Socialized Medicine in America?

Dear Editor,

         The implementation of a system of socialized medicine in the USA is an issue deserving careful consideration by all sectors of American society.  I would like to add my voice, the voice of a liberal ex-patriot formerly of the Northwest but now living and raising a family in Japan, by saying that such a system would fail within a generation or two due to American self-interestedness.
        Like most people around me growing up, my family had little money and no health insurance.  We were on welfare from the time my father abandoned us when I was five until I went to college.  My mother was single, working to support a family, and suffered from epilepsy, an affliction that required regular medical check-ups and medication and barred her from any good paying job that used a computer.  We lived in welfare housing, made our monthly visits to the food banks, ate government cheese, used food stamps whenever and wherever we could, shopped at K-Mart and the Salvation Army, and considered McDonald’s and Taco Time haute cuisine.  As my part of the deal, I never got seriously injured or sick, and internalized the values and mores of this lifestyle so that I wouldn’t think to question them or complain about our situation.  I graduated high school, went to university and then to graduate school, moved to Japan where my plans to stay a year or two to teach English were undone by falling in love and starting a family.  My stay went from two years to eight years, and may stretch on indefinitely. 
          In Japan, I have had to question or discard many of the assumptions I’d grown up with in America, especially those concerning health insurance.  Japan has one of the best socialized health care systems in the world, and its people live longer and pay closer attention to their health than anyone else in the world—and they do so at about a third of the cost Americans pay.  Based on my experiences of the Japanese system of socialized medicine, I fear that such a system could not function in America.  I believe socialized medicine is a necessity in America, but cannot see how it would be feasible, because in order for such a system to succeed in America, a transformation of American culture would first have to occur, a shift of cultural focus away from individuality and its attending self-interest to an increased recognition and awareness of one’s position in the continual feedback loop of communal relations—something that Japanese education and culture continually strives to instill within its participants, but which American education and cultural largely ignores.
        Of the benefits of the Japanese system, the most notable is low out-of-pocket medical expenses, a situation that allows people to worry less about their bank account and more about their health.  When I visit a clinic for a minor sickness, such as a cold, flu, or even a sinus infection, the bill for the exam, treatment and resulting medications is around $15.  I have become so accustomed to these low costs that I often forget to bring my wallet to the clinic.  Unlike in America, visiting a doctor in Japan is not the leading cause of financial stress.  Americans expect high medical bills and so seek medical treatment and advice much less frequently than their Japanese counterparts. 
        American opponents to socialized medicine claim that any individual savings at the doctor’s office is lost in the higher taxes paid to support such socialized systems.  If we evaluate benefits solely in financial terms then, yes, it is possible that less money paid to the doctor doesn’t necessarily equate to more money saved by the end of the month and a resulting higher standard of living.  However, I think its dehumanizing to measure happiness in terms of money.  Consider the following story.
        Before the birth of our son, my wife warned me that we would have to pay $2,500 for the delivery and the one-week stay at the clinic following.  I hadn’t expected it to be that cheap.  Friends of mine in America had told me of taking out loans for 2 or 3 times that amount just to cover the delivery expenses.  Misinterpreting my look of surprise, my wife then assured me that the money would be returned to us in full one month later.  I asked her to explain how this worked, but she couldn't.  That’s just the way it worked, she said.  After fourteen hours of grueling labor, our son was born healthy but underweight and with jaundice, and so had to spend a day in an incubator; the doctor and nurses were professional and kind; the facilities were clean and accommodating; my wife had her own room and was visited regularly by the nurses and doctor for check-ups and advice.  I saw none of the horror stories about socialized medicine I’d heard in America involving sub-standard facilities and inadequate care.
         A few weeks later, the city government informed me that not only would the city be covering most of my son’s medical expenses until he reached the age of six, but we’d also be receiving $50 a month in support for each child in our home.  We visited the pediatrician about once a week at fifty cents a pop, so we spent about two dollars a month on regular medical care for our son’s first six years.  We visited the clinic so often, in fact, that I protested to my wife that she was too worried about his health and that all this medicine was going to weaken his immune system or, worse, make him expect medicine at the slightest cough or sniffle.
         In America, I was familiar with the perplexity and hopelessness brought on by the presentation of hospital bills.  My former wife suffered from Type 1 diabetes, a vicious condition that, despite insulin injections of up to five times a day, hospitalized her twice a year due to skyrocketing blood-sugar levels.  One nasty peak put her in the I.C. unit for three days.  We were students and our student insurance didn’t cover such things.  To have afforded real insurance would’ve meant one of us giving up on university.  We were saved from financial ruin by a local Catholic church which kept watch for cases such as ours.  They paid our entire hospital bill and asked nothing in return.  I will never be able to thank them enough for that act of charity.  There aren’t enough such charitable organizations in America.  If there were, the world wouldn’t be scratching its head at why so many in the world’s richest country go without adequate medical care.  Despite my reservations regarding organized religion, I am convinced that churches, synagogues, mosques, what-have-you, can play important roles in a community.  However, it is vitally necessary that the separation of Church and State is maintained as much as possible.  If churches play too large a role in medical care, the temptation to proselytize becomes too great, at a time when people who are hurt, sick or dying are at their most vulnerable.  People should come to religion in times of strength and clarity, not weakness or confusion.  What kind of faith can be built on weakness, ignorance, or, worst of all, a lack of options?
