Monday, January 20, 2003

I've been thinking about health care and what is sometimes called "socialized medicine". Here in Spain we have socialized medicine, what they call here Social Security and what I call the National Health to avoid confusion. (In America, for you foreigners out there, Social Security refers to the government pension plan.) My experience with the Spanish National Health has been very positive. They unblocked my vas deferens (invasive surgery, four days in the hospital), they fixed my leg the time I cracked my fibula, they send me to a psychiatrist and pay for the expensive pills I take, and I can go in for a checkup anytime I want to which includes a complete blood test. Any emergency I might have, no matter how catastrophic, is covered all the way. In addition, they're going to pull an impacted wisdom tooth I've got--it's inconvenient, I had to go in first for an exam and another time for an x-ray and next time I go in the damn tooth will finally get pulled. So I don't buy the horror stories that occasionally show up in the American conservative press about public health care systems.

I will agree that a Western European-style National Health system would not work in the United States, but what I would be willing to pay for out of our tax money is a national preventative health care system. You could go in, say, a maximum of once every six months--or nine, or five, or whatever--for a general checkup which would include things like a blood test, a mammogram, and whatever other tests are predictive of illness. (Then you'd go to your insurance company and your private doctor to cure any problems discovered.) The National Preventative Health would also take care of such public-health matters as VD and contagious-disease control, vaccinations, flu shots, and the like. Antidotes to common chemical or biological weapons could also be stored in case of emergency. All of this wouldn't cost too much and would be the way to stop trouble before it happens, which is always much cheaper and better in the long run than fixing it after it's happened. I would include this condition that would really keep costs under control: you can't sue the National Health for malpractice. If you take advantage of its services, which you as a citizen have the right to, the risk is on your head. You can always choose to transfer the risk to a private doctor that you or your insurance company pay for and can sue. Using the National Preventative Health would be an option, not an obligation, but I would like it to be an attractive option for basic health maintenance that most people would choose.

I would get my doctors like this: we'd require, as now, a bachelor's degree in a hard science and then the standard four years in med school for an M.D. With a doctorate in medicine, you'd do a one-year internship with the National Preventative Health at full pay, and if your work was satisfactory, you'd become a regular staff physician. The NPH would give prospective doctors low-interest loans in exchange for five years' work after graduation (maybe three years' should they choose to serve as military doctors). Your income would be, say, between fifty and a hundred grand a year, enough to be solidly upper-middle class and comfortable. Nurses and staff would be well-paid, at market rates. Unionization and strikes by NPH personnel would be prohibited--that's the trade-off they would make in exchange for not being liable to lawsuit.

No, this isn't a part of a big-spending plan; I'm all in favor of reducing government spending as much as possible, which could be easily done in all kinds of ways that would allow us to pay for this. In addition, we'll quickly begin to see savings on both Medicare and Medicaid, which right now cost us more (together) per year than what we spend on defense. It's not part of a big-government plan, either; I would like to see the federal government's power to be considerably more limited than it is now. I do think, though, that there are several things that are so important to the functioning of a society that the government (whether federal, state or local), which is supposed to represent all of us, needs to take charge of them. National defense, police protection, the laws and courts, and foreign relations are among the most obvious. I would personally add education, which need not be provided by government but needs to be guaranteed by the government, the most basic food, clothing, and shelter for those who cannot take care of themselves, and, yes, preventative health care. It could be provided by private companies contracted by the government through open bidding, sure, I wouldn't mind that, but preventative health care is something that I see that people in America need and people in Spain have.

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