The more that I’ve listened to the media rhetoric surrounding the concept of “Death Panels” as a looming cloud threatening the population with the placement of “decision power” for an individual in the hands of the behemoth government bureaucracy the more I am saddened. Yes I am saddened not angered. I am saddened because those lemmings who follow that lead are truly illustrating the depth of their ignorance in the complex structure of our health care system. The simple route is to assign sole responsibility to an entity and to blame be it a group, an individual, a head of state, a congress or whatever. In this particular case I would advise an individual decision maker whose relationship in this equation is other than to achieve personal profit via some connection to the health care industrial complex to reconsider throwing their cards into commercial or public media basket. I would advise an individual to resist the Sirens of “government takeover” and “reduced freedom and liberty” and cut to the real chase. In essence I would advise my fellow Americans to belly up to the bar and take what I call knowledge responsibility.
There is no shortage of stories where the “government” has been at work in undermining our freedom and liberty. In the interest of freedom and liberty my curiosity continues to lie in the concept of measurement of what health really is at the scale of a national population. The beauty of the “Invisible Hand” is not only in the many interpretations by the academics, but in the modern movement toward the “free market” as the “optimal government”. We all have our run ins with the “government” and frankly there is a sizable population where those run-ins are most profitable to the individual both in entitlements and contracts. There are the rest whose run ins frustrate them to the point of anger even when viewing recipients of government programs.
My interest in this blog post is on two fronts. First life is not forever and as wonderful as our science has researched complex diseases and treatments the end outcome I would maintain has been to extend life and not prevent death. Second the Sage feels that the more we have entered into the life extension business the more we have placed ourselves in the uncomfortable position of being Gods. The notion that the private insurance market has no “Death Panel” is absurd. What is a “Death Panel” anyway if it is not denial of payment for life extending care financially out of reach. If “Death Panel” is an instrument to distract public opinion then it has no place in the decision making process of any citizen who cares enough to cast a responsible vote. That is their informed vote and not the vote promoted by the media. Perhaps a step would be to wrap the head around some fundamentals.
I hear “Invisible Hand” in the media today and I hear Laissez-faire. The cry seems to come from the fear of the direction our state is headed as if we suddenly took up a wrong direction on putting health care reform as a priority. As if we once had a golden age of choice in America regarding health care? You certainly have a choice if you are healthy. That choice is to stay that way, hope for the genetics and no accidents. All I hear about from the modern regressive movement is the creation of choice and competition. At least that is the political rhetoric. If you are on the street and you believe that then you deserve what you get and at the end of the day it ain’t the government. It’s the “System”.
My concern with my fellow citizens in this country is that there seems to be no understanding of fundamental properties of our health care system. I recently sat across the table from a retired executive who knew not that emergency rooms in this country were legally required to treat people who arrive at their door. The Emergency Medical Treatment and Labor Act actually does not absolutely mandate that emergency rooms provide care to the uninsured, but the effect of the act is that it does except for highly specialized hospitals. In the heat of the government take over of health care debate death panel rhetoric spewed forth from the media and what seems to be the case is hopeless corruption on both sides of the political isle. The media is the media and there where there is little incentive from the private media except to sell ads. The public media is an agent of liberalism, whatever that is, and the incentives are still linked toward maintaining a listener base.
To cut through the media rhetoric why not go to the source. What American is willing to belly up to the bar and say, “You don’t have the money you don’t get the care”? The position here is that you can’t have it both ways. Repeal the EMTALA. Why is this not on the agenda today. If the optimal freedom and liberty society is achieved through the unregulated free market then private insurance is the answer and he who “chooses” to not have insurance don’t get into the emergency room. The EMTALA more appropriately should require that emergency rooms deny care to those without insurance somewhat like you can’t get an automobile loan if you don’t buy insurance. This would provide the population with the incentive to choose rather than a mandate. It would cost a few lives before adoption, but think of the adoption rate and the lowering of costs.
The one thing the Sage finds a mystery is why some people in this country think that insurance companies have incentive to provide health care insurance to anyone but the healthy people. If we have a legal obligation to deliver care at the emergency room do we not have socialized medicine? Why are we even talking about socialism in this debate? Why do I hear Karl Marx’s name along with any other post WWII bad guy associated with real work we need to do to improve our “System”.
For all of those “Death Panel” people who are shivering with fear over a government take over I ask to get on board a movement to repeal and reform the EMTALA. Get specific. Don’t hand wave generalities. If we believe that the unregulated “free market” is the “optimal” solution to our economic issues with health care and even more important that which comes along with freedom and liberty then everyone should have the freedom and liberty to be denied at the emergency room if they didn’t plan ahead. That means pregnant mothers illegal or otherwise legal who have no insurance go somewhere where it doesn’t cost taxpayer dollars.
Considering the economic academic point of view I think that would fix a lot of problems. After all the automobile repair shop market is quite stable. You can take your car in for repair. If you don’t pay the bill they keep the car. What would that mean with a human body. I’m sure there are organs they could use to pay the bills. I take this to the extreme in the remote hope that I might communicate that insurance companies are not a model for optimal public health policy. They are in the business of ensuring against risk. Why you would expect a system of private health insurance companies to optimize public health is a mystery to me. Leave the insurance companies to do what they do. Insure against risk and let people purchase insurance against a future health insurance event based on the actuaries.
Once you let insurance companies deal with all the people that can pay their premiums and build out a system that serves them then as a society, not a socialist regime, you have to figure out what those outside of the system do. Much depends on the economy, but the Sage is intent on applying pressure to those who want to act like there is this private market nirvana that is waiting to solve all our problems if we just do the right thing. The Sage has been on the ground and the position here is that in order to support any of the conservative media and political rhetoric then we shut down the emergency rooms to only those that can pay.
In the spirit of economic incentive our entire health care system would change and stabilize following the path of the economic rationalists. You don’t have the money you stay at home and die under your own chosen terms. You don’t pay into a system and you don’t have cash in hand you stay where you are when you have an event. Those who see these conditions will either adopt them or work harder to afford health insurance. Pregnant females legal or otherwise are on their own from discovery of pregnancy until birth just like it used to be. That was the ultimate free market.
As I listen to decision makers in the media at various levels of government, local, state, federal there seems to be a some sort of message that we should return to a time that previously existed where the free market delivered health and well being to all the good democratic capitalists. I’m not sure what to make of that, but what I do want is all of the anti-socialist health care proponents to put their ideology where their mouth is. Shut down the emergency rooms to those who cannot pay and do it with the dignity and respect of the free market. This will remove more government from health care than you can possibly imagine. It will provide the private market all have been looking for to improve our health care system. Of course such a move would require appropriate tort reform to protect the emergency rooms.
You can’t have it both ways. You can say you are a free market conservative and believe that a private health insurance market is the foundation for the worlds top health care system. But as long as we have laws that require care at the emergency room we have socialized health care. So step up to the plate and call for reform of the emergency room laws and start turning them away. Let the market optimize like it is supposed to. It’s not about death. It’s about the economics of life extension…