Friday, 24 February 2012

Healthcare Mythology Exposed

Two women are standing in line for hours in 1983 Soviet Russia waiting for their loaf of stale bread. One woman says, "We are blessed that the government provides us with our daily bread, could you imagine living in America where the government doesn't even provide them with bread? Thank God for our Soviet hero Lenin!"

When I listen to people give thanks for our Canadian health care system and praise its founder Tommy Douglas I think of the long line and the stale bread that all of us Canadians have universal access to. This is the paradigm most of us Canadians are stuck in. Just as Soviets couldn't imagine a world where the government wasn't providing stale bread and ill-fitting shoes, we can't imagine a world where the government doesn't provide us with healthcare. Mark Steyn points out, "A citizen of an advanced democracy expects to be able to choose from dozens of different breakfast cereals...and hundreds of movies...but when it comes to a life-or-death decision about his own body, he has the choice taken out of his hands and given to the government."

I suspect that most proponents of universal health care are also opposed to state run food production and distribution. This doesn't make a whole lot of sense to me. I can't imagine anything more important to health than food, why then are they against government grocery stores? What do advocates of government run health care (aka universal health care, aka centrally planned health care) tell their children about why the Soviet model of centrally planned food production and distribution failed so miserably? Do they tell them they just had the wrong central planners in power? Do they say that evil people of nefarious intent were behind the failure of the centralized system and that what it needed was a virtuous hero leader? Or do they explain how exerting ownership over another person and their possessions is both evil and ineffective because of the corruption of incentives even if the intention is serving the greater good, and that almost all evil is done in the name of the greater good. I suspect they use the hero/villain myth to explain its failings.

Tommy Douglas is venerated as a Canadian hero for standing up to those evil Saskatchewan physicians and pushing through Medicare. Tommy was concerned about society, the greater good, the plight of the poor and the mentally handicapped. His 1933 masters thesis, "THE PROBLEMS OF THE SUBNORMAL FAMILY" advocated the forced sterilization of mentally disabled people, "Because this class tend[s] to intermarry... the second and third generations are nearly always worse than the first. The result is an ever increasing number of morons and imbeciles who continue to be a charge upon society." He wisely distanced himself from his advocacy of eugenics later on as it became rather less popular among the intellectual elites to share Hitler’s viewpoint, but one can see the fallacious thinking that led to his views on eugenics also led to his views on Medicare and one can sympathize, he was concerned about the greater good. The fallacy simply put is this, "The ends justify the means."

This is a tempting fallacy, after all there are smart people who have some great ideas and aren't we all convinced that if only our ideas were implemented the world would be a much better place. The reason that this argument is fallacious is that it lacks internal consistency. It says that "I" have a right to make rules for other people, to use them as means to "my" noble ends. This is obviously not a moral rule because it lacks universality (a necessary component to any moral rule), it can't be applied to everybody. Either everybody has the right to use others as a means to their end, or nobody does. It is also rank narcissism, the idea that “I” know what is best for other people.

When you have an above average education it’s easy to fall into the narcissistic thought pattern that the world should listen to you if not revolve around you. Its easy to fall prey to the idea that those other ‘morons’ out there, lovable as they are, need your policies for their own good. The problem with having higher education and intelligence is that it often gives one the false sense that you know what is better for others and not enough sense to understand ones own impulse to control people results from an unconscious psychological and philosophical flaw…the idea bred into every child that has had coercive force used on them by parents (do as I say because I said it) and public schools (where even biological needs like bathroom and lunch are controlled by others), that relationships with others are about ownership and domination, you are either the owner or the owned. Social engineering is the impulse to use people as a means to an end, and requires one to view people as property, at least at an unconscious level. This is where the myth of the greater good comes from.

The myth of the greater good/common good/public interest is a self-defense mechanism that a non-sociopathic individual requires to preserve the ego, the narrative that “I” am good and just. Without this narrative the domination and violence of ones relationship to others is revealed in all its ugliness. More specifically the domination and violence of your own childhood is revealed. It might reveal that those caregivers (parents, teachers, coaches etc) who you were completely powerless against as a child and utterly dependent on for survival, who used corporal punishment and/or dominating language and implied threats (do as I say because I say so) to control you, who weren’t curious about how your needs weren’t being met when you ‘misbehaved’, who imposed force and restrictions on you that exceeded that of protective force, who imposed their dreams and aspirations and self-failings on you, were not doing all these things for ‘your own good’ or because they loved you. They were doing it to control their own anxiety and fear and they were ignorant to this fact. This, my friends, is where the myth of the greater good comes from and the ugly truth is that it does nobody any good, not even the enforcer because it disconnects them from reality and from obtaining the self-knowledge necessary to break the cycle.

Rather than obtain self-knowledge through therapy, journaling, introspection, meditation etc. it is easier to build more and more elaborate myths to keep the narrative from unraveling. Here are some of the myths that are propagated about healthcare.

Myth 1 - Healthcare is Free in Canada
Health care professionals expect to get paid as do suppliers and support staff and this money comes out of our pocket...the government doesn't make money, it takes money. Alberta households that make more than $234,000/year (I suspect this describes a typical Fort McMurray Household) pay over $32,000/year or $2600/month in health insurance.* It is unbelievable to me that people perpetuate the myth that healthcare is free in Canada. It is actually unbelievably expensive.

