The above quote is from my late father. He had a very unique perspective on the practice of medicine, especially as it relates to the various delivery systems. He was born and brought up in England and entered medical school there in 1950, training under the National Health Service and graduating in 1956. He emigrated to the US in 1957 and went into private practice for 24 years, 8 years pre-Medicare and the period after until 1981, becoming a clinical instructor at Harvard Medical school and a US Citizen along the way. In 1982 he decided he wanted to give something back to his adopted country in gratitude for the wonderful opportunities it had given him, so he joined the US Navy at age 52 and served first as the head of the Radiology residency program (27 residents and the largest program in the military) and then Chairman of the Radiology Department at the Balboa Naval Regional Medical Center in San Diego until his retirement at the rank of captain in 1991.
That is at least three different systems my father practiced under, four if you count the pre and post Medicare private practice period as two. His views of each were formed from the perspective of someone on the inside who lived and worked within them every day, not some ivory-tower theorist.
We’ll leave the military system out of this discussion for now as it would only be a distraction from the question of whether the US private health care system or a socialized model like Britain’s NHS is better. The fundamental distinction Dad was making is how differently the two systems view the patient and the incentives that view creates in each. The private fee for service system has more incentives to keep its patient alive and help them get better. Under socialized systems, and Medicare/Medicaid is a socialized-lite system, the overriding incentive is to control costs because the funds are finite and the needs are not.
I don’t think I need to tell you which system Dad thought was better.