Friday, May 11, 2007
Cancer, and good and bad arguments against socialized medicine
Captain Ed declared today that "US healthcare saves more lives than socialized medicine." Maybe it does, and maybe it doesn't. I'm quite sure, though, that Ed's evidence -- a recent study that shows a correlation between the availability of certain anti-cancer drugs and survival rates in more than 60 countries -- does not necessarily support the proposition in the title of Ed's post. The Anchoress, bless her soul, is no closer to the target with her headline: "US Cancer Care 10X better than socialized UK."
There are a number of obvious objections to these post titles and the underlying claims made for them, but the most devestating one is this: It hardly matters if cancer cure rates are higher in the United States if we also have higher rates of advanced stage cancer because of other aspects in our health care system, such as infrequent or non-existent screening for an unfortunately large proportion of the population. Sure, we may cure more cancers than those parlor pinks in Europe, but perhaps we have more cancers to cure because we do a poorer job of detecting precancerous changes when they can be treated without drugs. Now, I don't know that any of the foregoing is true -- although I suspect it is -- but one cannot determine from Ed's post or the underlying links whether it isn't true. The conclusion in the post heading is therefore a leap of faith rather than a bankable conclusion.
That said, there are versions of socialized medicine that raise troubling questions that are quite independent from "collective" public health outcomes. First, better collective results do not necessarily make for a more just system. A socialized single-payer system might, for example, decide that it was wasting money on too-frequent screening of women for cervical cancer at the cost of, say, insufficient "well baby" care. A bureaucratic decision to shift resources from the first to the second might save the lives of more children than the lives lost to undetected cervical cancer, and so result in a "better" public health outcome. That collective victory, however, would be cold comfort to the dying woman who would have elected more frequent Pap smears but was not allowed even to pay for them out of her own pocket (for fear of creating an alternative private system for "the rich"). A rigid single-payer system does not allow for different appetites for risk -- those judgments become "social," rather than individual. That forced substitution of bureaucratic decision for individual choice is itself dehumanizing, whether socialists admit it or not.
Second, the supporters of hard single-payer systems completely ignore the rights -- yes, I mean the rights -- of physicians and other healthcare providers. Extra TigerHawk points to the first reader who identifies the author and context of this quotation:
"I quit when medicine was placed under State control, some years ago," said Dr. Hendricks. "Do you know what it takes to perform a brain operation? Do you know the kind of skill it demands, and the years of passionate, merciless, excruciating devotion that go to acquire that skill? That was what I would not place at the disposal of men whose sole qualification to rule me was their capacity to spout the fraudulent generalities that got them elected tot he privilege of enforcing their wishes at the point of a gun. I would not let them dictate the purpose for which my years of study had been spent, or the conditions of my work, or my choice of patients, or the amount of my reward. I observed that in all the discussions that preceded the enslavement of medicine, men discussed everything -- except the desires of the doctors. Men considered only the 'welfare' of the patients, with no thought for those who were to provide it. That a doctor should have any right, desire or choice in the matter, was regarded as irrelevant selfishness; his is not to choose, they said, only 'to serve.' That a man who's willing to work under compulsion is too dangerous a brute to entrust with a job in the stockyards -- never occurred to those who proposed to help the sick by making life impossible for the healthy. I have often wondered at the smugness with which people assert their right to enslave me, to control my work, to force my will, to violate my conscience, to stifle my mind -- yet what is it that they expect to depend on, when they lie on an operating table under my hands? Their moral code has taught them to believe that it is safe to rely on the virtue of their victims. Well, that is the virtue I have withdrawn. Let them discover the kind of doctors that their system will now produce. Let them discover, in their operating rooms and hospital wards, that it is not safe to place their lives in the hands of a man whose life they have throttled. It is not safe, if he is the sort of man who resents it -- and still less safe, if he is the sort who doesn't." (bold emphasis added)
The last two sentences strike me as particularly a propos.
11 Comments:
By 
, at
Fri May 11, 11:30:00 PM:
I have no sympathy for Doctors or the AMA, which severely throttles the number of people who can enter medicine in the first place.
By 
SR, at
Fri May 11, 11:35:00 PM:
Don't know who actually said it, but it sounds an awfully lot like Ayn Rand to me.
btw Anon, Docs don't want your sympathy, but neither do they want to be told when, where, and how and how much to work.
By TigerHawk, at
Fri May 11, 11:36:00 PM:
Well, it isn't the AMA that limits the number of people who enter medicine so much as state governments that kow-tow to the AMA. I agree, though -- any professional group damages its moral authority by seeking to limit competition through legislation and regulation.
By , at
Sat May 12, 01:08:00 AM:
It's a quote from Atlas Shrugged. Dr. Hendricks is one of the residents of Gault's Gulch, explaining why he joined the strike.
By TigerHawk, at
Sat May 12, 06:48:00 AM:
Ah, Anon 1:08, but who is John Galt?
(You get the points.)
By , at
Sat May 12, 09:39:00 AM:
the medical system in the uk is profoundly broken, and would never be allowed to operate in the U.S.
the hospitals are widely known to be a reliable source of new infections; i.e. you get something there, that you didn't bring with you.
TH, do you really think a system that has measurably higher death rates from cancer, is actually somehow doing a better job early on in the process ? these systems also have far fewer MRI machines, for instance, than here in the U.S.
some other interesting features of socialist medicine:
1. very long wait times for all procedures, even if you are in pain
2. no recourse if a doctor is negligent
3. denying treatment to patients with the wrong lifestyles, or politics
4. lower caliber of doctors due to the limited income potential
5. much much higher cost to the patients, in the form of social taxes
6. lack of choice in choosing a docotor (just like you don't get to choose your mailman, here)
Medicine and health care are no different than any other industry, and socialism simply can not compete with a more market oriented system, in any sphere.
For what it's worth, my wife (who is English) and I moved back to the U.S. when our first child was born, primarily because of the appalling lack of competent medical care.
By SR, at
Sat May 12, 09:54:00 AM:
TH: Do I get half credit? Never could slog through Atlas Shrugged, too busy reading anatomy, physiology etc. As far as competition, what I see everyday is exquisitely trained physicians quitting well before their time... to have families. Now that graduating classes are 50% women, shortages are guaranteed.
By , at
Sat May 12, 10:36:00 AM:
No one has mentioned that federalized health care is probably unconstitutional. Not an insult to Tigerhawk readers: Congress doesn't seem to care either.
By , at
Sat May 12, 05:33:00 PM:
If you have to have cancer, then you want to be in the USA where the cutting edge therapies are available.
Case in point was reported in the UK press in 2005 (hopefully the situation has improved):
http://www.telegraph.co.uk/news/main.jhtml?xml=/news/2005/08/21/ncanc21.xml
At issue was access to Herceptin, a breast cancer therapy for women whose cancer is not hormonally receptive -- such cancers are more aggressive and generally more deadly. Women in the UK were suing their government health service to get access to this drug which was and is freely available in the US.
We can certainly do better with our health care system in the US with respect to access to screening and preventative health care. Such would save money and heartache in the long run. Let's just not throw out the baby with the bathwater.
NT
By SR, at
Sat May 12, 10:25:00 PM:
Let's see, just how would this great screening plan work. Would the police round up every woman each year to make sure they got mammograms or Pap smears? Would everybody who had not gotten their free colonoscopy by age 51, be denied coverage under the national health scheme? Just who would perform all those screening tests anyway ( for minimum wage)? See, it is not all that simple.
By Georg Felis, at
Mon May 14, 10:57:00 AM:
Somehow I just don’t trust the government when it comes to sticking something up my…
