❖◗❘❱❳❩❬ ❭❳◗❪❫ ❴❬ ❵❛❞❣
✐❥❦ ❧♠♥❦qr❦q
Asking whether American health
care should be private or public is
like asking whether a house should
be built with wood or cement. The
answer is always both. This is why all
developed countries have a mix of pri-
vate and public health care.
The United States has a uniquely ex-
pensive health care system. We spend
50 to 100 percent more than other
developed countries on health care,
whether that is measured as percent-
age of GDP or per capita (healthysys-
temtracker.com). We get unusually
poor results despite that expenditure
whether it is measured by life expec-
tancy (CBS News), mental health
(ourworldindata.org/mental-health)
or infant mortality rate (healthysys-
temtracker.com). Even worse, we are
the most obese (worldobesitydata.org)
and most drug addicted developed
people on the planet (United Nations
data, un.org). We have lost our way.
The problem is not public vs. pri-
vate, cement vs. wood — we need both.
The problem is the house design. We
have a system in which insurance
companies, hospitals, pharmaceutical
➋➌➍➎➏➌➐➑➎➒➓➒➔→
➍➣➍↔➒➣↕➑➔→
➙➣➐➑➣➒➔→
equipment manufacturers and the re-
search industrial complex chase pub-
lic and private money like drunks at a
feast. Add layer after layer of state and
federal regulations (often written with
the best of intentions) and the billions
spent on lobbying by “stakeholders”
and you have a truly dysfunctional
mess. Imagine a house with a million
dollar budget, no general contractor
and the subcontractors writing their
own checks. In the end the house could
look pretty crazy.
What health care really needs is a
blueprint and a general contractor who,
with knowledge, experience and com-
mon sense, negotiates with subcontrac-
tors and manages overall construction
focusing on cost and quality. A building
➐➣➙➓ ➛➔ ↕➍➓→ ➜➎➑ ➛➑ ➔➝➣➎➞➙ ➜➓ ➑➓➋↔➓➒➓➙
with common sense. The contrac-
tor would have to be the government,
something like the Marines, an agency
built on integrity, honor, courage and
commitment. It would have to have full
control over the mission. The mission
would be to leave no patient behind, to
↔➒➣➟➛➙➓ ➑➝➓ ➜➓➔➑ ➌➍➙ ➋➣➔➑ ➐➣➔➑➠➓➡➓➐➑➛➟➓
Health care in the United States is
➁➂⑤➃ ⑦➄➅⑤
s①①s ③④⑤⑥⑤⑦
➤➌➢➓➙➨ ➝➣➢➓➟➓➒→ ➌ ➎➍➛➟➓➒➔➌➞ ➝➓➌➞➑➝ ➐➌➒➓
⑧⑨⑩❶⑨ ❷❶⑧⑨❸❹
⑧⑨⑩❶⑨ ❷❶⑧⑨❸❹
system would be a disastrous over-correc-
tion and would have people believe that
❼❺❶➆❺❻➀➀⑩➇❻➀➈➉❻➊❶❷❺❿❸➀
❺❻❼⑧❽❾⑩❷❿⑨➀
➑➝➓➒➓ ➌➒➓ ➍➣➑ ➙➓➟➌➔➑➌➑➛➍➩ ➑➒➌➙➓➣➡➔ ➏➣➒ ➑➝➛➔
care on the planet. Serving in this agen-
cy, like the military or NASA, would be
a calling, not just a job. Every employ-
ee should feel like her real boss is the
American people. We have the world’s
best military, and we could have the
world’s best health care system.
What would happen to the insurance
companies, hospitals, pharmaceutical
➋➌➍➎➏➌➐➑➎➒➓➒➔→
➍➣➍↔➒➣↕➑➔→
➙➣➐➑➣➒➔→
equipment manufacturers and re-
searchers? Those that provide good ser-
➟➛➐➓ ➌➑ ➌ ➒➓➌➔➣➍➌➜➞➓ ↔➒➛➐➓ ➢➣➎➞➙ ➤➣➎➒ -
ish. Medical school and other training
would be free, like West Point. Doctors
would pay back with their service. The
highest-ranking medical professionals
would make about what generals make.
Pride would make up for any loss in
pay. Insurance could be entirely private
like Switzerland or primarily govern-
mental like Great Britain.
Medical clinics would function like
platoons. Every citizen of the United
States would have a well trained MD
as a primary care provider. We would
have a universal electronic medical re-
cord as in other countries. Basic needs
such as diet, exercise, stress manage-
ment and sleep would be addressed in
quartermaster fashion. Pharmaceuti-
cal and medical equipment cost would
be controlled by the platoon and the
➥➝➛➓➏➔ ➣➏ ➦➑➌➡➧
Eisenhower warned of the “military
industrial complex” (and this has cer-
tainly come to pass), but it is nothing
compared to the “medical industrial
complex” that has gutted the integ-
rity, honor, courage and commitment
of medicine. Eisenhower believed the
military was too important to be left
to the immorality of the almighty dol-
lar, too important to be left to indus-
try. The same can be said of medicine.
