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A little dance on the role of government in health care

When it comes to health care, the only thing I know for certain is this; that despite your best efforts and all that modern technology has to offer, your fate is that you will get sick and die. 100% of the time, the end result of our lives is exactly the same for all of us. What we share as a species is the fact that no matter who you are, no matter your station in life, the very best you can hope for in life is to simply go to sleep one night and die comfortably unaware of your demise.

So, with that in mind, here is how I tend to break down the “health care conundrum”. Who should be responsible for my health care and why should they do it? I tend to think of the various solutions that exist along the lines of a “spectrum”. At the low end we have “Do Nothing” and at the high end we have “Do Everything”.

Let's examine this spectrum in some detail.

The “Do Nothing” option. Since it can be argued with some certainty that you will die, then it can also be argued that any health care at all is futile and a waste of time and resources. I tend to disagree with this option as I myself have survived several life threatening events like a burst appendix, which with the application of a moderate amount of health care allowed me to continue life beyond the 17 years I had lived at that time it occured. The use of the “Do Nothing” ethic also would have stopped the love of my life from existing at all, since she was born premature and without any health care, she would most certainly have died before her first few days of her life were complete and that would have been a true loss to the world and most devastating loss to me. Also, since I am of the first generation of humans to not live in the shadow of terror that came to all previous generations from polio, measles or half a dozen other all to common things that used to slaughter humanity with impunity; it would seem rather spoiled of me to reject all of what medical science has done since then and say “Ah screw it, rather than clean our wounds with antiseptics, lets all just die of septis instead because you know, were all going to die anyway, right?” So, while there is a pure scientific argument that can be made about zero health care, it can also be shown that it is somewhat silly to think that way, because vaccinations work, antiseptics work, diet works and as such allows the sick to get well and the near dead to go on living where just a short time ago, we would have simply died from things we can now cure easily and cheaply.

Now that we’ve examined (and dismissed) the lower end of the spectrum, let’s go to the other end of the argument the “Do Everything” option.

Unlike the “Do Nothing” option, this one is emotionally hard to walk away from because we are living things, and as living things we tend to strive for life. It’s the nature of everything with DNA to try to stay alive. Emotionally, we want every possible option there is to for us to be able to stay alive, no matter how expensive, no matter how small a chance there is that we understand intellectually to be in a solution to stay alive, we will still want it.

However, if we say we really want this option, we need to ask ourselves “who should go without, so that I can live”? Health Care resources are not infinite and under no “real world” plan could they ever be made to be; there simply are not an infinite number of beds, doctors nurses, gallons of plasma, sheets, operating room lights, ambulances, janitors and so on. They have to be parceled out along some sort of plan and some sort of priority basis; else you would have an oversupply of janitors and an undersupply of surgeons. If you think that you should go first to the front of the line in this decision of "who lives and who dies", then you need to ask yourself “who should go last?” Should my children spend all of their money and live destitute just to keep me alive? Should my neighbors forfeit their property just so I can stay alive for another week, a month or a year? How long is their obligation to my ill spent (in their opinion) life? “Do Everything” actually does have a limit and the limit is set by the bookend called “within reason”. The question that most people find themselves asking about this is “who gets to set that standard of “reason”? Is it Me? My Family? The Doctor? The insurance company? The Government? And this is the problem with “Do Everything” because it’s not entirely up to you, its up to those whom you yourself empower with your life and health. If you are the only person involved with your health care, then the “Do Everything” option is limited only by you and your own resources. But can you operate on yourself? Can you create and design medicines? Well, probably not, so you have to get other folks involved in the process.

The traditional method that humans use to fill a gap in what they have for what they want is to trade something they have for something else. Since the time of the Hittites, we have found it convenient to trade money for labor and resources. So one metric that limits “Do Everything” is how much money you have to trade to accomplish your goal of staying alive. When we think about this, let's try to remember that all of these people engaged in health care are not doing it as a hobby, they are spending a great deal of time and resources just to be able to provide this service to the world. It takes a great deal more time and skill to create a nurse or doctor than can be accomplished on Saturday afternoon at the Learning Annex, therefore, they tend to be in short supply.

