Trampling the Leaders - A Change We Can Believe In

Professional groups that don't care what their own members think.

One hundred years ago, the first faint stirrings of what would become today's socialists and leftists were beginning to be heard.

In the closing years of the Industrial Revolution, economic life was predominantly "every man for himself" in a way we would find hard to imagine today.  The great factories were not very safe places to work, nor were they expected to be.  The products that came out of them would today be viewed as very dangerous.

On the other hand, compared to the backbreaking manual farming done by the factory worker's fathers and grandfathers, the emerging industrial life was pretty good and was getting better all the time; peasants yearn to leave the farm for sweatshops unto this day.

Into that maelstrom of change stepped the social reformers - writers and philosophers who hoped to awaken the higher minds of their readers and spur mankind onward to perfection.  In his famous book The Jungle, Upton Sinclair told the sad story of a laboring man in Chicago's unsafe, unhygienic slaughterhouses, abused by his supervisors and exploited by capitalist pigs.

As the author told interviewees while writing his book, "I'm here to write the Uncle Tom's Cabin of the Labor Movement!"  The plan was for America to be shocked and horrified at the conditions of the factories and immediately agitate for socialism and stronger unions.

The book was published and became an instant bestseller.  America was indeed shocked and horrified at the conditions of the factories - because of the food they were eating.

Most readers didn't give a hoot about the poor slob whacking away at the cow carcasses, but they cared very much that those carcasses were dirty, disease-ridden, and potentially deadly to America's diners.  Popular outrage eventually led to the establishment not of a socialist paradise but of the Food and Drug Administration.  As Sinclair sadly related years later, "I aimed at the public's heart, and by accident I hit it in the stomach."

Eyes Being Opened

Something similar is happening this summer as congressmen all across the fruited plain are being torn apart - verbally, for now - by constituents enraged over the un-American and potentially murderous clauses written into the "health care reform" bill.  The new law represents a revolutionary change in our medical culture.

For thousands of years, doctors have had a tradition of doing everything possible to sustain life without regard to cost.  This made it simple to decide whether to do a procedure - if it might prolong the patient's life, you did it no matter what.

This was OK when there wasn't really much that doctors could do, because sitting up with patients while they died of fever didn't cost much.  It was OK so long as people paid their own medical expenses just as they pay their other expenses, because if someone couldn't afford a treatment it wasn't given.

Our current health care system disaster grew out of two factors.

First, medical insurance means that patients don't spend their own money for medical services.  Instead, they expect someone else to pay for any treatment their doctor recommends, which means that the patient doesn't really care about what that treatment might cost.

Second, modern new medical technology allows many patients to be saved who would have died in earlier years.  There are many more opportunities to spend money - as we saw with the woman who stuck the state of California with the huge bill for taking care of her 8 premature babies.

Fifty years ago, this wouldn't have been a problem: she couldn't have got pregnant with octuplets in the first place, and if by some miracle she had, she and all the babies would have promptly and cheaply died.  Only because of lifesaving but extremely expensive equipment was she and her children able to even have a chance to survive and go on to consume even more of someone else's money.

These two forces have produced a situation in which medical costs are taking an increasing share of our economy.  The cost of medical care helped bring down GM and Chrysler; it is projected to destroy budgets of state, local, and ultimately federal governments in the coming decades.  Private businesses are bending under the crushing load of their employee's health insurance premiums; as a result, employer-funded health insurance is becoming more rare.

When something can't go on, it won't, and we're getting to that point.  Most Americans agree that Something Must Be Done.  The question is, what?

The Rubber Has Met The Road

The central problem with Obamacare is that our lawmakers have admitted that someone besides insurance bureaucrats has to limit what we spend on health care.  If people paid for their own medical care, this wouldn't be an issue - they'd limit their own consumption, just as we all limit what cars we buy based on what we can afford - but since the new law will have government paying for most of it, government wants to control what treatments you can have and what you can't.  As more and more people read the bill, they're getting upset at what government wants to take away.

Enforced euthanasia counseling for the elderly?  An unelected board of bureaucrats who decides when you're too old to receive any treatment beyond painkillers?  Financial incentives for employers to dump their employees off into the government insurance scheme?  Congress explicitly exempting itself from having to obey any of the rules and restrictions forced on everyone else?  Anything that could be expected to infuriate and outrage voters is found buried in the depths of the thousands of pages no Congressman has had time to read.

