Health Care: Quality or Equality?

By | October 31, 2011 | 8 Comments

Most people on the left are not opposed to freedom. They are just in favor of all sorts of things that are incompatible with freedom.
Thomas Sowell

Equality and freedom are both fine-sounding words, but are they equally worthy goals? This question is crucial, because equality and freedom are in conflict. But, you ask, how can this be? That depends on how you define equality.
If equality is defined the way it was in my youth, it means equality before the law, and equality of opportunity. It means that everyone begins the race at the same starting line. How they finish the race depends on many factors − innate ability, intensity of training, and excellence of coaching. In sports, we all understand this. But in other fields, the idea meets with strong resistance.
Now we define equality as equality of result. Of course, no one does this in sports. No one, at least no one who is sane, suggests that an athlete who has short legs, or who slacked off in training, or who has a lousy coach, should start the race several meters in front of the others. That would be seen as grossly unfair, and in addition as insulting to the athlete and to the sport.
Through most of my medical career, what we did was referred to as “medical care.” This seemed reasonable, since it was overseen by physicians. But some felt that this term undervalued the contributions of nurses, technicians, paramedics, and all the others who provide care. So, with some justice, the name was changed to “health care.”
But then the trouble started. The words were condensed to “healthcare.” This was part of a tendency to put combine words into compounds like “backseat” and “backyard,” as if we were speaking German. But that makes me nervous. The modern welfare state was introduced by Bismarck, who was hardly my role model.
The term “healthcare” emphasizes the goal, health, but it also reduces the emphasis on those in charge of achieving that goal, doctors. Doctors were in charge of medical care. But who is in charge of “healthcare”? We think it’s the government, but it surely isn’t doctors.
The World Health Organization rates U.S. “healthcare” as 37th in the world, and Cuba as 39th. But how can anyone in touch with reality rate our health care as the virtual equal of Cuba’s, where common people can barely get an aspirin? On the contrary, America has the best survival rates for most cancers.
As far as life expectancy is concerned, if you eliminate violent deaths − homicide, suicide, and accidents, for which medical care has the least effect − the U.S. has the longest life expectancy of all nations. I’ll bet you didn’t read that in pro-ObamaCare articles. For example, counting all causes of death, Japan has the longest life expectancy at birth, 78.7 years, while the U.S. is number 19 at 75.3 years. But omitting violent deaths, the U.S. is number one at 76.9 years, while Japan is number nine at 76.0 years. But in any case, we are doing much better than the advocates of government-run health care would have us believe.
Einstein was famous for his “thought experiments,” which were difficult or impossible to carry out in reality, but which were instructive even when carried out only in the imagination. I’m hardly an Einstein, but I’d like to suggest a “thought experiment” that may shed some light on the difference between equality and freedom.
If we are to believe the World Health Organization and the proponents of socialized medicine, the quality of a nation’s care is judged not by life expectancy, or by survival rates from cancer, or by other indices of quality of care, but by equality or care.
So how can we improve the equality of care? We could improve the care of those now receiving the worst care, as has been our goal for many years. Or we could use the Marxist approach by decreasing the care of those receiving the best care. And this, regrettably, seems to be what the ObamaCare advocates have in mind.
To improve the U.S. ranking on the World Health Organization scale, we could simply close the 100 top hospitals in the country. We could close Columbia-Presbyterian in New York, M. D. Anderson in Houston, and Cedars-Sinai in Los Angeles. And instead of making technology like MRI scans more available in outlying areas, we could make it less available in urban areas. Instead of making expensive drugs and treatments more available to the needy, we could make them less available to the affluent.
But, you say, this is ridiculous, dangerous, even homicidal. Yes, but isn’t all Marxism? Isn’t this “thought experiment” in “healthcare” the equivalent of what Occupy Wall Street wants to do to the economy?
Marxism is the outgrowth of the peasant revolts of the Middle Ages, and specifically of the French Revolution. Despite the examples of the English Revolution of 1688, and the American Revolution of 1776, which led to greater freedom, the French proceeded with a series of decapitations of the nobility and the wealthy.
The guillotine removed the “top one percent” so hated by Occupy Wall Street. By the standards of the World Health Organization, this led to greater “equality.” There were just as many poor. And through the years of the Terror and the Napoleonic era, their condition was, if anything, even worse than it had been under the monarchy. But many people still felt that they were more “equal.”
But which is more important − to make people feel better about their condition, or to actually make their condition better? Leftism emphasizes feelings over reality. So for the leftist, the question is easy to answer. Leftists want to feel better − about themselves.
Leftists talk endlessly about doing things for “the people.” But the people they actually want to do something for are themselves. They want to feel altruistic, but feeling altruistic and really helping others are two different things.
● Many (not all) leftists would prefer that all people get mediocre care rather than that some get mediocre care while others get excellent care.
● They would prefer that all people have the minimum to survive rather than that some have the minimum and others have an excess.
● They would prefer to lower the ceiling rather than to raise the floor.
The Soviet Union collapsed after 74 years of “building socialism.” They did build socialism, but what else did they build? A huge military and police apparatus, yes, but not much else. How many new drugs did the USSR develop in those 74 years? I am aware of only one. And how many new medical devices? Not the CAT scan. Not the MRI. Not fiber-optic diagnostic and therapeutic devices. In fact, aside from a few elite hospitals and clinics where Communist Party bigwigs received Western-style care, health care in the USSR was mediocre at best, and more often terrible or nonexistent.
Leftists do not intend to construct a Soviet-style economy and health-care system in America. But they did not intend to construct them in the USSR, either. They had more lofty goals in mind. They dreamed of universal peace, brotherhood, plenty, and health. But their dream, like the dreams of all totalitarians, turned into a nightmare.
At least Russian communists had the excuse that their ideas had not yet been tried. At least they could hope that their dreams could be put into effect. But American leftists have the example of 74 years of Soviet failure and despotism. What’s their excuse? They have the example of 60 years of Western European socialism, with its overbearing bureaucracy, stifling regulations, mountainous debt, and collapsing social-security and health-care systems. But they ignore that example.
Our goal should be to assure that everyone has at least adequate health care − that is, to raise the floor. If at the same time the ceiling is raised less, then health-care equality will increase. That’s okay with me. But if at the same time the ceiling is raised more − that is, optimum care is raised to a still higher level − then health-care equality will decrease. And that’s also okay with me.
When equality and freedom conflict, we must come down in favor of freedom. In the end, we must come down in favor of quality of health care. In the end, we must recognize that there already exists a place where there is equality of health care, equality of income, equality of housing, as well as a guaranteed job. It is called prison.
Dr. Stolinsky writes on political and social issues. Contact: You are welcome to publish or post these articles, provided that you cite the author and website.

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