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As a traditional conservative I oppose for profit medicine. The classical liberal who calls himself a “conservative,” would probably label the previous sentence as an oxymoron. However, conservatives are not all of one stripe. The ethics of medicine must stem from the nature of medicine itself as an inherently moral enterprise. A patient, sick or injured, in need of help, comes to a health care practitioner. The practitioner, whether he be a physician, a D.O., a physician assistant, or a nurse practitioner, has the moral responsibility to use his skills and knowledge for the good of the patient. The profit motive should not enter into the patient-practitioner relationship–if it does, it becomes inherently corrupting.
For-profit hospitals are a monstrosity. When part of the responsibility of the physician is to the shareholders, business decisions often end up trumping medical decisions. This can lead to suboptimal patient care in order to bring more profit to the corporation, especially in a capitation system in which the practice keeps money left over that is not spent on patient care. . Even in “non profit hospitals,” business decisions affect medical care, and business people “run the show.” Hospital administrators are paid enormous salaries (500,000+ per annum in some cases) along with expensive benefits. I know of a case in which a CEO received a huge bonus even though the hospital had been in the red the previous year. Does this sound familiar? Remember the Wall Street bankers.
The American system of medicine, then, is run as a business rather than as a practice. It is no longer a true profession. Physicians are distrusted. Lawsuits are common and sometimes result in big judgments against a physician.
In reading UK newspaper articles about accidents or shootings, I have found (informally) that paramedics and physicians in the UK are more aggressive in starting trauma codes than their American counterparts. This is, of course, anecdotal–it would be interesting if a large-scale study could be done to compare the numbers in both systems. American physicians used to work up to two hours on a patient in a medical code (that did happen with my mother, who lived with no neurological sequelae). Now, three shocks interrupted by CPR, and often that’s it. Twenty minutes, perhaps thirty, and in rare cases, over an hour–but shorter periods are becoming more and more the norm. Doctors will say this is due to the low success rate–still, twenty minutes even in witnessed arrest in which the patient has no DNR is a short time to say, “He’s dead Jim,” given the utter finality of death. Money may play a bigger role in these decisions than medicine. The UK lacks the profit motive in medicine outside the private health facilities there, so the incentive is to keep trying in a code rather than stop in order to save money (I am indebted to my friend Megan for this insight).
Is it possible for a traditional conservative to endorse a non-for profit single payer system of health care for the United States? It has already happened: Paul Craig Roberts, whose conservative credentials are stronger than most self-styled “conservatives,” has endorsed that system. Affordability in the age of massive deficits is the problem, but if the system is run correctly more money might be saved in the long run due to decreasing health care costs–and if tort law is revised so as to protect physicians from frivolous suits, this could help even more. I am not quite ready to endorse such a system, but the more greed I encounter in the present privatized system the more I am tempted to endorse a nationalized system of health care. It would at least take out the profit motive that is corrupting current medicine and taking it away from its proper ends.
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