Wednesday, May 27, 2009

Obama's Socialized Medicine Program - Sign Me Up!

Actually, sign me up for Plan B or C instead. Many fear that Obama’s end game for health care reform is a single-payer (read: government) system, despite his denials that this is his objective. Single-payer zealots argue that if government takes over health care, that many of our intractable problems will be solved. We will save tons of money, they argue, from increased administrative efficiencies. Spiraling health care costs will be tamed under the government’s whip. Private insurance companies will no longer gouge the public with rising premiums and unfair exclusions for preexisting medical illnessess. The 46 million uninsured would be covered. Big Pharm can finally be caged by Big Government establishing price controls. And, with the government in charge, the president can submit a bill to congress simply outlawing cancer.

I agree that single-payer would resolve many recalcitrant issues, but at what cost? What health care system would we be left with? A guillotine is an effective treatment for a headache, but most of us would rather have the disease than the cure. Single-payer may also kill the very patient it is trying to save.

Single-payer cheerleaders are shrewd strategizers. They know that we choose shampoo based on the shape of the bottle and the color of the contents. Similarly, they are trying to package their panaceas in the most palatable manner possible. You’ll never hear any of them use the term socialized medicine or medical rationing as they advocate for a government run health care. Instead, they will use a bland description such as National Health Program.

Even a sanitized label, however, cannot disguise their health care vision for America. (I’m tempted to use the lipstick on a pig line that Obama used in the presidential campaign, but I will refrain in order to preserve the dignity of this blog.) Let’s look at another government run institution that we all know well. Do we want our health care system to have the same high level of quality and customer service that we enjoy at the Division of Motor Vehicles? Keep in mind that health care is probably more important than the quality of our drivers licenses and vehicle registrations. The DMV experience is what is it because the incentives of the government and those they serve are not aligned, and the public has no recourse whatsoever. Does this sound like a prescription for a better health care system?

Every breathing American knows that we face complex failings in the current health care system. We need thoughtful reform that will achieve and preserve outstanding health care for all of us. Government has a role and an obligation in this process, but ultimately it should not hold the entire world of health care on its shoulders. With the exception of the military, I don’t think that government runs things particularly well. In general, I think that the private sector does it better. For those who think otherwise, I have a great financial tip for you. Invest in General Motors today since the government now owns 70% of the company. This is a Cadillac opportunity for all savvy single-payer investors to strike gold. I predict, however, that the lines of investors will be much shorter than those at the Post Office, the DMV or at medical clinics and hospitals in England and Canada.

Socialized medicine, I mean single-payer, is really a new application of Obama’s cap and trade environmental policy. Costs are capped and medical quality is traded for mediocrity.


  1. Hey, read your article on EMR's. Got one all right. Sure, you have advantages related to having a computer, but current systems (I have eClinicalworks, but they all suck the same)are so poorly engineered that they overwhelm most of the advantage. I'd say I am marginally better off, but these systems don't do anything you can't get MS word to do. Speaking of data mining, you can't even search 'em for a string of text like "last colonoscopy". And if God forbid the way the system wants you to input data is too clunky and you work around it, then it creates a blind spot to the computer. It really doesn't come close to living up to expectations, unreliable, clunky, time consuming and constantly crashing. Let's not even get into the fact that you can only have one window open at a time, a` la pre Windows DOS based software.

    And yes, Mr. Obama will indeed cap and trade by encouraging such systems. They are so distracting to use that perhaps 50% of my brain power is devoted to simply navigating it. So my patients now only have half the doctor, but ten times the transcriptionist, because that's what this system turns physicians into.

    My experience compared to that of my colleagues, and current literature speaks ill of the current crop of purchasable EMR's. The only ones to benefit from EMR's besides the payors whose chart audits will be made more easy will be the charlatans who stand to make big money pandering them to unsuspecting doctors and their patients.

