In his editorial (EMN 2008;30:4), Dr. Lewis Goldfrank suggests that the following theoretical question should be included in the emergency medicine board examination: Universal health care is (A.) a good thing or (B.) a bad thing.
Dr. Goldfrank's answer to that question would have been A. He would have gotten that answer wrong.
Dr. Goldfrank and I have vastly different perspectives on the concept and reality of universal health care. I did my emergency medicine training in Canada in the mid-1970s. I saw firsthand the disaster called universal health care. Tax dollars were paid into a general fund from which health care dollars were dispensed. When money became tight, bureaucrats rationed care. At that time, little could be done for stroke patients when bureaucrats decided that no beds would be allotted for those patients. As an emergency resident at that time, I was forced to send newly hemiplegic patients home with only family members to care for them. Women waited months for a biopsy of suspicious breast lesions. Physicians fled from this system into the U.S. This system cost a lot of money, and hurt a lot of patients and their families.
The 47 million so-called uninsured people in the U.S. include a large number of young healthy folks who, understandably, choose to spend their money on things other than health insurance. Because we have hospitals that turn a blind eye to theft of service, they get away with paying little or nothing for emergency care when they finally do become sick or injured. If someone walked out of a store with a TV set and didn't pay for it, he would end up in jail.
The truly needy should continue to be cared for at society's expense, but a man with $2000 worth of tattoos and piercings on his body who smokes $3000 worth of tobacco and drinks $1000 worth of alcohol yearly will have a very hard time convincing me that someone else should pay for his health care. He has chosen to spend $4000 a year on tobacco and alcohol rather than on health care.
Every day a patient with rotten teeth tells me that he “can't” go to a dentist because he has no insurance. If a tire blows out on his car, though, he doesn't delay replacing it because he doesn't have insurance. He opens his wallet and pays for the tire. If he saved the $10 a day he spends on tobacco, soon he would be able to pay cash for dental service just like he paid for the tire.
The last two things we need in this country are another group of dependent, entitled people and the government running a universal health care system. The answer to the board question is B. Government-sponsored universal health care is a bad thing.
Kenneth J. Wright, MD