Almost 50% of all health care dollars in the United States are spent by the government, and the other half is spent by private insurers and individuals on a market that is heavily regulated and controlled by government.
What might medicine look like if government weren’t so deeply entrenched in it? It can be a tough thing to imagine, since government and medicine have been “joined at the hip” (to borrow a recent phrase from Obama) for more than half a century.
There are some Americans, however, who have lived long enough to remember the state of medicine when it was freer. In a recent op-ed in the Wall Street Journal, a doctor describes how his experience in medicine dramatically changed over the course of his medical career—and not for the better. Dr. Marsh says:
When I graduated from medical school in 1962, the profession of medicine was for many graduates an opportunity to provide care—as distinguished from, though aligned with, treatment—and to provide it to individuals, not to populations or governmentally specified groups. Young doctors hoped to establish an independent business, enjoy lifelong intellectual excitement as knowledge and therapies expanded, and have an income sufficient to live decently and support a family….
After eight years of postgraduate study, I opened a solo pediatrics practice in a community of 10,000 souls an hour from Boston. A number of lean years passed before I could build a robust practice. Yet the experience was exactly what I—and I think many of my colleagues—sought: a personal, direct and unimpeded relationship between me and those who chose to become my patients….
I had to give my acute attention to the price of every medical intervention. The costs could have a direct and painful impact on a family’s budget. So I had to know the prices for most of the medications I prescribed and of most of the tests I might order. I learned to play for time by waiting, when it was safe to, before ordering an X-ray or a test—and to substitute less-expensive medications for more costly ones wherever possible….
Then, in the mid-1970s, things changed, and we became enlightened. Third parties, typically the insurance companies, were interpolated between the physician and the patient. Some of the consequences were unfortunate….
Physician compensation is tied to “efficiencies,” which means reducing the outlays and costs to the group (translation: skimp where possible) and thus generating for internal distribution a larger share of the prepaid premiums….
Insurance relationships drove practice relationships.
What Dr. Marsh is referring to is the rise of HMOs in the 1970s, propped up by government subsidy. He describes how these government-bred entities transformed his relationship with patients from one in which their interests were aligned (the better care he took of his patients, the greater rewards he received) to one in which doctors had incentives to sacrifice the quality of patient care to pad their pockets. The whole editorial is worth reading.
Dr. Marsh describes how the quality of medicine fell as government intruded further in health care. His observations suggest that medicine would look radically better if it were completely unchained from government control, especially considering the remarkable technological advancements made in the last fifty years.