Keeping it Real

So, I have passed another week unable to look at that crazy health bill again. I know I am not keeping my promise here to evaluate it, but it is phenomenally vague, causing the law itself to look like it is meaningless until the rules come out that fulfil it. And of course, that is how the government actually takes things over. Administrative law can be incredibly oppressive for the sake of accomplishing the overall goal, but at that level, comprehending how the rules affect freedom and rights is so difficult the oppressiveness gets by without question. Here is a lovely example. The quote of the week on conservative talk shows is the one where the newly appointed director of Medicaid, Donald Berwick indicates that our health care will be superior to that in Europe or wherever else because we will "ration services with our eyes open." Of course this has every talk show person bouncing with "I told you sos" but truly, those of us who are in health care know that there are not enough resources for every single person to be serviced without limitation by any program. The man is saying a truth (that services must be rationed) and is stepping up to be "open" by saying we will ration them with good judgment and fairness (our eyes open). And here, America, is your opportunity to see what is really happening. The past ten years of medical market advertising that has caused you to somewhat magically think that health services are unlimited for everyone at all times has finally been washed away, and you can look at the real issue. At all points in time medical services have been rationed and limited and only given when very specific benefits were in place (whether economic or charitable) and the real thing that is happening is who is going to decide how they are rationed. No one has been thinking clearly about this because everyone has been drinking the kool-aid of advertisements and acting like unlimited health is a right of nature. It isn't. Health is a personal responsibility and medical services are a limited commodity. Now, open your eyes and get your right to services back not by trusting the government, but by demanding that the government get out of it. When health care is a private and personal endeavor, irresponsible people are kept under control. The government is totally unable to keep irresponsible people under control. As a crisis worker I have heard plenty of stories from people about how the local doctor gave free care to them when they couldn't afford it. But you can be sure that that free care was exactly the care the person needed, and not every piddly thing the person wanted because the whole dynamic of thankfulness and dependence when there is no obligation lets the doctor call the shots. Now try to apply that to a free governmental clinic. All of a sudden the person who can't afford care is no longer obligated to a professional who can properly limit the complaints that will be addressed. Every service is now something the Dr. is being paid for, so the client no longer appreciates getting free service and wants to control the decision making instead of going to the doctor requesting help. But these problems are not just about money. When it comes down to it, personal care is exactly that: personal. If a proper relationship does not exist, care does not happen. So in every clinic, when the professional begins to feel that the client is not grateful, is not respectful, and basically does not want help, only wants to demand things, care will stop. Treatment won't. There will still be lots of orders, tests, prescriptions,etc. But the process will lose that extra value called care, and the over treated patient is as likely to die from neglect as the untreated patient because no real issues are being addressed because no one is really talking to anyone anymore because no one cares. This situation already exists so extensively it is hard to believe anyone is pushing for more of it by wanting government intervention. And if you imagine that non-caring over treatment is less expensive than no care, you are wrong and you can open the books of every medical system in Europe for proof of that. In his science fiction allegory The Great Divorce, C.S. Lewis sets up a Hell where no one has needs because everyone gets what they want just by imagining it. Of course nothing is actually real, so even though you have everything you want, no one is satisfied. Our health care is on its way to being exactly such a hell. By trying to provide things everyone wants without any knowledge of what it takes to meet needs, the government is creating a service that will not be real health care. No doubt Dr. Berwick is hoping to counter this, and believes his knowledge will be the thing that makes the system right. But the nation as a whole has too many conflicting needs to be figured out from the top. Smaller groups are the parties that have the capacity to care. Even beyond that, individuals are often the only ones gifted enough to know and enforce what is needed. Even if Berwick can bring miraculous wisdom to Medicaid, there is a very long train of workers who will be pegged into that system who will not have the talent to carry on the miracle. When health care is no longer an individual endeavor but is a process and procedure that citizens go through as a part of civic responsibility instead of private life, it will no longer be health care, it will be oppression. The road to hell is paved with good intentions.