Americans are not just realizing their betrayal by the elected officials who claim to represent them - politicians who betray the voters who elect them are hardly news.  Most Americans expect politicians to be natural-born liars and self-centered cheats.

The eye-opening part of these events is how Americans have been betrayed by trusted organizations.

For example, the powerful American Association of Retired Persons (AARP) claims to represents the interests of America's elderly; since those same folks have, collectively, a lot of money and free time, AARP carries massive clout in Washington.  AARP has come down foursquare on the side of Obama's plan, despite the fact that, if passed, the rationing based on the patient's age and "end of life planning" it advocates will hasten the death of AARP's own members!

AARPers may be old, but they're not all senile; we're seeing video clips of oldsters roasting their AARP representatives along with their congresspersons.  USA Today reports that 60,000 AARP members have quit the organization due to its support for Obamacare; nothing says "pain" to a nonprofit org like canceled memberships.

Doctors have made the same discovery and have reacted in the same way.  Rather than defend the independence and finances of its members, the American Medical Association has endorsed the Democrats' bill, consigning its membership to indentured servitude to Uncle Sam.  What happened then?  The AMA may not be America's premiere medical group for much longer, as Breitbart reports:

The Association of American Physicians and Surgeons issued the following statement from Kathryn Serkes, Director of Policy and Public Affairs, in response to the AMA's endorsement of House Bill 3200:

"The American Medical Association has sold out patients and the profession by endorsing House bill that supports government medicine.

"Why did the AMA do it? For a few dollars increase in Medicare reimbursement rates. In effect, it's told patients, 'It's about the money, stupid.'

"We don't think that a miniscule raise -- one that can be revoked at any time on Congressional whim -- is worth selling out for government control of medicine. The AMA has sold patient choice, patient privacy and patient control to the highest bidder."

Discontent is spreading as Congress Daily tells us:

Concerned that the American Medical Association has taken too tepid a position on Democratic healthcare reform plans, a coalition of state medical associations and specialty organizations is breaking from the country's largest physicians' group to mount its own push against the inclusion of a public insurance option in any overhaul bill. [emphasis added]

Power Corrupts

We conservatives spend so much time arguing against the evils of unaccountable Big Government that it's easy to forget that government is far from the only organization with a built-in tendency to commit evil.  Big business can be, and often is, every bit as unaccountable, greedy, evil, and oppressive as government.

The only reason - the single, solitary reason - why big businesses are not usually as oppressive and totalitarian as their all-too-human bosses would love to be is competition.  As long as you have the free choice to leave a badly run company and buy from anyone or no one, bad companies die and good ones prosper.

Those industries held in low public regard tend to be those who've succeeded in making it very hard to change vendors - cellphones, cable TV, even airlines (via frequent-flyer programs), whereas industries which face open competition tend to be better liked.

If you find Wal-Mart frustrating, you can just go to K-Mart instead, so both -Marts try very hard to keep you at least contented with their service and wares.  The problem with government is that it is very hard to change to a different supplier - you have to have a dangerous revolution or move to a different country with a vast amount of bother and emotional disjunction.

For some time now, many professional groups have had one primary association.  There's the AMA; there's the AARP; there's the ABA for lawyers; the Chamber of Commerce; and so on.  Whenever there is no real competition in a market space, the monopolist will not have to be responsive to customer needs.

Indeed, we see the AMA and AARP supporting Obama's bill against the interests and against the loud and angry protests of their own members.  Hey, what are the dissidents gonna do, found their own group?

Well, just maybe - and not before time.  Will the Association of American Physicians and Surgeons displace the AMA?  Will a new group arise to challenge the AARP?  Once, IBM ruled the computing world; then came Microsoft and Apple, and then came Google to perhaps dethrone them.

Before people will reject their "leaders," they must first realize they're being lied to and betrayed.  Without meaning to, Obama's push to remake one sixth of our economy in great haste has revealed just how deep that betrayal goes.

Somewhere, there are ambitious young politicians and nonprofit executives watching the giants of public policy getting shellacked by soon-to-be-ex-members and recalling the advice of French politician Alexandre Auguste Ledru-Rollin:

There go my people, I must find out where they are going so I can lead them.

Mr. Obama promised to make America look at things in a new way and he's certainly succeeded - but not quite in the way he intended.

