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A Tale of Three Patients: Preventive Care or Preventing Care?

By | August 12, 2018 | 0 Comments

Proponents of vast programs like ObamaCare often shrug off complaints by claiming, “Those are just anecdotes.” Still, what is history but a series of anecdotes? And while anecdotes may give an incomplete picture, they are less susceptible to fabrication than large “studies,” which can be – and often are – manipulated to suit the agenda of those who conduct or pay for the study.

If you torture data sufficiently, it will confess to almost anything.
− Fred Menger

With these points in mind, consider these three patients:

Patient One was a mid-level executive in a large health-care organization. He was well-liked by his co-workers and was a husband and father. His mother had been a heavy smoker and died at the age of 57 of lung cancer. Despite this fact, or perhaps because of it, the man smoked cigarettes incessantly.

But one day he did not appear at the lunch table. A colleague reported that he had been diagnosed with inoperable lung cancer. Six months later he was dead – like his mother, at age 57. One may speculate about whether his identification with his mother was so strong that he arranged to die at the same age she had, and of the same disease.

But some facts are beyond speculation. Because of his early death, he had not drawn a penny from Social Security, Medicare, or his employee pension. On the contrary, he was still paying into them till the day he died. From the point of view of his family, his friends, and his dog, his premature death was a tragedy. From the point of view of his physicians, his death was a failure. But from the point of view of economists, it was a success.

Some time ago, I attended a lecture on the economics of health care by a professor from Boston. Thinking about my late colleague, I went up after the lecture and asked the professor what would happen if everyone stopped smoking. He replied that Social Security and Medicare would go bankrupt sooner because people lived longer.

I asked why he did not mention this fact. He replied that he had tried to do so in lectures and journal articles, but anti-smoking activists raised such a howl that he just gave up. The professor was nationally known and, being semi-retired, was immune from retaliation. Yet even he was inhibited from expressing what seemed like an obvious fact. So much for academic freedom, which in reality means freedom to express leftist opinions – but definitely not freedom to express anything contrary.

Patient Two worked for a large public-service organization. A relative had early-stage prostate cancer detected by a PSA – and was cured. Despite this obvious lesson, the man refused to get annual PSAs. He developed urinary symptoms and back pain. X-rays revealed widespread metastases from prostate cancer. He was dead in less than a year. He had just observed his 67th birthday, and thus had been paying into Social Security all his life, but had been receiving it for one year.

Medicare helped pay his medical expenses. But he didn’t live to age 86, which was his life expectancy at age 67. He didn’t draw Social Security or use Medicare for all this time. He didn’t break his hip and require surgery and rehabilitation. He didn’t develop dementia and need a long stay in a nursing home. Like Patient One, he represented a medical defeat but an economic success.

Patient Three is the relative of Patient Two and a blogger. He had been getting annual PSAs since his 50s. When he was 66, his PSA rose. A biopsy revealed cancer of intermediate aggressiveness, but it was confined to the prostate. He chose radiation instead of surgery. He had two months of therapy, paid for by Medicare, with mild side-effects. He remains well at age 83, and can expect to live to 91.

During all this time, Patient Three will continue to receive Social Security and his employee pension, and to benefit from Medicare – assuming Medicare remains functional. Patient Three represents a resounding success for his family, his friends, his dog, and his physicians, but an abject failure in terms of economics.

Is this an exaggeration? Read the multitude of news reports and opinion pieces which detail the cuts in Medicare that have been made and are being planned. Then consider the words of President Obama regarding health care for the elderly:

Maybe you’re better off not having the surgery but taking the painkiller.

And now, predictably, pain medication is being restricted. Have a nice day.

Maybe you are better off not having expensive treatment. But maybe you’re not. The key question is: who decides? Not you. Not your family. Not your doctor. No, whether you have the expensive treatment will be decided by remote, faceless, unaccountable, unelected bureaucrats.

