…why we want to get rid of this system?
The last few months have seemed almost like they were meant to illustrate, with real-life events, the excellence of American medical care in its current incarnation.
It has become downright funny, just from the perspective of my own family members. Of course, the medical issues for them are not humorous – but the juxtaposition of their options and care, with the clear trend of the arguments on Obamacare, is increasingly so. As I have outlined here, here and here, what Obama and his advisors specifically intend to do is control access to medical care so that we – we millions of individuals – cannot command the amount of it that seems good to us, by being willing to pay for it. Their concern is not the price of procedures or of “health plan” insurance, but the amount of total “resources” that is going to the practice of medicine in the US. They want to deny people medical care so that they can spend what we produce on other things.
Here are some of the things that will be lost if we let government impose this future on us. One of my sisters had her first child in April, up in Silicon Valley. There was nothing particularly unusual in her pregnancy or delivery, and that’s wonderful. She and my brother-in-law were very happy with her pregnancy and delivery care, as millions of expectant parents routinely are. They’re getting excellent new-baby care as well. They are a middle-class household, not wealthy by any means, covered by a major health plan provider through their jobs. Yet my sister had a regular physician with whom she felt very comfortable attending her throughout her pregnancy, and received a level of attention and care during her delivery that, only 100 years ago, was reserved for the extremely wealthy, and the nobility of Europe.
Would they like for the plan to cost less, and see more in the paycheck? Probably. They would probably be willing to hear new ideas about bringing down the health care plan premiums and reducing the price of services. But they would not want to give up quality of medical care in exchange for price reductions. I’m pretty sure millions of Americans who had babies in April 2009 would say the same.
My mother went in for cataract surgery on both eyes earlier this summer. She was able to elect to have this surgery now, even though she was not blind yet in either eye – unlike seniors in Britain. Both surgeries went beautifully, and featured advanced procedures that included the insertion of lenses to improve her vision overall. Mom lives in Oklahoma City, and is on Medicare supplemented by some rather expensive “Medi-Gap” insurance she pays for herself.
During the first surgery, her heart monitor detected an arrhythmia that led to further tests, including an angiogram, with a cardiologist; and he determined in July that she would need a bypass for both chambers of the left side of her heart. She will be having that surgery tomorrow. She is otherwise in very good health, at a few weeks shy of her 70th birthday, and has been ambivalent about this whole process because, other than tiring easily, she has been having no apparent symptoms of obstructed blood flow from the heart. But the standard of American medicine is to address a problem like this when it is caught.
Her children are glad it was caught, and that she can have a bypass now, and better prospects for at least 20 more years with us, instead of 10 or 5. Dealing with it early improves Mom’s prospects for full recovery and high quality of life, as well. Moreover, unlike Canada’s or the national health systems of Europe, America’s medical system is able to get her in for a bypass in 18 days from the angiogram that told the cardiologist she would need one. (The Optimistic Conservative will be heading for Oklahoma City early next week to accompany Mom home, and stay with her for the monitoring period after her release from the hospital.)
Meanwhile, my other sister is also pregnant, and is nominally due in October. Her husband is an Army officer stationed at Fort Sill in Lawton, Oklahoma, and for most pregnancies the services offered there, or in the civilian facilities in Lawton, are sufficient. My sister is 40, though, and early ultrasounds showed a possible hole in her baby’s heart, along with a condition called a “placenta previa” that can cause unexpected bleeding. So as a “higher-risk” mother she has been sent regularly to Oklahoma City for the most advanced ultrasounds and tests, and advised that she should deliver in OKC as well, to ensure that whatever complications there are can be handled on-site.
As an aside, I had a friend – a fellow Naval officer – who was diagnosed with a placenta previa while we were both stationed in Japan. Fortunately the diagnosis was early enough that she and her husband (also an officer) could make a decision about moving her back to the States for the remainder of her pregnancy. The Naval hospital in Yokosuka was not prepared to deal with her potential complications – and neither was the Japanese national health care system the Navy would have paid for her to use. As a national health care patient, she would not have had access to the level of care that the wealthiest Japanese could afford. But there are US military hospitals in the States that can handle complications of the type that occur with previas, so she ended up being transferred to the care of Trippler military hospital in Hawaii, where she was on bed-rest for the months until she delivered.
