The Power to Declare You Crazy

One worrisome aspect of greater government involvement in health care is the politicization of health care, which would allow the government indirectly to punish critics, oddballs, and any others that are deemed undesirable.  Obamacare is nothing short of giving the government the power to destroy the lives of individuals without any due process whatsoever through the hazy and easily manipulated realm of “psychological institutionalization.”

This might appear, at first, kind of paranoid.  This is America, after all.  But it’s not unprecedented.  The Soviet Union declared political dissidents as mentally ill rather than having formal charges pressed through the criminal justice system.  Even in that sorry regime, it was easy for state evil to fly more easily under the radar in the medical field rather than in traditional law enforcement. The Soviet Union’s doctors locked decent men up for many years in mental wards. The state-paid psychologists did the bidding of the Communist Party in the end.

In the Soviet Union, where the government was the sole employer, the notion of professional independence had disappeared.  The state swallowed up every group or institution that might provide some locus of resistance–the wealthy, private property, private industry, free speech, education, labor unions, professional guilds, and the Orthodox Church.  In these circumstances, lone individuals had very little power to stop the state’s destruction of private life and were often themselves deemed “difficult” individuals suffering from mental illness.  All in the name of creating a socialist utopia.  The same trend of increasing government power over our lives is underway in the United States today.

It may be objected that there is a strong culture of professional independence and concern for patient welfare in the American regime.  How viable is this alleged protection?  For starters, whatever ethic prevails today depends on the about-to-be-destroyed system of fee-for-service, which will be eroded to nothingness under the influence of Obama’s “government option.”  Obamacare will require government approval for payments to doctors for the majority of patients and further encourage conformity to government-dictated “best practices.” It may go something like this:  “Well, you doctors can do whatever you like doctor, but we’ll only pay for X, Y, and Z. Govern yourself accordingly.”

Even today, it’s not so clear that the purported ethic of physician responsibility provides effective protection for patients.  Drug companies, for instance, have created a serious financial incentive for doctors to prescribe particular drugs to patients, regardless of their effectiveness, their own lack of expertise in psychological illnesses, or the desirability of therapies that do not involve mind-altering drugs.  Nowhere is this more evident than in the field of mental health. Hitherto unknown diseases like “shyness” now are declared sicknesses that require expensive drug treatments.  Primary care physicians with no time for time-consuming counseling instead hand out Prozac and Paxil like candy canes.  According to Forbes, “We now spend more on mood-altering drugs for our children, including antidepressants, than we spend on antibiotics.” This is a scandal.

We have also witnessed psychiatrists in particular gladly assist the military, the police, and industrial organizations with an eye towards institutional goals like effective interrogation, screening of employees, and the creation of systems that promote worker productivity. Institutionalization of people was once the norm, as too is a habit of experimentation, including in the abuses of lobotomies in the middle 20th Century right here here in the United States.  Patient welfare is secondary in all of these well established practices, and the proximity of the abuses should give pause to those that call critics “paranoid.”

What historical or ethical limit would prevent careerist doctors from also engaging in punitive diagnoses of “authoritative personalities” and labeling conservative “sickos” under Obamacare?  What would prevent the creation of new diagnoses such as “homophobia” or pathological conservatism?  After all, such politicized definitions of mental health and long-term involuntary incarceration of political dissidents happened under the long-standing socialist medical regime in history, that of the former Soviet Union.

The world is more politically correct than ever.  To a great extent, we’ve become desensitized to the brainwashing and indoctrination of liberal group-think in corporate and academic settings.  Why wouldn’t medicine also be abused?  From diversity seminars to the scandalous sub rosa euthanasia that takes place in hospices to the anti-life practice of abortion, the potential oppressiveness of liberals knows no boundaries, because it’s not limited by the conscience:  it imagines itself to be good and promoting the good of all; therefore, dissent can be dismissed and classified as an expression of hate, racism, and, most sinisterly, “sickness.”

We must consider all the possibilities of evil under the Obamacare regime.  The potential abuses of Obamacare will not be spelled out in the plan.  Instead, the plan must be reviewed critically in light of the times, the dilapidated state of medical ethics, and the sorry history “repressive psychology” in the world’s longest-running experiment of government-run healthcare.

