Whose Medical Decisions? Part IV
Thomas Sowell
Friday, August 21, 2009
The serious, and sometimes chilling, provisions of the medical care legislation that President Obama has been trying to rush through Congress are important enough for all of us to stop and think, even though his political strategy from the outset has been to prevent us from having time to stop and think about it.
What we also should stop to think about is the mindset behind this legislation, which is very consistent with the mindset behind other policies of this administration, whether the particular issue is bailing out General Motors, telling banks who to lend to or appointing "czars" to tell all sorts of people in many walks of life what they can and cannot do.
The idea that government officials can play God from Washington is not a new idea, but it is an idea that is being pushed with new audacity.
What they are trying to do is to create an America very unlike the America that has existed for centuries-- the America that people have been attracted to by the millions from every part of the world, the America that many generations of Americans have fought and died for.
This is the America for which Michelle Obama expressed her resentment before it became politically expedient to keep quiet.
It is the America that Reverend Jeremiah Wright denounced in his sermons during the 20 years when Barack Obama was a parishioner, before political expediency required Obama to withdraw and distance himself.
The thing most associated with America-- freedom-- is precisely what must be destroyed if this is to be turned into a fundamentally different country to suit Obama's vision of the country and of himself. But do not expect a savvy politician like Barack Obama to express what he is doing in terms of limiting our freedom.
He may not even think of it in those terms. He may think of it in terms of promoting "social justice" or making better decisions than ordinary people are capable of making for themselves, whether about medical care or housing or many other things. Throughout history, egalitarians have been among the most arrogant people.
Obama has surrounded himself with people who also think it is their job to make other people's decisions for them. Not just Dr. Ezekiel Emanuel, his health care advisor who complains of Americans' "over-utilization" of medical care, but also Professor Cass Sunstein, who has written a whole book on how third parties should use government power to "nudge" people into making better decisions in general.
Then there are a whole array of Obama administration officials who take it as their job to pick winners and losers in the economy and tell companies how much they can and cannot pay their executives.
Just as magicians know that the secret of some of their tricks is to distract the audience, so politicians know that the secret of many political tricks is to distract the public with scapegoats.
No one is more of a political magician than Barack Obama. At the beginning of 2008, no one expected a shrewd and experienced politician like Hillary Clinton to be beaten for the Democratic nomination for President of the United States by someone completely new to the national political scene. But Obama worked his political magic, with the help of the media, which he still has.
Barack Obama's escapes from his own past words, deeds and associations have been escapes worthy of Houdini.
Like other magicians, Obama has chosen his distractions well. The insurance industry is currently his favorite distraction as scapegoats, after he has tried to demonize doctors without much success.
Saints are no more common in the insurance industry than in politics or even among paragons of virtue like economists. So there will always be horror stories, even if these are less numerous or less horrible than what is likely to happen if Obamacare gets passed into law.
Obama even gets away with saying things like having a system to "keep insurance companies honest"-- and many people may not see the painful irony in politicians trying to keep other people honest. Certainly most of the media are unlikely to point out this irony.
Whose Medical Decisions?: Part III
Thomas Sowell
Thursday, August 20, 2009
Amid all the controversies over medical care, no one seems to be asking a very basic question: Why does it take more than 1,000 pages of legislation to insure people who lack medical insurance?
Despite incessant repetition of the fact that millions of Americans do not have medical insurance, hardy souls who have actually read the mammoth medical care legislation being rushed through Congress have discovered all sorts of things there that have nothing whatever to do with insuring the uninsured-- and everything to do with taking medical decisions out of the hands of doctors and their patients, and transferring those decisions to Washington bureaucrats.
That's called "bait and switch" when an unscrupulous business advertises one thing and tries to sell you something else. When politicians do it, it is far more dangerous to far more people.
Deception is not an incidental aspect of this medical care legislation, but is at the very heart of it.
That such a massive change of the entire medical care system, from top to bottom, was attempted to be rushed through Congress before the August recess-- before anybody in or out of Congress had time to read it all-- should have told us from the outset that we were being played for fools.