Obstetricians have effective procedures for dealing with previas now, but they are non-routine conditions and increase the risks for a pregnancy. This was illustrated dramatically on Sunday evening, two days ago, when my sister began to bleed unexpectedly, and ended up being airlifted in a helicopter from Lawton to OKC. Since then the hospital staff has been working to suppress contractions and keep her comfortable. Her baby boy is still less than 2 pounds, and they want to delay delivery as long as possible, although at nearly 28 weeks he has a good chance – under American-quality neonatal care – of being viable already. This is a period of extreme discomfort and worry for my sister and brother-in-law, and our families, but one thing we are thankful for is that she is under constant care from skilled, well-equipped specialists whose goal is the same as the parents’: safe delivery of a healthy baby, and as much comfort for the mother as possible, with safe recovery for her as well.
When I first got word that my sister was being airlifted to OKC, I immediately thought of Natasha Richardson, the actress who might have been saved after a skiing accident if such airlift had been available in Québec (Canada’s most Europeanized province, by far). My sister is covered, as military families are, by Tricare insurance. She is getting the standard of insured American medical care, as Natasha Richardson did of care in Québec. Like my mother, she is getting it in “flyover country” – not a surprise to those of us who are from there, and already know that the best care and the most advanced procedures are as available there as they are on the coasts, but something that might well be a revelation to coast-dwellers who cultivate an “elitist” perspective.
Proposals to make this amazing system less capable and less responsive are simply not palatable to me. If we, in my family, had not had these dramatic illustrations of its amazing quality in just the last few months, all I would have to do is look a little further through the extended family, or a little further back in time. My brothers, who have had surgeries to correct neck and shoulder problems, and the one who has had an esophageal reflux problem addressed with a series of procedures over the years – both able to live normal, healthy lives (and one, very abnormally, into running marathons and triathlons). A sister-in-law who had to have a pacemaker inserted when she was in her thirties, due to a previously-undetected congenital condition, but who lives a nearly 100% normal life now. Older in-laws who have successfully battled cancer and joint problems. An older aunt who has had major back problems largely corrected with surgery – all of these senior relatives retaining their ability to do things they enjoy, contribute to their communities, practice skills they have spent a lifetime developing.
Politically, the mask is off of the national health care proposals now, as outlined in my earlier pieces linked above. There is less and less effort to pretend that national health care will not make the kinds of medical care that members of my family have needed less available. Instead, we are treated – by advocates in the public debate – to discussions of allocating “society’s resources” away from medical care, and of using the tax code and other means of punishment to force people to lose weight and stop smoking. Interestingly, not one of the problems my family members have had to address has been related to either obesity or smoking. None of them are obese and none of them smoke, or ever did. In just about all the cases, medical intervention has been to correct pain or dysfunction: from conditions with no relation whatsoever to obesity or smoking, and mostly not on an emergency basis, but to either prevent potential emergencies, or ensure longer life with a better quality of life.
Maybe you can avoid osteopathic problems, esophageal reflux, placenta previas, and congenital predisposition to heart issues with diet and exercise. But there is no proof of that proposition. If there is a way ahead on it, nothing has been communicated to the public in that regard. Without American medicine, even the best of diet and exercise would probably not have kept my family members out of chronic pain from unaddressed joint problems, or in some cases kept them alive, past emergencies with a statistical likelihood of occurring.
Our medical care system is a tremendous blessing. The advances it makes on a routine basis, in technology and practice, are astounding. And they quickly become available to the average patient, something that is not the case with national health systems. Technically (apart from the categories used by insurance companies and regulators), all procedures that are not being performed for the purpose of keeping alive someone who is literally about to die are “elective” – but when they are performed on a more and more advanced basis, they give more and more people more and more longevity and quality of life.
