Health Care Or Armageddon?

September, 2009 Feature--Truth Based Logic

Thoughts on the almost frenzied pursuit of uniformity in personal health care, under the guise of addressing a crisis. The Federal role in soaring medical service costs. Doctor/Patient or Master/Slave.

The current American debate, triggered by President Obama's proposal for radical "Health Care Reform," would offer all the potential for Swiftian satire that any droll humorist might desire--were it not for an ongoing, but progressive, tragedy. This is evident, both in what is being discussed & what is not being discussed, even in the most spirited exchanges.

Consider the endless gabblings by Mr. Obama, Mrs. Pelosi & others about a "Crisis" in health care in America. Yet while most Republicans now challenge the proposed Obamanist remedy, many meekly concede that some additional Federal involvement is "necessary." Yet the Crisis, which for hysteria, at least, is beginning to suggest almost a contemporary Armageddon, is not in "health care." The Bubonic Plague was a Crisis in health care. To an extent, the Flu Epidemic at the end of World War I was a Crisis in health care. So, certainly, was the situation after every major battle in the tragedy that wracked America in the earlier 1860s--the horror captured in the Atlanta Rail Yard scene in the film classic, "Gone With The Wind." But that is not what Mr. Obama & Mrs. Pelosi are gabbling about. Nor, if one would be precise, are the gaggling echoes amongst Mr. Obama's slavering supporters in the media, really about the outrageous inflation in the cost structure of American health related services, since Congress went "all the way with LBJ."

There is certainly no "Crisis" in the fact that a significant segment of the population is without health insurance. Throughout most of the medical history of mankind, the concept of medical or health insurance was unknown. Nor does the present availability of insurance, create an inalienable right to be provided with same. The absurdity of Obama-contrived hysteria on the subject is easily seen in a basic analysis of function. What is any form of insurance, but an expense incurred to narrow the parameters of future risk. Health insurance does not reduce the amount of money Americans spend on "health care"; in a macro sense, it actually increases such. The benefit to an individual is simply in that narrowing of parameters of what he or she might have to spend in some future contingency. When one has health benefits in connection with one's work, they are an earned attribute of that employment; no new Blessing from above, only a part of the total an employer is willing to assume to obtain the benefit of that employee's labor.

To suggest taxing someone, who does not have the benefit of the services of a non-insured individual, to provide what in historic terms must be viewed as an earned luxury, in response to an imaginary "Crisis," is to distort the market for both labor & health care--as well as for insurance. The additional clerical services required, beyond any pure "health care" that might result, would be an additional allocation of American resources. What such allocation would buy would be a wasteful & expensive redistribution of the fruits of the labor of the more productive, for a luxury that makes no sense in either economics or morality, even as it surely & progressively feeds upon itself. Again, the functional purpose of any form of insurance is the reduction of individual risk. It is an added expense to whomever pays for that insurance, which has no positive function if it does not reduce the risk of excessive future expenditure.

It serves no public purpose to provide health insurance to the indigent, against expenses that such persons would never bear: Far cheaper to simply pay the reasonable health care costs of those actually in need, than attempt to do so through the medium of subsidized insurance. Better, yet, to actually cut to the chase; to get the Federal Government out of civilian health care; to return to pre-Medicaid America, where health services to the poor were provided by physicians who honored their Hippocratic oath, and in charity wards of locally directed hospitals, both secular & religious. The paperwork & processing costs in providing unearned insurance policies, under a host of Federal regulations, amounts to an expensive waste of American achievement. [We will address advantages in traditional ways, by which American societies once responded to those in genuine need of medical services they could not afford, below.]

No! The "Crisis," being addressed, is actually a gambit of Collectivist Utilitarians (a term to include Communists, Nazis & those we have taken to labeling "Mipips" rather than "Liberals," who are determined to force social uniformity in many aspects of American life) to exploit envy, rather than emulation; to rally those who cannot afford the medical luxuries of the more affluent, to a new sense of entitlement; a battering ram against such free societies as still remain in our more fortunate communities. The Obama proposals involve an additional taking of the fruits of the labor of productive Americans, to benefit a growing political clientele for Collectivist Utilitarian organizers. The gambit is not about better health care; certainly not about cutting the total cost of American health care; but increased dependency & control.

Second, yet obviously no less important, is the written Constitution. There is no authority for the Federal Government to even exist, but for explicit language in the Constitution. And there is nothing in the Constitution to suggest any Federal role in meeting the peculiar medical needs or desires of individual citizens. Even the contrast to rationalizations for other extensions of Federal function & power, in the last century, is striking. Most forays into regulation of behavior, or interference with State & local institutions & procedure, were premised upon a claimed interpretation of either the Interstate Commerce Clause in Article I, Section 8, or of the claimed XIVth Amendment to the Constitution. Neither relate to a pretended Federal duty to manage health services--the relationship between a physician & patient.

