Attacking the Heart of Medicine

by | Nov 24, 1996

One vital fact was omitted in the news accounts about the success of Boris Yeltsin’s recent heart surgery: the failure of socialized medicine. And this fact underscores the question of whether America’s health-care policies are courting a similar failure. Competent physicians with specialized technical skills are scarce in Russia. Yeltsin, because of his privileged position, […]

One vital fact was omitted in the news accounts about the success of Boris Yeltsin’s recent heart surgery: the failure of socialized medicine. And this fact underscores the question of whether America’s health-care policies are courting a similar failure.

Competent physicians with specialized technical skills are scarce in Russia. Yeltsin, because of his privileged position, had access to qualified cardiologists–an access unavailable to most Russians. And even Yeltsin’s doctors had to rely heavily on the training and advice of American heart specialists. For example, Dr. Renet Akchurin, the head surgeon on the Yeltsin operation, was trained by an American pioneer in the field, Michael DeBakey. While DeBakey did not apply the scalpel to Yeltsin, he was called on to make the crucial decisions not only about the diagnosis but about the timing and the method of Yeltsin’s surgery.

But the rest of the country has virtually no modern health care. Bypass operations, now routine in the U.S. (300,000 per year), remain rare in Russia (3,000 per year). Most are done by American-trained doctors at special facilities reserved for political leaders. Heart surgery is “free” for Russian citizens, but 98 percent of those needing bypass operations die without getting them. Patients suffer and die on interminable waiting lists. Some choose not to even seek needed care. Dr. Yevgeny Rogozin, of Moscow’s Cardiology Center, reveals that “Many people in this country are afraid to let someone take a knife to their heart.” What they fear are the scalpels wielded by socialists.

Why is this so? Because decades of socialism have replaced conscientious medical professionals with low-skilled, mindless bureaucrats. Scrupulous rationality and independent thinking are the key traits of a good doctor. But these are the very traits penalized, and then destroyed, by socialism. Under socialism, doctors have no freedom to choose the terms under which they work: not whom they treat, nor how, nor at what price. They must surrender their private concerns and serve the “public interest.” There is no profit in being a good Russian doctor–so good doctors disappear. Patients are thus left in the incompetent hands of those who are skilled–not in advanced medical procedures–but in obedience to government directives.

In medicine, as in other fields, the socialists must turn to the capitalists for help. American medicine has been the envy of the world, because at its heart stands the independent doctor, left free to think and act by the standard of his own rational self-interest. His judgment is not subordinated to the dictates of government bureaucrats.

But freedom is now under attack. Capitalist doctors are being replaced by medical bureaucrats–and medical care in America is slowly vanishing. When Medicare and Medicaid subsidies were initiated in the 1960s, it was claimed that doctors would retain their freedom. But when government foots the bill, it first inflates costs, then realizes it must control the spending of the “public’s” money. In order to cap skyrocketing costs, the government now herds doctors and patients into HMOs, where care is rationed. Doctors are under “gag orders” not to alert patients to alternative, life-saving–but costly–procedures.

HMOs are increasingly staffed by generalists, medical specialization is declining–a big step down the socialist road to medical incompetence and barbarism. Tragically, the results of this socialization of medicine–rationing and deteriorating care–are now blamed on private doctors and the profit motive.

Even as it deteriorates, American medical care is being made compulsory. The Kennedy-Kassenbaum bill, for instance, imposes fines and prison terms on doctors who fail to comply with regulations governing subsidized tests and treatments. Many conscientious doctors are quitting. The capitalist doctor–independent, expert, caring–is an endangered species.

Dr. Thomas Hendricks, the brain surgeon in Ayn Rand’s 1957 novel, Atlas Shrugged, who flees from socialist medicine, explains his choice as follows: “I have often wondered at the smugness with which people assert their right to enslave me, to control my work, to force my will, to violate my conscience, to stifle my mind–yet what is it that they expect to depend on, when they lie on an operating table under my hands? Let them discover the kind of doctors that their system will now produce. Let them discover, in their operating rooms and hospital wards, that it is not safe to place their lives in the hands of a man whose life they have throttled. It is not safe, if he is the sort of man who resents it–and still less safe, if he is the sort who doesn’t.”

Americans will see more and more of this sort of doctor–unless we categorically reject government involvement in medicine.

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Dr. Salsman is president of InterMarket Forecasting, Inc., an assistant professor of political economy at Duke University and a senior fellow at the American Institute for Economic Research. Previously he was an economist at Wainwright Economics, Inc. and a banker at the Bank of New York and Citibank. Dr. Salsman has authored three books: Breaking the Banks: Central Banking Problems and Free Banking Solutions (AIER, 1990), Gold and Liberty (AIER, 1995), and The Political Economy of Public Debt: Three Centuries of Theory and Evidence (Edward Elgar Publishing, 2017). In 2021 his fourth book – Where Have all the Capitalist Gone? – will be published by the American Institute for Economic Research. He is also author of a dozen chapters and scores of articles. His work has appeared in the Georgetown Journal of Law and Public Policy, Reason Papers, the Wall Street Journal, the New York Times, Forbes, the Economist, the Financial Post, the Intellectual Activist, and The Objective Standard. Dr. Salsman earned his B.A. in economics from Bowdoin College (1981), his M.A. in economics from New York University (1988), and his Ph.D. in political economy from Duke University (2012). His personal website is richardsalsman.com.

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