PrintAugust 26, 2009
Death Panels and Decision Makers
When the town halls adjourn and the cameras stop rolling, the health care debate is about one thing: decisions. Issues like end-of-life counseling, comparative effectiveness boards, uninsured Americans, and rising health care costs all, when examined, reduce to a question of who will make medical decisions.
One of President Obama's answers at a recent town hall meeting properly sets the parameters of the health care debate. When asked about potential government rationing of medical care he responded with the following:
The concern is that somehow [my proposals] will mean rationing of care, right? -- that somehow some government bureaucrat out there will be saying, well, you can't have this... procedure because some bean-counter decides that this is not a good way to use our health care dollars....Right now insurance companies are rationing care. They are basically telling you what's covered and what's not.... So why is it that people would prefer having insurance companies make those decisions?
Cutting through the focus-group-enhanced rhetorical smokescreen, Obama's answer is essentially that his plan will not lead to rationing but...government rationing won't be any worse than what exists now. Thus the debate is not whether the government will ration care, but whether that government rationing will be better or worse than the current system.
For argument's sake, let's accept the president's premise that the debate over health care is a simple matter of government decision makers versus private decision makers.
Government advocates contend the absence of profit allows the public plan to save money over their private counterparts. Without the private sector's greedy need for profit, government will provide better coverage (that is, make better decisions) at a lower price. After all, they claim, billions of dollars in insurance industry profit could be taken right of the top of a public health plan.
What these big-government backers fail to recognize is the positive effect profits have. Economist Dr. Thomas Sowell explains:
To the economically illiterate, if some company makes a million dollars in profit, this means that their products cost a million dollars more than they would have cost without profits. It never occurs to such people that these products might cost several million dollars more to produce than if they were produced by enterprises operating without the incentives to be efficient created by the prospect of profits.
The cure-for-corporate-greed theory has a weakness beyond the lack of incentive. The absence of monetary greed (which is far from guaranteed when it comes to government) is not the absence of greed entirely. The lust for power is no less pervasive than the lust for money. As a result, government becomes the worst of both worlds, lacking the proper incentive to produce efficiently and still subject the flaws of humanity (specifically the flawed idea that one human, because of his genius or good intentions, should impose his ideas on the rest of mankind).
To argue only the merits of private versus public health care ignores the fundamental fallacy in Obama's argument. The difference between public and private health care is not simply a question of who rations treatment. The functions and methods of a private insurance company are not the same as government's and only bear superficial resemblance.
An insurance company is nothing more than a risk pool. If an insurance company denies a policy due to a "preexisting condition" it is not a refusal of treatment but is simply a refusal of participation in the risk pool. The patient may still find another insurance company that will take him in or use the money he would have spent on premiums to make finance payments on the medical procedures he seeks.
The key difference when dealing with the government rather than the private insurance industry is force. The government forces you to pay "premiums" in the form of taxes. Bureaucrats then decide what allowance to return to the people and under what conditions. Because government has the ability to take from the people, it, unlike an insurance company, actually does have the power to stop us from using our own money to obtain medical care.
In other words, a rejection from a private insurance company can take away one payment option, rejection from a government bureau, combined with government's confiscation of money through taxes, can destroy all payment options.
Ultimately the debate runs deeper than comparisons of private versus public insurance. Health insurance is one of the many ways an individual or family can provide for their medical care. Other options include Health Savings Accounts, raining-day funds, finding part time work to make ends meet and so on. The real question is whether treatment decisions should be made individually or collectively.
President Obama himself accidentally answered that question during his ABC health care special a few weeks ago. Jane Sturm (whose spunky 100 year old mother received a pacemaker five years ago and is still living) asked the president if, when making medical decisions, consideration can be given for a person's spirit. Obama responded that he doesn't believe the government can "make judgments based on peoples' spirit. That would be a pretty subjective decision to be making."
The president is right. Basing end-of-life decisions on a person's spirit is absolutely subjective. Since a government must spend tax dollars based on a bureaucrat's statistical formulas, it will never be equipped to handle a matter as personal or as "subjective" as medical care.
The issue of who makes decisions is at the heart of a society. A society in which the people retain maximum decision-making power is free. A society in which the central government assumes maximum decision-making power (especially regarding something as fundamental as medical care) is tyrannical. America, like all societies, is in between these two extremes. Adopting any version of ObamaCare would be a giant step in the wrong direction.
