First, from Solzhenitzyn's The Cancer Ward comes this exchange:
"But it's our greatest achievement, the fact that it's a free service."
"Is this in fact such a great achievement? What does 'free' mean? The doctors don't work for nothing, you know. It only means they get paid out of the national budget and the budget is supported by patients. It isn't free treatment, it's depersonalized treatment. If the patient kept the money that pays for his treatments, he would have turned the ten roubles he has to spend at the doctor's over and over in his hands. He could go to the doctor five times over if he really needed to."
"But he wouldn't be able to afford it?"
"He would say, 'To hell with the new drapes and spare pair of shoes. What's the use of them if I'm not healthy?' Is it any better as things are now? You would be ready to pay goodness knows how much for a decent reception at the doctor's but there's no one to go to get it. They all have their schedules and their quotas, and so it's 'Next patient, please.' As for the clinics that do charge fees, the turnover's even faster than the others. Why do people go there? Because they want a chit or certificate or sick leave or an invalid's pension card. The doctor's job is to catch the malingerers; patients and doctors are like enemies. Do you call that medicine?
This illustrated the state of the Soviet medical system back in the mid-1950's. It also parallels some of the experiences of patients being treated under the UK and Canadian health care system today. Is this something to which we want to subject patients in the US? It appears the Democrats have no problem doing so.
Next, Megan McCardle writes about one of the effects of socialized medicine already being felt here in the US – the dearth of primary care physicians.
A lot of liberal blogs, and a few conservative ones, are discussing this article from the New York Times, which points out that if you look at actual economic resources, instead of prices, increasing health care utilitization isn't going to be so easy, because there's not a lot of spare capacity in the system.
The core problem is that we don't actually have a ton more doctors and nurses. In 2008, 42,000 people applied to medical school, and 18,000 enrolled. Presumably some who were admitted decided not to go, and some who weren't shouldn't be doctors. There don't seem to be, say, 10 qualified people for every slot. And nursing schools aren't swamped by more qualified applicants they can handle, yet there's a nursing shortage.
Another problem is that a teaching hospital is a hard thing to construct--given how much training doctors need, we won't do that overnight. Teaching hospitals are very expensive, and receive heavy government subsidies. Obviously, we could increase the number of doctors by some amount, but it wouldn't take care of the supply problem.
It's more reasonable to note that reimbursement structures are creating an undersupply of primary care physicians, compared to the number of specialists. We reimburse for procedures, not wellness, so surgeons are well paid and GPs aren't. This has led to the bizarre fact that Medicare chronically underreimburses (and thus insures an undersupply of) geriatricians, which should be the one doctor a program like Medicare produces a lot of.
So the present government-run system already gives us a preview of what medical professionals will have to put with, and a universal system like that will help generate a shortage of needed doctors and nurses, just as it has in Canada and the UK. Again, is this something we really want to do here in the US?
The question that must be asked of the Obama Administration and Congress: “Why do you insist the only way to provide health care to everyone is to destroy the health care system, as imperfect as it is, and replace it with a system that will make sure everyone receives equally poor treatment?”
Unfortunately we already know the answer.