Petrarch is a contributing editor for Scragged.  Read other articles by Petrarch or other articles on Society.
Reader Comments
Forgive me -- can you point out to me specifically where Obama's proposal includes "Enforced euthanasia counseling for the elderly"?

August 18, 2009 10:22 AM
Happy to. Here's a draft of the bill:

On page 425 it says:

... "The term 'advance care planning consultation' means a consultation between the individual and a practitioner described in paragraph (2) regarding advance care planning,
if, subject to paragraph (3), the individual involved has not had such a consultation within the last 5 years. Such consultation SHALL include the following:
(A) An explanation by the practitioner of advance care planning, including key questions and considerations, important steps, and suggested people to talk to..."

And so on. Note the SHALL - we've established that the discussion is required every 5 years. Regarding euthanasia, obviously the bill doesn't SAY "Convince them to croak" but we know from other similar socialized healthcare systems that's what every incentive points to.

In Oregon, for example, the state medical agency told a patient that the state plan would not cover cancer drugs, but would be happy to cover costs for her euthanasia.

Did they REQUIRE euthanasia? No. But they certainly tried to nudge her in that direction; Obamacare will do the same. I see you posted on "Terri Schiavo's Revenge"
so you've seen the underlying logic and I needn't repeat it here.
August 18, 2009 12:01 PM

I would agree with you that giving the state a financial incentive to euthanize people would be a dangerous thing, as I've seen well enough what has become of our "family" court system since the states have been given financial incentives to collect as much child support as possible (a policy first instituted by Ronald Reagan, by the way -- I think he meant well but didn't consider the very political reality you are considering here). Many if not most injustices against men and their children at the hands of the "family" courts can be traced back to these incentives.

However, I am not seeing where "advance care planning consultation" equates to "euthanasia counseling".

Perhaps you could show us where "advance care planning consultation" is defined.

My GF is a pediatric oncologist and, while she has witnessed recoveries that were nothing short of miracles, the unfortunate fact is that sometimes her young patients do not survive their cancers. She participates in consultation to prepare young children and their parents for death on a fairly regular basis, and at no time has she revealed this to include advocating the euthanasia of the children involved.

Is it possible that "advance care planning" is similar to this sort of counseling, effectively about explaining the reality that death is a likely end to the medical condition of the patient and exploring the options left with what lifetime remains? Because I see no problem with this valuable service whatsoever.

August 18, 2009 12:51 PM
It is probable that at least some of the Congresscritters who support this bill, interpret it exactly the way you do. That's not the question. The issue is, how will the bureaucrats who administer the program interpret it on the ground? And to answer that, we only need to examine what other bureaucrats with similar mandates have done - and it's not pretty.

I can easily imagine defenders of the family court system saying "Of course nobody would ever yank kids for no good reason! That's evil!" Yet, thanks to that law, it happens every day.

Here's what famous economist Thomas Sowell has to say about this issue, you may find it enlightening.
August 18, 2009 1:11 PM
@ werebat

I have heard that an enormous percentage (something like 75%) of Medicare is spent on the last 30 days of life. If that's true, there will be a tremendous incentive for bureaucrats to shrink those very expensive last 30 days down to 2 or 3. How do you do that? By pushing early termination of some kind. Like you, I don't believe that Congress is secretly intertwining euthanasia into the system. But it WILL become a reality by the natural forces of supply and demand.
August 18, 2009 1:19 PM
Petrarch, lfon, I can well appreciate your concern with how bureaucrats will interpret a piece of legislature. I do take issue with statements that the bill includes something that it does not in fact include -- in this case, "enforced euthanasia counseling for the elderly".

To me, the possibility that a bureaucrat may willfully misinterpret a piece of legislature to mean a thing is different from the piece of legislature specifically stating a thing. I am sure you can see the difference as well. We all know the political game being played by insistence that the bill "mandates euthanasia for the elderly" when in fact it does no such thing.

The criticism should be that some potentially abuseable wording needs to be cleaned up, not that the bill is flawed at its core because it mandates the euthanization of the sick and elderly.

In any event, surely the phrase "advance care planning consultation" is defined somewhere in the body of the bill?
August 18, 2009 3:23 PM
Another thing to look at is nations that already have socialized medicine. How many of them are euthanizing their sick and elderly?

