|Health CareAttacking the
Heart of Medicine By Richard M. Salsman
ocialized medicine has produced cowering medical bureaucrats who have to turn to capitalist doctors for help. Boris Yeltsins heart operation and treatment demonstrate how this happens. But rational, independent doctors are now also vanishing from American medicine, as socialism threatens to destroy what was once among the most noble and free professions in this country.
One vital fact was omitted in the news accounts about the success of Boris Yeltsins recent heart surgery: the failure of socialized medicine. And this fact underscores the question of whether Americas health-care policies are courting a similar failure. Competent physicians with specialized technical skills are scarce in Russia. Yeltsin, because of his privileged position, had access to qualified cardiologists an access unavailable to most Russians. And even Yeltsins doctors had to rely heavily on the training and advice of American heart specialists. For example, Dr. Renet Akchurin, the head surgeon on the Yeltsin operation, was trained by an American pioneer in the field, Michael DeBakey. While DeBakey did not apply the scalpel to Yeltsin, he was called on to make the crucial decisions, not only about the diagnosis but about the timing and the method of Yeltsins surgery.
But the rest of the country has virtually no modern health care. Bypass operations, now routine in the U.S. (300,000 per year), remain rare in Russia (3,000 per year). Most are done by American-trained doctors at special facilities reserved for political leaders. Heart surgery is free for Russian citizens, but 98 percent of those needing bypass operations die without getting them.
Patients suffer and die on interminable waiting lists. Some choose not to even seek needed care. Dr. Yevgeny Roguzin, of Moscows Cardiology Center, reveals that Many people in this country are afraid to let someone take a knife to their heart. What they fear are the scalpels wielded by socialists.
Why is this so? Because decades of socialism have replaced conscientious medical professionals with low-skilled, mindless bureaucrats. Scrupulous rationality and independent thinking are the key traits of a good doctor. But these are the very traits penalized, and then destroyed, by socialism. Under socialism, doctors have no freedom to choose the terms under which they work: not whom they treat, nor how, nor at what price. They must surrender their private concerns and serve the public interest. There is no profit in being a good Russian doctorso good doctors disappear. Patients are thus left in the incompetent hands of those who are skillednot in advanced medical proceduresbut in obedience to government directives.
In medicine, as in other fields, the socialists must turn to the capitalists for help. American medicine has been the envy of the world, because at its heart stands the independent doctor, left free to think and act by the standard of his own rational self-interest. His judgment is not subordinated to the dictates of government bureaucrats.
But freedom is now under attack. Capitalist doctors are being replaced by medical bureaucrats and medical care in America is slowly vanishing. When Medicare and Medicaid subsidies were initiated in the 1960s, it was claimed that doctors would retain their freedom. But when government foots the bill, it first inflates costs, then realizes it must control the spending of the publics money. In order to cap skyrocketing costs, the government now herds doctors and patients into HMOs, where care is rationed. Doctors are under gag orders not to alert patients to alternative, lifesavingbut costlyprocedures.
HMOs are increasingly staffed by generalists; medical specialization is declininga big step down the socialist road to medical incompetence and barbarism. Tragically, the results of this socialization of medicinerationing and deteriorating careare now blamed on private doctors and the profit motive.
Even as it deteriorates, American medical care is being made compulsory. The Kennedy-Kassebaum bill, for instance, imposes fines and prison terms on doctors who fail to comply with regulations governing subsidized tests and treatments. Many conscientious doctors are quitting. The capitalist doctorindependent, expert, caringis an endangered species,
Dr. Thomas Hendricks, the brain surgeon who flees from socialist medicine in Ayn Rands 1957 novel, Atlas Shrugged, explains his choice as follows:
Americans will see more and more of this sort of doctorunless we categorically reject government involvement in medicine. NJ
Mr. Salsman writes for the Ayn Rand Institute and Medical Sentinel magazine, from which this is reprinted with permission.