign-speech.html) And in looking at only four years of data, the statement is true. But Bernie, a career politician, has learned to skillfully misrepresent data even though the truth is far more optimistic. When Bernie first assumed congressional office in 1991 the US life expectancy was 75.4 years; in 2018 it was 78.7 years (Data.Worldbank.org). In the few recent years in which life expectancies did decline, the variance can be measured in weeks instead of years and the greater trend in the data is still upward not downward. The passage of MFA would be Bernie’s legacy so I guarantee he will stop at nothing to get it passed – even at the expense of honesty.
The second reason MFA will not work is that the language is too ambiguous. Both Sanders and Elizabeth Warren (D., Ma.) will have you believe MFA will bring about this utopian dream that you can stroll into any Doctor’s office, make your demands, and then leave without charge. But please read the bill. (https://www.congress.gov/116/bills/s1129/BILLS-116s1129is.pdf). The key concept that underpins the bill is that of “medical necessity”. All “medically necessary” healthcare costs will be covered in full by the US government (aka, the US tax-payer). But who decides what is medically necessary for you? And at what time? You, or your doctor? What happens if you do not like the treatment options that your doctor (and the government) will define as medically necessary? Will you have the right to other options? What if the government disagrees with you about what is medically necessary for your body?
Additionally ambiguous is the fact that medicine – especially emergency or critical care medicine – is equal parts art and science. I have learned that humans are not robots, and treatments that work for one patient will not necessarily work for another. Furthermore, treatments that were saving a life an hour ago, may not work for the same person in the next hour. Often in those critical times it is a hunch or a gut feeling – an instinct – that illuminates a healthcare provider’s vision to find the answers to fix a broken body. My fear is that art and innovation will be lost to compliance and reimbursement, and that healthcare providers will be so bootstrapped by their overlords that inspiration will no longer have a place in medicine. Eventually, healthcare quality will suffer as the “art” of medicine disappears.
Strike number three relates to cost and sustainability. I have personally cared for two separate patients so far in my career that have stayed in a hospital continuously, at the end of their lives, for greater than two years at a time, while we prolonged their lives with ultimately futile care. Two years of non-stop, uncomfortable, and futile care. Without leaving. Why? Because it was “medically necessary” to keep them alive. No other facilities would accept them. Their families either could not take them home to be cared for around the clock, or would not “pull the plug” so the patients went nowhere. Can you imagine the financial cost? And the misery their bodies endured? I cannot. Though you may fairly ask “These cases happened in a world without MFA, so what is your point?” My answer is: these are the only two such extreme cases I’ve seen so far. Imagine the ridiculousness of what Pandora’s box would reveal if no one had to consider the costs of healthcare so long as the care they or their family member receives could be certified as “medically necessary”. Have you ever known anyone to abuse a handicapped parking tag? Now multiply that abuse by a factor of 10 million.
In contrast, either hospitals and nursing homes would remain at capacity such that routine care is inaccessible, and/or the government would have to decide that it is time for certain people to stop receiving care. Those two patients I mentioned before would not have been allowed to live in a hospital for two years at a time in a single-payer system. The government will say that would be unfair to the taxpayers and executively decide to “pull the plug”. Don’t believe me? Just look at the UK’s National Health System (https://www.dailymail.co.uk/news/article-2161869/amp/Top-doctors-chilling-claim-The-NHS-kills-130-000-elderly-patients-year.html). This is Medicare-for-All. This is the Democrats’ vision for America.
Conservatives believe the government should stay out of healthcare (and education, and religion, etc) as much as possible. But even the average, middle-of-the-road voter would agree of Americans that we’re Cowboys. Rebels. Self-reliant. Protesters. We broke free from monarchical tyrants and founded our own nation. We endured a Civil War and afterwards became back-to-back World-War winners. We have survived and thrived in spite of nearly three hundred years of internal and external threats. Freedom is our legacy. So Socialized medicine has no place here. It would not fit into our culture of freedom-of-choice. I do not have all of the answers to fix the healthcare system but it is a terrible miscalculation to believe that Socialism will do anything but cause harm. And as the saying goes in healthcare “First, do no harm”.
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