Wednesday, August 12, 2009

The Roots of Fear

I'd like to cherry pick this excellent post by Hunter at dKos to make a point. Specifically, I'd like to riff on this:
They don't want government to supposedly decide who's too expensive to keep alive, with visions of "death panels" and the like -- but insurance companies are doing that now, all the time, and there's nary a peep about that.
The "they" in this sentence refers to the protesters at the health care forum who are shouting down any intelligent debate on these issues. It raises a question in my mind that has bugged me for quite some time and I only now think I'm coming to better understand: why is it that the screamers are so upset about the idea that Faceless Government Bureaucrats (FGBs) might make life or death decisions about their health care when Faceless Corporate Bureaucrats (FCBs) have been making the same decisions for years?

First of all, if we are to understand what is going on here, we have to acknowledge one cold hard fact: no health care system can provide everything for everyone. Beside the simple fact that we are all going to die, the resources necessary to provide complete and total care for everyone for every single health problem they might have (from headaches to brain tumors) just doesn't exist. Triage is at the core of all health care decisions. Treatment for some conditions will have to be prioritized. This is usually described by the dreaded word "rationing".

So let's be honest and acknowledge openly that any system for managing health care will include rationing. Of necessity.

So who gets to make the rationing decisions? Advocates for various policies would like you to believe that their system places the rationing decisions with the health care consumer. But that's another myth that we should leave behind. Yes, we sometimes are given choices of treatments. But the choices that are offered to us all exist within parameters that are decided by those previously mentioned Faceless Bureaucrats. It doesn't help any advocate's case to try to bullshit this point. The voters get this. Under any system we adopt, private or public, someone else will make decisions that will significantly impact our ability to choose our own care.

But let's not get distracted on this point. The fight we are having is not, as far as I can see, over who gets to make that first choice. While the visible argument is about public vs. private, the FGBs vs. the FCBs, I think the underlying fear that drives that argument is not WHO but HOW. And this fear exists on both sides of this debate.

Those who advocate for public health care fear that the profit motive of corporations leads the FCBs to make cold decisions about health care options based purely on profit-loss statements with no consideration for the well being of individuals (result: excluding pre-existing conditions, cutting benefits just when you need them the most, etc.).

But, those who advocate against public health care fear that the "best intentions" of the FGBs will lead to them making judgments on "value to society" that will be based on prejudices they don't agree with (result: "death panels", etc.).

Now, I happen to be driven more by the fear of the profit motive. But I can understand the fear of the social engineers. If I were like those on the other side and I didn't trust those social engineers or their motives, I might conclude that it would be better to throw my fate on the mercy of "cold hard numbers" generated by accountants rather than the "well meaning" intentions of those who sit on government run health care panels. If my care is denied under the former method, I wouldn't have to feel that I was invalidated because some part of society judged me as being less than worthy (and if I happened to have certain prejudices against those who might make those decisions ... well ... that certainly wouldn't make me any more comfortable with the results.)

This, I think, is the primary fear that is being used to drive the screamers: that the FGBs, the social engineers, the do-gooders will sit in judgment of my self-worth. And how dare THEY sit in judgment of ME?

I doubt you will ever be able to find a strong common ground between these two sides. But those who advocate for public health care might do a better job of easing the fears of the other side if they were to at least acknowledge the legitimacy of these fears. And yes, I do think they are legitimate, even if they aren't always well founded. While I would still rather trust in the judgment of people who are not entirely driven by the profit motive(*), I acknowledge that the fear of poor judgments by social engineers is not, inherently, an irrational fear.

(* - For one thing, I don't buy into the belief that the "cold hard calculations" of the profit motive are entirely devoid of the kind of personal value judgments that the screamers fear would come from government bureaucrats. But then I'm not free market ideologue.)

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