Health Care--The Real Issue

October, 2009 Feature--Truth Based Logic

Little understanding of functional dynamics behind statistical aggregations in American Health Care: Collectivist Egalitarians seeking to impose uniformity in place of personal responsibility in the millions of daily decisions by individual participants, exercising free will in pursuit of their own needs & desires.

The public debate over so-called "Health Care Reform," has been fatally skewed by a failure on most sides to recognize the most essential aspects of the issue. Politicians outdo one another in expressing alarm & disdain over the cost of medical services in America; the "problem" of tens of millions of uninsured; the aggregated cost of medical services as a percentage of Gross Domestic Product. They differ on how Congress--the Federal Legislature--may best resolve problems on a Continental scale; but there is little or no discussion of any claimed Constitutional authority for such Congressional action; there is little or no demonstrated understanding of the actual functional dynamics of the "problem"--of what those statistical aggregations actually measure.

The Reality Behind Statistical Aggregations

Do the statistics, cited by both the Obamanists and their foes, have great--or direct--relevance to any specific potential consumer of medical or other health related services, at any given moment in time? Certainly, within those aggregations are measures of phenomena--the tide of rising costs--that may themselves have relevance. But the endlessly cited macro statistics are merely aggregations of the effects of the daily decisions of millions of patients, or potential patients, interacting with the decisions of hundreds of thousands of physicians, practitioners of other health care techniques, nurses, pharmacists, concerned relatives, etc., as well as with the policies, decisions & rates, of a considerable array of insurance carriers, as well as public & quasi public institutions, including an intrusive Government. The actual determinants, in this incredibly vast array of individual decisions, are far from uniform. They involve considerations as varied, simple or complex, as the individuals involved.

Those who understand the functional dynamics of a free market, whether for goods & services or ideas, should have no problem in grasping the essential point. The essence of every form of human action & interaction are the countless decisions that individuals make in their own affairs, every day. Those, who think that bureaucrats can plan an economy, suffer from a form of blindness as to what is actually involved in economic dynamics. The same blindness is very evident in those who think that they can centrally direct decisions effecting individual health. Indeed, the depth of possible factors, and ever shifting perceptions, that come into play with something so varied, both objectively and subjectively, as any individual's perceptions of his own physical needs & priorities, may be even greater than those that will determine his purely economic decisions at any given time. Consider:

Putting aside, for the moment, potential effects of different levels of insurance coverage, or lack thereof, which may compound the complexity of older, more basic, decision influencing phenomena; some of the fluctuating factors that might influence one's priorities with respect to health related concerns--the particular combination of which, at any moment, being always unique to the individual--would include: Age, previous experience with all conditions to which the particular individual has been subject & any treatment received for same, any experience with medical or nutritional alternatives, any relevant knowledge or attitude flowing from such experiences, other information--good or bad--previously obtained from any trusted source, shifting priorities based upon immediate personal considerations--which may or may not relate to health--as to what personal needs appear most in need of attention;--cost factors aside from any insurance considerations, including an always partly subjective cost versus likely benefit analysis, compounding all previously listed & implied factors, and still others not even hinted at.

Such subjective cost vs. benefit analysis must include a considerable array of factors that no bureaucratic analysis, regulation or intrusion could ever address in a manner truly consistent with respect for fundamental liberty or the free will of the individual involved. Included would be not just an immediate analysis of any effect on one's present finances--for some among the least of concerns--but the totality of what the individual would expect to endure against a potential result, weighed on the basis of probabilities. A major consideration would usually be those dependent on the subject individual. The simplest example: Contrast a parent with young children, willing to endure great cost & unpleasantness, to prolong potential usefulness to an immediate family, with a much older person, whose appreciation of his own usefulness to anyone is already in decline, willing to forgo a possibility for some remission of unpleasant symptoms, if the treatment, weighed, might jeopardize an estate intended to ease the future struggle of his grandchildren.

We but scratch the surface. Yet, let there be no confusion. It is neither the business nor the right of Government, in a free society, or under the political principles that led to the birth of America, to try to influence such decisions as suggested in our last example. Americans are not the property of a Utilitarian Collective. The moral (ethical) decisions that any of us make, as to whether or not to seek medical services in any situation, are intensely personal & private. One may talk over those decisions with one's family, or other intimates; with a doctor, clergyman or attorney--each of whom is honor bound to respect the privileged nature of the subject. It is no business--and no legal right--for Marxist influenced pseudo-intellectual poseurs ("Mipips") in the Obama Administration to seek to intrude Federally financed "counselors" into those inherently personal decisions that any of us make.

As varied as the factors that govern an individual's health care priorities, at any moment, those which motivate potential medical "providers" would be only less so in proportion to the fact that there are fewer Physicians than there are patients. We do not compel people to become doctors; nor control in what fields of medicine, those choosing to become doctors, choose to enter. Federal programs intended to allocate medical services & control their cost, can only "muck up" the market driven forces--those pulsating daily individual decisions--which once provided Americans with quite decent medical services. As for insurance carriers, as emphasized last month, they provide a luxury--a chance to reduce the cost parameters of future problems. An indigent has no need for medical or health insurance, as the physician's oath requires that he be treated, even if he cannot pay.