The people that work in the health care industry are doing it partially because they believe they are helping people in the process, but they are also doing it because they can trade their skills and time for money and with that money, they can go on to live their lives as they see fit, to buy curtains, or go on vacation in the Bahamas or perhaps even breed and create little doctors and nurses as well. They need money to get paid to them so that they can pay for their homes, their families wants and needs, their food, and yes, their own health care because even the best surgeon in the world finds his own Proctology to be something that is beyond his own reach.

Some people are greatly offended by this idea of trading money for health, saying that its not fair that those with lots of money can get more care than those without. I say that if you recognize that people in the health care industry deserve to be paid for their skills and that people who make the goods that are used in health care deserve to be paid for the effort and that the people who create the buildings and infrastructure that will become hospitals and clinic, also deserve to be paid for their work; then we are more in agreement than the "money is bad" people probably realize. If you are arguing instead for a fundamental “fairness” of the world, then you are arguing for a whole series of things that go far beyond health care and start to become the purvey of the discredited ideas of Mr. Marx ( Karl, not Groucho. Karl was a moron on the same scale as L. Ron Hubbard, where Groucho was a genius. One would be better served by the ideas of the latter rather than the former, and if history had listened to Groucho instead of Karl, there would be far fewer mass graves throughout the world).

It is no more fair to say to doctors and nurses that money should not be used in health care than it would be to say to Farmers, Fishermen and and Stockmen that you shouldn’t have to pay for food. Farmers, Fishermen and Stockmen around the world will understand the true nature of what I’m saying here, in that there is nothing more expensive than something that is “free” and that life itself, it has been said many times by many people, is not fair.

So, the “Do Everything” option is limited, if not by your own resources, then by those whom you bring into the decision. Should your family decide? Well, if you let them, then they will and they will make that decision like all humans do, based on what’s in their best interest, ( which sometimes is shockinging to discover that their interests are not the same interest as yours). If they like you and you have a good relationship, then you can be somewhat assured that you will be dealt with properly but as someone who himself doesn’t trust his own relatives with his car much less his life, this option provides me with no real comfort whatsoever.

Should the insurance company decide? Well yes, if you have insurance, then you have a contract that you honor by paying the premium and they honor by the terms of coverage. They are bound by contract to observe the terms of that contract. However, if the insurance company is silly enough to sign a contract that essentially has no bounds on the level of carewell then! good for you!, but the likelihood of that company surviving the economics of providing a subscriber with "never ended care" is very small. Worse still, by you insisting on “Do Everything” and then trying to force the insurance company to provide it, you will have limited a large number of other people from having a “Do Something” option from the same company. Its that old “finite resources” problem again. If I give you everything, it costs a great deal for everyone else to pile it up for you (and exactly who are you anyway?).

So what about the Government? Shouldn’t they decide? Well, what is the obligation of Government? Is it to keep you alive or to provide for the general welfare of the citizenry? If we agree that you will get sick and die, then the government cannot be obligated to simply keep you alive in all situations and circumstances, in fact history has repeatedly shown that just the opposite is true. History shows that what Governments are obligated to do by the rest of the healthy citizenry is to keep you from being a drain on the finite resources or in your declining health from becoming a risk to the rest of the population. You, as the individual and your “quality of life” are the last thing on the agenda of Government. If you are sick and no longer paying taxes, then you are an expense, and as is in the universal nature of all human governance systems, you will become a problem to be solved and all governments exist to eliminate problems.

If you are also a member of a minority, a religious, racial, political minority from the government or the populace, you will have little satisfaction on the idea of the government acting as an arbiter for your care. If you want an example of Government health care when the individual is not in control of the decisions being made, visit any Indian Reservation or spend a day at the VA. When you are given the fact that all modern government sponsored health care systems were started as an offshoot of the 1890’s eugenics movement, with what was then called “progressive” idea that it would improve mankind by basically killing off or sterilizing large portions of the citizenry who were deemed by "The Government" to be “undesirable, feebleminded, somehow less than whole”, then you can understand why I find idea of the government being involved with my health care decisions, fundamentally repulsive. So again, what is the role of government in my health care? Should "The Government" fulfill a role in with my life that I wouldn’t allow my mother-in-law to do?

Hardly.

Government does have a role in health care, but I want to make sure that the role is a small as possible. It should set standards, set training guidelines and licensing, even allow and adjudicate some form of legal redress, but should it decide who lives and who dies? It makes me shudder to think that there are so many out there who think that it should. The collective history of 7,000 years of organized human history is rife with examples of why that’s always a bad idea.

