Barriers To Health
When a man the size and
general girth of S.Q. Lapius gets beside himself there is a lot to contend
with. At the time I didn’t know whether or not to take it seriously, but
word had gotten into the newspapers that Lapius had decided to give up his
citizenship in the United States and had asked for a visa to go to
Russia. The implication was clear. He was protesting. He was
going to be the American Solzhenitsyn.
True or not, the item
caused a splash, and important people were calling. The White House sent
feelers to find out if the rumor was true. An agent from the FBI was
interviewing neighbors. The phone rang constantly, and now Lapius was
jawboning with a senator, the receiver held tightly to his ear when he wanted
to hear something, but when Lapius was shouting he held the mouthpiece of the
phone in front of him like a microphone, as if he were addressing the American
public.
“I’m not going to tell
you anything about my private plans, senator. Whether or not I renounce
my citizenship is a very personal matter. Why don’t you check with the
state department and see if it’s true? What? They consider it a
confidential matter? Good for them. Now don’t get upset,
Senator. One doctor less in America won’t spell the doom of American
Medicine. I’m sure National Health Insurance will get along without me.”
“But trust me, Senator,
I won’t leave immediately, not, that is, until I have finished my book.
You didn’t know I was writing a book? It has a great title. It will
be called the ‘Medical Archipelago’. The title is reminiscent you say,
but what is the book about?”
“The book is about the
vast administrative system in which patients, doctors and hospitals disappear
into an infinite bureaucratic limbo. It will describe in detail, the
destruction of the system of free enterprise and individual liberty by the
government of the United States. No, I’m not fooling, Senator, I’m deadly
serious. What’s that? What about the impeachment? Isn’t that
a sign of the vigor of the democracy?”
“Perhaps it is Senator,
but in my view it is just window dressing. The presidency is the last
political arena.”
“It was a great show you
people put on in the impeachment proceedings, Senator. Any stranger here
would envy us, the way we toss our leaders around, vox populi, town meetings
and all that. But we know better, don’t we, Senator? You have us
strangling in the noose, fashioned by the congress of codes, rules, regulations
and legalisms that will ultimately deprive the American people of the best that
medicine has to offer. What do I mean by such outrageous statement?
I’m glad you asked.”
“You are trying to
skinflint the public out of decent medical care. You are worrying
yourselves to death about the cost of health to the nation. Here is the Congress
of the United States that has given atomic reactors to Egypt and Israel, that
for years paid farmers extraordinary fees to plow under their crops, that has
subsidized railroads, trucking and airlines, each in turn, that gives away
munitions to friends and enemies alike, that paid 30 billion dollars a year to
subsidize an illegal war, that has moth ball fleets of useless ships,
graveyards in the desert for outdated tanks and planes, suddenly worried about
the cost of health of its own citizens.”
“The government which
never to my knowledge had a serious concern about waste, suddenly has become
cost conscious when it comes to medical care. So you have erected a
vicious circle of legal barriers that prevents communities from building to
their needs. Suddenly every hospital bed has to be filled; suddenly it is
less evil to have patients on stretchers in the hall than to support an empty
hospital bed; suddenly it is more serious to have vacancies in the coronary
care units than to have a patient die for lack of special care; suddenly you
are going to force the patients to buy generic medications instead of
trade-name drugs, despite the fact that you don’t have the manpower to police
the generic drug makers who will pop up like poppies in Turkey.”
“I am aware of the
abuses of unbridled capitalism, but if there has been a successful capitalist
industry it is the drug manufacturers who have, by virtue of their research and
productions, produced medicines that have saved the lives of millions.
They will surely be dismantled if the results of their research and quality
control methods of production can be borrowed gratis by any cluster of
businessmen who smell a dollar on the generic market.”
“You are so worried
about wasting American dollars on American lives that you have committees that
force doctors into conflict, that urge them to discharge patients from the
hospitals at the earliest possible moment, yet you don’t permit more hospital
beds to be erected even by private investment. You create monetary incentives
for brief hospitalization, and are erecting policing agencies to insure that
these policies are being carried out. You don’t worry about the money you
spend on policing medical care as much as you worry about spending it on
medical care itself.”
“Suppose there is waste
in health care? What difference does it make? We should have a
surplus of health care, not a deficit. The nascent ideal of the founding
fathers, the credo on which the nation was created, was based on consideration
of the individual. You won’t save the individual by catering to the
public at large, but if each individual is properly cared for, the nation as a
whole will enjoy good health.”
“In other words,
Senator, in your zeal to distribute health at the lowest possible price, you
have stifled incentive, imposed a government monopoly, and created a situation
where most new medications and innovations in medical instrumentation now
originate overseas. A sad state of affairs for a nation that prides
itself on initiative and inventiveness.”
“I don’t disagree with
your intention that all Americans should have medical care. But I am
ashamed of your pocketbook considerations. If you want to distribute
health care and subsidize the medical welfare of all of us, then do it.
Damn the expense and full speed ahead. Since there is nothing else you
have to say on the matter, Senator, I think I’ll close off now.”
“What was that all
about, Simon?” I asked as if I didn’t know. “Are you really going to
yield your citizenship and move to Russia?”
“Of course not,
Harry. That is a silly rumor. Besides, there is nothing that Russia
can offer me that I haven’t got right here.”