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Giving the wrong people seemingly harmless power can result in unintended consequences.
Even granting control of the office coffee pot can determine a man's corporate fate. This possibility isn't listed in the job description for "snack and beverage provider," but I have seen an aggressive and clever employee use their role near the java to make the contacts and dish the dirt that got them their next promotion.
Everybody in the office dreads the bureaucratic tyrant who can twist well-intentioned human resource policies into work-stopping messes, but we sometimes forget this fear when government wants to do something good. Do you want more government health care? Imagine the kind of person attracted to endless useless meetings flocking to get a civil service jobs making end of life decisions, only this time with the police power of the state behind them.
Michael Scott of The Office may end up supervising your health care.
Everyone supports our current laws requiring health care providers to provide basic health care regardless of ability to pay. No decent person is happy with gaps in the coverage for our fellow citizens. Our current system has problems and requires an overhaul, but the best way to do this is to disperse decision making as much as possible.
Good intentions to help the sick may have unintended consequences if too much of our liberty is given up to government.
Government should protect human life and liberty, but having secured those rights should leave as many decisions as possible to the individual. We already see what happens when insurance companies get too big with the resulting inhumanity. Why should government, with even less competition, become more compassionate or wise?
For the sake of our liberty, power should never be concentrated in a few hands, but spread out to as many people as possible. Christianity and the American Founders teach that only God is perfect and that the safest course for humans in this life is to disperse the power He has granted us into different organizations: the family, the church, and the state. This will not result in paradise, but it is the best way to secure our Creator given rights.
End of life counseling is a good thing, but people with a financial interest in the decision should not do it. For the same government agency that must pay the bill to give advice about treatment is as unwise as having the heirs to a large estate decide the medical options for a rich relative.
Their advice will be tainted no matter how hard they try.
My own father and several of my colleagues have been involved in end of life counseling for years without being in the pay of government, hospitals, or insurance companies and I have seen these good caregivers bring peace and reason to confusing situations. No reasonable Christian ethicist supports prolonging unavoidable death or involuntary heroic measures that cause gratuitous and extended suffering. Discussions about living wills, something I have required many of my students to make as part of an ethics class, and end of life decisions should be part of any good education.
These services are available from many religious and non-religious nonprofits of varying viewpoints. They are often available for free or for very low cost. Your religious minister does not make money by cutting your life support or talking you into a unnecessary surgery. We do not need to turn these highly skilled and compassionate professionals into civil servants.
Sarah Palin was right to worry about "death panels," because good intentions often go bad when government is involved.
Our diverse society will have different ideas about appropriate care or whether "quality of life" should be used to determine who is given care options. To begin to further centralize those decisions in government, which already has judicial and police power, is unwise. Must North Carolina or Utah be forced to adopt standards made by "experts" from Washington D.C?
We don't have to guess whether United States government "experts" can make dreadful decisions about medical care. Minority groups, particularly African-Americans, can testify that government experts in the name of medicine have done great evils. Plans filled with noble sounding intentions degenerated into unconscionable acts. Do-gooders with the power of the state behind them are uniquely dangerous. Involuntary sterilizations, racist eugenic schemes, and nonconsensual experimentation on human beings received government support in the past.
I have known at least one victim of such treatment. Palin is being reasonable, given past government behavior, to fear that good intentions in government can become the excuse for wicked men to exercise power over the handicapped or minority groups that are not in favor.
The old and the terminally ill are always particularly apt to suffer in faceless systems.
Of course, no bill will, at present, be passed with a "Let Granny Die" provision spelled out. Instead, there will be one organization that pays the bills, provides the care, and provides the counseling. The potential conflicts of interest are obvious and only a fool would not fear abuses.
I do not favor the Obama plan, but this is not because I like insurance companies. My own family has suffered from their self-interested advice. Fortunately, even in our broken and imperfectly free market system, we were able to get different opinions and better care. This is not because we are wealthy, but because we are free to bring our own values to bear on medical decision.
Congress should act to increase competition and decrease government's already large role in health care. A little medical trust busting may be necessary. Government should not end up destroying competition by putting private companies in unfair competition with a larger state run health care option.
When private hospitals, insurance companies, and medical personnel abuse this trust, the state must intervene.
Sane regulation is the answer, not creating an even larger single bureaucracy likely to be staffed with the same people that worked for the old insurance companies, but now granted gold-plated federal pensions and health care!
Finally, giving government more control of health care will only encourage ideologues of both the right and the left to politicize health care even more than it is. Why? They will try to protect themselves from the other side and mandate their own particular vision of good health care.
Conservative governments will provide different answers than liberal governments. Women might get a free abortion under one party, but lose the ability to get extraordinary care under a "quality of life" test if they had a serious disease. Another party might cut off government funding of abortion, but increase spending on the end of life.
The political problems will only multiply as the Supreme Court that turned abortion into a raging political controversy is forced to make multiple decisions about our "rights" within government health care. Why? Politicians will dodge these hard decisions and push them off on the courts and unelected civil servants.
The same sort of people that flock to work at the DMV will be making end-of-life decisions. Bluntly, my biggest fear is not death panels, but decisions made by the kind of person who loves corporate human resource meetings. Wicked decisions will come from lethargy, incompetence, and a desire to produce multiple binders filled with research on every issue before acting.
We will get medical care by incompetent panels, but we will be dead just the same.
