Why Everyone Should Fear Universal Healthcare

Three weeks ago, I was struck with an intensely painful, and briefly highly dangerous, MSSA staph infection, with a full recovery underway.

The experience, plus time on my hands recuperating, has given me a personal appreciation of the coming nightmare of universal healthcare.

The month-long recuperating period has afforded me the opportunity to think holistically about my medical experience, especially as it relates to health care policy.

My conclusions are based solely on direct experience, in particular what I learned watching the system operate up close and personal.

Given my general conservative political views, I am mindful that I do not want to take advantage of “patient” status to discuss grander matters of health care.

So here goes, with apologies in advance if this post steps too far into the stream.

I leave from the story that it took eight days from the onset of the severe pain until I was under genuine medical care. As it turns out, the pain was due to a raging staph infection in my bloodstream, whereas my doctors to date had convinced themselves that it was a disc pull.

The unfortunate consequence was eight days without a blood test.  I was even discharged by the attending Emergency Room doctor with instructions to get a massage, which I did, to my walloping regret.

In retrospect, I believe it is fair to chalk up the missed diagnosis to normal bad luck and a difficult to diagnose condition. I focus instead only on the medical care received once I was properly admitted to one of the best hospitals in the U.S., in a luxurious (and expensive) private room, getting exceptional attention.

Here is the one thing I want to communicate, without being polemical or partisan.

Under Elizabeth Warren’s plan, or anything resembling a dramatic increase in demand for health care, inevitable once health is declared a “right,” no less a fundamental human right, I never would have left that hospital alive. Without any doubt.

Why?

For a couple of reasons that I want to share.

Most proximately, I saw firsthand how extremely limited already are the expensive diagnostics that were required to understand, and then treat, my condition.

In four days, I had two intensive MRIs, one Pet scan, two specialized ultrasounds, a swallow the camera procedure known as TEE, and an intensive Interventional Radiology procedure done inside a CAT scan (the actual interventional procedure that got me out of the danger zone).

To put it bluntly, the system is already stretched beyond capacity. Even my doctors were careful to say that they could not promise when I would be scheduled for each procedure.

Now add the huge increase in demand that is the whole point of universal health care. Starting first with these machines, the system will unequivocally break. In every other part of the world with a form of universal health care, the wait time for MRIs and the like has expanded to 30 days or more.

There is absolutely no chance I could have survived this type of delay, and when you consider the unusual quantity of such procedures that I received in a compressed four days, my personal outlook would have been a foregone conclusion.

Beyond the machine time, in the hospital you see the extreme forms of rationing already in effect for doctor time. In total, during the height of the crisis, I probably spoke directly with doctors for a total of fifteen minutes a day. Not to say they were not working on my behalf at other times, but you feel the unbelievable pressure they are under every second that they are speaking with you.

Add one more element that was the central problem in my case. No one knew where the true problem was hiding, and so they had to explore all, cardiac, pulmonary, neurologic, autoimmune, internal, chief among them. When I asked the supervising internist (whom I will return to in a moment), how they reached consensus decisions in this complex setting, she put a hard stop to my question. “I never meet these people, ever.”  Rather there is a central file that all specialists consult and, based on their reading of the evidence, recommend a course of action.

Put simply, in a universal health care system, anyone who happens to be suffering from a multi-dimensional set of ailments, or diagnostic complexity, is quite literally doomed. The system today, clumsy as it is, will assuredly be replaced with something orders of magnitude worse-unalterable authorized procedures. You will at best get what the system can afford, on average, for most patients. If you happen to fall outside of that world, tough luck.

The third area of rationing that is coming is with respect to prescribed medication. For reasons of cost, the reimbursed and allowable medications will be, on average, sharply reduced. In my case, I would never have received authorization for self-administered morphine, which even now required me to engage in a titanic struggle. No less would I have been given several times the typical fentanyl dosage during the vital, but unexpectedly long IR procedure.

Next we come to nursing services. It is inevitable that as much of doctoring and health care that seemingly can be offloaded to lower cost nurses, will be offloaded. In my case, the expensive luxury ward nursing services were quite good, and occasionally above and beyond compassionate care (you learn a great deal in the wee hours of a sixteen-day hospital stay how a hospital operates). But all that said, it still took time, sometimes quite long, for nursing to respond. They too are so obviously already working at capacity.

Now at last we are ready for the supervising, and therefore decision-making internist, who at bottom is entirely representative of the doctoring to come in universal health care. Once the crisis passed, her entire medical focus was on getting me discharged as fast as possible. In the future world, my hard-staring, pitiless internist will become yards more pitiless and the standards for discharge ever more stringent and stingy.

All of this is my directly observed experience. Independently the economic system will be eviscerated by new taxes, inevitably falling especially hard on the middle class (only so many 1%ers in the end, and not nearly enough to pay for what is coming).

Due to low reimbursement rates, innovation will suffer, the greatest cost of all, but also entirely unseen, in all phases, vaccines, medication, medical equipment and innovative procedures.

Last but not least, the harsh, inhumane conditions imposed on doctors will result in a declining supply of care, especially among the most valuable and experienced cohort of older doctors, who will inevitably choose retirement. This will yet further, alarmingly, increase the calamitous rationing about to descend upon us.

That’s it.

As I said at the outset, I do not mean to be provocative here in a political sense. It is simply my heartfelt observations after a particularly intense engagement in Health Care World as a patient. Usually, and hopefully, we read about such political proposals from a healthy chair at the table. Switching seats turns out to really matter. And since inevitably all of us will one day be there, opposition to universal health care ought to be a shared goal crossing partisan lines.

