Thursday, August 20, 2009

Single Payer

In August, 1972 the artist Christo made a second attempt to hang a 400 meter curtain across Rifle gap in Colorado. The display lasted 28 hours. There was no real purpose to this project other than to do it for its own sake; the artists prerogative or something. The transience and frivolity of the enterprise were not considered grounds to dissuade the artist from proceeding, no matter how objectively pointless.

The left pursues single payers for the same reason that Christo hung his curtain. It is simply a socialst ideal that should be pursued for its own sake, not because it delivers any tangible benefits, (and in fact is likely to be detrimental) to the healthcare of 300 million people. The goal is not to improve people lives by implementing enlightened policy, the goal is to satisfy an emotional yearning, to achieve a socialist ambition that origniates not in rational thought, but in a dreamy romantic fantasy unvexed by fact.

The left want single payer, not because it makes any sense, but because it is part of an orthodoxy that too few of them question. Just as Christo was forced to dismantle his creation after a few hours because of the elements, the left really don’t care what becomes of healthcare if they achieve single payer. The goal is not to improve or stabilize or even establish an enduring model. It is simply to promote the illusion of the committed activist, marching endlessly, and petulantly toward imagined paradise.

Sunday, August 16, 2009

The questions "Why is healthcare so expensive?" and "Why does healthcare need reformed?" are related, but not as closely as Obama would have us believe. Heathcare reform is essential to government obligations, not to the health of Americans.

To illustrate the principles, consider two businesses, say landscaping companies, operating in a community. Let us call the first NSLS for "Non subsidizied Landscaping." This is a very well managed business that uses the the latest technology, hires the best landscape architects and technicians, manages its finances, is responsive to customers and achieves good results. NSLS's customers are very happy with the service and are willing to pay for it, even though the costs go up as the company tries to stay on the cutting edge.

Let's call the other company SLS, for "Subsidized Landscaping." This company was started by a billionaire for his son to run. Father has deep pockets, and son is not the most astute businessman, but the company has access to father's support. The business plan for SLS was to sell pre-paid landscaping service, providing future service in exchange for small upfront payments in an attempt to secure market share. To keep customers happy, SLS has to buy services from NSLS, and because the latter's fees are increasing in response to customer demands, SLS has no choice but to pay more to provide service to customers than it collected from them in upfront fees. SLS operates at a widening loss. Son keeps hitting up moneybags father for more support until father realizes that SLS is a losing proposition. Bankruptcy is out of the question; family pride and all that.

Father decides that what he must do to control SLS's costs, and keep it from bleeding him pale, is to control the costs that SLS pays to NSLS for the services that people actually want. He cannot compete directly with NSLS on quality or efficiency, so he does the logical thing: tries to take over NSLS, so that he can control landscaping costs for the entire community by limiting the expensive services that NSLS's willing customers pay for. Finally, in order to boost the balance sheet while costs are being brought under control, Father decides to have all of SLS's and NSLS customers pay a surcharge to subsidize services for new customers, in hopes that they will provide revenue for SLS's current obligations and eventually provide revenue for future operations.

There is no time to worry about what people's yards will look like.

Not a perfect analogy of course, but it illustrates the principle: the government has to reform private healthcare because 1.) It buys services from the private system, 2.) the fees for those services are set by what people are willing to pay for service that they are satisfied with, and 3.) the government assumed obligations that it is incapable of servicing because frankly, it is not very good at delivering healthcare.


Liberals seem to be genuinely baffled by opposition to healthcare reform proposals. Their natural response is to hypothesize some malign motives for such opposition, and to, of course, demonize the "villains," in the manner of Speaker Pelosi. It does not seem to occur to the liberal reformer that there are in fact valid grounds for opposition that have nothing to do with privilege or profit or greed. It does not seem to occur to them that their "vision" assumes a set of values that are dissonant to our culture and adverse to our traditions. The left is shocked that ideas that are predators in the academy are prey in the real world.

The starkest examples, of course, are the end-of life philosophies clumsily articulated by Obama and Ezekiel Emanuel. Obama's extemporaneous musing "maybe she'd be better off taking the pain the pain medicine" assumes a societal fatigue and moral penury which we would lead us to collectively declare that some life is not worth living in a finacial sense. This is contrary to America's history as the most generous nation in history; it is antithetical to our tradition of philanthropy and charity and our moral senses.

When George H.W. Bush was shot down in World War II following a bombing raid on Chichi JIma, Japanese soldiers on the island were amazed that the U.S. Navy would dispatch a submarine to rescue a single pilot. It seemed a foolish risk and waste of resources. Similarly, the U.S. Army's liberation of the POW camp on Cabanatuan seemed extravagant by liberating soldiers who likely would never fight again. When the people of Midland Texas mobilized magnificently to rescue Jessica McClure from a well, one can only imagine the moral costs of doing nothing compared to the finacial costs of doing the right thing. We Americans pay freely to rescue half-wit hikers who get themselves lost in the wilderness, miners trapped by earthquakes, unlucky mariners caught in storms and out of bounds skiers trapped in avalanches. It seems quite natural to us to support the premature infant who is struggling for life, or the burn victim facing multiple surgeries and prolonged rehabilitation. President Obama should expect annoyance when he taps his pencil on the balance sheet and tut-tuts the fact the most Americans still believe that human life is never an ordinary thing.

I will conjecture that most Americans have an intuitive sense for what is meaningful in their lives, much more than what their life should be worth monetarily. Obama just plain sounds stupid when he presumes to lecture centenarians on what is "better" for them. President Obama has no clue whether the last three weeks of a particular person's life might be the most meaningful three weeks. It is simply a matter of individual liberty and good conscience to allow a patient to decide whether pain control or being able to participate in treasured activities is more important. The healer's role after all is not to serve the state by performing repair and routine maintenance on the vassals of Utopia, it is to minimize the effect that disease and trauma have on the ability of individuals to pursue that which is most meaningful to them. If one person opts for hospice and another in the same condition rages against the dying of the light, free from the coersion of the state, that is a positive reflection on a free society, because it respects the humanity of the individual. People who are elderly or terminally ill are just as free and just as capable of meaningful life as are the academic snobs who fret about the cost of their therapy.

The fact that Chris Matthews and Obama and Pelosi can't see that they are openly challenging the values of a significant portion of Americans, and instead attribute opposition to healthcare reform to "greed" or special interests, or racism or ignorance or whatever really just suggests that they are not nearly as smart as they think they are.