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Rep. Alan Grayson is a Coward

I attempted to go to a Health Care Town Hall today with my radical local congressman, Alan Grayson.  What a joke.  It was held in a tiny union hall that held about 120 people.  The event was announced only a day before.  Still, around 1,000 people showed up.  Prior to the public meeting, a local Democratic Committee meeting was held.  About 70 of the seats were already filled when it was opened to the public.  Some of the “no” questioners asked things like, “You changed my mind.  Why can’t everyone realize how great this is?”  It was a farce.

The crowd waiting hopelessly to get in was large and varied and mostly against the bill.  It was fairly diverse and a bit younger on average than I expected.  A few supporters were there, apparently members of college Democrats, union folks,  ACORN members, and a few random supporters.  A large cohort of opponents were there, though, perhaps three fourths of the attendees.

The few I spoke to showed up after hearing it on the news.   Many had home-made signs, including a pretty funny one that said, “Don’t Kill Granny.”  Many opponents’ signs said, “Read the Bill.”  People were generally well behaved, but there was a little bit of shouting, particularly when we all realized how full the hall was and how impossible it would be to get in.  People spoke to their neighbors in line, mostly in fear of the bill, expressing concern for declining quality, euthanasia, abortion, and their elderly relatives being deprived of care.  A great many people were worried about government spending and our loss of freedom.  His strategic choice of a friendly and tiny venue was almost universally reviled as a cowardly gesture.

Grayson is a radical who snuck into Congress on the reverse coat-tails of local mediocrity, Ric Keller.  He is a trial lawyer in the back pockets of ATLA and has proposed “free vacation” and other feel-good giveaways.  I hope his embrace of Obamacare is his Waterloo.  It was encouraging to see so many opponents asking generally intelligent questions and showing fear and outrage at the prospect of a significant growth in government and government’s role in our lives.

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Obama’s Spreading Death Panel Rumors

There is a strange idea that it’s “cynical” and “dishonest” to be skeptical of the claim that (a) a new entitlement will be created (b) that will lead to more medical services being consumed by more people and (c) that this regime will save costs as promised without rationing, particularly rationing aimed at reducing care for the elderly.  The last piece is the only way.  Otherwise we’ll have more healthcare spending even than we do today.  Some have called the bureaucrats who will make this decision “death panels,” which means many things, but includes the promotion of best practices that show little regard for the elderly and their welfare and also paying doctors for suggestive counseling to the elderly for “nonresuscitation” and other death-accelerating measures.

But consider Obama’s own statement to the NY Times in an April 28 issue.

THE PRESIDENT:  Now, I actually think that the tougher issue around medical care — it’s a related one — is what you do around things like end-of-life care —

INTERVIEWER:  Yes, where it’s $20,000 for an extra week of life.

THE PRESIDENT: Exactly. And I just recently went through this. I mean, I’ve told this story, maybe not publicly, but when my grandmother got very ill during the campaign, she got cancer; it was determined to be terminal. And about two or three weeks after her diagnosis she fell, broke her hip. It was determined that she might have had a mild stroke, which is what had precipitated the fall.

So now she’s in the hospital, and the doctor says, Look, you’ve got about — maybe you have three months, maybe you have six months, maybe you have nine months to live. Because of the weakness of your heart, if you have an operation on your hip there are certain risks that — you know, your heart can’t take it. On the other hand, if you just sit there with your hip like this, you’re just going to waste away and your quality of life will be terrible.

And she elected to get the hip replacement and was fine for about two weeks after the hip replacement, and then suddenly just — you know, things fell apart.

I don’t know how much that hip replacement cost. I would have paid out of pocket for that hip replacement just because she’s my grandmother. Whether, sort of in the aggregate, society making those decisions to give my grandmother, or everybody else’s aging grandparents or parents, a hip replacement when they’re terminally ill is a sustainable model, is a very difficult question. If somebody told me that my grandmother couldn’t have a hip replacement and she had to lie there in misery in the waning days of her life — that would be pretty upsetting.

INTERVIEWER:  And it’s going to be hard for people who don’t have the option of paying for it.

THE PRESIDENT: So that’s where I think you just get into some very difficult moral issues. But that’s also a huge driver of cost, right?

I mean, the chronically ill and those toward the end of their lives are accounting for potentially 80 percent of the total health care bill out here.

INTERVIEWER:  So how do you — how do we deal with it?

