Viewpoint: Individual not separate from society

May 25, 2013

A reader responds to an opinion essay from a Medical Economics editorial board member with a defense of government's role in the nation's healthcare system.

I am surprised by the naiveté expressed by Craig Wax, DO (“Plato versus Hippocrates,” February 25, 2013). To try to separate the individual from society is a long-held myth in America and a philosophical argument that has been dispensed with in most of the developed world. The basic tenets of Plato and Hippocrates have been dissected, argued over, and revamped, and there are any number of more applicable philosophical approaches to the problems inherent our current healthcare system.  

In America, we seem to be stuck on the idea that the individual and society (often described as big government or big business) are separate. The fact is, we are the government, we are business (check you 401[k] balance). Socialized medicine (perhaps it would be better to say “healthcare organized for the common good”) is not a 20th-century phenomenon. Read Leviticus.

Rationing of healthcare in America is not a new concept, either, or don't you have to deal with prior authorizations, denial of coverage for procedures or drugs, or patients who cannot afford COBRA, let alone basic insurance? Do you also deny that it has been public health, occupational health and safety, and immunization programs that could only be done with organized societal infrastructure that have had such an impact on our health as a country in the past 100 years? Please go to a developed country and explain why the basics of clean water and proper sewage disposal (which are only tenable with an organized-dare I say government-infrastructure) are less important than one person’s right to have an magnetic resonance imaging scan of the lower back that he or she injured yesterday.

I have lived and worked in the United Kingdom and in Canada. I have found the ethical relationships of the doctors there identical to ours here. Contrary to your assertion of "minimal health maintenance...and destruction of the doctor- patient relationship," the opposite is the truth. I have found from experience, and I think all studies have shown, closer relationships with a patient’s primary care doctor, more cost-effective care, better population-based health outcomes, and better coverage. Granted, not every patient or doctor gets to do what he or she wants, but as I tell my patients, just because we can does not mean we should.

I do think, however, that the administration of healthcare in those countries could learn a lot from our system in terms of putting the patient first and how to separate the politics from good medical care. On the other hand, I find in unbelievable that we will provide legal aid for anyone as a right but not medical or dental care, that we require drivers to have proof of insurance before they can license a car, but parents do not have to have health insurance before they have a baby...and the list goes on.

Please join us in a constructive debate by looking at the other systems in the world and what works well for them; what might help us guide our system to provide better care for our patients and stop the fear-mongering by perpetuating the myth that we as individuals should not try to live as a society. It’s never been the case.

Bruce W. Young MD, PhD

Brooklyn Park, Minnesota

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