  2. Dr. Kirsch,
    An incredible blog. I certainly hope the powers that be and maybe even the media can hear the voice of one crying in the desert.
    Thanks for your perspective.

  3. Your comments, including the phrase "socialized medicine" and the comment you posted at WSJ where you gave a link to this page ("rationing", "long waits", etc.) sound identical to my dad's. He's an ophthalmologist, but I think he gets his talking points on this issue from the AMA. It sounds like you do too.
    My experience suggests a very different take than the AMA's story.
    I live in Germany, again. The last time I lived here I had problems with ovarian cysts, including one that was growing very fast. It took 3 days to get me into the OR, where 2 cysts the size of tennis balls were removed. The one week post-op stay was nearly as long as I was able to stay home after childbirth before going back to work in the US. The surgery was done laproscopically, but I was surprized to find that I couldn't sit up without using my arms to push myself up.
    Now I'm living here with my son. He has bad allergies and a bit of asthma. We get pretty run down sometimes, because when he doesn't sleep well he has a hard time controling his temper the next day and there's no one but me to get him calmed down to get him to help clean up the mess after a fit. Social security (the German version--Deutsche Rentenversicherung) is sending us to an allergan-free environment (the coast) for four weeks to give his lungs a chance to heal and grow without allergans, and to give me a chance to just rest up. Health care covers his meds (as in the US, but for lower co-pay here) and the cost of those special mattress and pillow covers recommended for dust mite allergies.
    I recently pulled my back. My health care paid for visits to the doc and PT visits.
    Is there paperwork to fill out? Of course--it's Germany! Is there rationing, are the waits long? Not in my experience. I suspect that what a lot of those arguments are referring to are non-urgent treatments or things that are optional. The US's claim to "best medical care in the world" is based in those special cases of people who can afford to pay for treatments which are high tech, uncommon, or optional. Looking at the overall population, as in the records of infant mortality rates and life expectancies, will show that the US is behind a couple dozen countries in providing a decent standard of care for the large majority of their population.

  4. Actually, the Department of Motor Vehicles is not a good example.

    I renewed my license so quickly some years ago that I could not move through the line fast enough. It was that simple in NY State. People had complained about the DMV and the process was automated to a t. The office is in Herald Square which is a very convenient location.

    Mediocrity is a risk but if people and society and medical professions keep the pressure on the system does not have to be at all mediocre.

    I do not think that care is mediocre in Canada.

    For many in America, even mediocre care would be better than none. It is a question whether we care about our fellow man.

    From a societal point of view, it is much better to provide everyone average care than some people terrific care and others none.

    The savings that we would engender would enable us to pursue excellence in health care or anything else as we choose to do.

    So from all three points of view the argument in this blog about mediocrity is wrong: cost, equity and fairness, and the inevitability of mediocrity.

    I would recommend that Dr. Kirsch visit one of those mediocre countries and judge for himself through direct contact.

    Bohdan A. Oryshkevich, MD, MPH

  5. Appreciate everyone's comments but would like to respond to Dr. Oryshkevich's thoughtful remarks. First, with regard to his experience at the New York Division of Motor Vehicles, I am almost tempted to move back to New York! His utilitarian comment, "From a societal point of view, it is much better to provide everyone average care than some people terrific care and others none.",is more troubling. I do not think that we should be lowering standards for purposes of inclusion or for political correctness. I believe that with regard to medical care, education, income, work standards, college entrance requirements, etc, we should be striving for excellence. I do not want our goal to be 'average', as Dr. Oryshkevich suggests. We should encourage folks to reach higher, not lower the bar of achievement. Finally, recently a man from England visited our home. We queried him in detail about the medical system 'across the pond'. The system he described was worse than mediocre, far inferior to the care that most American pets enjoy.

