Be Careful What You Wish For

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Courtesy: Photography Collection, Harry Ransom Center, The University of Texas at Austin. Cartoon by Edmund Waller “Ted” Gale, Jr. in 1946 from a pamphlet of the National Physicians’ Committee.

By Gordon Allison | Technical Writer

CANADA – Here are a few brief stories that urge caution when assessing situations. In engineering speak, there is a saying, “There are no free lunches.” This concept means there are always positives and negatives to every situation, plan of action, and product design. In this article, we discuss medical care.

The first story is about some friends in Canada. Their names are changed to protect their privacy. Thomas and Rachael have a daughter who also lives in Ontario, Canada. Susan is about 40 years old and has a 4 year old son. She was taken ill and rushed to the hospital emergency room. She had a dissected artery, which caused the artery lining to separate from the outer wall, causing an arterial blood flow blockage. If the dissection had occurred in the aorta, circumstances could have caused instant death. As it was, Susan was given some medication and told to see a pulmonologist. Some time later, she was told to see an allergist. The allergist sent her to a cardiac specialist.

About this time, you should be asking why wasn’t Susan sent to the cardiac specialist in the first place? Well, single payer health care is when the government pays the bills for everyone. This is a popular idea in the Democratic party right now.  In a single payer system, access to medical care has to be rationed to keep expenses from overwhelming the government. Let’s be frank here — some deaths are to be expected as the patient is often given the runaround to delay the care that would have been expected in a market-based system. Maybe the cardiologist was too busy and the patient was sent elsewhere to get some treatment, whether it was appropriate or not. Naturally, over the months of the runaround, Susan’s health deteriorated.

Our friend, Tom (Susan’s father) then took things into his own hands and flew Susan to see a cardiologist in Houston, TX, where she had the surgery that was needed at M.D. Anderson Hospital. Tom rented an apartment so Susan could recuperate over the next five weeks. After getting home, Susan developed a small leak in the artery and required more surgery in Canada to repair the leak, which was successful.  Susan returned to good health and had another child.

Tom could not get the surgery for Susan in Canada in a timely manner! There is no option to find a doctor and hospital to have private surgery. The Canadian health system is similar to the United Kingdom’s system. I am aware of a case where an English woman with cancer was happy with the medical care she got. The problem is that not everyone gets adequate care in a timely manner.

I had a business associate in Canada who developed shingles. Because Bill was in his early sixties, the Canadian medical providers declined to provide him treatment, telling him that the cost was too high ($100 for a prescription for Acyclovir in 1980) to provide for someone as old as he was. Because he lived near the U.S. and could afford it, he obtained medicine in the U.S. to treat his shingles, recuperated and continued working and paying taxes. My wife’s experience with recurring shingles is that it can best be controlled when Acyclovir is administered as soon as the outbreak occurs, rather than waiting for an appointment to get a prescription. It’s best to have the medicine already on hand when needed.

Germany has its own version of medical care.  It is quite different and at least you get the chance to get health care on demand. My friend, Herr Doktor Georg, was a physician in the Munich area. His specialties were gynecology and sports medicine. (Go figure!?)  The German system is a hybrid of public (government paid care) for the general public and private for those with money. To have a successful practice, Herr Doktor Georg calculated that he needed 35 percent of his patients pay the full amount for his services and the other 65 percent were patients whose reduced charges were paid by the government.

Medicines in Germany are similar in price to the identical drug in the US. But, the German health system only pays the equivalent of $10 (U.S.) per patient per month. So if you are a public patient and need a cancer drug that costs $1,000 per month, the doctor has to give a lot of his patients aspirin or over-the-counter medicines to save enough money to pay the $1,000 a month for that one patient.

If the patient complains to the German government that they should pay more money per month for medicine, the government tells the patient: “Talk to your doctor about it. We pay him/her enough for medicine.” What a terrible burden to put on the physician, who must decide who gets care, and who lives or dies.

Now this is another interesting part of German medicine. The government sets a limit on the number of patients any one physician can see per three month period. If his patient quota is met in two months, he must turn over his practice to a young medical doctor for the remainder of the quarter. In this example, the regular physician took a vacation for a month every quarter.  Herr Doktor Georg had condos or time-shares in Spain, New York, Los Angeles, and Puerto Vallarta, MX. Imagine that you need a doctor while he is on forced vacation.  Well, it doesn’t happen! Instead, you see the replacement doctor who is fresh out of medical school!

Footnote: Herr Doktor Georg contracted ALS (Lou Gehrig’s disease) and died five months later at age 59. He left a huge legacy of treatment services to guests and staff at the Sheraton Buganvilias Vacation Club. He treated my wife, my mother-in-law, my mother, and me over a 20-year period.

You may say that I have only given a couple examples when there are millions of patients in the socialized medical system – – and you would be correct. The problem is whether you get the real treatment needed, or some placebo that only has a 30 percen chance of working.  As Clint Eastwood’s character, Dirty Harry said: “Do you feel lucky, Punk?”

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