THE PRESIDENT: Well, I think that there is going to have to be a conversation that is guided by doctors, scientists, ethicists. And then there is going to have to be a very difficult democratic conversation that takes place. It is very difficult to imagine the country making those decisions just through the normal political channels. And that’s part of why you have to have some independent group that can give you guidance. It’s not determinative, but I think has to be able to give you some guidance. And that’s part of what I suspect you’ll see emerging out of the various health care conversations that are taking place on the Hill right now.*

Let’s parse this out.  First, it’s a “democratic conversation,” which is another way of saying this will be a matter for law and bureaucrats and politicians.  But that’s not enough, there also must be “some independent group.” Typically this means a blue-ribbon panel that does the things politicians can’t or won’t do.  Hmm, a panel deciding on difficult issues of “end of life care” with an eye to social utility and saving costs.  It is perfectly reasonable to call them Death Panels.   Sure, it’s rhetoric.  But it’s useful, evocative rhetoric.  Their goal is to save money by making people die before they cost too much and also to tie us all collectively to the mast not to treat them through a combination of best practices recommendations and high pressure tactics to get people to sign limitations on future care.  The whole thing is downright pagan in its apotheosis of the society and disregard for the individual and his welfare.

Now, I don’t disagree that people getting health care from the public should not be able to spend extravagantly to take each and every heroic measure there to prolong life.  It’s not morally required for them, nor for the doctors or for the broader society.  That said, it is a dangerous thing for society to throw away it’s weakest, and more dangerous still to corrupt those in the caring professions to undertake this task.   Consider that the “end of life” care has become a bit of a business.  There are already financial incentives for hospices to accelerate death, and many do, essentially starving and dehydrating patients to death before the limited compensation from Medicare runs out. It would be worse to bring this perverse ethic to the entire medical establishment.

It’s perhaps understandable that younger and uninsured patients would like the idea of government health care, as the current regime of high nominal prices, anxiety, and untreated minor problems is extremely inconvenient and stressful for them.  But what is Obama offering seniors–one of the most powerful lobbies with one of the most gold-plated and expensive entitlements there is–to support his plan?  It’s they who seem the most pissed off at these town meetings, and understandably so, because Obama’s plans would create a wedge of distrust between provider and patient.  Socialized medicine does this by rendering a doctor more concerned for saving costs for the “system” than he is for patient welfare. And while medicine includes many worthy and caring people, I’ve not known too many doctors that work for free, nor those that will fight the system if it means going broke.  Over time, especially the newer ones, will be coopted and corrupted.

Some distrust already exists on financial matters through the Byzantine and insulting medical billing practices.  We all think, “Oh crap, how much is this gonna cost me,” even when we’re insured.  How much worse, though, will it be when the distrust relates not to bills and paperwork but to your health.  The doctor today get paid more when he tries to fix you; if anything, you have to spend some time each visit fending off his overly cautious suggestions that also happen to earn him fees.  “OK. OK. Doc, I’ll get it done, next time.”

It will be one more major destructive event in the history of liberalism if the medical profession too is ruined by destroying its essential character of doctor-patient trust by creating financial and legal mandates for doctors to harm their patients.

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Not that Kind of Community Organizing!

This is called doubling down on a failed p.r. strategy: Nancy Pelosi calls protesters at health care town halls “un-American.” This after a few weeks of calling them “mobs” and similar calumnies.

I think whenever the legitimacy of opposition is questioned, as when Bush and Cheney suggested some anti-war protesters were unpatriotic, that is strong language that galvanizes one’s opposition and makes the speaker appear unhinged and afraid of criticism. Since Obama and his people have not made a positive case for health care reform, they’re now just going on the attack to distract the public from their lack of a persuasive and clear proposal.

At least Clinton’s ’94 proposal had a simple logic: there’s 40mm uninsured Americans, and his plan would entail universal coverage. Obama’s plan does not have universal coverage, and the plan is being promoted in wonkish detail without a unifying narrative: it will reduce costs supposedly, but it will not ration; it will cut from Medicare; it will wean people off private insurance; it may or may not fund abortion; it may or may not cut care to the elderly; it will allow you to keep your doctor, but what it won’t allow and how it will save costs and not raise taxes is still hazy.

All the public choice factors are in place for weak support and strong opposition. The people who care about health care the most–the long-term ill, doctors, the elderly with their gold-plated and highly subsidized Medicare–have no reason to embrace this unknown change, and neither is there any basis with which to create less passionate but more widespread support among the rest of us. It’s all pain and no apparent gain, it sounds expensive, and they haven’t even come up with a basic theme of what the benefits are. This is pathetic salesmanship. It mirrors the campaign with its glittering generalities, but here the object is not a charismatic leader who will supposedly heal our divisions, but a law with practical, indeed, life-and-death, consequences.