  6. Having seven relatives currently practicing in Canada, I can only comment on their beliefs in socialized medicine. Originally the problems were vast, but decades later, the care is excellent. Medical errors are met with educational improvements. Research is active. Certainly know system is perfect, but the numbers of unisured patients entering our ERs is staggering. Let's hope we move in a direction that enables excellent care for all of us. Let's hope we do it soon. Don Spaner MD

  7. Dr. Kirsch states that I suggest that we strive for average care. Nothing could be further from the truth. I stated that everyone having average care is better than some having excellent care and some having no care (what we have now).

    Is Dr. Kirsch against social justice?

    I trained at McGill University under univeral insurance. Our training was superb and I think that our care was damned good even if I have to say so mywelf.

    The training was better than anything I ever saw in America. We had fundamentally more respect for patients than I ever so anywhere in America practicing or taking care of my family.

    The reality is that more doctors work on a fee for service basis and are advocates for their patients in Canada than here in the USA. There are no charity cases. They have no Medicaid.

    If we work to make univeral care the best, it can be the best and EVERYONE will have access.

    I recommend that he visit or work in another country for some time before he condemn everyone else of mediocrity.

    Bohdan A. Oryshkevich, MD, MPH

  8. Canadians complain about their mediocre health care:

  9. I appreciate Dr. Oryshkevich's comments. I am not against social justice. (Who could admit to being against this?) I am against lowering bars of quality for inclusion. I did review the laudatory comments of the Canadian system on Dr. Oryshkevich's link, hardly a scientific study. I'm sure we could select favorable comments from a few folks in North Korea who would make this country seem like Shangri-La. I concede that we can learn from the Canadians. They pay a lot less per capita on health care and more favorable life expectancy and infant mortality statistics than we. Some of these difference may be attributed to higher incidence of disease in America and higher homicide and accident deaths in the U.S. I'm open to lessons from our northern neighbor, but I'm hostile to accepting the single-payer model here.

  10. No one claimed that the street polling done in Toronto was a scientific study. Your comments here are not a scientific study.

    You are just "hostile".

    Comparing Canada to North Korea is quite frankly ridiculous if not bizarre. It is that American arrogance that gets us in trouble all over the world. Are you stating that these people were coerced like they were in North Korea?

    The reality is that Canadians complain much less about their health care system than we do. US satisfaction with health care is much lower than in other countries.

    How many bankruptcies related to health care were there per capita in Canada in comparison to the USA?

    What percent of people are uninsured in the USA and in Canada?

    What percent of people in Canada did not get in medical care what they needed in comparison to the USA?

    Ontario had to introduce photo IDs for health insurance since there were so many Americans borrowing the cards of their relatives in Canada.

    If everyone had Medicare so to speak we would be raising the bar not lowering it. It would be raising the bar on those who have Medicaid and raising the bar on those who have no health insurance. It would be raising the bar on those who are underinsured.

    You are, in fact, against social justice. You are against equity. So what if someone in Beverly Hills would have to have a social insurance card?

    If we saved money on health care we would have funds to deal with better education, lower accidents, etc and thus improve our health care profile.

    Lampooning Canada by comparing it to North Korea is only showing that you have no argument.

    Provide something specific and factual.

    Bohdan A. Oryshkevich, MD, MPH

  11. Dr. Oryshkevich,

    I will let the readers read both of our comments and decide which one of us is hostile. I have suggested in my comment above that Americans can learn important lessons from the Canadian health care system. It does not appear, however, that you feel you can learn anything from us.

  12. I am an American who trained in Canada. So I cannot learn from us. I am us.

    I am a native New Yorker. But I have seen two systems and theirs (not mine or ours) is better.

    It is hardly perfect. Bu they have solved many problems which we have not addressed.

    I hope that we do better. But we refuse to step up to the plate. We have to make choices. You can criticize them for making the choices that they did but that is the political process. We can criticize California for choosing the terminator for governor, or the USA for selecting Obama for president but those are democratic choices. Canada is not North Korea.