And they will be making these life-and-death decisions based on their interpretation of thousands of pages of ObamaCare and other health-care laws, and more thousands of pages of regulations – which are increasing daily. Incomprehensible laws and regulations confuse citizens but empower bureaucrats.

Even worse, the bureaucrats will be making these decisions based on their own whims and prejudices. And their primary consideration will be to save money. As you can see, Patient One and Patient Two fit in nicely with this line of thinking. Perhaps for this reason, annual PSAs are no longer recommended at any age, and mammograms are no longer recommended below age 50 or after age 74.

It may be a coincidence that the studies justifying the omission of these preventive tests came out just at the time that ObamaCare was being enacted. Then again, it may not be a coincidence.

If a drug company funds studies showing that its products are beneficial, everyone cries foul. But if the government funds studies showing that PSAs and mammograms are unnecessary and waste money, no one utters a peep. Nevertheless, the result is the same: unreliable research that is bought and paid for. Once science is subverted, who knows what to believe?

Ezekiel Emanuel, MD, one of the chief architects of ObamaCare (and brother of Rahm), confirmed plans to substitute nurse practitioners and physician assistants for doctors. He stated, “You don’t need a doctor for every part of your health care.” No, you don’t. But he, his family, and his fellow elites will see a doctor when they are sick or injured – bet on it. Zeke also opined that everyone should die at 75. Don’t you feel reassured?

But, you object, didn’t Obama promise more funds for “preventive care”? Yes, but to him and those who think like him, “preventive care” means only contraception and abortion. The aim is to prevent pregnancy, not to prevent death from potentially fatal diseases.

Patient Three, on the contrary, didn’t go along with the program. Regular screening detected a potentially fatal illness when it was still in an early, curable stage. But as a result, Patient Three probably will be around for many more years. Obviously, we would all prefer to be like Patient Three. But painful as it may be, we must face the fact that many of the “elite” – in government, universities, or think tanks – would prefer us to be like Patients One and Two. It’s a lot cheaper that way.

Naturally, the “elite” expect to be like Patient Three. They expect to be cared for under special plans and in special clinics – you know, like members of Congress in the United States, or like members of the Central Committee of the Communist Party in the former Soviet Union. But they expect us peasants to tolerate being like Patients One and Two. They expect us “deplorables,” us “bitter clingers,” us uneducated boobs in “fly-over country” to make do with DMV-style health care.

Our job is to decide which patient we want to resemble. And then we need to do something about it. We need to be sure that we and our loved ones have regular medical checkups and screening tests. And we need to become politically active. We need to oppose centralized, bureaucratic, penny-wise health care doled out by the “elite” to the rest of us ignorant, benighted slobs.


Author’s Note: You might be interested in a tale of three other patients. The first two were Charlie Gard and Alfie Evans. They were babies offered potentially life-saving treatment, Charlie in America, and Alfie in Italy. But the UK National Health Service refused their parents permission to take the children for treatment.

This occurred even though Charley’s parents had arranged funding for the trip, and the Vatican arranged funding for Alfie’s trip. That is, the NHS would have saved money if it had allowed the transfers. True, the cash-strapped NHS wants to save money. But this is not its primary objective ‒ which is to assert the power of the state to decide life-and-death questions for everyone, including children. Single payer is about people control, not health-care control.

The third patient is Oliver Cameron. Embarrassed by the Charlie and Alfie cases, the NHS put up a fight but finally gave in, and allowed Oliver to be transferred to Boston Children’s Hospital. There his cardiac condition was corrected, and the child may look forward to a normal life ‒ no thanks to the NHS.

Yes, we can learn a lot from the tale of these three patients as well. As Dennis Prager says, “The bigger the government, the smaller the citizen.” And if the government grows big enough, the citizens ‒ like Charlie Gard and Alfie Evans ‒ disappear entirely.

Contact: You are welcome to publish or post these articles, provided that you cite the author and website.

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