Wednesday, July 7, 2010

Health is the War of the State

In all of the discussion swirling around ObamaCare – as with its ill-starred predecessor, HillaryCare – one seldom sees any serious consideration of the problem of limits – i.e. limits in the quality or quantity of care that must sooner or later be imposed, either willingly or otherwise. And it's not that this issue has been totally ignored by the health care commissars – it's just that it never comes up in general discussion. The only exception to date has been Sarah Palin and some of the “tea partiers” who started worrying out loud, a while back, about “death panels”. Well, this was based on a real provision in the legislation – only the name was changed to make it a better political hook. But the point, again, is that either we put some limits on health care or those limits are imposed on us – by reality. Whoever deals life, and health, ultimately has to deal death as well – that's what socialized medicine is all about. Decisions that have been made by patients and families for eons will now be made by the state – and its considerations will be remarkably non-sentimental. And yet that is the reality of the situation. You won't have a group of your friends and neighbors standing around your bed deciding whether you should live or die, like in some Shirley Jackson novel; instead it will be a bureaucrat you've never met, in a place you've never heard of, who will make the decision. Some might find this comforting, but I get a distinct “Brave New World” feeling out of the whole thing. For one thing, who, besides myself and a few people who know me well, are qualified to make judgments about my “quality of life”? Yet you can be sure that this will all be boiled down to metrics, in a thick manual, that said bureaucrat will keep on his or her desk for ready reference.

Now, as to how we came to this sorry pass, it's all based on the premise that it's the government's job (among many) to see to it that every citizen receives the best available health care throughout their entire life, regardless of cost. (Once they've managed to avoid being aborted, that is.) That's really it in a nutshell. Now, to say this is nowhere in the Constitution would be the understatement of the century – which is why Nancy Pelosi had a hissy fit in public when she was asked that question. Of _course_ it's not in the Constitution – but that's not going to stop us from making it into the law of the land. The only problems with the premise of “the best available health care for all for life” are (1) it's impossible; (2) just the attempt will bankrupt the country and the citizenry; and (3) it's based on the most costly medical model there is.

Why is it impossible? Well, health care, like every other human activity in the material realm, is based not only on laws of supply and demand, but on a sort of pyramid with the best care (Mayo Clinic level) at the top – high expense, and therefore low demand, and therefore low supply – and the most rudimentary care (DC General ER level) at the bottom – low expense, high demand, high supply. What is proposed now is to flatten that pyramid so that all that is left is the very top, which has to grow to accommodate the entire population – and while this could be done in theory (every hospital, clinic, and ER a Mayo Clinic) I doubt if we could ever find the personnel suitable to man it, at any price... and it might not even be possible to acquire that much exotic and specialized equipment, again at any price. And we would already be talking about more money than there is in the entire country – and this for what the “reformers” call “basic health care that everyone is entitled to”, by which they mean the very best for everyone... or at least giving everyone the same level of health care, even if it's not the best. (Sort of like the radical bumper sticker that says, “No one gets two houses until everyone has one.”) (I wonder what Ted Kennedy, John McCain, and John Kerry thought of that one.) So rather than being left with the gleaming, golden top of the pyramid, which miraculously grows to cover the entire landscape, we are more likely to wind up with only the bottom layer – every hospital, clinic, and ER a DC General, just like in England or Canada.

Now, the medical model issue just aggravates the situation. The model universally favored by nearly all health plans, and therefore by the government, is what's called the “standard” or “conventional medicine” model – AKA allopathic medicine, symptom-oriented, disease-oriented, and so on. This is the model that the AMA represents, and that has dominated American medicine for at least a century now – and it stands in stark contrast to “alternative”, “holistic”, or “natural” models, which include things like naturopathy, chiropractic, homeopathy, herbal, acupuncture/acupressure, and so on – all those things that just about died out, but were revived, thanks in large part to the hippies (and, I admit with head hung low, to some of the more sincere liberals). One of the more striking things about the world of holistic medicine is that it treats underlying causes rather than just symptoms – and it is just as concerned with keeping people healthy (through nutrition, exercise, etc.) as with treating sickness. Another striking thing is that it's relatively inexpensive. But here's the rub. With a typical American “health plan”, you can either go to a holistic practitioner and get a $50 treatment that will not be covered, or to an M.D., clinic, or hospital for a $1000 treatment (for the exact same ailment or symptoms – and no more effective, maybe less) that will be covered. So which do you think most people will choose? Plus – and I see this in Pittsburgh all the time – patients of M.D.s wait until they're really sick, or feel lousy, or are injured, before they go to the doctor... and the chances are he won't “get on their case” about the unfortunate life style choices that led them to their current ill state – after all, diseases “just happen”, right? They just attack, out of the blue, like “heterosexual AIDS” was supposed to do. And aren't we bombarded, every day, with messages from the MSM debunking everything we thought we knew about nutrition, exercise, and supplements? It's all part of the same plan to get us to ignore our bodily needs – a sort of modern-day Manichaeism. Just leave it to the experts (or bureaucrats) and all will be well. And ignore those cranks who try telling you that you're only living half a life, that you're satisfied with being, basically, sick all the time. The attitude partakes of the longing for arbitrary but all-powerful authority that seems to have infected Americans over the last few decades – a wish to return to infantile dependency and non-responsibility, and leave it all up to the “nanny state” (as exemplified by Hillary Clinton... brrrrr...).

