Posted by: drrozkaplan | January 4, 2010

Socialist Leanings

It’s the new year and time for me to get serious here.  What respectable medical blog can avoid addressing health care reform?And obviously I’m going to have to state my persional opinion.  At the risk of alienating some of my readers, I am staunchly in the socialist camp.  Don’t worry, though, I know it’s not the answer for the United States, at least right now.  It simply won’t work here.  Hell, we can’t even get a Public Option for the uninsured.  So I know.  But one only has to look at the statistics for the nations that have socialized health plans to see that there is a positive effect of the physical well-being of their inhabitants:  countries with national health care, including Great Britain, Sweden, Finland, and Canada, to name a few, have lower infant mortality rates, higher rates of vaccination, and routine care like pap smears and mammograms, and longer life expectancy than we do.  Go figure. Everyone is so worried that if we went to a nationalized health plan, they wouldn’t get services, but people are actually getting MORE services in those countries. 

     The issue is appears to be how these services are distributed.  Not how people, particularly people with money, who are used to getting what they want, when they want it, would like.  Yes, there may be some waiting for specialist visits and elective procedures.  No, you might not get that MRI you think you should have but the doctor isn’t so sure you need.  The environment may not be cushy..

  It’s kind of like the Rolling Stones song:  You can’t always get what you want, but if you try sometimes, you get what you need.

     But okay.  I’ve truly accepted that this is NOT what’s going to happen in the U.S.  So what can we take from the nationalized nations that, without completely freaking Amiericans out, might improve our health care statistics?  How about this?  Nationalized health care is based on a system of Primary Care.  That means that, before patients head to that expensive specialist who will likely perform multiple expensive and possibly invasive tests, a patient sees a generalist- someone who can separate the simple form the complex, the serious from the self-limited- and treat symptoms simply before shooting with the high-priced elephant gun.  That is not to say that the elephant gun may not be necessary in some cases, but most of the time, it’s not.

And while we’re at it, we primary care docs will check that you’ve had your vaccines and your colonoscopy and, if we’re worth our salt, will address the lifestyle habits that can maintain your well-being, like proper diet, exercise, and smoking cessation.

So, what if the United States got more on board with the Primary Care idea.  That’s one of the things on the table right now.  And I think it should be a high priority.  More on this in my nex post.  Just wanted to lay the foundation.  I’m poised and ready for objections, so if you need to, fire away.



  1. My only objection is that more docs do not think like you.
    Change is inevitable ,might as well include the
    havenots with the haves in respectful healthcare.
    It will make a better world.

  2. Unfortunately what both the Senate and House bills are is health insurance reform, not health care reform. It is a great start, but as the citizens of Massachusetts found out that hard way, simply having insurance does not guarantee access to health care. Even if you dramatically increase the number of primary care ‘providers’ with NPs and others, there will simply not be enough access. Does it even matter? So what if folks just go to Cardiologists or Orthopedists? There are numerous studies that demonstrate that costs rise and health care outcomes get worse in direct proportion to the number of primary care providers. As you stated in your blog, every other developed country has a nationalized health care program, with at least twice as many primary care providers as specialists. We are the reverse and almost dead last in every WHO health care quality measure. Until this country has true health care reform, with health workforce reform (do we really need more Radiologists?), everything else that comes out of Washington is simply going to be a Band-Aide.


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