    Any mature system has to make choices. But we prefer to ininsure the poor, spend without control, and bankrupt people. We are like over grown adolescents.

    I am interesting in learning from anyone who does better.

    A learning organization will soon be better than any of its competitors.

    You were the ones who used the world hostile first in the context of accepting a single payer.

    I am not for a single payer advocate. I am for universal health insurance with global budgeting.

    Think about that. That is what Canadians call their health care system. There is a substantive different from the PNHP proposal.

    PNHP has no Canadians in it and Canada is not North Korea.

    Bohdan A. Oryshkevich, MD, MPH

  13. I was dissappointed that you used the standard AMA and Republican talking points. Your skewed perspective is obvious. You didn't even bother to hide it.
    First, your idea that government programs are run poorly is straight from the GOP talking points list. The police dept, fire dept, sanitation dept, and the post office, to name a few, are all government run and they do fairly well. We've seen what real free markets can do - cause a global financial crisis. Free markets are about profit. That is their one and only priority. Patient care is a necessary side-effect for the free market. ANd where has that gotten us?
    1. Millions uninsured. THousands die because of lack of insurance (
    2. Millions with insurance go bankrupt, amounting to 1 of these bankruptcies every 30 seconds.(
    And youthink this is a good idea? You think private insurance helped these people?

    Every other industrialized country has a national plan, that works. We spend twice the healthcare dollars per capita as they do, and they insure everyone. Private insurers overhead 30%, Medicare - 3%. So Medicare spends more dollars to actual health related issues. It's not surprising that a private company spends less on health and more on profit.

    And your GM example is useless. GM was a private company and via its business decisions was going bankrupt. If the government hadn't stepped in GM would have had to close its doors and all those people would be out of jobs. Damn the government for saving all those jobs. WHat do think their job is? To help people? Crazy idea!

    Please refrain from using GOP talking points as arguments. They are intellectually disinegenuous and like the GOP, help no one.

  14. Why can't we ALL have the guaranteed health care that seniors have? Why do we have to wait until age 65 to get health care that is publicly financed and privately delivered? Why should insurance companies get to fleece us when we are young and healthy, then dump us on the taxpayer when we are older and less healthy? Why are we even discussing the continuation this obscene practice?!

    Coverage does NOT equal care. We need to get the health insurance cartel out of the health care equation. Continued toleration of the 30% administrative waste caused by having 1,200 insurance companies is an economic suicide pact. Insurance is for accidents. Health care is no accident! Support health care for people, not for profit, by supporting H.R.676, single-payer, universal health care. The Congressional Budget Office projects that single-payer would reduce overall health costs by more than $225 billion despite the expansion of comprehensive care to all Americans. No other plan projects this kind of savings. (

    Single-payer Medicare for all is the ONLY real healthcare reform. Everything else is just putting lipstick on a pig. For more info on single payer, including the Mike Farrell videos:

  15. I am an RN who works within a "so called" Catholic hospital system. The CEO makes close to $1.5 million yearly salary. In fact the 3 top administrative officals in our medical campus's combined salalries equal to well over 3 MILLION ANNUALLY!!Do you realize how many nurses WITH benefits that 3 million could cover??!! (Not to mention health care for the uncared for)The administration's plan is to accept as many pts as possible whether there are staff or nurses to care for that other hospitals in the out-lying areas will not be able to "get the business" so to speak.
    If however, the pt's being admitted are poor or lack good insurance they are gladly shuttled off to some other unsuspecting facility. The Top earning surgeons have been given "gifts" from the administration such as Hummer vehicles with all the "bells and whistles" of their choice. As well as paid Memebership to the local country clubs. They have taken away overtime pay from the nursing staff and refuse to replace nurses who have left the facility for work elsewhere. If a nurse leaves they are simply not replaced, and units are forced to work short. The administration has replaced the nursing staff's "better" health care plan with a cheaper plan that provided less at a higher cost. Health care workers get less care than the administrative staff. When administrative personnel (or their family members) are admitted into the hosptial they are given VIP treatment. Placed at the "front of the line" for tests, and procedures: ahead of pts needing stat labs, or stat treatments. This fact is constantly denied, and covered up. TRUST me, unless you are working on the "frontlines" of patient care in this country, YOU have NO CLUE what takes place among this administrative GREED, and RAPING of the public. Ask yourselves why the top paid CEO's in this country (USA) are CEO's of Health Insurance companies, Hospitals, and drug companies. A society is judged by how they care for their children, poor, and elderly. In this area the USA ranks very LOW!!
    Look at our INFANT MORTALITY RATE!! The USA is a country that has always been a so called forward country. If anyone can take Social Medicine and make it BETTER it is the USA!! We literally have nothing to lose except lining the pockets of the greedy and powerful Bureaucratic groups that would like to see our country as simply the very rich and the very poor. GREED is what stops progress and forward thinking! Not the open caring minds and talents of its people. We need to wake up to a better way!

