Most Americans find the notion of “socialized medicine” to be abhorrent. In most citizens the concept evokes visions of a moribund, inefficient bureaucracy more concerned with paperwork than in attending to the complexities of health problems. However, I would like to observe that the United States has “socialized defense” that works quite well. The armed forces are comprised of linked government agencies strictly regulated by massive bureaucracies. What if our army, navy and air force operated like our healthcare system does? What if individual commanders were allowed to innovate at will, set their own rules, procure and contract for materials and equipment at the unit level, and let the best units win, as hospitals do? That would, I submit, be a disaster.
Six years ago, a Navy doctor was alarmed by a 1999 Institute Of Medicine report about medical errors, a report that said,
” . . . between 44,000 to 98,000 people die each year as a result of preventable medical errors. For comparison, fewer than 50,000 people died of Alzheimer’s disease and 17,000 died of illicit drug use in the same year.”
The doctor decided to compare how Naval Aviation handled errors and accidents with how our healthcare system handles them. In his paper (emphasis mine) he said,
“In 1953 alone, there were 2,266 major aircraft accidents involving 5% of the 14,051 operating Naval aircraft and claiming the lives of 423 Naval aviation personnel.”
What has happened since 1953? Dr. Harmon’s report says,
“(in 2005), Naval aviation has drastically decreased its incidence of Class A mishaps (an accident involving a fatality, a major injury, or destruction of the aircraft) over the past 50 years to a current rate of 11 per 183,000 flight hours.”
To put that in perspective, 183,000 flight hours is more than 20 cumulative years of flight time.
When I look up commentary on this situation the language I find is mostly purged of political opinion. Few experts want to advocate the Public Option or a socialized system outright because, I submit, they well know the prejudice against it. But that would be the most direct way to adopt a systems approach for healthcare like the U.S. Navy’s for aviation. What is a systems approach? It would mean standards for medical procedures, checklists, medicines, monitoring, sanitation, equipment sterilization, personnel training, etc. Look, doctors and naval aviators have some things in common. They’re smart, well educated, and like being in charge. But they’re both confronted by complex situations, sometimes fast-moving, and they’re not gods The systems concept works for Naval Aviators who fly on and off carriers in all kind of weather the world over, so why can’t it work for medicine too?
Our present healthcare system has profit as its primary goal. If we had a socialized system purposed for optimum patient care, both preventive and acute, there is no doubt in my mind that the system would not only be vastly improved but doubled in financial efficiency. Indeed, it is well known that socialized medical systems in numerous countries deliver comparable results to ours with fewer errors and for less than half the cost.
My latest AARP bulletin has an editorial on page 3 advocating, “Let’s Launch a War on Waste”, and it’s about this same issue. It quotes the most recent IOM study:
“The U.S. health care system now is characterized by more to do, more to know, and more to manage than at any time in history . . . The result is a paradox: advances in science and technology have improved the ability of the health care system to treat diseases, yet the sheer volume of new discoveries stresses the capabilities of the system to effectively generate and manage knowledge and apply it to regular care.”
AARP’s message is not so much about waste, really, despite the title. Carelessness or poor character aren’t the reasons for the problem. No, the problem is that we have the wrong kind of system. We haven’t made much progress since 1999 because the present system is outmoded. A true systems approach is needed to remedy both the medical error problem and the financial problem and AARP ought to be telling us we need some form of government medicine – socialized medicine. Let’s get over our prejudice against the concept, and let’s get over
the illusion that healthcare is a commodity like farm produce where one shops for the best value. When you’re sick you commit to a supplier and you’re pretty-much stuck there. Congressional Republicans tried to make Obamacare a dirty word – it’s not. It in fact contains the seeds of reform, but because of Conservative opposition and lobbying by the medical industry it was shorn of what it should have been. It’s way past time for America to get a healthcare system that puts patient welfare above profit. If the medical error rate doesn’t convince, the fiscal cliff should because medical costs are the prime driver of that problem.