Socialized Medicine Is A Reality

Back in 1993 and 1994, America pretended to have a huge debate about whether health care should be radically reformed, and a lot of sane people actually believed that since President Clinton lost the debate, the answer was a resounding “no.”

Four years later, we have a health care system that has been stood on its head, that is a barely recognizable version of what existed then. And there are still people who pretend nothing happened, or that what would have happened if Hillary Rodham Clinton had had her evil way would have been some horrible disaster.

We have, in other words, become a nation of medical idiots.

In a lot of ways, nothing has changed, of course. Since 1993, more people are without medical coverage, but anyone who can drag him- or herself to a hospital still gets examined, eventually. True, Public Citizen, the consumer advocacy group, has just reported that 700 U.S. hospitals “dumped” poor patients in violation of federal law since 1986, but by and large, if you have the strength to cause a big enough scene and look like you’re about to croak, even the most wretched patient gets looked after by somebody.

Basically, we have become a nation in which socialized medicine exists. Poor people get it. Old people get it. Anybody dying in the street gets it. We’re just not allowed to call it socialized medicine because, heaven forbid, too many people might get the idea that paying immense premiums to an insurance company or a health-maintenance organization is a sucker’s game.

Meanwhile, the profit-driven sector has muscled in on medicine in a way that suggests physicians have been relegated to the position of what the dean at my old graduate school called “those barbers.” He referred to the time when people who felt bad went to a barber to get bled. And hospitals - those temples of medicine that were charities you actually gave money to or were facilities operated without apology by governments and churches - have become generators of revenue, case studies of profit maximization, institutions in which cost control and the allocation of liabilities are what an administrator looks at checking on how many patients had conked the night before.

I see where Columbia/HCA Healthcare, the largest for-profit health-care company on Earth, has just ordered the appointment of “ethics and compliance officers” in all of its 338 hospitals. I haven’t the faintest idea whether this is because Columbia/HCA Healthcare is under investigation for being a bunch of greedy pigs feeding off the government, but has anybody read an itemized hospital bill lately and not gotten the idea somebody wasn’t trying to take them to the cleaners?

These ethics czars will presumably become the tiresome busybodies who run around checking on interns who have affairs with young nurses in the linen room.

What’s clear is that the American health-care system is still headed for the same road wreck it was careening drunkenly toward in 1993.

What saved it then was a reduction in medical-care inflation as more and more people were herded like sheep into systems that limited their choice and converted their personal physicians into underpaid cost-control freaks.

What will happen now is that everybody - the insurers, the doctors, the laboratories, the nurses, the hospitals, the American Medical Association, the Catholic dioceses, the people who have to empty the bedpans - will discover new, more imaginative ways to eat their share of the pie that is baked when we have the bad fortune to get sick.

And I guess none of us has to ask who will pay for it.

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