What I'm saying is that health care in America is a government-supported (by both money and law) monopoly, and, in many respects, a racket. And this does not mean that it has no worth – far from it. Our emergency medical technology is the envy of the world (even though much of it was developed as a result of wars we shouldn't have been fighting). But it's as if the government supported and subsidized Chrysler and GM and let Ford sink or swim on its own. (oops... )

But politics and social history aside, the fact remains that the species of health care that is envisioned in the ObamaCare package is the most expensive of all the possible choices – and yet it is the only one that is “approved”, without reservation, by massive bureaucracies like the Department of Health and Human Services and the VA. And there is, of course, much money to be made by providing those particular types of goods and services – which is why they are preferred by the business community, and therefore by their servants in the government. You see this with every battle that breaks out between “conventional medicine” and its alternatives – despite all the propaganda, it ultimately boils down to money. That, and power – over the lives of the citizenry. The sine qua non of the collectivist state is its control of health care; they have all done it, and done it as soon and as thoroughly as possible, going back at least as far as the Bolshevik Revolution. Our own Progressives, so-called, had health care high on their list of things about America that needed to be reformed – and the funny thing is, health care in America has been “reformed” any number of times, but apparently none of that was enough, and we need to go at it again (just as with the public schools, which can never be given enough money to succeed even though they've been in business since the days of Horace Mann).

And I daresay that even ObamaCare, with all the cynicism and back-room dealing and threats that have accompanied its formulation, contains within it the occasional dollop of genuine charity – or at least humanism. (There are, apparently, a few liberals out there who actually think this stuff works. They're the ones who think Nina Totenberg is a reincarnation of the goddess Isis.) But it is, by and large, a massive power (and money) grab... but the good news is, it can't possibly work. There is literally not enough money in the United States to pay for everything ObamaCare intends to pay for. (I mean, prior medical history not relevant? Please. So I'm going to be in the same insurance pool as someone who had their first heart attack at age 18.) Now, if they were willing to envision a much broader concept as to what constituted health care, it might be possible to actually make some substantial improvements at a relatively low cost. Consider pre-natal care, for instance (or the lack thereof, which may explain the problems of our “inner cities” and other “poverty pockets” better than any other single factor). So much can be done for so little cost – but again, that's precisely the point. Nothing is going to be written into law that does not also add up to massive profits for one or more of the preferred industries that have been so generous with their campaign contributions. And our farmers are too busy growing corn for ethanol to worry about what's good for human consumption.

So what I'm saying is that collective health care where the government is the single payer is, actually, impossible (not only as envisioned, but as already written into law and passed by Congress) – but it's more impossible given the medical model behind it than it would be otherwise. Not only that, but guess what – the cutting edge of this impossibility is going to be what is euphemistically termed “end-of-life care”. As the plan is being presented now, Joe Snuffy, the retired pipe fitter, is going to enjoy just as many drips, tubes, scanners, pumps, and other gadgets during his last days as Ted Kennedy did. All I have to say is, “Lots of luck, Joe!” What will – what must, inevitably – happen is that, at some point, a “cost-benefit analysis” will be done as to the advantages vs. disadvantages (to the system, not to Joe Snuffy or his family) of keeping Joe alive – and the decision will determine whether or not the “plug” is pulled. (But wait, what if this had been applied to Ted Kennedy? Or Robert Byrd? Maybe I should quit talking right now.)

And please note that – in line with the above discussion of medical models vs. health care costs – the vast majority of “end-of-life decisions” would not have been available up until quite recently. The Progressives, who were so concerned with public health, would never have heard of them (because they didn't exist), and neither would the New Dealers, by and large. I can remember when it was the usual thing for people over 80 to die of “old age” -- unlike now where there always has to be an expensively-treated cause. It has only been in the last decade or two that there was a real, tangible choice between letting someone die a (relatively) natural death and keeping them hooked up to machines costing $10,000 a day in order to extend their lives 10 days (mostly in a coma) and racking up a cool $100,000 in medical bills. Now, doesn't this strike you as the sort of thing that could be abused – that, in fact, veritably invites abuse? It is, and it has. How many women have spent the family's life savings in the last two weeks of their husband's life, just in order to keep Old Fred around a bit longer (even though he was about as conscious and lively as a Halloween pumpkin in mid-November)? And there is no one around to tell her that that's a bad idea; even Old Fred would be appalled – but he doesn't have a whole lot to say at that point. Now, under ObamaCare, this problem will be solved, in short order, by the “death panels that aren't called that”. (Sort of like “The Knights Who No Longer Say 'Nee!'” or “The Rock Star Formerly Known as Prince”.) Since it's the government's money we're talking about, and since the system is going to be bankrupt about 5 minutes into implementation, they're going to sit down – and not with Old Fred's wife, either – and come up with something, and fast. And ironically, that “something” may turn out to be a return to a more natural way of death for more people than what we have now – i.e. something like palliative or hospice care, rather than having people live their last days as part of a machine, like some hapless blob out of a science fiction movie. This would, truly, be an unanticipated consequence – a small dose of humanity in an otherwise humanity-crushing system.

But the main point is that none of these very real possibilities is open for discussion by the health-care bureaucracy, Congress and all its committees, or the administration. It's being handled like a dirty secret that everyone knows but no one wants to talk about – kind of like the way cancer used to be handled in the old days. The problem is, if they came out and admitted that this was a real issue, the public's shock and horror at the realization might cause a backlash against ObamaCare – or let's say, more of one than there is already. And surely we can't have that. So the legislation gets passed and a vast bureaucracy starts to form, like an oil blob in the Gulf – and sooner or later, mark my word, we are in fact going to have “death panels”, or whatever they'll be called... and everyone will be dismayed, but if they had thought about it more at this point it could all have been avoided – not death per se, of course, but the bizarre spectacle of paper-pushers in Washington getting to determine when your number is up. And better still, the fond illusion of “the best health care in the world for every citizen throughout their life” would be exposed for the delusion that it is.

1 comment:

LINUX FONT said...

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