Despite President Obama's statements that he is not advocating a "single payer" system for medical care-- which is to say, a government monopoly of power over life and death decisions-- just a few years ago, he was telling a union audience that he was in favor of a "single payer" system. At that time, he pointed out that it was unlikely that such a system could be put in place all at once, that it might take a number of years to advance, step by step, to that goal.
In other words, Barack Obama fully understood the "entering wedge" political strategy that has allowed so many government programs to start off small, and apparently innocuous-- and then grow to gigantic size and scope over the years.
If telling us that he is not for a single payer system will soothe us into going along, then it is perfectly understandable why he said it. But that is no reason for us to believe him.
As for those uninsured Americans who are supposedly the reason for all this sound and fury, there is remarkably little interest in why they are uninsured, despite the incessant repetition of the fact that they are.
The endless repetition serves a political purpose but digging into the underlying facts might undermine that purpose. Many find it sufficient to say that the uninsured cannot "afford" medical insurance. But what you can afford depends not only on how much money you have but also on what your priorities are.
Many people who are uninsured have incomes from which medical insurance premiums could readily be paid without any undue strain. But they choose to spend their money on other things. Many young people, especially, don't buy medical insurance and elderly people already have Medicare. The poor have Medicaid available, even though many do not bother to sign up for it, until they are already in the hospital-- which they can do then.
Throwing numbers around about how many people are uninsured may create the impression that the uninsured cannot get medical treatment, when it fact they can get medical treatment at any hospital emergency room.
Is this ideal? Of course not. But nothing is going to be ideal, whether the current medical care legislation passes or not. The relevant question is: Are the problems created by the current situation worse than the problems that will be created by the pending legislation? That question never seems to get asked, much less answered.
No small part of our current medical care problems have been created by politicians who drive up the cost of medical insurance by mandating that insurance cover things that many people are unwilling to pay for.
Many of us are willing to pay for treatment of a sprained ankle ourselves, if we can get less expensive insurance to cover us just for catastrophic illnesses. But that is one of many decisions that politicians have taken out of our hands. There will be many more decisions taken out of our hands if Obamacare passes.
Whose Medical Decisions? Part II
Thomas Sowell
Wednesday, August 19, 2009
When famed bank robber Willie Sutton was asked why he robbed banks, he said: "Because that's where the money is."
For the same reason, it is as predictable as the sunrise that medical care for the elderly will be cut back under a government-controlled medical system. Because that's where the money is.
My experience is probably not very different from that of many other people in their seventies. My medical expenses in the past year have been more than in the first 40 years of my life-- and I did not spend one night in a hospital all last year or go to an emergency room even once.
Just the ordinary medical expenses of keeping an old geezer going along in good health are high. Throw in a medical emergency or two and the costs go through the roof.
So long as my insurance company and I are paying for it, it is nobody else's business what my medical expenses are. But once the government is involved, everything is their business.
It is not just a question of what the government will pay for. The logic of their collectivist thinking-- and the actual practice in some other countries with government-controlled health care-- is that you cannot even pay for some medical treatments with your own money, if the powers that be decide that "society" cannot let its resources be used that way, or that it would not be "social justice" for some people to have medical treatments that others cannot get, just because some people "happen to have money."
The medical care stampede is about much more than medical care, important as that is. It is part of a whole mindset of many on the left who have never reconciled themselves to an economic system in which how much people can withdraw from the resources of the nation depends on how much they have contributed to those resources.
Despite the cleverness of phrases about people who "happen to have money," very few people just happen to have money. Most people earned their money by supplying other people with goods or services that those people were willing to pay for.
Since it is their own money that they have earned, these people feel free to spend it to give their 80-year-old grandmother another year or two of life, or to pay for a hip replacement operation for their mom or dad, even If some medical "ethicist" might say that the resources of "society" would be better used to allow some 20-year-old to talk over his angst with a shrink.
Barack Obama has talked about the high costs of taking care of elderly or chronically ill patients in terms of "society making those decisions." But a world in which individuals make their own trade-offs with their own money is fundamentally different from a world where third parties take those decisions out of their hands and impose their own notions of what is best for "society."
Calling these arbitrary notions "ethics" doesn't change anything, however effective it may be as political spin.