  16. I have read the disturbing comments above. I wonder if you considered airing your grievances with the Catholic heirarchy, who presumably have some oversight over the hospital? Despite the excesses you chronicle, I do not think that socialized medicine, or a sanitized form of it, is the cure we all seek.

  17. The French, British, Germans, and Canadians are all happy with their "socialized" medicine. I want a single payer system. It can be a public/private partnership, like Medicare. In fact, I would love Medicare-For-All instead of the "Deny-you-care" system we currently have.

    Love your blog, learning lots, I hope you change your mind about single payer and "socialized" medicine. I'd rather have medicine socialized instead of bankers' and corporations' losses socialized.

  18. Thanks Maggie. Medicare is breaking the bank. Is this really the model you would like to extend to the whole country?

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  20. I have been an RN about 25 years as a Naval Officer and civilian nurse in critical care medicine. Socialized medicine is just plain bad medicine. It is a disaster looming for the American people with long waits, denial of care, reduction in research and development of drugs, poor access to care, increased medical errors, reduced status of physicians and nurses, reduction in pay for nurses and physicians and death panels to determine who lives and dies. Read Ezekiel Emanuel's book about healthcare. It is frightening in his book where states that healthcare should be focused on ages between 15-65. Anyone else is rationed. Barack Hussein Obama states that some people should go home and take a pill to die. Now this is coming from a layperson who is uneducated in medicine and has done nothing of significance in his life to open his mouth on such as topic. He is unqualified and uneducated and needs to keep his mouth shut. I am sure that all Congressmen and Senators, including Barack, will have a great health plan for themselves while the lowly American masses watch their family members die from lack of care.
    If Dr. Oryshkevich believes that socialized medicine is so great. Then maybe you can answer this one for me Dr. Oryshkevich. Why are you working in this country instead of Cuba, Canada, Britain or some other country with socialized misery for healthcare? If it is so great then you need to pack your bags and go. Take Barack, Michelle (the unhappy one) Barney, Chris, Nancy and Harry with you when you go. I have lived around the world and saw the rationing of healthcare in Italy, France, Britain, and Greece. To say that socialized healthcare is great, you are propagandized, ignorant, or blind.
    As for the post from the RN above, I believe too that she should take this up with the administrative people of her hospital. Complaining will not get her anywhere. Take action. Words are meaningless unless they are put into action. There is nothing wrong with CEO’s making a large salary as long as the company is not is being driven into the ground. 3 million is not what it used to be after paying the obscene taxes in this country. GM has been teetering on the edge for years and thanks to the unions, it has driven this company virtually bankrupt. Unions have also driven out manufacturing in this country. Sad, but true. If the RN wants to complain about greedy people, take a long hard look at unions and their leaders who make hundreds of millions of dollars. People need to be careful of coveting what other people take and have achieved in their lives. If the RN desires to earn more, then take a risk and start your own company. I did, and it was worth it.

