I think we can all agree that we want people who are sick to get better, to have access to good health care and to not suffer due to health ailments. But can we also agree that we believe in personal freedom, the right to make decisions for ourselves?
Yes, Canada, England, Europe, China etc all have some form of universal health care. That is great. They also have limitations to a free press, less innovation, bad economies and less freedoms. The United States represents 26% of world GDP. The next largest economy is 1/3 the size of the United States. The United States went from a start up 230 years ago to the most powerful country in the world. Did that happen because of the greatness of our government actions or the greatness of our people? Should the United States follow the path of others, or set the course for others as we have since our inception. Our personal freedoms and rights to see opportunity, gather and engage each other, partner and invest, and think and dream are just an element of what makes the United States truly unique.
The health care debate is a foil to help us reflect on our rights and personal freedoms. The President tells us, (Paraphrase) "...Health care is a mess and we need to take immediate action or it will collapse...". If true, that is bad. Though it is unlikely true. I am not sure I know of any period in our country's history where our ability to address a challenge lead to total failure. We were close in the depression and the cival war, but only close.
I would argue, innovation and personal freedom have always been a correcting force for government failure. Isn't that what democracy is about? We the people have assigned some of our rights to the government because it is easier to manage. We get to pick the managers. And if they don't do a good job, we will fire them. We only gave them some rights, not all. We reserved all other rights to ourselves, and we are not going to give them up without consensus (i.e. constitutional convention). Ronald Regan reminded us in 1961 about how subtle encroachment of the state can weaken our rights over time:
"One of the traditional methods of imposing statism or socialism on a people has been by way of medicine. It’s very easy to disguise a medical program as a humanitarian project. Most people are a little reluctant to oppose anything that suggests medical care for people who possibly can’t afford it." Ronald Reagan - 1961
With all the noise on health care and distraction of Nazis, socialism, the bill is not decided, republicans are racist, etc, part of my discomfort with the debate has crystallized around a WSJ article about the President regarding end of life care. The President starts of the interview....
The President: "Now, I actually think that the tougher issue around medical care—it's a related one—is what you do around things like end-of-life care."
Yes end of life care is tough, each of has had to deal with it in some manner (Wife, Child, Mother, Grand Parent)
The President: "...I just recently went through this. ....when my grandmother got very ill during the campaign, she got cancer; it was determined to be terminal. And about two or three weeks after her diagnosis she fell, broke her hip.....
So now she's in the hospital, and the doctor says, Look, you've got about—maybe you have three months, maybe you have six months, maybe you have nine months to live. Because of the weakness of your heart, if you have an operation on your hip there are certain risks that—you know, your heart can't take it. On the other hand, if you just sit there with your hip like this, you're just going to waste away and your quality of life will be terrible. And she elected to get the hip replacement and was fine for about two weeks after the hip replacement, and then suddenly just—you know, things fell apart.
I don't know how much that hip replacement cost. I would have paid out of pocket for that hip replacement just because she's my grandmother. Whether, sort of in the aggregate, society making those decisions to give my grandmother, or everybody else's aging grandparents or parents, a hip replacement when they're terminally ill is a sustainable model, is a very difficult question. If somebody told me that my grandmother couldn't have a hip replacement and she had to lie there in misery in the waning days of her life—that would be pretty upsetting.
So the President seems to get that end of life care is tough. He would have personally paid. But then he goes to statism, questioning if "...a hip replacement when they're terminally is a sustainable model, is a very difficult question..." Difficult question for who? The government? Society? Its not their question. Government, Society, everyone (except for the patient and maybe their family) has no right whatsoever to any part of the discussion. None! Nothing! Nil!. The constitution has provided no power to anyone to infringe on ones personal rights for what to do next with their life.
Recognizing the impact on cost of care, the President goes on:
The President: "Well, I think that there is going to have to be a conversation that is guided by doctors, scientists, ethicist. And then there is going to have to be a very difficult democratic conversation that takes place. It is very difficult to imagine the country making those decisions just through the normal political channels. And that's part of why you have to have some independent group that can give you guidance. It's not determinative, but I think has to be able to give you some guidance. And that's part of what I suspect you'll see emerging out of the various health care conversations that are taking place on the Hill right now."
Guided by doctors, scientists and ethicist? They will guide the decision about how we mange end of life decision on the economics of care? Really? What about the patient and their family? The President says he would have "paid out of pocket for his grandmother", but wants doctors, scientists and ethicist to guide for the rest of us under the health care bill. Did we ask for this help? If we did not ask for it, why do we need it? Probably because, the only way to run a government program is to cut cost, and the only way to really cut cost with out innovation is to pull the plug on Grandma. (But he didn't say that right?)
What the health care bill contains and the degree to which the public option restricts funding certain treatments does not really matter if other options exist (secondary insurance and paying cash). Practically it is hard to believe that the government will close down the right to supplement ones health care. In a market economy though excessive government restrictions may very well shut down private options. But what is outrageous is that the government thinks it even has the right to implement a health care program, using public resources, that restricts personal choice. (all must opt in and follow the "Plan"). Furthermore, it is outrageous for the government to do anything that impinges on our rights to buy insurance (opt out) from other health care innovators. Impinges includes restricting how other insurance plans can operate, who they enroll, what preconditions they accept, etc.
The great thing about the "Market" is that people have the right to choose. People do not have a constitutional right to government funded end of life care. People have the right to choose if they want to use their resources to buy insurance and/or pay extra out of pocket for grandma's care. They have the right to choose that independent of the government, doctors, ethicists, and scientists.
In sales mode, the President keeps saying the choice for end of life care is between the doctor and the patient, not government or private insurance (making some veiled comment that somehow insurance companies already restrict rights). Private insurance is really not currently involved in the decision. They contribute, via a contractual relationship, to the decision in their willingness to fund a portion of end of life care, but they don't have ethicist making the decision for patients or ethicist deciding on a formulation for what can/can not be funded. The calculus of what is paid for at end of life is a result of an economic decision between the insurance company and the patient. And, really end of life care decisions are not the doctors prerogative. I have had these conversations with regarding my mother with docotrs (sample size 1) and never found them steering me in any direction. The Doctors left the decision to the patient and family.
I am pretty sure the President Obama is president of the United States, not the CEO of a new health care company. I don't think he is a doctor, though he seems to think he knows how doctors should practice medicine. Since he is president, he should focus on first preserving our rights to personal freedom i.e. "First do no harm". In the context of Health care, he should preserve our rights to have a competitive health care market that maximizes the ability for patients to choose. Health care should not be about society choosing/limiting our options through government regulations. That might work for Europe, Canada or China, but the United States is made of different stuff.
Through personal choice we have created the most prosperous country in the world, driving unbelievable levels of innovation and opportunity. The WSJ interview with the President signals that he is a man that believes Doctors, Scientists, and Ethicists can shape the best decisions on our behalf forgetting that its individual freedom that made us great. He needs to choose between Statism and personal freedom. I have. We can innovate our way through this problem if he gets out of the way. That would be the honorable path to universal health care.