“I am deeply disturbed by the unmistakable fact that I am not taking as good care of my patients as I did before. The appealing slogan that medical services should be ‘free to all’ sounds good. But when such a scheme is adopted, as Britain has done, these consequences can’t be escaped: a small part of the people who are malingerers, or who exaggerate their aches, or who are hypochondriacs and imagine they are ill continually clog our offices, take up our precious time, and constantly ask for unneeded care. They get in the way of those who really need care.”
The above quote, attributed to an unnamed a Scottish physician, is from a January 1950 Readers’ Digest article by then-University of Pennsylvania President Harold E. Stassen, decrying Great Britain’s National Health Service.
Stassen, you may recall, ran unsuccessfully for the Republican nomination for President of the United States 12 times between 1944 and 2000. He concluded—based on interviews with British physicians and his own “intensive study”—that Britain’s newly minted National Health Services would lead to “More medical care at lower quality for more people at higher cost. ”
Funny how things turned out: Just last week, Great Britain celebrated the same National Health Service at its Olympics opening day ceremony! Apparently, contemporary British don’t agree that their system turned out as Stassen had predicted.
An ACP member gave me a copy of the Stassen article during my recent visit to his state. He observed that the rhetoric against “socialized medicine” really hasn’t changed much in six decades. There is still a view that universal coverage will open the doors to the malingers and hypochondriacs, demanding care they don’t need and taking it away from the rest of us, and the related view that we have no obligation to pay for the health care of people who make poor choices.
Remember when last spring, a Tea Party audience at a GOP presidential primary debate cheered the suggestion that a (hypothetical) uninsured 30-year-old working man in coma should be allowed to die, because he had made the bad choice of not buying health insurance?
Now, I don’t think most critics of the ACA want the uninsured to go away and die.
But I do think that there is underlying tone to much of the criticism of the Affordable Care Act, which is that it is your own fault if you get sick and end up needing health care, especially if you didn’t bother to buy insurance. If you are overweight and out of shape, it’s you own fault—the rest of us have no obligation to pay for your poor choices.
But the need for health care is not a choice.
Even the running-obsessed, non-smoking, non-drinking, slim and trim will get sick, if not right away, someday, and being a fitness guru is no guarantee of good health and longevity.
People do sometimes contribute to their own poor health by bad lifestyle choices, but there are many other factors at work, including bad genes, bad luck, bad parents, unhealthy communities, and poverty. (Most of the uninsured are poor.) And who are we to judge why someone is sick?
And sure, “free care” will lead to some people demanding services that they don’t need, as the Scottish physician complained about six decades ago, but is that a reason to exclude tens of millions of people from having access to affordable health insurance coverage?
Health insurance in my mind is not something to be earned, like a late model car or better house, the brass ring for hard work and ambition.
Sick people are sick people, no matter the reason and the choices they made, and they need our compassion and they need care.
We are all in this together, we all need health care at some point, we all are deserving of compassionate and affordable care, no matter what choices we made, the genes we were born with, or how much money we make.
Dr. Atul Gawande may have put it best, when he recently wrote “We are all born frail and mortal—and, in the course of our lives, we all need health care. Americans are on our way to recognizing this.”
I hope so.
Today’s questions: do you think some people are more or less deserving than others of having access to health insurance and compassionate and affordable care?