Quora Question: Progressive Reform Needed in U.S. Health Care

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Democratic presidential candidate Bernie Sanders speaks during a campaign rally in Washington, June 9. Joshua Roberts/Reuters

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Answer from Ian Jackson, journalist, former lecturer in politics.

I think Bernie Sanders' health care plans would do doctors a world of good. Wherever you go in the world doctors have to take the Hippocratic oath, which amounts to 10 solemn promises. Personally, I was always struck by the ninth promise: "I will remember that I remain a member of society, with special obligations to all my fellow human beings, those sound of mind and body as well as the infirm." It's a reminder that they hold a position within society, not apart from it and that their duty is not only to the sick, but to those who are well. They are guardians and would do well to remember that fact, since its one of the reasons they get paid so well in the first place. Which always makes me wonder about stuff like this: New study finds 45,000 deaths annually linked to lack of health coverage. That's around 5 Americans an hour. How can these people who are sworn to protect society allow so many to die just for being poor? How can they turn sick people away? Oh, I know what you are going to say, that cannot happen, it's illegal. Well.

The EMTAL Act forbids hospitals from turning away patients based on their inability to pay but it only applies to 1) emergency conditions and (2) hospitals with ER and (3) hospitals that get federal money, including via Medicaid. Hospitals are legally bound to stabilize a patient, but that is all; many life-saving operations will not be performed. There also have been cases where patients unable to pay were transferred repeatedly between different emergency rooms until they died.

People who are uninsured, can and do die in the USA due to lack of money. People in the USA who are insured can and do die when their insurance companies refuse to pay for anything "exotic" or "experimental."

The number one cause of bankruptcy in the USA is medical bills. More than 10 percent of the population will face debt collectors over the issue, 17 million Americans will receive a lower credit rating, 16 million children live in households struggling with medical bills and a staggering 1.7 million Americans filed for bankruptcy due to medical bills in 2011 alone! That's around 5 percent of your population!

Two points:

  1. This does not and cannot happen in Europe. We pay a flat fee that scales with our income; there are no deductibles, no premiums; exotic and experimental treatments are treated the same way as any other treatment. Medical staff operate upon a binary system. If there is a treatment, you get it, if not (and sadly, some things are still incurable,) then they will provide palliative care and allow you, in the worst case, to at least die with dignity.
  2. The medical personnel, and especially the doctors who are not allowed to treat the sick, must be shamed by that fact on some level. I'm sure that most doctors take their oath seriously; they might throw their hands up and say "nothing I can do, it's management" but they are still breaking their oath. However used they are to the status quo I fully believe that were they granted an opportunity to treat their patients without concern for the cost, they would be better for it on an emotional level.

Now, to the cost.

The AMA spent $28 million lobbying government last year. The organization has a lofty mission statement but incredibly, at no point do they even mention patients. It does however take some time to discuss the financials at the heart of the matter. That's because the AMA functions in almost exactly the same way as a medieval guild.

Now, if you don't know what a medieval guild is then that's because for the most part they don't exist anymore. At their heart they were unions of tradesmen who came together, set prices and, thanks to royal patents, achieved a complete monopoly over a certain geographic area. The guilds "negatively affected quality, skills, and innovation." And in the words of Historian Sheilagh Oglive, generated "no demonstrable positive externalities." Guilds persisted over the centuries because they redistributed resources to politically powerful merchants. They were anti-free market, oppressive and territorial, they kept prices high and although they at least protected the wages of their members they still had to go and go they did.

But a couple of guilds or guild-like entities did survive. They were exclusive clubs that sought to keep out the riff-raff, fill their pockets and make sure that nobody else so much as took a piss on their territory without their say so. The most obvious modern guild is that of lawyers, but that's outside the scope of this question. The AMA most certainly is a guild and does what guilds do best. It monopolizes, it schemes and everywhere it inflates the wages of its constituent members.

Are American doctors paid too much? Yes. Yes, they are.

(Reference: Are U.S. Doctors Paid Too Much?)

Which would not matter at all if the USA had the best health care in the world and not just the most expensive one; after all, we are all happy to pay for quality products, especially important ones such as health care.

Oh, well at least the U.S. beat Slovenia and economically ravaged Cuba.

The best healt hcare in the world according to the WHO is France and in the USA you pay 90 percent more than the French do. That's because France, like most European countries, operates under the auspices of a group discount. Their socialized medicine works like your socialized police force, your socialized fire service and your socialized education system. Nobody is excluded, everybody pays.

Now, I'm not saying that the AMA is evil or anything, after all they are only doing what they are supposed to do: inflate the earnings of their guild-mates and protect their interests in some other ways. However, since the organization is made up of physicians, they are breaking their oath. That's because the key word in any modern system of health care is affordability. I don't mind paying for health care, it comes out of my paycheck every single month. I may be unlucky and recoup that money back (and then some) by getting a serious illness. But if not, then my money went into a pot and helped cure some poor kid with leukemia. I'm OK with that too. Ultimately though, we are being asked to make a choice between two systems: pay around $4,000 into a federal fund that will evenly distribute care and make the rich pay more than the poor? Or pay at least twice that to some company that pays huge dividends to its shareholders and CEO s and gets that money whether you ever get sick or not.

And there is the key to the wonderful world of affordability. I'm a healthy guy; I've never had a serious ailment so the money I paid into national insurance, that went back into the health care fund. It cured someone else, my good fortune, helping somebody else's misfortune rather than lining the pockets of an already too rich corporation that in some cases doesn't even pay tax anymore. In the UK, as far as health is concerned, we've all got each others back. We would not have it any other way.

So will physicians wages come down? Probably not. The cost of health care in the USA is in part due to inflated wages but it's mostly due to greedy corporations charging obscene premiums. But I think they will have to be frozen for a while. To be clear, the medical profession will always be well paid. It is in Europe; it will be in the USA. But they swore an oath and at this point, in order to fulfill it they need to vote for Bernie Sanders or at least back a progressive move to do something about the onerous state of health care in America; a slight pay cut in order to show some solidarity wouldn't be remiss either.

How would Bernie Sanders' health care plan affect physicians? originally appeared on Quora - the knowledge sharing network where compelling questions are answered by people with unique insights. You can follow Quora on Twitter, Facebook, and Google+. More questions:

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