Insurance costs are market driven. Nothing could be better calculated to drive up such cost, than more Federal meddling in the market for medical services. The political rhetoric of panic, but feeds the demand side for health insurance, while making it less competitive by intimidating new would be entrants into the market with the threat of bureaucratic regulation. Anyone who truly understands market dynamics will see the point. For others, put yourself in the place of a would be entrepreneur; consider what might be involved in launching & operating in a field where politicians endlessly meddle. Would that make you more or less eager to risk your assets?

Medical, Political, Economic, Ethnic Or Psychological Determinants

The actual demand for health & medical services reflects an immense array of variables, in constant flux and extremely difficult to fully understand, as they are very individualistically determined. We may catalog some factors that play a discernable role in influencing the level of medical services, which a particular subject may seek at any moment, beyond those flowing from the actual presence or suspicion of an identifiable medical problem. While those flowing from actual problems--and an awareness of potential solutions--may tend to be the most significant, the ever greater injection of Government into health care has brought with it identifiable political factors, which effect the demand for medical services. Those given to expect an "entitlement" to subsidized health care, will have an increased tendency to demand same; while, as a consequence of that tendency, others may be more inclined to treat themselves--or turn to alternative forms of medicine--to avoid the resulting congestion at public & quasi-public medical facilities.

Economic conditions--always in flux, both in the macro (aggregated) & individual case--will have a major influence as to the extent of demand for medical services; determinative in some situations for those who expect to pay their own way, yet with little effect on those who feel entitled to free care. But the effect, here, is not just from the immediate impact on a subject individual's finances. General conditions, and resulting perceptions, can have profound effects on future anticipations.

While "Mipips" may disdain discussion of racial & ethnic factors, it is well understood that genes affect susceptibility to various medical problems, as well as a body's ability to avoid others. But there are other ethnic factors, whether gene or culture driven--and of course genes influence culture, not the other way around--which are in play here. A people who tend to be reserved, stoical or very thrifty, will tend to spend less money for health care. This factor is not generally acknowledged, when the proponents of more Federal involvement in American medical services & health care compare costs in America with those in other lands. Yet it certainly must be considered by anyone who intends to be at all objective in his analysis.

Other psychological determinants would include religious beliefs, as well as the whole gamut--that pulsating dynamic of attention grabbing phenomena, and the more subtle or subliminal--of factors that may influence people to be more or less eager to seek medical services, whether of a diagnostic, preventive or therapeutic, form; or, alternatively--and perhaps inversely--competing health promoting regimens.

While perhaps tangential, we might here acknowledge a logical fallacy, employed by some supporters of Federal control over the distribution of medical services in America: An attempt to attribute causation to what is more a parallel effect than cause of a perceived "problem," the citation of a greater mortality rate among the uninsured, as opposed to those with adequate coverage. We do not suggest that having good insurance may not induce an individual to more readily address a problem, which might indeed be life threatening; but it does not therefore follow, that not having insurance is the principle reason for a lower life expectancy among those who go without insurance. Consider:

Those who can afford, but elect to forgo medical insurance, are not likely to be among those who employ medical services on a regular or recommended basis. Their lack of insurance & the consequences of untreated conditions are not related as cause & effect, but as parallel effects of a given attitude or temperament. Those who cannot afford medical insurance, are also less likely to afford a healthy diet, or healthy general living conditions--for example avoiding overly congested living areas--as those who can. While there may be some causal relationship, here, in addition to the parallel effect arising from a general lack of resources, the causal relationship is not so clear as to justify the argument being made; especially, when one considers, also, the fact that physicians, by sacred oath, have never required payment to treat the indigent. The actual bone of contention is not really insurance at all, but the inequality of man--both material & non-material--which has always been the real target of Leftwing movements.

An American Future?

The battle, here, is an old one; that between man as an individual--as a reasoning, responsible creature--and those who would recast him as a programmed or programmable specimen of conditioned reflex; a being controlled by a collectivized aggregation of like beings, focused to singular purpose, intolerant of any eccentricity which would relate decision making to unique individual purpose.

There is no rational reason to inject the Federal Government of the United States into the daily health care decisions of Americans. It is clearly outside the concept of the Federal Government as created by our written Constitution. Yet it not only reflects one more abandonment of the rule of law. There is clearly no way that a growing bureaucracy, interfering with private decision making, can ever be economical. The cost of a bureaucracy, not limited to salary and office expenses, but including almost incalculable wasted hours on the part of those forced to interact with that bureaucracy, cannot possibly be beneficial as a substitute for the normal efforts of those motivated by personal self-interest and desire to act on their own behalf, in any economic sense. The very notion flies in the face of everything we have ever leaned of the workings of free markets. Any seeming benefit in cost control, would be clearly paid for by an effective loss, sustained by some of the participants in a once free market; in part by reduced service to the productive citizenry; in part by less freedom to the providing professions. In the vernacular, "there is no free lunch," and the bureaucracy can never be other than an added net cost.

This is not about better or cheaper health care, but the pursuit of egalitarian uniformity. The motive, however rationalized verbally, is clearly intended as an attack on human individuality, on the idea that the more successful should have the benefit of their success, in being able to afford better and more volitionally directed health care & medical services, than those enjoyed by the less successful--even as the more successful enjoy better food, raiment and shelter, than others. Whether one wants to view the proponents of this absurdity as Marxists, Communists, Nazis, or "Mipips," as we have lately turned to calling America's false "Liberals," is not so important as finding a means to successfully resist their foray. We are not so many ants, to be programmed & controlled for our own good--or the good of a colony, directed by a queen with wings. Even were there, in fact, true economies in the process, the process would be intolerable.

William Flax

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