Blog | Thursday, September 12, 2019

For those who want socialized health care, be careful what you wish for


Admittedly, my views on funding health care have done a 180 since I left medical school. I grew up and went to university in the United Kingdom, which famously has one of the most heavily centralized socialized systems anywhere in the world. Born out of the ruins of World War II, the core concept of the National Health Service (NHS) is to provide equitable care to the entire population which is free at the point of use. It's a wonderful and noble concept. Most people who grow up in the UK see health care as a fundamental right and view any notion of making a profit out of illness, as not only strangely foreign, but also to be honest, a bit sick.

Fast forward to coming to America to do residency training, and there were a lot of things I had to get used to seeing and hearing about for the first time. Uninsured patients who were struggling with getting any follow-up, elderly patients cutting pills in half because they couldn't afford them, and heartbreaking stories of medical bankruptcy. Yet the UK is not without its share of concerning stories too—such as excessive waits, significant rationing, and hospital patients lined up in multi-bed and multi-sex wards. Talk to most people over there, and they won't always give you particularly glowing accounts of their NHS experiences (the private sector over there is extremely small compared to almost all other Western countries). However, no patient will ever say they can't afford their treatment or fail to get any urgent care they need.

From the physician perspective, it's no secret there's a job dissatisfaction and burnout crisis that's escalated in the U.S. over the last 20 years. Large numbers of practicing physicians are not happy. As for the UK, speaking as someone who still has friends and former colleagues in the NHS, I honestly believe that staff morale is actually far worse over there—for a number of reasons including the government having total control over working conditions and the NHS being the sole employer for almost all doctors (it would be like all doctors in America receiving a direct deposit each month from Medicare for their entire salary). In America, if a doctor (or any health care professional) isn't happy with one particular organization, they can quit and go to a neighboring facility— which could be completely different and give them a better deal. That option doesn't really exist for British doctors working in a monolithic system.

My own opinion is that the ideal health care system rests somewhere between the two extremes of private insurance-based coverage and an entirely government-controlled system. The U.S. health care system is fraught with issues and so is the UK. In my final year of medical school I worked in Australia, which came as close as I've seen to having an ideal middle-of-the-road system, with solid public health care for those who need it, running parallel to an insurance-based system, with tax incentives for those who buy their own coverage. But with the current political debate, I would implore those in America who are blankly advocating for “centrally socialized medicine eliminating private insurance” to be very careful what they wish for. I don't think it would work for either patients, physicians, or the country.

Suneel Dhand is an internal medicine physician, author and speaker. He is the founder of DocSpeak Communications and co-founder at DocsDox. He blogs at his self-titled site, where this post first appeared.