On the other hand, if I let the government pay for my health care, If I surrender my rights for the childlike and unattainable dream of “Do Everything” then what right do I have to argue when they say that they have done everything they can and I "should go"? If I surrender my right of life to "The Government" for a "cost vs. benefit" evaluation then what does that make me? Is this not THE fundamental “Quality of Life” issue the issue of should I live at all and who is it that makes that decision?

So, in the middle of the spectrum from "Do Nothing" to "Do Everything" is a spread that goes somewhere between “What can I do?” and “what can I afford to pay someone else to do?”. I am not one of those who lives his life like he will live forever and I will not find myself disappointed when I discover that the end is near (for all I know, it probably is even as I write this). As I said, we, the living – die; each and every one of us, without exception. So what can we do in the mean time? And this is where I think that this phrase "quality of life" comes into play because what I think we really want is not “insurance” but “cost containment”. To put it simply, I don’t want to go broke in the process of staying alive.

By myself, as an individual I cannot get the Bayer company to create something as simple as Aspirin because I don’t have enough capital incentive for the Bayer Company to do that just for me. But if 400 million of other headache sufferers all say: “ Hey man! I got a headache and I’m willing to pay someone to get something that makes it go away !” then I can bet that the marketplace, of which Bayer is just a part, will crawl all over themselves to get me a solution. This is as I’ve said before how Humans has solved problems since the time of the Hittites. You have something that you want to get, and I’ve actually got that “something” that you want, so we sit down and trade each other something for it. Anything else other than simple commercial trade, is really just some form of collective coercion and governmental tyranny.

As a consumer, I can walk down the pharmacy aisle and see that I’m correct in this observation. We live in a society where there are 400 brands of toothpaste, competing for my toothpaste dollars, not because its “fair” or the government has decided that everyone has a right to good teeth or that there are companies that are mandated to create and sell toothpaste to me. We have 400 brands of toothpaste because the people who are good at making toothpaste have found out what people with teeth want to buy and the people who want to buy toothpaste are free to choose what toothpaste they desire to buy.

It needs to be said, that not every human society that exists on earth today, or at any time in the past, has ever had such wide choices in the marketplace. The choices what to buy and how much to spend on it is almost entirely left in the hands of its citizenry. With 400 brands to choose from, if you make toothpaste, you need to make really good toothpaste for a very low price or you wont make toothpaste for very long. Until recently, there were few toothpaste options for the individual to buy but now we have 400 brands to choose from, and overall they are pretty damn cheap.

What I want out of "health care" is more of that. I want doctors and hospitals competing to keep me as a customer because that will be the single best proven method to actually contain the cost of health care. Notice I didn’t say “Insurance”, because our primary premise is that you will die, therefore you cannot “insure” against it like you can insure against fire, with the application of building codes and the assessment of premiums. But for that to happen, I have to decide that its my responsibility to take care of my own health, good or bad, and not the responsibility of the neighbors next door or that pack of rabid, wild dogs who live next to the Potomac River who call themselves "The Congress of the United States".

Good or bad my life is my own. You roll the dice, you take your chances and there are no guarantees one way or the other how it will all turn out. My family has a role to play in my quality of life decisions, just as they do in everything else in my life, but in the end, its my choice how I live or die and it should remain exactly as such. I will allow my insurance company to be involved only as far as I have contracted them to help me, but in the end, my life is my own. If they choose not to honor the contract we have agreed to, well, so be it. I can reasonably expect them to honor their end of the bargain and I can legally hold them to it to the best of my abilities, but I cannot expect them to go bankrupt in the process of taking care of me. If such a thing were to be mandated I would find it offensive that I should, in my own desire to live, steal so much from others who could have found care from that insurance company had I not destroyed it, so I could go on living. It would be wrong to demand life for myself when it could be given to me only at the expense of other peoples lives.

I ask only that while I am alive that I am left in a condition of as much liberty as I see fit to use and as much as I can handle responsibly. For my health, I do not want everything that can be done to be done, I only want everything that can be reasonably done with the resources that I have at hand. I have no essential right to expect anything else.

Posted @ August 29, 2008 07:25 AM | Current Affairs

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