Socialized Medicine and Its Counterpart: A False Dichotomy

A dichotomy is a division or contrast between two things that are or are represented as being opposed or entirely different (The New Oxford Dictionary of English, 1998). A false dichotomy is a dichotomy, which does not accord with truth or fact.

An economist, Uwe E. Reinhardt, an economics professor at Princeton, defines socialized medicine as a health system in which the government owns and operates both the financing of health care and its delivery. He cites the American V. A. health system as the purest form of socialized medicine. The British NHS, which we saw being touted in the opening ceremonies of the 2012 London Olympic Games, is another example of socialized medicine. What is the counterpart or alternative to socialized medicine? What is its name? Is it private, but non-profit; private, and commercial; some mixture of these two? What do we call it? The above reference from Professor Reinhardt explains the answer and is well worth reading and studying.

For those of us who are not trained economists and who just want a healthcare system, which really works for us, what is the practical (every-day-functional) difference between systems which are labeled or thought of as socialized or non-socialized? The answer depends on the context of the question, i.e., on which end goal of the healthcare system we are talking about. If the end goal is your individual health care, i.e., the effected work of a sound, ongoing, non-conflicted, spontaneously functioning doctor  patient relationship, then there is no difference between the two systems at all. If you and your doctor are functioning in a manner consistent with the priorities which I describe then you will receive good medical care regardless of which type of system operates in your country, as long as all the other parts of your healthcare system operate in dedicated, non-conflicted service to the doctor  patient relationship. If the end goal is $$$$, dollar profit and political gain (under the smokescreen of reducing healthcare spending), being viewed as more important than the non-conflicted functioning of the doctor  patient relationship, then the practical difference between socialized and non-socialized systems depends on the amount of interference which the 3rd party payer and other healthcare businesses press onto that non-conflicted functioning. All 3rd party payers (private or public) and some other healthcare businesses directly interfere with the doctor  patient relationship. What determines the amount of this interference? At least four factors and maybe more:

  1. The nature of functioning of the 3rd party payer,
  2. The power of the 3rd party payer,
  3. The courage of doctors and others to stand up to these payers by working without allowing conflicts of interest to intervene,
  4. The cleverness of 3rd party payers’, politicians’, drug companies’, and others’ manipulative rhetoric and how easily we are duped by it.
Make no mistake, the American healthcare system is compromised by 3rd party payers and others regardless of the economic terminology, which we use to describe our system. The practical difference between calling our system non-socialized or socialized falls by the wayside, and this economic terminology is a false dichotomy. But it is a dichotomy which the politicians and the businesses of medicine want you to stay preoccupied with. Why? Because then you are arguing about which form of compromise of your individual health care best suits you or you agree with. And you are not thinking about the dollar games which benefit them and for which, we supply all the dollars. This is what these healthcare administrative business people and politicians, irrespective of party, do: Serve you rhetoric, which poisons your thinking with false concepts, weasel words, and other manipulations.
Your mission people, should you decide to accept it, is to understand a different, individually applicable definition of socialized medicine: Socialized medicine means socialized, controlled, obstructed, conflicted, (and a myriad of other adjectives) doctor  patient relationships. And isn’t this the fear that people feel when they here the expression, socialized medicine: That the hand of the payer will squeeze their health care to accomplish its own ends, the hierarchy of which places the doctor  patient relationship lower than $$$$? American health care is already socialized because it makes no difference which entity functions as the payer as long as that entity is allowed to interfere with the non-conflicted functioning of the doctor  patient relationship.
The other part of your most difficult mission is to force, by using the ballot box, your elected politicians to grasp this and act on it with your health care and access to it at reasonable out of pocket cost as their primary focus as opposed to kowtowing to lobby groups and political ideologies. These politicians are supposed to be civil servants. They do not function this way. Moreover, when it comes to themselves or a member of their family, they will be on the phone immediately obtaining the most advanced specialist to come tend to their needs.
What can we do about our healthcare system, we who pay for the entire government and the entire healthcare system? The answer is that WE MUST CHANGE OUR SYSTEM OF HEALTH CARE because the current system (with or without the farce of Obamacare) is not serving us, and the politicians are too inept, too unconcerned, too compromised to do anything about it to help us.
The question then becomes, How do we change it? Two basic concepts must form the foundation of true healthcare reform in America:
  1. The absolute demand for clear and equal access to sound, ongoing, non-conflicted, spontaneously functioning doctor  patient relationships for everyone at a reasonable price,
  2. A central payer, which negotiates transparently and repeatedly with all necessary healthcare businesses regarding payments for their services and products; which is composed of people with extensive experience in the various healthcare business disciplines such that negotiations take place between knowledgeable people from both the payer and the business; whose negotiators have long term appointments and remain free from the influences of the private or public sector (like the Supreme Court); and which has two major goals in the following order of importance for the payments which it administers: First, the existence of doctor  patient relationships as described above; Second, the recognition and absolute support of the Profit Motive for necessary healthcare businesses to a level short of greed.
I have developed this type of thinking in my two books, Equal Health Care For All and Socialized Health Care Reform and in various essays on this website. In future posts, I will relate some previously recorded and some new ideas for the financing and the functioning of this central payer to include clear explanations of why, if structured properly, it will alleviate all of us from the socialized medicine which currently plagues us. You should note that I believe an individual mandate for everyone living in America is absolutely necessary, even though Obamacare is awful on its best day.
R. Garth Kirkwood, MD

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