This does not mean entrepreneurial
➓➍➑➓➒↔➒➛➔➓ ➌➍➙ ↕➍➌➍➐➛➌➞ ↔➒➣↕➑ ➌➜➌➍ -
don their roles as primary engines of
change. However, it means the private
sector is given a “mission” and a set of
rules based on a deep commitment to
the country above and beyond the al-
mighty dollar.
“free” government program.
One of the pitfalls we see in other coun-
tries in implementing public health care
is the quality and access to health care
dramatically decreases. In comparative
performance studies between private and
public health care, the results are fairly
consistent — private health care provid-
➓➒➔→ ➢➝➓➑➝➓➒ ➏➣➒ ↔➒➣↕➑ ➣➒ ➍➣➑→ ➢➓➒➓ ➋➣➒➓
responsive, spent more time with pa-
tients, had more access to medications
and were more able to adjust for commu-
nicable diseases.
An argument for public health care
is that it will increase access and there-
fore encourage individuals to get regular
checkups, thereby preventing diseases
or the progression of potentially fatal ill-
nesses that were caught early. However,
in countries where large public health
care systems are in place, access is more
limited due to perpetual triage that these
systems have to do because the demand
for health care is so high. For example, the
National Health Service in the U.K., the
largest single-payer health care system
in the world, organizes medical consul-
tations and treatments by medical prior-
ity, which creates long waiting lists where
patients wait months for surgeries or
consultations. The wait time in the 1990s
was up to two years and they had to create
laws to reduce the wait time from years to
months. In Sweden, the 2016 nationwide
average wait for even prostate cancer sur-
gery was 17.4 weeks. The Frazier Institute
of Canada reports last year the wait time
for medically necessary treatment was
19.8 weeks and roughly 52,513 Canadians
seek medical care in the United States ev-
ery year.
In these public health care systems it
has become common for individuals to
pay for private insurance so they can be
seen quickly, then they are taxed for their
national health care as well as paying for
private insurance. In Sweden, it is esti-
mated one in 10 people now have to buy
private insurance. Then, when they are
↕➍➌➞➞➫ ➔➓➓➍→ ➜➓➐➌➎➔➓ ➐➣➟➓➒➌➩➓ ➏➣➒ ➑➒➓➌➑ -
ments and medications has been decided
by bureaucrats, coverage for necessary
medications or treatments is limited and
SUBSCRIPTION INFORMATION
things such as diabetes medication, can-
cer treatment and many others are not
covered.
The next big concern is expense. Using
the projected cost of a single-payer health
care system such as “Medicare for All” as
an example, a George Mason University
study projected in 2018 that “Medicare
for All” would, by a conservative esti-
mate, cost the United States government
an additional $32.6 trillion over the next
10 years. Charles Blahous, the author of
this study, states, “Doubling all currently
projected federal individual and cor-
porate income tax collections would be
➛➍➔➎➭➐➛➓➍➑ ➑➣ ↕➍➌➍➐➓ ➑➝➓ ➌➙➙➓➙ ➏➓➙➓➒➌➞
costs of the plan.” The Canadian Institute
for Health Information believes Canada
spent approximately $228 billion on
health care in 2016. That’s 11.1 percent
of Canada’s entire GDP, and $6,299
per year or roughly $525 per month for
every Canadian resident. However, the
demand for health care is increasing dra-
matically every year thereby inevitably
increasing the federal budget’s allotment
for health care and ultimately increasing
taxes.
Once again, it is clear that private health
care has its failings, but idealizing univer-
sal health care instead is not the remedy.
➯➍➓ ↔➌➒➑➛➐➎➞➌➒➞➫ ➣➡➠↔➎➑➑➛➍➩ ➙➓➑➓➒➒➓➍➑
to public health care is the matter of medi-
cal research. The United States currently
spends more on biomedical research than
any other country with nationalized pub-
lic health care. The vast majority of that
spending comes from the private sector
➜➓➐➌➎➔➓ ➑➝➓➫ ➐➌➍ ↔➒➣↕➑ ➏➒➣➋ ➌➍➫ ➌➙➟➌➍➐➓➔
➛➍ ➋➓➙➛➐➌➞ ➒➓➔➓➌➒➐➝➧ ➲➝➛➔ ↔➒➣↕➑ ➛➔ ➌ ➩➒➓➌➑
motivator to invest in more research,
which allows for new treatments and
cures. It is not perfect, but the free market
for insurance companies and health care
providers in the United States keeps these
↔➒➣↕➑➛➍➩ ➩➒➣➎↔➔ ➐➣➋↔➓➑➛➑➛➟➓ ➌➍➙→ ➜➓➔➑ ➣➏
all, it is not funded through taxes.
I would rather have the freedom to
choose my insurance, even if it is expen-
➔➛➟➓→ ➑➝➌➍ ➜➓ ➏➣➒➐➓➙ ➑➣ ↔➌➫ ➔➛➩➍➛↕➐➌➍➑➞➫
more in taxes for an expensive and inef-
↕➐➛➓➍➑ ↔➎➜➞➛➐ ➝➓➌➞➑➝ ➐➌➒➓ ↔➞➌➍➧ ➯➍➓ ➔➛➳➓
➙➣➓➔ ➍➣➑ ↕➑ ➌➞➞➧
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