There is a colossal silence on the benefit this is to the lives of modern Americans, from advocates of a single-payer national health system. It is not a point that helps make their case, but given the other outlines of their argument, I think it’s not a point they would be moved to make under any circumstances. It looks to me like they honestly believe “society’s resources” would be better spent paying faculty at universities than spent operating on my brother’s shoulder so he can have full, pain-free use of his neck, shoulder, and arm. I don’t think it’s at all alarmist to suspect that they would rather put “society’s resources” into making oil and gas as expensive as biofuels and wind, than put them into seeing my sister through her pregnancy complications, so that she can deliver a healthy baby in safety for him and herself. I don’t know how they’d feel about spending “society’s resources” on my sister-in-law’s pacemaker; after all, she’s a physician, so maybe she’s one of the people worth the expense. But there are probably some who figure that Mom, at just about 70, should probably take her chances with her arterial blockage instead of using up “society’s resources” with an expensive bypass operation – and others who figure a healthy gal like my other sister can perfectly well be pregnant and deliver a baby without all the personalized care and attention that costs “society” so much for this ordinary life event.
The problem with us individuals is that if we can pay for something, we will – and we’ll command more of “society’s resources” for our selfish wants than the pessimistic planners of the left think is appropriate. Well, yeah. That’s what we do. As heavily regulated as our medical system already is, it still responds to our choices. And it does so much for us when we make those choices. I can’t see a single good reason to turn the keys over to the government, and let its ideologues start telling us how much medical care we get to have. Two people dear to me who are in the University of Oklahoma medical center in Oklahoma City today, receiving life-saving and life-enhancing care, are driving that point home for me at a very important juncture in our nation’s history.
The Optimistic Conservative 
“She was able to elect to have this surgery now, even though she was not blind yet in either eye – unlike seniors in Britain.” That’s not quite accurate. Private health care, and private medical insurance, is widely available in the UK. But those who choose to buy themselves out of the ghastly ‘National Health Service’, as I have for most of my life, end up paying twice, once through taxes and once via the medical bills we pay. In your mother’s case, you and your sisters would probably have clubbed together to pay for the treatment she needed rather than risk the lottery (and MRSA) on offer from the NHS. Poor families don’t have that option, of course.
David Green (1993, Reinventing Civil Society, IEA) has argued, in effect, that the working class did better (relative to the health care standards of their era) with the private insurance arrangements intended for them (“friendly societies”) that existed before the government destroyed them over the 1911-1948 period. Green’s monograph is well worth a look for those involved in mounting the intellectual opposition to Obamacare.
The battle cry for health care “reform” is totally baseless and completely ideological. The Dems spouted this nonsense continually when they were out of power — you remember the triple mantra of universal health care, increased funding for education and a pristine environment — and now they apparently feel compelled to mindlessly destroy (for all except the political elite, of course) the best health care system in the world.
The whole phenomenon — a bill that is cobbled together in secret, with all the usual payoffs to those who have funded their campaign; the race to pass “it”, whatever it is or is not, without any interest in debating it, or even reading it; and the active disinterest in what all of “it” will cost — is truly surreal. It’s the same feeling I got watching the sinister world of the Dark Knight, as the Joker destroyed everything and everyone in sight.
I too have a family example of why Obamacare is likely to result someday in my death or the death of a loved one. My 53 year old brother-in-law had been in denial about his shortness of breath for a year or so. He finally went to a cardiologist last week who, upon examining and testing him, found an almost completely occluded major heart artery. We all know what then happens in our current medical system — and did happen for him. Rushed into the hospital within the hour, angiogram performed, stent placed, now recovering at home with no permanent harm. Think of the reduced costs re future care that this approach will likely achieve. But if my brother-in-law faced the same situation in the wonderful world of Obamacare, he would undoubtedly have to wait — three weeks, a year, who knows — and might well suffer a heart attack before he could be treated.
I have many liberal friends, and I’m used to their cliched skepticism about capitalism, but I must say that their robotic embrace of this charade of a plan proves one of three things: (1) they are utterly and mindlessly in love with the Joker; (2) they really do hate themselves, their country and its best institutions/systems; or (3) they are easily mislead fools. Or maybe it proves all three.
