By Deane Waldman, M.D.
Mary began to experience abdominal pain but ignored it.
When she finally told me, I said, “I’m your husband, not your physician. Go see her, now.” Mary got the next available appointment—seven months in the future. The diagnosis was inoperable pancreatic cancer. Twenty-two months later, my college sweetheart and wife of 54 years died. Might things have been different if she had been seen when symptoms started?
Everyone now knows of the COVID-19 pandemic, ‘big con’ scam though it was. Few have heard of a pandemic killing millions of people with no media attention at all: death-by-queue.
Death-by-queue means dying waiting in line for care that is technically possible but unavailable. Death-by-queue has long been a feature of delayed care in the British National Health Service, namely heart attack victims and cancer patients.
Death-by-queue—the unheralded pandemic—has come to the U.S.A.
Health Care Not a Marketplace
In all marketplaces except health care, the consumer is the payer. The consumer/payer chooses whom he or she will pay and how much based on the buyer’s calculation of value received for money spent.
The seller must offer what the customer considers value and must price services or goods in competition with other sellers of similar products. The buyer is spending money out of pocket and thus has a strong incentive to economize. Competition between sellers drives down prices. There are only two “parties” in a true market: buyer-customer-consumer-payer—demand in economic terms—and seller-provider—supply.
U.S. health care is not a true market. There are three parties: the patient or consumer; the provider or seller; and a third party—government and/or insurer—that makes all financial as well as medical decisions. The third-party “disconnects” the buyer from seller, supply from demand.
In health care, the buyer (patient) cannot choose the seller (provider): the third party does. The buyer (patient) does not pay the seller (provider): the third party does. The seller (provider) does not choose the services provided: the third party—Washington—does. Sellers (providers) can set whatever prices they like but third parties will pay what they decide.
As a result of this disconnection, prices constantly rise, and care is delayed: death-by-queue.
Health Care Raison d’être
Health care systems exist to assure people get the medical care they need when they need it. Lowering costs or saving money is important only after timely care is available.
Before Obamacare, the average maximum wait time to see a primary care physician was 99 days. Afterward, wait times increased to an unconscionable 122 days.
The end-result of excessive wait times is death-by-queue. This happened to 752 Illinoisans, 47,000 veterans, and a 12-year-old boy, Deamonte Driver, who died of complications from a tooth cavity as no pediatric dentists in his area accepted Medicaid insurance.
Common wisdom says people with insurance get care and people without insurance do not. Common wisdom is dead wrong. History shows the exact opposite, seesaw effect: as the number of individuals covered by government-run insurance goes up, access to care goes down!
Democrats and the mainstream media hail the decrease in the uninsured rate from 15 percent in 2010 to 8.3 percent in 2021. Medicaid now covers 93 million Americans, 28 percent of the population. As more Americans have insurance, more people will reasonably expect to receive the care they need when they need it. They will be disappointed.
Staff Shortages
Shortages of doctors, nurses, and mental health professionals contribute greatly to death-by-queue. The reason for the shortages is cultural: intense frustration. Caregivers believe they are doing honorable work, healing sick people. Doing this used to generate immense psychic reward.
Caregivers naturally assume the system in which they do their noble work would help them. Instead of making their professional lives easier, government regulations and insurance rules constrain, obstruct, and penalize care providers.
Washington’s medical mandates and insurance controls have taken medical authority away from care providers. By “disconnecting” patients from their care providers, third parties deny those providers the psychic reward that would normally bring them to the operating room at 2 AM.
Root Cause of Death-by-Queue
Death-by-queue is the direct result of federal control of health care and the resulting BARRCOE: bureaucracy, administration, rules, regulations, compliance, oversight, and enforcement.
First, there is the regulatory burden. Time providers should spend with patients is consumed by regulatory and administrative compliance. This regulatory burden is largely responsible for physicians refusing Medicaid and other government-insured patients, and even for early retirement.
Second, there is “bureaucratic diversion” of money from clinical care to pay for BARRCOE. Every dollar spent on these non-clinical activities is a dollar taken away from patient care. Estimates of this expense range from 31 percent to more than 50 percent of all health care spending.
Prior to 1965, the U.S. expended 6.5 percent of gross domestic product on health care. Last year, it was 19.7 percent. The result of Washington’s unrestrained spending is death-by-queue and the impending bankruptcy of Medicare.
Shrinking Wait Times
To eliminate death-by-queue, we need to reconnect patients directly with doctors. Remove third parties—the federal government and/or insurance companies—from making medical and financial decisions for patients and stealing precious health care dollars from care.
Only by directly reconnecting patient with doctor, can “We the People” recover our constitutionally guaranteed freedom: patients’ medical autonomy!
Deane Waldman, M.D., MBA, (dw@deanewaldman.com) is a professor emeritus of Pediatrics, Pathology, and Decision Science at the University of Mexico; the former Director of the Center for Healthcare Policy at Texas Public Policy Foundation; and author of the multi-award-winning book, Curing the Cancer in U.S. Healthcare: StatesCare and Market-Based Medicine. A longer version of this article will appear this summer in Clinics in Nursing. Reprinted with permission
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