Graphic credit: Skyluke

Three weeks ago, I was struck with an intensely painful, and briefly highly dangerous, MSSA staph infection, with a full recovery underway.

The experience, plus time on my hands recuperating, has given me a personal appreciation of the coming nightmare of universal healthcare.

The month-long recuperating period has afforded me the opportunity to think holistically about my medical experience, especially as it relates to health care policy.

My conclusions are based solely on direct experience, in particular what I learned watching the system operate up close and personal.

Given my general conservative political views, I am mindful that I do not want to take advantage of “patient” status to discuss grander matters of health care.

So here goes, with apologies in advance if this post steps too far into the stream.

I leave from the story that it took eight days from the onset of the severe pain until I was under genuine medical care. As it turns out, the pain was due to a raging staph infection in my bloodstream, whereas my doctors to date had convinced themselves that it was a disc pull.

The unfortunate consequence was eight days without a blood test.  I was even discharged by the attending Emergency Room doctor with instructions to get a massage, which I did, to my walloping regret.

In retrospect, I believe it is fair to chalk up the missed diagnosis to normal bad luck and a difficult to diagnose condition. I focus instead only on the medical care received once I was properly admitted to one of the best hospitals in the U.S., in a luxurious (and expensive) private room, getting exceptional attention.

Here is the one thing I want to communicate, without being polemical or partisan.

Under Elizabeth Warren’s plan, or anything resembling a dramatic increase in demand for health care, inevitable once health is declared a “right,” no less a fundamental human right, I never would have left that hospital alive. Without any doubt.

Why?

For a couple of reasons that I want to share.

Most proximately, I saw firsthand how extremely limited already are the expensive diagnostics that were required to understand, and then treat, my condition.

In four days, I had two intensive MRIs, one Pet scan, two specialized ultrasounds, a swallow the camera procedure known as TEE, and an intensive Interventional Radiology procedure done inside a CAT scan (the actual interventional procedure that got me out of the danger zone).

To put it bluntly, the system is already stretched beyond capacity. Even my doctors were careful to say that they could not promise when I would be scheduled for each procedure.

Now add the huge increase in demand that is the whole point of universal health care. Starting first with these machines, the system will unequivocally break. In every other part of the world with a form of universal health care, the wait time for MRIs and the like has expanded to 30 days or more.

There is absolutely no chance I could have survived this type of delay, and when you consider the unusual quantity of such procedures that I received in a compressed four days, my personal outlook would have been a foregone conclusion.

Beyond the machine time, in the hospital you see the extreme forms of rationing already in effect for doctor time. In total, during the height of the crisis, I probably spoke directly with doctors for a total of fifteen minutes a day. Not to say they were not working on my behalf at other times, but you feel the unbelievable pressure they are under every second that they are speaking with you.

Add one more element that was the central problem in my case. No one knew where the true problem was hiding, and so they had to explore all, cardiac, pulmonary, neurologic, autoimmune, internal, chief among them. When I asked the supervising internist (whom I will return to in a moment), how they reached consensus decisions in this complex setting, she put a hard stop to my question. “I never meet these people, ever.”  Rather there is a central file that all specialists consult and, based on their reading of the evidence, recommend a course of action.

Put simply, in a universal health care system, anyone who happens to be suffering from a multi-dimensional set of ailments, or diagnostic complexity, is quite literally doomed. The system today, clumsy as it is, will assuredly be replaced with something orders of magnitude worse-unalterable authorized procedures. You will at best get what the system can afford, on average, for most patients. If you happen to fall outside of that world, tough luck.

The third area of rationing that is coming is with respect to prescribed medication. For reasons of cost, the reimbursed and allowable medications will be, on average, sharply reduced. In my case, I would never have received authorization for self-administered morphine, which even now required me to engage in a titanic struggle. No less would I have been given several times the typical fentanyl dosage during the vital, but unexpectedly long IR procedure.

Next we come to nursing services. It is inevitable that as much of doctoring and health care that seemingly can be offloaded to lower cost nurses, will be offloaded. In my case, the expensive luxury ward nursing services were quite good, and occasionally above and beyond compassionate care (you learn a great deal in the wee hours of a sixteen-day hospital stay how a hospital operates). But all that said, it still took time, sometimes quite long, for nursing to respond. They too are so obviously already working at capacity.

Now at last we are ready for the supervising, and therefore decision-making internist, who at bottom is entirely representative of the doctoring to come in universal health care. Once the crisis passed, her entire medical focus was on getting me discharged as fast as possible. In the future world, my hard-staring, pitiless internist will become yards more pitiless and the standards for discharge ever more stringent and stingy.

All of this is my directly observed experience. Independently the economic system will be eviscerated by new taxes, inevitably falling especially hard on the middle class (only so many 1%ers in the end, and not nearly enough to pay for what is coming).

Due to low reimbursement rates, innovation will suffer, the greatest cost of all, but also entirely unseen, in all phases, vaccines, medication, medical equipment and innovative procedures.

Last but not least, the harsh, inhumane conditions imposed on doctors will result in a declining supply of care, especially among the most valuable and experienced cohort of older doctors, who will inevitably choose retirement. This will yet further, alarmingly, increase the calamitous rationing about to descend upon us.

That’s it.

As I said at the outset, I do not mean to be provocative here in a political sense. It is simply my heartfelt observations after a particularly intense engagement in Health Care World as a patient. Usually, and hopefully, we read about such political proposals from a healthy chair at the table. Switching seats turns out to really matter. And since inevitably all of us will one day be there, opposition to universal health care ought to be a shared goal crossing partisan lines.

Graphic credit: Skyluke