“You Like Europe’s Health Care So Much? Then Go Live There”
I use the above phrase to attack socialized medicine a lot. I’m not trying to be hostile or sarcastic when I say this. I’m not trying to convey an “America…love it or leave it” type message, nor am I interested in cutting off the debate about the problems with health care in this country, which I agree do exist. I say this to people who try preaching the doctrine of universal health coverage (or, more accurately, socialized medicine) because, frankly, I believe that the best counter-argument to their ridiculous proposal is for those people to go live for a few years in a country that has socialized medicine (as I did) so they can see for themselves what a horrifically bad idea it is.
To fill in the gaps a bit, I’m UCrawford. I’m a libertarian (small-l) from Wichita, Kansas and a guest poster here. Until 2006 I spent 10 years as a member of the United States military, just under six of them stationed at a small base in northern England (five if you don’t count a short vacation I took to Afghanistan on the Army’s dime). Due to the fact that the base I was on was both small and rather remote from any other U.S. bases we ended up falling between a lot of administrative cracks, most of which aren’t worth going into here, which often led to problems with funding. Needless to say, the U.S. government was often forced to improvise to provide quality of life services for us at a reasonable rate, so one of the solutions they came up with (since the closest base with medical services was 4-5 hours away) was to arrange to have all of our health care provided by Britain’s National Health Service (NHS). That decision provided all of the military personnel on our base with the unique experience of living under a system of socialized medicine that Michael Moore recently held up as among the best in the world. That decision also made it unlikely that anyone stationed at our base will ever end up in one of Moore’s little press conferences singing the praises of socialized medicine…the experience was terrible.
My first indication that something shady was up with our medical care came in my first year when I went into our base clinic (staffed by two NHS doctors) with a chest cold, only to be told that my cold was likely “viral” and wouldn’t require antibiotics. That in itself wasn’t really so odd. We worked in a close environment and doctors aren’t supposed to prescribe antibiotics for viruses. Except that after talking to other people on the base I eventually came to realize that about 90%+ of the people who went in with colds were told the same thing. I’m saying “90%+” because in the three years where the NHS staffed the clinic unchecked nobody I met on the base (I knew almost everyone and we all got sick at least once or twice a year because of the climate) could actually identify anyone who had been diagnosed with a non-viral cold or had received antibiotics for said cold. I’m not willing to bet there weren’t at least one or two in three years, although I never ran across any of these people. My platoon sergeant certainly wasn’t one of them. He later came down with severe pneumonia as a result of his untreated non-viral cold. I couldn’t figure out why this skinflint attitude towards medicine was happening, until I talked to my uncle (a doctor who had studied in Scotland for awhile) and he told me about the key to many of socialized medicine’s problems…controlling costs. More on that in a second.
The cost controls took a variety of forms at my base, ranging from the merely annoying (as when our base physician refused to order x-rays unless you had a bone sticking out of your arm), to the mildly amusing (as when the local hospital refused to admit our First Sergeant’s in-labor wife, forcing her and her husband to deliver the child in their car on the drive home), to the ethically questionable (as when one of my soldiers was discharged with a severe case of appendicitis on the grounds that surgery would be too expensive), to the medically indefensible (as when my best friend’s girlfriend nearly died because the hospital didn’t bother to check her for internal bleeding after a very complicated miscarriage). For the first couple of years, I thought it was because our area had the most incompetent doctors in Britain. Eventually I realized that the problems we had in our area were pretty much standard in comparison to the rest of the country (or compared to any country that uses socialized medicine). And the reasons for that are pretty simple.
Basically, the NHS’s “free” medical system isn’t really free at all, which shouldn’t be a surprise to anyone who doesn’t believe in magic money. It’s funded by taxes…income taxes, corporate taxes, capital gains taxes, property taxes, and hidden taxes (revenue generated for the national government from things like Value Added Tax, speed cameras, fuel taxes, and congestion charges that you often don’t notice or think of as taxes unless you’re paying attention). In exchange for all these taxes, the British government provides lots of services for the taxpayers like public transportation, a pension system, and socialized medicine, often at subsidized rates which has several regrettable effects:
1) It makes unobservant people who don’t understand economics think they’re getting a great deal by giving them medical treatment at a superficially low price, which
2) Pretty much insures that low-cost private alternatives don’t develop (since it’s tough to compete with “free”), which
3) Removes any incentive for the health care users to try and save costs by limiting their use since they see health care as a free (as opposed to “free”) entitlement, which means that
4) Demand for services often outpaces the ability of tax revenue available to pay for those services.
When these things happen government is then forced to find new streams of revenue to pay for the additional demand (more taxes). And when they can’t find more revenue or raise taxes any higher, they’re forced to control costs by reducing services where they can, by doing things like telling their doctors to prescribe less drugs, or understaffing medical facilities, or extending wait times for surgeries and consults (unless you’re willing to be extorted, of course), or starving terminal patients to death against their wishes, or skimping on oversight to insure that their doctors aren’t serial killers. Basically, when it comes to a choice between quality of care for patients or saving a buck, government-run health care will choose the money, same as socialized medicine proponents accuse private industry of doing. They’ll just offer you a lot less in return.
Unsurprisingly many Britons I knew had very little faith in the NHS’s commitment to excellence. Unsurprisingly many Britons I knew chose to pursue private routes to get medical treatment where it was available. Unsurprisingly, it was usually very expensive (partly because they were still paying taxes for a health care system they no longer used). Fortunately for us, after my soldier had to be medevac’d to the distant military hospital to get his appendix out, that base saw fit to provide our base with military doctors who had the authority to override the recommendations of the NHS doctors , and with the support of our command they enabled us to get access to private clinics in the local area more often. Frankly, I’d say that getting us away from government health care was one of the best things our government ever did for us. And if our politicians want to do the right thing by us back here in the States, they’ll do everything they can to stop socialized medicine from popping up here.