Don't let good intentions end up empowering government workers to set the ethical standards for end of life care and counseling. Every office knows that if they hand out some power the local Michael Scott will seize it and try to abuse it. You can get away from a bad boss, but you cannot get away from a bad government. Don't give the federal Michael Scotts more power over our health care.
By
John Mark Reynolds
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November 6, 2009; 3:13 PM ET
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Posted by: bw437 | November 9, 2009 12:10 PM
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John,
This part of your argument seems to focus on the probability of unintended consequences; in the case of health care you seem to think that the government's track record moves the probability toward failure. Am I understanding you correctly?
Let's look at American history to see what lessons we can learn. Prior to the passage of Medicare was it not true that the majority of older Americans died in poverty and many times, without any kind of health care? In fact, Medicare was probably the single most effective action taken that resulted in a healthier senior population. After Medicare, the elderly lived longer and in better health and average life expectancy grew substantially. Are those facts you can agree with?
Now, which party, by a significant majority, opposed Medicare? Come on. You got it. That's right, republicans. In fact, here's some of the language they used and it sounds remarkably similar to the language in 1964-1965:
In 1965, the republicans stated that Medicare was "brazen socialism". Does that sound familiar?
On the House floor, Representative Hall (R-MO) said, “...we cannot stand idly by now, as the Nation is urged to embark on an ill-conceived adventure in government medicine, the end of which no one can see, and from which the patient is certain to be the ultimate sufferer.” [4/8/1965]
In fact, virtually every social program this country has passed was fought by republicans. Now I realize that hindsight is 20/20, but did any of the consequences predicted by republicans come true? Did seniors not enjoy better health care, better health and longer, healthier lives as a direct result of government health care?
So why is it that you think we are incapable of a big, effective program for Americans? Are we incapable of building a program that works? Do you really think that end of life discussions are worse than being dropped for a preexisting condition or arbitrarily consigned to the streets because you've lost your job and went broke when you also lost your health insurance?
I think we can do better but not when the opposition spews vitriol bereft of facts like Sarah Palin and most republicans. And when you support her condemnation instead of insisting that all sides support their claims with facts, then I believe you do a disservice to the debate.
Posted by: twmatthews | November 7, 2009 1:51 PM
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TW,
You are right . . . if my entire argument was based on unintended consequences. If your church had a track record for stealing money and if it became all powerful in your town, then I would say you would have reason to fear those unintended consequences.
Here is what we know:
1. the government has used medical power to hurt groups it did not favor in the lifetimes of many minority Americans
2. once a medicine is politicized (see the abortion debate) is becomes a continuous blot on the body politic
3. the federal government already has the power of the sword and adding more scalpels is a lot!
So I am not merely arguing that things can go bad, but that we are putting a known Michael Scott (the federal government) in charge of the office.
Posted by: John Mark Reynolds | November 7, 2009 10:27 AM
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Dear John,
Your concerns for unintended consequences are cynical at best and vaporous at worse. Of course there is the possibility of unintended consequences every time someone takes action -- EVERY TIME. That's not an argument against anything.
My software company has been doing surprisingly well in this economy and we (my wife and I) thought we could help out some people by establishing a little fund under the direction of the ministers of our church, to help members in need; make a mortgage payment, buy food, whatever.
We put money in every week and its dispersal is at the discretion of a minister in my church.
Now John, there is the possibility that our minister could steal the money, could use it for friends rather than people in real need; could waste it on expensive goods rather than necessities. So let me ask you, should we not have bothered to set up this fund? Because of the possibilities of unintended consequences, should we not have bothered?
Almost every action humanity takes can have unintended consequences. Using that as an argument against trying something different -- like health care reform -- resigns humans to always doing nothing.
Take any great plan or action from declaring war against Japan and Germany to building nuclear power to inventing the transistor all have the potential for unintended consequences.
Every action we take has the potential for unintended consequences. I walk out of my house in the morning and I could trip on my front porch. Should I never leave the house?
Even the modest proposals you put forward has their own potential for unintended consequences. Your argument is simply an argument for doing nothing and to me, allowing hundreds of thousands of people to go into personal bankruptcy because of medical bills is morally repugnant. Allowing the sickest people -- those with preexisting conditions -- to not be able to get health insurance speaks volumes to the flaws in our current health care system.
Sometimes John, you have to be willing to step out of your house.
Posted by: twmatthews | November 7, 2009 8:40 AM
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John,
You state "No reasonable Christian ethicist supports prolonging unavoidable death or involuntary heroic measures that cause gratuitous and extended suffering." Do you remember when not only did "Christian" leaders fight the removal of Mr. Finn's PEG, but even the Governor Gilmore of Virginia fought it and cost Finn's widow and children over $86,000 to legally end his life.
That legal fight cost 7 lives that I know of at this time. My wife had a PEG at that time and lived an additional 3+ years because of a PEG as she had a progressive neurological disorder. Many people with movement disorders can not swallow properly and get aspiration pneumonia without a PEG. When Governor Gilmore fought the removal of Finn's PEG, it caused many people with movement disorders to refuse a PEG placement as they figured the cost of getting it removed as too great.
I'm sorry, but my doctors were a MUCH better source of REAL info on a PEG. They explaned all of the Pros and Cons to us and we decided together to place the PEG with the understanding that I (as her medical power of attorney) could have it removed when two doctors and I felt she was dead.