‘They say the world has become too complex for simple answers. They are wrong.’ — President Ronald Reagan (1911-2004)
Editor-In-Chief, Chester “Trip” Buckenmaier III, MD, COL (ret.), MC, USA
This month’s quote comes from a speech made by Ronald Reagan (“Ronald Reagan: A Time for Choosing Speech,” 1964). It was essentially a warning against socialism and the expansion of government. He stated, “Public servants say, always with the best of intentions, ‘What greater service we could render if only we had a little more money and a little more power.’ But the truth is that, outside of its legitimate function, government does nothing as well or as economically as the private sector.” I agree with Reagan’s sentiment if the discussion involves producing something specific for profit. At the end of the day, the federal government does not make anything, because that is “outside of its legitimate function.” So, what is the federal government’s function?
At its most basic, the answer lies in protecting and defending the U.S. Constitution. The purpose of the Constitution, I contend, could be summed up with the document’s first sentence:
“We the People of the United States, in Order to form a more perfect Union, establish Justice, ensure domestic Tranquility, provide for the common defense, promote the general Welfare, and secure the Blessings of Liberty to ourselves and our Posterity, do ordain and establish this Constitution for the United States of America.”
I might agree, in principle, that governmental bureaucracy is rarely as efficient as the private sector in building things (perhaps the military is a notable exception). Business is neither intended nor interested in providing any of the “Blessings of Liberty.” Business is in the business of profit. When a company is pursuing profit, which it should be doing for the sake of investors, this goal can (and often has) conflicted with the constitutional goals of providing—We the People—justice, tranquility and general welfare. We depend on our constitutional government to secure these blessings to ourselves and posterity.
For example, businesses efficiently create the machines and tools a modern fire department needs to fight fires within your community. However, the government creates the rules and regulations to establish the need for a community fire department. I doubt firefighting would make a profitable private business, and do you really want to risk your neighbor not subscribing to the for-profit fire department? Some general services are part of the government’s legitimate function. This same argument could be made for roads, bridges, water, sewer, power, police and, I would argue, medicine.
I began thinking about these issues because of an encounter I recently had at Peace Community Church in Foley, AL. Pam and I were visiting my father-in-law, who is active in this church community, and we accompanied him to Sunday services. Following the service, the congregants often have coffee in a fellowship hall. We were introduced to a congregant who was experiencing intense headaches, and I was asked whether there was a role for acupuncture. During our conversation, which included Pam palpating his neck and back muscles (a classic source for tension headaches), we learned he had had a shoulder pain complaint for years that he had been unable to resolve.
In a few minutes of conversation, including Pam’s physical examination (imagine a clinician touching a patient today), we clearly understood that the source of his headaches was likely related to his remarkably tight neck and back muscles. He clarified that his headaches were on the right side of his head and corresponded with the onset of his shoulder pain.
The answer, at least initially, was simple. Massage and acupuncture would be a minimally invasive first approach to his condition, but there is typically no insurance support for these medical services in our modern American healthcare system.
What saddened me about this individual’s interaction with our business-focused health system was how complicated many local health professionals had made his condition. A visit to orthopedics resulted in a recommendation for surgery, and a visit to the chiropractor suggested spinal issues necessitating frequent adjustment appointments. It is not that these other medical professionals are not aware of these other minimally invasive approaches; the system does not reimburse clinicians for these services, making them generally unavailable.
I have lamented numerous times in this column concerning how the business of medicine interferes with providing patients with a more integrative approach to healthcare in this country. Many minor health problems evolve into major issues because too many Americans lack basic health insurance. Imagine if the individual I described received shoulder surgery, as was recommended, for a condition that might easily be managed with massage therapy.
I believe healthcare is a fundamental human right. It is as vital to civilization as the fire department, a police force, roads, and other necessities that support the general welfare. Healthcare should not be run as a business where the motivation and benchmark for success are profit rather than patient health. I have always maintained that one of federal medicine’s greatest strengths is that it is a socialized system of medicine focused on patient outcomes. I specifically used Reagan’s speech for this editorial because he used the socialization of medicine as an example, stating “the doctor’s fight against socialized medicine is your fight.”
I do not believe clinicians care to fight against socialism; they just want to practice medicine and be fairly compensated for their time. Perhaps, if the pressure to do things to patients that generate money for the medical business were removed, less invasive, integrated therapies could finally thrive. I believe federal medicine has demonstrated in the past decade that this approach is possible.
I agree with Reagan that government is often not the answer. However, the government is essential for something as fundamental to human rights and universally needed as healthcare. As the dismantling of the U.S. Department of Health and Human Services (HHS) continues under the current administration, I fear the consequences of this retreat from investment in the nation’s health will cost American lives.
