Socialism, Corporatism, and Destruction of Patient-Centered Medical Care

by Elizabeth Lee Vliet, M.D.

“Medicare-for-all” medicine is the ultimate goal of progressives or “liberals,” fully embraced by Democrat candidates in the midterms. Candidates claim “single-payer” government-run medicine will “solve” all the problems of Obamacare and our “broken,” purportedly free-market system.

Liberal proposals ignore or deny the massive cost burden to taxpayers of “free healthcare,” the long delays, and the limited treatment options that plague every taxpayer-funded (socialized) medical system in the world, from Canada and the UK, to Cuba and Venezuela—and increasingly to U.S Medicare and Medicaid.  Some claim to have received fine medical care in such a system. But having been a patient—and had a family member as a patient—in several countries with socialized medical care, I can personally attest to the difficulty of getting proper care at all.

The U.S. system has similar problems because of the flip side of the same coin: the corporatization of medicine. High cost, long delays to see specialists, limited doctor networks, “insurance” (managed care) companies dictating clinical “guidelines” to be followed, pharmacy benefit mangers (PBMs) causing harm to patients by adding another layer of costs and restricting access to optimal medications, and a deluge of prior authorizations and other administrative barriers are keeping patients from the medical care their doctors would like to provide.

I see these problems daily in my own medical practice as I help coordinate care outside my field for patients from different parts of the U.S. as they struggle with getting insurance approval for the referrals, medications, and treatment they need, often from physicians treating only one organ system or body part without coordination with the patients’ other physicians. Even though I am independent of insurance contracts and able to focus on serving patients according to their individual needs, I am still restricted in testing and treatment options by what “insurance” plans and PBMs will pay for.

Two behemoths control medical care around the world: socialized medicine with government-run massive bureaucracies (in Canada, UK, Europe, etc.), and corporatism, with corporate bureaucracies (Think: AetnaAnthemCaremarkHumanaUnited Healthcare) controlling most “healthcare delivery” in the U.S., including an increasing proportion of care funded by Medicare and Medicaid. The single-payer chorus has yet to acknowledge this, or to ask whether their proposal will affect it. (It won’t.)

Neither socialism or corporatism is about serving individual patients. The collective or the corporation comes first. “Healthcare” is simply the pretext for bringing revenue into the system.

Physicians, on the other hand, have for 2,500 years stood on the foundation of the Oath of Hippocrates to use our best abilities and judgment for the benefit of the individual patient who seeks our help. Physicians cannot effectively serve two masters—the corporate or government entity AND the patient. When inevitable conflicts arise, it is the patient who ultimately suffers.

“Medicare for all” is no solution—it just perpetuates and cements the flaws we already have—while destroying the prospect for genuine reform.

The real answer is to get ALL the third parties out of the physician-patient relationship.

We need:

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Patients spending their own money as they choose, as through Health Savings Accounts.

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Price transparency to allow patients to make sound choices, through genuine patient value-based purchasing.

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True risk-based catastrophic, reasonably priced medical insurance plans, formerly called “major medical” coverage, which were outlawed by the ironically named Affordable Care Act.

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Competition in the pharmaceuticals market, and removal of safe harbors for kickbacks to PBMs.

• Tort reform

These are the very hallmark features that Candidate Trump espoused that helped his election to President. Sadly, Congress, the FDA, and HHS have so far blocked these reforms that businessman Donald Trump proposed to cut costs and put decisions back into the hands of patients and physicians. Obstruction of true reform has been from both political parties, evidenced recently by the failure of the Republican-controlled Congress to successfully repeal costly Obamacare, a betrayal of their many campaign promises to undo damage inflicted by Democrats in 2010.

Free-market solutions have consistently worked best and served the most people at the lowest cost. Would-be reformers should be looking at places like Chile and Malaysia, which have thriving private sectors, rather than the tired, failing systems of Canada and the UK, for examples of excellent care at a fraction of U.S. prices.

Free markets in medicine have not been broken, as Democrats like to say. True free-market approaches have not been allowed to work since Congress started to Impose more and more regulations and restrictions in a futile attempt to rein in the soaring costs of Medicare soon after it was implemented in 1965.

More of the same socialist or corporate interference and control will have the same effect: outrageous costs and declining quality. To restore excellent affordable medical care, we must first restore medical freedom and unleash the competitive market forces that help all sectors of our economy thrive.