While some may claim that the term "general welfare," in an authorization to raise revenue in the opening paragraph of Art. I, Sec. 8, could justify such Federal involvement; that notion will not stand review in context. There is little "general" about health services. They are inherently personal; inherently peculiar to the particular nature, needs and afflictions of an individual being served. Even a cursory glance at the other specific powers & functions addressed in the Section will reveal nothing functionally analogous to such overreach. All deal with functions that serve a purpose common to the interests of the whole people, in each of the several States--truly general in nature, never particular to those who suffer from a personal problem, such as an inability to afford something (here, insurance). Considering, also, the direct restriction on the taxing power in Art. I, Sec. 9, to prevent the use of taxation as a leveler of wealth & achievement; it is clear, indeed, that a program intended to equalize the medical resources of individuals, was neither authorized nor imagined. [Note: While the XVIth Amendment did change the Constitutional ban on a graduated income tax, it is confined to the power to tax. It does not extend powers or purposes, for which spending is authorized. Again, there is no suggestion of a power or function to subsidize any individual civilian's access to expensive health care.]

Under the division of functions between the State & Federal Governments, those, traditionally referred to as "Police Powers," remained with the States. These have been defined as including "all regulations promotive of domestic order, morals, health, and safety." Clearly, any Governmental involvement in civilian health matters was left to the States; and the fact that ideological Socialists, in contemporary America, do not like that Constitutional allocation, is no legal or moral basis to simply ignore it. Besides, it is ludicrous, when the claimed motive is to reduce the out-of-control costs of health care, to suggest that a public role in dealing with the day to day costs of citizens, seeking local medical services, could be handled more economically by injecting a remote Federal Bureaucracy into such peculiarly local & immediate interactions.

What Causes American Health Care Costs To Soar

As there is no general, or genuine, "Crisis" in health care, so there is no new or increasing problem for the poor among us. Indeed, the increasing problem is for those who pay their own way in an economy where the Federal Government has become the most disruptive force in the history of market economics. Those unable to pay for medical services have always benefitted from the Hippocratic Oath, which requires medical practitioners to treat patients in need, even where they cannot pay. The compensation for such care has always been to the Physician's honor, not his purse. Secondly, before the acceleration of disruptive Federal posturing as protector of the "disadvantaged," a wealth of charitable institutions provided Hospital care, funded by the contributions of the congregants of major American religious denominations. None of this required political involvement; and as Jefferson's analogous note on Welfare in Virginia, in 1782, would suggest, it usually worked out quite well:

The poor, unable to support themselves, are maintained by an assessment on the titheable persons in their parish. This assessment is levied and administered by twelve persons in each parish, called vestrymen, originally chosen by the housekeepers of the parish, but afterwards filling vacancies in their own body by their own choice. These are usually the most discreet farmers, so distributed through the parish, that every part of it may be under the immediate eye of some one of them. They are well acquainted with the details and economy of private life, and they find sufficient inducements to execute their charge well, in their philanthropy, in the approbation of their neighbors, and the distinction which that gives them.

The poor who have neither property, friends, nor strength to labor, are boarded in the houses of good farmers, to whom a stipulated sum is annually paid. To those who are able to help themselves a little, or have friends from whom they derive some succours, inadequate however to their full maintenance, supplementary aids are given, which enable them to live comfortably in their own houses, or in the houses of their friends. Vagabonds, without visible property or vocation, are placed in workhouses, where they are well clothed, fed, lodged and made to labour.

Nearly the same method of providing for the poor prevails through all our States; and from Savannah to Portsmouth you will seldom meet a beggar. In the larger towns indeed they sometimes present themselves. They are usually foreigners, who have never obtained a settlement in any parish. I never yet saw a native American begging in the streets or highways. [Query XIV-- Laws, Notes On The State Of Virginia, 1782]

The massive Federal involvement in medical services & health care, since the 1960s, has worked out no better than the disastrous Federal Program (ADC), launched in 1938 to subsidize unwed motherhood. One of the more obvious advantages to having non-political, non-office seekers, administer aid to the poor, is that it does not become corrupted into a device to buy votes. Rather, there remains an ability to apply morally based consequences to undesirable behavior; far less of a tendency, on the part of the receivers of aid, to abuse the largesse of their neighbors. After two generations of an already Socialistic public system, the sense of entitlement has produced the exact opposite effect. As neither the recipients nor the dispensers of medical services pay the cost of the programs, there is very little incentive for either to rein in cost. Yet these are hardly the only bases for the explosion in health costs.