More is at stake than the outcomes of medical decisions, extremely important as those are. What is also at stake is freedom and the dignity of individuals who do not live their lives as supplicants of puffed-up power holders who are spending the money taken from them in taxes.
One of the many phony arguments for government-controlled medical care is that Americans do not have any longer life expectancy than in other countries, despite much higher medical expenditures.
This argument is phony because longevity depends on health-- and "health care" and "medical care" are not the same, no matter how many times the two are confused in the media or in politics. Health care includes things that doctor cannot do much about.
Homicide affects your longevity but there is not much that doctors can do about it when they arrive on the scene after you have been shot through the heart, except fill out the paperwork. Rates of homicide, obesity and narcotics usage are higher here than in many other countries, reducing our longevity.
But in the things that medical care can do something about-- like cancer survival rates-- the United States ranks at or near the top in the world. But that can change if we give up the real benefits of a top medical system for the visions and rhetoric of politicians.
and the first one...
Whose Medical Decisions?
Thomas Sowell
Tuesday, August 18, 2009
There was a time when rushing a thousand-page bill through Congress so fast that no one has time to read it would have provoked public outrage. But now, this has been attempted twice in the first 6 months of a new administration.
The fact that they got away with it before, with the "stimulus" bill, may have led them to believe that they could get away with it again.
But the first bill simply spent hundreds of billions of dollars. The current "health care" bill threatens to take life-and-death decisions out of the hands of individuals and their doctors, transferring those decisions to Washington bureaucrats.
People are taking that personally-- as they should. Your life and death, and that of your loved ones, is as personal as it gets.
The mainstream media are again circling the wagons to protect Barack Obama, but this time it may not work. One of those front-page editorials disguised as a news article in the New York Times begins: "The stubborn yet false rumor that President Obama's health care proposals would create government-sponsored 'death panels' to decide which patients were worthy of living seemed to arise from nowhere in recent weeks."
Nowhere? Dr. Ezekiel Emanuel is "Special Advisor for Health Policy" for the Obama administration. That's nowhere? He is also co-author of an article on Americans' "over-utilization" of medical care in the June 18, 2008 issue of the Journal of the American Medical Association. Is that nowhere?
Dr. Emanuel's article points out that Americans do not visit doctors or go into hospitals more than people in other industrialized countries. In fact we go to both places less often than people do in those other countries, which include countries with government-controlled medical care.
As the article points out, "It is more costly care, rather than high volume, that accounts for higher expenditures in the United States."
There are more Magnetic Resonance Imaging (MRI) devices per capita in the United States, more coronary bypass operations and Americans use more new pharmaceutical drugs created within the past 5 years.
Americans also have more of what the article calls "amenities" with their medical care. "Hospital rooms in the United States offer more privacy, comfort and auxiliary services than do hospital rooms in most other countries."
In other words, it is not quantity but quality that is different-- and more expensive-- about American medical care. This is what Dr. Emanuel's "over-utilization" consists of.
At one time, it would have been none of Dr. Emanuel's business if your physician prescribed the latest medications for you, rather than the cheaper and obsolete medications they replaced. It would have been none of his business if you preferred to have a nice hospital room with "amenities" rather than being in an unsanitary ward with inadequate nursing care, as under the National Health Service in Britain.
The involvement of government gives Dr. Emanuel the leverage to condemn other Americans' choices-- and a larger involvement of government will give him the power to force both doctors and patients to change their choices.
As for a "death panel," no politician would ever use that phrase when trying to get a piece of legislation passed. "End of life" care under the "guidance" of "some independent group" sounds so much nicer-- and these are the terms President Obama used in an interview with the New York Times back on April 14th.
He said, "the chronically ill and those toward the end of their lives are accounting for potentially 80 percent of the total health care bill out there." He added: "It is very difficult to imagine the country making those decisions just through the normal political channels. That is why you have to have some independent group that can give you guidance."
But when you select people like Dr. Ezekiel Emanuel to give "independent" guidance, you have already chosen a policy through your choice of advisors, who simply provide political cover. The net result can be exactly the same as if those providing that guidance were openly called "death panels."
Copyright © 2009 Salem Web Network. All Rights Reserved.
No comments:
Post a Comment