For that matter, how many houses in the US are left to burn because it's cheaper for the state to let them burn than it is to send in the fire department? This may seem like apples and oranges but many of the same forces are at work here.
August 18, 2009 3:26 PM

The Sun, A British tabloid, had an article

PENSIONERS with dementia should consider ending their lives to stop "wasting" NHS resources, it was suggested yesterday.

Medical ethics expert Baroness Warnock, 84, said senility sufferers were a burden to their families and doctors.

And she said there was nothing wrong with them feeling they had a "duty" to opt for euthanasia for the sake of others.

She said: "If you are demented you are wasting people's lives, your family's lives and you are wasting the resources of the NHS.

"I am fully in agreement with the argument that if pain is insufferable then someone should be given help to die."

It is a very short step from thinking people ought to die to helping them die to helping them when they don't want to. There are reports that many of the assisted suicides in Holland are a tad light on paperwork......
August 18, 2009 8:20 PM

I appreciate the article. I do wonder if the British Sun is anything like the American Sun, especially considering that the article next to the one you quote dealt with whether or not readers had seen "space aliens".

August 18, 2009 9:58 PM
I don't think the UK Sun is a total rag; the much more respected Telegraph had a very similar article citing the same quote from Baroness Warnock.

Regarding Holland, there's a study out that 11.3% of euthanasia deaths there were to some degree involuntary.
August 18, 2009 10:04 PM

It would seem that the story about the Baroness is correct. I will say that she caught a lot of flak from many people due to her statements, which I do believe were ignorant at best, and that Britain does not at this time seem to have any policies of euthanizing the "demented" or anyone else.

I guess it's a good thing that no one in the current system has a vested interest in sick people dying rather than lingering on for a long time on expensive treatments. Oh, wait...
August 18, 2009 10:06 PM
Huh? The Baroness reflects elite British thinking. You can see it at work in their NICE board that decides who can get what treatments, or not.

"In the past three years, 1,053 applications for funding were rejected by local primary care trusts (PCTs), meaning that patients had either to go without or pay up to £20,000 for treatment."
August 19, 2009 8:02 AM

Who were those 1053 applicants and why were they rejected? Were they alcoholics looking to get second liver transplants after having been caught binge drinking with the first? I'm sure you can agree that in some cases, applicants really SHOULD be rejected. Without more information we can't know what this number really means.

Under any realistic system there will have to be some people who want treatments that they can't get. I understand the fear of putting all of the decision-making power into the hands of the government, but when I see all of the money the insurance companies are spending to keep this from happening I have to wonder if we're all just being led down the primrose path by arguments against Obama's proposal, especially when as I understand it the plan calls for a public "option", not mandated public control of all medical payment plans. Surely the insurance companies aren't spending all of this money because they're concerned about the welfare of the citizenry?

In any event my original point stands -- the proposal does not actually include anything about enforced euthanization of the elderly, as the scaremongers are claiming it does. When a person of either political side resorts to twisting the facts to get their point accepted, they ultimately end up weakening both their argument and their credibility.
August 19, 2009 8:18 AM
By the way, Petrarch, I'm pleased to see that you seem to have some knowledge of the many troubles present in our "family" court system. The plight of men (and, occasionally, women) and their children caught in this system should be of great concern to anyone interested in the welfare of "the family" or just kids in general, as well as the defense of Constitutional rights.

Can you tell me if Scragged has any articles on this important issue? I don't recall having ever seen one.
August 19, 2009 8:25 AM
Regarding the "family" court system, as it happens the writers of Scragged have very long and deep familiarity with the outrageous abuses there. It hasn't come to national attention much recently, but Will Offensicht has written a few articles on the subject:

These articles actually relate directly to the health care debate. Nobody involved in passing the child abuse prevention laws - not ONE SINGLE PERSON - intentionally set out to create a system where innocent families would be torn apart. Yet not only has exactly that been the result, anyone with familiarity with how bureaucracy works over the long term should have been able to forsee that result.

Similarly, nowhere in Obama's health care plan does it state, "Try to kill old folks to save money." But anyone with the slightest knowledge of history, other national healthcare systems, or the motivations of bureaucracy, can instantly see that regardless of the original intent, that will IN FACT be the inevitable end result - because that's where the incentives are. And that's why we're opposing it now, before it's too late.