A sense of entitlement goes far beyond merely destroying a recipient of subsidized health care's motive to hold down costs. It actually encourages extravagant misuse. In place of personal responsibility for one's own needs, recipients of free medical services have been made to feel that they are actually owed a good, problem free, life. It reflects a social vision, well captured by Rudyard Kipling in his poem that provides the theme for our novel, Return Of The Gods:

. . .after this is accomplished, and the brave new world begins
When all men are paid for existing and no man must pay for his sins, 
As surely as Water will wet us, as surely as Fire will burn, 
The Gods of the Copybook Headings with terror and slaughter return!

The blunt reality is that people who have been given to believe that the world owes them, simply because of a claim to humanity, will spend more of other peoples' money for medical services & health care, than a productive, working American, paying his or her own way, would ever seriously consider. And since this phenomenon must cause a sharp increase in the demand for medical services & health care, it exerts an immediate, but continuing, upward pressure on costs for such services, which those paying their own way must incur in one form or another. There are yet other factors in play, pushing in the same direction.

Just as bad money drives good into hiding (Gresham's Law), so false altruism drives genuine charity from a community. America once had many eleemosynary organizations with at least partial focus on the medical or health care needs of the poor. A hospital for profit was a rarity; and because of the non-profit, altruistic purpose of most hospitals, Courts applied far more stringent limits on the potential liability for medical malpractice, or the like, on the premises of a hospital. The medical services culture, as a whole, was less materialistic. But before the massive Federal intrusion in the 1960s, the whole psychology of practitioners in the medical service field--in the very concept of health care institutions--began to shift away from altruism towards a collectivist utilitarian approach--to concern over aggregated problems, rather than the individual in need;-and with that shift, it rapidly became almost impossible to fund a true eleemosynary organization in the health care field. This, coupled with an increasingly hideous pattern of litigation directed at institutions, businesses & providers of medical products & services, further accelerated upward pressure on cost. More of the same--and the Obama program offers only more of the same--is certainly not a rational response.

Communists, Nazis Or What?

As the controversy over what has been termed "Health Care Reform" becomes more vitriolic, conflicting efforts to label both the proponents & opponents of an increased Federal role become, if anything, less precisely focused. That the Obama plans are Socialistic is obvious. But there are many forms of Socialism. Can they be correctly described as Communist, National Socialist or something milder or more novel? The Speaker of the House, Mrs. Pelosi, has described ordinary citizens attending "Town Halls" to protest Obamanist proposals, as "Nazis." Mrs. Pelosi either does not understand National Socialism, a movement which sought & achieved virtually absolute control over all aspects of German life, or she simply does not care to be accurate. Those protesting a Federal take-over of personal health care are the ideological opposite to Nazis. But Obamanist threats to report those in opposition & to introduce strong-armed tactics to intimidate, are right out of the Nazi playbook. A likely psychological interpretation of Mrs. Pelosi's rhetoric, would be that she has projected her own totalitarian tendencies on others.

But what about those who support a medical take-over? Angry Conservatives & moderates are all over the Leftist menagerie in seeking to define the Obmanists, from "Communist," "Marxist," "Nazi," to mere terms of derision. Does precision require European nomenclature? Clearly Obama is a Collectivist Utilitarian. He seeks a collective, continent wide, solution to the health wishes of a clientele at the expense of individual Americans. He would verbally clothe himself in morality, but offers no legal, Constitutional, rationale for extraordinary proposals--only a sham pragmatism. Pretended utility, not law or morality, is his only real argument. While not all Collectivist Utilitarians are Communists or National Socialists, the Communists & National Socialists were the most successful of Europe's Collectivist Utilitarians in achieving sweeping aggrandizements of centralized power. The differences between Communists, Nazis, Obama & other radical Socialists, are not particularly significant in the American context. Our institutions were never premised on a Utilitarian "greatest good for the greatest number" shibboleth, but on the dignity, responsibility & accountability of the individual. The Constitution, so far from being designed to rally the mob, was carefully & precisely crafted as a defense against same.

While the Obama approach is absurd from a cost sparing perspective, it is indeed utilitarian in one sense. There is precedent for the mandatory care provisions, although certainly not on a Federal basis. Privately funded, twice yearly, preventive medical examinations on the great plantations of the Old South were clearly beneficial--as witness the Prudential Insurance study in the 1890s, showing a sharp decline in the health of the Freedmen after 1865. Those health services were, of course, paid for by the sale of cotton, tobacco & indigo, etc.. They were an attribute of ownership, a benefit from being owned. The point is that we are not the property of the Collectivists; not owned by Obama or the Federal Government. The current Obamanist rhetoric suggests that that fact is not well understood in Washington. The real crisis is not about health care.

William Flax

Health Care--The Real Issue

Medicare: A Death Potion?

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