Jewish World Review Sept. 12, 2003 / 15 Elul, 5763
Drs. Michael A. Glueck & Robert J. Cihak
Why do human beings co-operate in their own destruction?
The question has been asked many times, about many human disasters - from
great republics whose citizens surrendered their liberties - to innocents
who walked into gas chambers.
Many answers have been adduced: inability to resist, fatalism, the belief
that some emergencies require stern but "temporary" measures. But perhaps
the most common reason why people choose slavery is the belief that -
despite all the evidence of history and all the force of logic and common
sense - they're going to get something out of it: they'll benefit.
In the August 13th issue of the medical journal JAMA, an article
appeared that must rank as one of the great historical examples of how
people talk themselves into subjugation and disaster. The "Proposal of the
Physicians' Working Group for Single-Payer National Health Insurance" is so
odious, so evil, and so utterly illogical in so many ways that it's hard to
know where to start dissecting it - or to conquer the queasiness
sufficiently to get started. These are its main points:
Let's dispose of the obvious first.
- "Access to comprehensive health care is a human right. It is the
responsibility of society, through its government, to ensure this right. . .
- "In a democracy, the public should set health policies and budgets. Personal
medical decisions must be made by patients with their caregivers . . ."
- "A single public plan would cover every American for all medically-necessary
services . . . Unnecessary or ineffective services . . . would be excluded
form coverage. . . . The NHI (National Health Insurance) program would pay
each hospital a monthly lump sum to cover all operating expenses. The
hospital and the regional NMI office would negotiate the amount . . .
[doctors could choose among payment "options"]"
- "Only a single comprehensive program, covering rich and poor alike, can end
disparities . . ."
Rhetoric and the United Nations notwithstanding, there is no enforceable
American "right" to "comprehensive" medical care. Legally, such medical care
would be an entitlement. Which means: You get what the government gives you.
The notion that an abstraction called "the public" will set policies and
budgets is ludicrous; disclaimers notwithstanding, the government will. And
those who set policies and budgets will determine who gets what, regardless
of doctor/patient desires - especially when the government determines that
something you desperately need is "unnecessary."
Equally ludicrous is the notion that the best way to provide medical care
for the poor is to assume responsibility for everybody, including the vast
majority who neither need nor desire state medicine. "Equality" in health
care is impossible and pernicious; no two patients are alike.
Where medical practice follows the preaching of these medical egalitarians,
medical treatment for those with "incurable" or simply expensive medical
conditions, this "equality" formula very often computes to a simple
solution: death. And this death usually comes sooner rather than later,
sometimes even before birth.
Medical caregivers and the government will "negotiate" payments?
Economically, "single payer" is a "monopsony," that is, one buyer controls
the market. If you want to see a monopsony in action, just ponder the
so-called Military-Industrial Complex. How do the sellers respond to the
ever-changing priorities and whims of the single buyer, in this case the
Pentagon and the Congress? By endless duplicity and mendacity, by shady
dealings and sweetheart relationships, by distortion and outright corruption
and dreadful inefficiency.
And finally, if you don't like what you're getting, as a doctor or a
patient, what is your recourse? Where else can you go?
Nowhere - unless you're wealthy enough to escape to a foreign country where
you can buy services with your own money, as many Canadians and other
foreigners already do.
But there's an additional problem, which the advocates of state medicine
rarely bother to acknowledge. The American economy already groans under
unsound government policies and regulations. Social Security and Medicare
cannot be sustained, let alone expanded, in their present forms. (These were
based on the assumption that we'd breed fast and die young. Now we do the
opposite). Our manufacturing and many sectors struggle under increasingly
complex and increasingly wasteful regulations. The federal deficit is
skyrocketing, thanks to our foreign adventures. Were America any other
country, we'd be in receivership.
It can't go on. And handing the medical economy, already one-seventh of the
GDP, over to the government will only hasten the reckoning.
In sum, those physicians who wish to spend their lives as government
apparatchiks are welcome to do so; there are many opportunities, such as in
the service of domestic and foreign governments; many of these wannabe
apparatchiks admire foreign medical systems - but not to the point of
actually hiring on full-time.
But those physicians or patients who expect to benefit from hastening the
inevitable day of economic reckoning - and those who would destroy medicine
in the name of nonexistent rights and spurious equality - should have the
honesty to call such slavery by its proper name.
Michael Arnold Glueck, M.D., is a multiple award winning writer who comments
on medical-legal issues. Robert J. Cihak, M.D., is a past president of the
Association of American Physicians and Surgeons and a Discovery Institute
honorary fellow and board member.
JWR contributors are Harvard trained diagnostic radiologists.
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