The key issue here is competition. What keeps Geico from denying car accident claims? Obviously they would save money if they did that and just kept your premiums. But word would get round, everybody would switch to Progressive instead, and Geico would go bankrupt. So they HAVE TO properly pay out claims in a reasonably fair and just way if they want to stay in business.

We hear stories about health insurance companies wrongfully denying claims. How can they get away with this? Because most people have no choice over their insurer - they are stuck with whoever their employer chose.

The solution to the problem is NOT a government monopoly that nobody can escape. It's certainly not a "public option" that inevitably will evolve into an inefficient, catastrophically-incompetent monopoly just as Fannie Mae and Freddie Mac did in the mortgage business. No, the solution is increased competition.

The easiest solution is leveling the tax-deduction playing field between employer-purchased and individual-purchased health insurance. John McCain proposed exactly that and was savaged for it, but that one simply change would have solved 50% of our health care problems. Allowing cross-border purchase of health insurance, just as we do for car insurance, would have solved an additional 30% by increasing competition even more. The last 20% is tort reform, which is its own issue.
August 19, 2009 9:36 AM
You make some good points Petrarch. And I enjoyed the articles, although they seem to focus on the evils of CPS, which is only one piece of the problem with our "family" court system (it's an important part, though). What we need is a rebuttable presumption of joint physical placement in custody cases, as well as to open up the these courtrooms (sunshine being the best disinfectant). Of course there are too many special interest groups working hard to keep things the way they are, not all of them in government per se.

You've pointed out some real problems with Obama's plan, although I'm not convinced that it might not be better overall than what we have today.

As for the elderly being euthanized by bureaucrats, I think they'd actually have less to worry about than, say, middle aged men. One reason the abuses of the "family" court system are allowed to continue is that they are primarily directed at men, and where they are directed at children the blame is easily foisted onto men due to public perception (which is, of course, reinforced by the institution). No one cares about single or divorced fathers, because after all they aren't people, like us.

Elderly grandmas, on the other hand, are a group that politicians hesitate to dump on because it can come back to bite them in the butt come the next election cycle. Why, the very fact that they are used as an example to frighten people about what Obamacare might do is an example of why they don't need to worry so much. No politician wants to be seen as responsible for causing the death of an elderly woman.

Meanwhile, politicians and the bureaucrats they hire can essentially spit on single fathers and laugh about it, in public, because "everyone knows" they're all "rat bastard deadbeats".
August 19, 2009 12:26 PM
Bingo, Werebat. And that is why we believe in a limited government as the founders intended - a point we have long, long, long since passed. The more strictly limited the government is, the fewer the ways it can destroy or end your life.
August 19, 2009 12:54 PM

Elderly Grandma's will be affected. My own grandmother was affected in a Scandinavian country with socialized medicine. She was diagnosed with stomach cancer, but not told, just medicated to keep the pain down. Once it had progressed to an inoperable state, she was informed she had cancer and it was too late to do anything.

I'm pretty sure they didn't offer "end of life" counseling, either. They just did it.
August 19, 2009 2:05 PM
More so than the end of life counseling, I'm very concerned about "rationing" of medical services. Certainly the availability of services would be greatly compromised if we add another 47 million individuals without a corresponding increase in the capabilities of the existing medical system.

In particular, to maintain a doctor to patient ratio of 100, the system will need 470,000 new doctors to handle this load, along with additional auxiliary staff, equipment, offices and hospital rooms. While it could be argued that these people currently make use of the existing medical system it is relatively limited. With the advent of "free" or low cost care that use would dramatically increase, and without the necessary system growth the result would be less availability for all.

Additionally, more and more doctors are now limiting the number of Medicare and Medicaid patients they accept due to the lower fee schedules. If a new program is enacted an even larger proportion of reduced-fee patients will be generated, further reducing doctors' incomes. While doctors don't generally enter the field of medicine solely on a mercenary basis, with the high cost of education and overhead many would consider other professions. The effect will be more doctors leaving the field and fewer entering the field, resulting in a net loss of practicing doctors in the future.

Therefore in order to ensure some semblance of order as a result of these pressures on the system, it will be necessary to make a determination of how the available services will be allocated (rationed). Since costs will be predetermined the free market cannot be a factor, so what criterion will be used? Health and Human Services bureaucrats would undoubtedly be responsible for making these determinations.

As Shakespeare said, "a rose by any other name."
August 22, 2009 9:51 PM
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