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Truthers, Black Helicopters, and the Mombasa Candidate

Obama likes to manage the message in all its contradictions.  For him and his ardent supporters, it’s misleading to quote what he himself said about his goals when those quotes are inconvenient. Far from being a misstep, I believe these rather heavy-handed tactics to suppress come from The Man himself, the old Community Organizer, the Saul “Get in Their Faces” Alinsky disciple.  This arrogance was evident early on in a striking image:  his physical confrontation with a persistent reporter during his first trip to the White House briefing room.  How dare a journalist ask questions when he doesn’t want to be asked?

There is a lot of fairly pointless speculating about Obama’s secret life. He’s a Muslim.  He’s born in Kenya.  He’s a Manchurian candidate.  This is all mostly ignorant stuff.  But every presidency spawns its paranoid myths.  For Bill Clinton, it was the “black helicopters” and the UN plan to destroy Christianity and take away our guns.  For Bush it was that he was behind 9-11 and was going to create further pretexts to start wars with Iran and China.  Without regard to their truth or falsity–they’re nearly all  unbelievable on their face–these myths tell us something important about the anxieties a president provokes.  For Clinton, it was that he was too beholden to liberal and non-American values.  For Bush, that he was a militarist tool of shadowy forces.

Obama provokes the anxiety that he secretly is something quite alien from us–at best, a hardcore partisan for an extreme leftism, who is merely playing the political game as best he can to conceal the long-term agenda.  The myths gain credibility because of his secrecy about his leftist past in Chicago.  His centrist image is undermined when an old video or unscripted truth slips out, whether the talk of “bitter and angry” gun owners during the campaign, or siding against law enforcement in the Henry Gates situation, or suddenly embracing his middle name, Hussein, when crapping all over America’s reputation in Cairo.

The perception of Obama as a secretive, alien figure creates special anxiety in his attempts to change health care, because health care depends upon intimacy and trust of the doctor and patient.  This trust would be broken down by unknown and opaque government directives to save costs, to promote the “public health” agenda on guns or birth control, or cost-saving pressure in regard to inconvenient patients that “hurt the common good.”  In response to this narrative, Obama’s angry and forceful attempts to maintain his image will only reinforce such anxieties about the “Real Obama” among Americans already uneasy with him and his agenda.

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Health Care Debate

I love politics.  I read the political news regularly.  Yet I have no idea what the basics are of the Obama health plan.  I have no idea what problem it is supposed to solve.  I don’t know how it works.  I know it keeps changing.  But I don’t know how it benefits or hurts me.  I do know it will cost a lot of money, and I know it will expand the government.  I think lots of conservatives and moderates and even Democrats are in this same boat of bemusement and skepticism.

This is the first moderately complex policy Obama has pursued.  Everything else as been ready “off the shelf,” such as the “grab bag” stimulus or has been no policy at all such as his “Hate America” speech in Cairo.  Pushing policy is where skills besides speechifying come into place:  he must have the ability to translate complexity, the ability to compromise, and the ability to separate needs and wants in major legislation.  He’s shown none of those skills.  He’s descended into policy wonk abstractions talking about “the government option” or whatever it is this week.  He’s gotten side-tracked by abortion and other concerns.  He’s seen revolts from the Democratic Party’s left and right.  He’s been called out on his lies and exaggerations by the CBO Director.  In short, he’s failing before our eyes, just as Clinton failed, with an overly ambitious and scary policy that may radically change and ruin the quality of health care we receive.

The truth is most people want something impossible on health care:  the same level of care and benefits, while paying less, with minimal out of pocket expense, no penalties for preexisting conditions, and without regard to whether you’re employed.  This is impossible.  Either costs must continue to rise, benefits must be cut, or both.  That is called reality.  Obama is avoiding reality in his plan by suggesting the richest Americans can foot the entire bill.  But some of his critics are living in fantasy land too if they think the distorted market we have is an efficient one.  It’s probably overly generous in terms of quality of care, patient choice, and investment in R&D.  But that can all be easily fixed by giving people more pain from high medical costs and by giving people “good enough for government work” options of lower quality (but cheap) clinics and insurance.

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