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  22. I thought you might be interested to know Dr. Oryshkevich that the Newfoundland and Labrador Premier Danny Williams will undergo coronary heart bypass surgery (CABG) in the United States rather than Canada this week. He has been seen by cardiologists in this country for a number of weeks. Now why do you think that this is happening, especially to a Premier? Maybe he does not have faith in the quality of Canada's socialized healthcare system? Maybe the quality of cardiologists and surgeons are not up to par? If he were a rank and file Canadian, he would still be waiting to see a cardiologist.

    I have been an RN for 20+ years and have worked with Canadian nurses when I was stationed in San Diego in the military as an officer. It was a common consensus among the Canadian RN's that socialized healthcare is great in Canada as long as you never have to use it. They were working in the US because the quality of care was far better, working conditions were superior, pay was much better, the status of RN’s was more respected, and there were supplies when needed. No one in the US is ever turned away in a hospital. Barack are you listening?

    Dr. Oryshkevich I have been to Europe and have seen socialized healthcare first hand. I have worked in government healthcare and it is bad healthcare. To state in this blog that it works is completely untrue. You seem to have contempt for the healthcare in this country. If I were as unhappy as you and Michelle Obama for their country, I would find another country that would make me happy. Why try to change a system that works for the vast majority of Americans? We know why Barack wants to overhaul this system and it is not for the good of the people. It is about social justice, giving back to rightful owners, taxation, and control of who lives and who dies. When you control the healthcare of people, you literally control their lives. I believe that each state needs to decide on their healthcare and not the federal government. After all, I believe in states’ rights as outlined in our Constitution. Maybe you should acquaint yourself with the Constitution of the United States and gain a better appreciation of the freedoms that we hold dear as Americans. Barack, Harry, Barney, Nancy are you listening?

    Altruism and political correctness are destroying this great country. I am suggesting a book, Dr. Oryshkevich, by Ayn Rand titled Atlas Shrugged. I believe after reading this book, you will gain an appreciation why the American people do not want socialized healthcare.

    My mottos:
    When the government sleeps, the nation prospers

    If you don’t work, you don’t eat. ACORN are you listening?

  23. Is in it interesting that the insurance companies supports the health care reform. It seems they will make a lot of money. The increase in health care cost in the U.S. seems to be connected to the FDA regulations and the numerous law suites with multi million dollar settlements that the other countries have some control over. This reform will not change the increasing medical costs without tort reform and as long as we have majority of attorneys represented in congress this is a remote possibility.

  24. Anonymous:

    You are correct about the lawyers. I am tired of seeing commercials on the television about lawyers suing pharmaceutical companies. These trial lawyers are greedy, arrogant and out of control. I read not too long ago that the trial lawyers from the lawsuits from 9/11 walked away multi-millionaires and the victims got very little. These lawyers, commonly known as parasites or predators of our society serve no useful purpose but to drive up costs of doing business. Lawyers do not produce or create anything to make society better. Instead, most of them are career politicians who know nothing about business, let alone healthcare. They are just lawyers who want to be more, but aren't.

    We have a greedy trial lawyer who is a politician in central Florida called Alan Grayson. He has gotten rich by suing businesses. Again, he serves no useful purpose to society but to suck off hard working Americans who produce something.

    Americans I am hoping have opened their eyes to what they did in 2008 by voting in this corrupt evil thing called Barack and his band of thieves. We saw how they operate in circumventing the will of the people with this healthcare scam. The utter corruption, payoffs and bribes that occurred when the vast majority of Americans did not want this evil healthcare bill passed. This healthcare bill was not about healthcare, but control of the American people and who lives and who dies, giving back to rightful owners, and spreading the wealth.

    All I can say about politicians who operate in this corrupt manner such as Barack, his wife, and all politicians have a special place waiting for them in the afterlife and I hear it is very hot there. Just ask Ted Kennedy.