        Another benefit of socialized medicine is that it eliminates the burden of emotional debt incurred when a person is “saved” by an organization or group.  No matter how such groups claim that they are just helping and expect nothing in return, most beneficiaries of such aid feel they are taking on debt and thereby placed in a position of servility where their independence and self-sufficiency is diminished.  This situation is not healthy: it sours the soul.
         In a perfect system of socialized medicine, all people pay, and so all are indebted to all, and so none feel indebted to any specific person or persons, and any sense of losing one’s self-sufficiency is crossed out.  Such a system, however, is always already undone by human nature: some strive harder than others and some are more keenly aware of their duties to the community.  There will never be a socialized medical system that frees its participants from all feelings of indebtedness, but I would rather feel indebted to all members of my community than to have that feeling concentrated on one single person or group. So, I pay my taxes, social insurance and health insurance payments in full every month without fail.
      Many Japanese residents complain about the expense, but I don’t mind paying.  Taxes are a social necessity.  Political graft, mismanagement of public funds, and people not paying but still milking the system for all its worth, are drawbacks of this system, but they are unavoidable consequences of any political system.  These forms of fraud need to be limited as much as possible, but I understand them as necessary for the peace of mind afforded me by always having access to quality medical care.  I pay knowing full well that though I may never receive all the benefits equal to my input to the system, someone else will.
         Over-medication is ubiquitous in Japan.  Since clinics receive most of their income from the government based on insurance claims, doctors prescribe large amounts of medicine in order to reap as much money as possible from each patient’s visit.  Visiting a doctor will guarantee you at least a dozen packets of various medicines, but you get used to it, and you might even start to feel anxious if the doctor doesn’t order a cocktail of powders for you to take home.  Furthermore, everyone here believes doctors and drug companies work in collusion, and I’ve seen nothing to make me believe otherwise.
         Long waits are another problem, but this is not the doctor’s fault.  Instead, blame the elderly who gather in large numbers at the hospitals and clinics.  They are chatting happily with one another, not at all impatient to have their name called.  You could tell them that the doctor was away for the day, and that’d make no difference to them.  They are not sick.  They have gathered here for their peers, friends, fellow gossips, and old chums.  The hospital waiting room is a place where people of their age are certain to meet people their own age, who share their interests, and its cheaper, cleaner, and more convenient than many of the alternatives.　 Until recently, the elderly could visit the hospital for practically free; now, they are required to pay up to 30% of the bill.  Still, they will sit and wait for up to three hours or more, thereby requiring others who are there for legitimate ailments to do the same.  It can be frustrating because a visit to the hospital can eat up your entire day.
         The last significant drawback I’d like to mention is the relatively high amount of taxes Japanese people pay, with its attendant effect of creating in the populace an expectation of medical services.  When I pay several hundred dollars a month in taxes and insurance, which is about 15% of my monthly income, I hope that my family will get the most for its money, and I might be angry at the merest hint that my money was not used in my best interests.  That may be a selfish way to think, but prudent in a country where fiscal policy and public officials have earned almost universal distrust.
         This same self-interest would be the undoing of any socialized health care system in America.  Self-interest is one of the key principles necessary to a capitalist state as it is the driving force behind consumerism.  Advertising, marketing, massive credit card debt—these would be unthinkable in a populace bereft of self-interest.  No matter how altruistic their specific actions appear, Americans are defined by a self-referential values system that always drives them to ask: “What’s in it for me?”  Imagine a father of two, with a wife, stable job, and middle-class income.  He works hard and—because we are imagining here—his wife does not also have to work in order to make ends meet.  Between the mortgage, car payments, and saving for college, every penny of their monthly budget is accounted for.  Now, imagine them participating in a system of socialized medicine wherein a significant percentage of that same monthly budget goes towards taxes to support the system.  Even if the tax bill was not large, the desire to make that money work for their family would be strong.  Being prudent, they would try to make the most of their money.  The money spent in taxes would soon become a monthly medical budget, especially for those individuals accustomed to viewing expenses in light of their own self-interest.  The self-interest engendered in a poor family would be much stronger, and there are many more poor families in America than middle-class or rich.  The drive to use the medical services to the fullest extent would put the system in serious financial jeopardy as an increasing number of people, both rich and poor, sought treatment for ailments of decreasing severity.
         The problems that plague the health care system in Japan would occur in America to a more severe extent.  The self-interest that is a key element of American culture is tempered in Japan by the cultural focus on one’s relation to community, but it still threatens this socialized health care system with bankruptcy.
        I realize this contribution of mine to the debate surrounding the implementation of socialized medicine in America is based solely on anecdotal evidence and so lacks the numbers or other hard data to be readily convincing, and as such can easily be ignored.  I also realize that this letter could be read as an argument against attempting to implement a socialized health care system in America.  Even worse, this letter could be seen as a validation of American policies that have thus far regarded self-interest as the core of human being, and so have legislated against socialized medicine in an attempt to save us from our own selfishness.  Instead, I hope that the problems mentioned in this letter are taken into consideration before experimenting with the implementation of such a health care system, for I truly believe that such an experiment needs to be undertaken in America.  America is the richest, most powerful nation in the world, and its people some of the most uniquely talented and generous in history.  Widespread and concerted conversation, education, and cultural change would be required to address the inherent pitfalls, but as recent events have shown, Americans have a long history of overcoming difficulties.  All that is wanted in this case is for the people to focus less on themselves and a little more on each other.  Thank you for your time.