An Insidious Selfish Nature of a Complaint About Health Reform

Circulating amongst some critics of health care reform is that the health care system cannot handle all the extra new people who would come into the system. They state there are no provisions for increasing hospital capacity or the number doctors. Hence, there will be longer waiting times to see a doctor or get treatment in a hospital so health care should resisted.

In my August 7 blog was the first time I noted this criticism. While I touched upon it then, due to its insidious selfish nature it is worth visiting again. While expressed in various frameworks, the argument is essentially, if you are not already insured I do not want you in the system as I will have to wait a little longer to see my doctor and wait longer in an emergency room or get a bed in a hospital. While people using this argument may be good and well intentioned, I suspect that most are using this uncritically and without any thought as to its self-centered natured, that they would rather someone else not get medical care because they do not want to wait. What I have found most disappointing is that this thinking is circulating within the evangelistic community, the very community the speaks with pride about the value of sacrificing self for others, and the importance that we love and care for those in need.

As for hospital capacity, let us not forget the hospitals are private corporations that are expected by their shareholders to make at least a 20% profit annually (see my Sept 10 post). The firms that run hospitals are some of the most profitable firms on Wall Street. Like any corporation, their mission is to make as much money as possible by charging as much as they can while keeping their expenses as low as possible. As there is such competition between hospitals, they are driven to have the latest and largest machines possible, to provide décor and frills for staff, patients and visitors that are designed to make people feel more positive about the hospital in question so that they will give them their business.

If hospitals feel that they can make more money by expanding, they will do so. If expanding services does not add to their bottom line, they will not expand. As hospitals are a for profit identities, the government should not fund their expansion so that they can increase their profits. Government should only fund hospital construction when there is a clear benefit to the citizens, such as in attracting a hospital into a low income or rural community, or that there will be some control on fees charged.

As for the number of doctors, whereas in other industrialized countries governments are heavily invested in paying the majority of the costs of medical training, this does happen in the United States. Whereas in other countries the government helps to regulated how many individuals may be accepted into medical schools, in the United States this does not happen. Each medical program sets its own enrollment levels which are balanced between the demand-supply formula, attrition and the costs of producing a medical practitioner. While medical schools may get some funding from government grants, the bulk of a medical school’s funding comes from tuition and donations from the public, corporations and private foundations. A student receiving grants/forgivable loans to work in underserved communities is another matter. Ultimately, if there is a demand for more doctors, nurses and other medical personnel, and if the schools can raise the funds, and if there are sufficient qualified applicants, they will produce more medical personnel.

The United States unlike Canada and many other developed countries produces far more specialists that general practitioners. In Canada, France, Scandinavia, Germany, Great Britain, Italy a as well as in many other industrialized countries, more doctors are GPs than specialists. In these countries governments are involved in funding medical education at a much high level than is the United States. These countries allow only so many specialists to emerge from their medical schools for they place their focus upon preventive care and catching problems at an early stage. Within a financially driven system as exists in the United States the medical schools produces more specialists than GPs since specialists have greater earning potential than do GPs. In Canada I often could get into see my GP for a non-pressing matter in less than half the time it takes for me to see my GP in Iowa City or in Fairfax.