Roger.

Here's an interesting take on the possible unintended consequences of socialized medicine:

By the time of Weimar, German doctors had become accustomed to cooperating with the government in the provision of medical care. The reforms of the Weimar Republic following the medical crises of World War I included government policies to provide health care services to all citizens. Socially minded physicians placed great hope in a new health care system, calling for a single state agency to overcome fragmentation and the lack of influence of individual practitioners and local services. The focus of medicine shifted from private practice to public health and from treating disease to preventable health care. During the German “economic consolidation” of 1924-1928, public health improved under new laws against tuberculosis, venereal disease, and alcoholism, with new advisory centers for chemical dependency and counseling bureaus for marriage and sexual problems.

Medical concerns which had largely been in the private domain in the nineteenth century increasingly became a concern of the state. The physician began to be transformed into a functionary of state-initiated laws and policies. Doctors slowly began to see themselves as more responsible for the public health of the nation than for the individual health of the patient. It is one thing to see oneself as responsible for the “nation’s health” and quite another to be responsible for an individual patient’s health. It is one thing to be employed by an individual, another to be employed by the government.

Under the Weimar Republic these reforms resulted in clearly improved public health. However, the creativity, energy, and fundamental reforms found in social medicine during the Weimar Republic seem in retrospect a short and deceptive illusion. Medical reformers had wanted to counter the misery inherited from the first World War and the Second Empire on the basis of comprehensive disease prevention programs. In the few years available to the social reformers, they had remarkable success. But in connection with these reforms the doctor’s role changed from that of advocate, adviser, and partner of the patient to a partner of the state.

Where traditional individual ethics and Christian charity had once stood, the reformers posited a collective ethic for the benefit of the general population. Private charity and welfare were nationalized. The mentally ill, for example, having been literally released from their chains in the nineteenth century and placed in local communities and boarding houses in regular contact with others (the so-called “moral therapy”), were returned to state institutions to become the ultimate victims of state “solutions.”

With the world economic crisis of 1929, welfare state expenditures had to be reduced for housing, nutrition, support payments, recreation and rehabilitation, and maternal and child health. What remained of the humanistic goals of reform were state mechanisms for inspection and regulation of public health and medical practice. Economic efficiency became the major concern, and health care became primarily a question of cost-benefit analysis. Under the socialist policies of the period, this analysis was necessarily applied to the selection of strong persons, deemed worthy of support, and the elimination of weak and “unproductive” people. The scientific underpinning of cost-benefit analyses to political medical care was provided by the new fields of genetics and eugenics.