Myth 2 - U.S. System is Free Market **
The system would be more aptly called fascistic. Imagine a vehicle maintenance system analogous to the US health system. First you would require strict licensure of all aspects of vehicle maintenance. The US College of Oil Changers and Mechanics would ensure that schools only graduate so many qualified people each year to ensure they remain in high demand. Laws would prohibit you from doing your own work or going to a mechanic of your choice. You could only take your vehicle to government approved companies. Employers would be required to purchase vehicle insurance for you. Every oil change would be covered by insurance. Parts are only available from approved suppliers. Inventors that create improvements or new breakthroughs would be subject to years of bureaucratic scrutiny. Thousands of new pages of regulations would be created each year to deal with the unintended consequences of rules from previous years. What do you think would happen to both the quality and price of vehicle maintenance?

In order for a system to be considered free-market it needs to contain voluntary interactions, relationships and trades and be free of coercion, fraud and imposed force. This does not describe the US system at all.

Myth 3 - Health Care is a Right
There is no such thing as a positive right. There are only negative rights, the right to be left alone and not be aggressed against. Every person has the right to his or her own life and property (product of ones labor). No person has the right to initiate force against another person or their property. If you hold these 2 axioms to be true and apply them universally then you will understand that calling Health Care a 'Right' is to say that it is permissible to force a health care provider against his will to provide a service for another person and that it is permissible to prevent entrepreneurs from providing services that are outside the box to consenting customers, and that it is permissible to prevent a terminally ill patient from trying experimental treatments. Obviously this is a violation of the first 2 axioms and so can't be taken seriously. You either believe (wrongly) that people can be used as a means to another persons end, or you believe that people are ends in and of themselves.

Myth 4 - The Poor Would Suffer if Not For Medicare
The poor and the middle-class are the first to suffer from the effects of central planners. Today's poor live infinitely better lives than yesterdays kings precisely in the area's that people have been free to trade and produce. The rising cost of health care in both the US and Canada is because of central planning and it is rising for the exact same reasons food became scarce (aka expensive) under central planners...initiation of force creates a corruption of incentives and entropy. Those that live on the margin are the first to suffer. If you care about the poor you have to reject socialization of goods and services.

Before the government told doctors how to run their practice and changed how they were to get paid there were few people who did not get treatment they needed. The idea that health care practitioners who dedicate their lives to helping people would deny someone care because they couldn't pay is reprehensible. Lack of charity can only occur in a system that treats its health care providers as gears in a machine and removes the humanity from the sacrosanct relationship between a practitioners and the patient, a system that denies the needs of both practitioner and patient for that nebulous, vague, politically convenient concept called, "the greater good."

One just has to look at area's of medical care where the free market is relatively unfettered (ie cosmetic surgery and corrective vision procedures) to see how many poor people can afford these elective procedures now as their costs have come down and effectiveness has drastically improved over the years...the opposite of government monopolized services. It’s not hard to see how the free-market improves the lives of everybody, allowing even the poorest North American to enjoy a life of infinitely more quality and comfort than pre-industrial kings.

Myth 5 - We Just Need The Right Leader
The pervasive cultural narrative is that our political landscape is made up of heroes and villains. When things go wrong it was a particular villain that caused the issue and we just need to get the right person in power and things will improve. This view is empirically pervasive as evidenced by the fact that people vote and expect their candidate will change the system. Any system of domination inherently incentivizes the infringement of human rights. You can see the temptation that arises when would-be social engineers have a tool like government at their disposal. It allows everybody to wash their hands of moral culpability. Intellectuals can make up intelligent sounding rules in ivory towers and let others enforce them. Enforcers can say they didn't make the rules they are just following orders. Politicians can say it’s the will of the people. The voters can say the politician turned out to be a villain.

Try and imagine a system where people were personally accountable for their policies. Tommy Douglas actually doing his own dirty work of identifying, detaining and personally castrating a 'defective' (his language) seems worse than having a healthcare system that results in the sterilization of mentally handicapped person. The evil of the act is the same in both cases, testicles are removed from an unwilling person, yet in the latter case no person is accountable we can simply blame the system.

Myth 6 - We Get Universal Healthcare in Canada

As Chief Justice Beverly McLachlin points out, "Access to a waiting list is not access to health care." Healthcare is what happens when a doctor treats you not what happens when you are standing in line. Enough said.

A Modest Proposal

Before you accuse me of hypocrisy for making a proposal that is binding on everybody, allow me to differentiate my proposal from others. I am not proposing a system; I’m simply saying lets all admit we don’t know what is best for the lives of other people. I’m simply saying DON'T INITIATE FORCE AGAINST ANOTHER PERSON, not even if someone else wants you to initiate force against someone, not even if popular opinion says you should initiate force against someone. That's it! Simple, universally applicable and something that I think we should all agree on.

This means that I can seek healthcare from anybody I want, whether that's a nurse, a physician, a physician assistant, a naturopath, or a neurologist. This means that I can get whatever medication I determine I need as long as it doesn't harm another. Why shouldn't I be able to go to the pharmacy and get what I need, I know what medicine I need for my ailments, why should I be required to get the permission or advice of a physician? This means I can start a medical insurance company to tailor service to a market niche that I see as an entrepreneur and compete against the big boys without worrying about corporatist legislation prohibiting me. This means if I have a terminal illness, I can experiment with untested and risky drugs that just may save my life as opposed to accepting a death sentence...after all I own my body.

I propose that we start to investigate the reality of our own psyche. I propose that we start living conscious lives. I propose that we stop using other people as tools to manage our own anxieties. I propose we view leadership as attraction as opposed to force. I propose we make self accountability a priority in our own lives. I propose we start treating children as humans and recognize they have the same rights we now recognize slaves and women have. I propose we recognize that other people own themselves and their property and that violating this ownership is what evil is.


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