A.Reader — thanks very much for your informed perspective. It has become received wisdom in the US that Britain’s national health system doesn’t authorize cataract surgery until a patient is blind in one eye. Is that an inaccurate report?
For me the question here is not so much the availability of the procedure as the NHS policy on it. In America, cataract surgery is routinely authorized for Medicare patients, even those without supplemental insurance, as long as a doctor prescribes it. No conditions of disability have to be met for Medicare to cover the procedure.
The difference for a patient without supplemental insurance is that fewer doctors will accept him as a patient. He may have to wait longer to have his surgery than the patient WITH supplemental insurance, but it will not be denied to him by policy due to his not having met a disability condition yet.
So what I’m really interested in, for this discussion, is less whether Britons are ABLE to get cataract surgery if they can find a way to pay for it in the private system, than what the NHS policy is on authorizing it.
Meanwhile, thank you for the excellent link, which I hope readers will take advantage of.
Sleepless — I fear your last option — All of the above — is what we are seeing proven with the mindless embrace by his followers of Obama’s Death Care plan.
Someone commenting at another blog a few weeks ago made the point that, now that we are so much better at it, it does us so much more good, and it keeps more people alive longer than it ever did before — OF COURSE we spend a large portion of our productivity on medical care. People like your brother used to just die or heart attacks at 53. People like my sister used to just die in childbirth, and their babies with them. Back when we didn’t know how to keep them alive, of course we didn’t spend “resources” on medical procedures that hadn’t been invented yet.
And there’s no question that coffins are cheaper. But what kind of people are we if we make that our criterion? And how dare we, each of us, use it to judge the situation of anyone else?
Collectivism is a culture of death, and Obamacare is its “health” system. That’s becoming clearer with each passing day.
“It has become received wisdom in the US that Britain’s national health system doesn’t authorize cataract surgery until a patient is blind in one eye. Is that an inaccurate report?”
No idea, I’m afraid. Since I don’t use the NHS, I don’t take much interest in what it does. I do know that there’s an Orwellian committee called ‘NICE’ (National Institute for Clinical Excellence) that sets out what NHS doctors are allowed to do and what drugs they are allowed to prescribe (see, e.g., here).
My point was just that if you have the money, or the relevant private insurance, then you can get whatever treatment you want in the UK. This contrasts with the situation in Canada where, as recently as 2006, it was illegal to take out medical insurance for treatment that the state was obliged to provide (even if the state was failing to meet its obligations). Although Canadian single payer provision is probably better medically than UK NHS provision (it could hardly be worse), it comes (or came) at a heavy cost to individual liberty.
Your point that effective medical treatment is, of course, more expensive than no treatment at all, is apt. We also spend dramatically more for telephone service, air transport, automobiles, and cable TV than our great grandfathers. Before the medical miracles (now regarded as routine) humans had to accept premature deaths that simply no longer occur in our age. In the 18th century, smallpox killed millions. Even a notable personage like Queen Anne, with ready access to the best medical care of the time, was pregnant 18 times and never had a surviving child. Extensive areas of the US were virtually uninhabitable as late as the end of the 19th century because of endemic malaria. Nobody seems aware that the health of the entire world has improved dramatically in just the last few years.
“Yet while elevation, mental and physical, of the masses is going on far more rapidly than ever before–while the lowering of the death-rate proves that the average life is less trying, there swells louder and louder the cry that the evils are so great that nothing short of a social revolution can cure them. In presence of obvious improvements, joined with that increase of longevity which even alone yields conclusive proof of general amelioration, it is proclaimed, with increasing vehemence, that things are so bad that society must be pulled to pieces and reorganized on another plan.”
Herbert Spencer, “From Freedom to Bondage”, 1891
As you can see, this post was the runner up in this week’s Watcher’s council voting. Congratulations.
(That’s all you get, we don’t have cash prizes.)
Soccer dad — many thanks — it’s enough! I appreciate your submissions to the Council on the TOC blog. It seems to bring in the highest class of readership too…
I am a working class person who cannot afford a health care plan… why should I be against this?