Why Grandma Must Die

2009 July 2

by Wesley M. Brown

There’s been much hoot and palaver recently about the prospect of Obama’s health care plan. Of course, we must have a plan, preferably with an alphabet administrative agency to both regulate us further and demonstrate some sort of symbolic commitment to whatever it is that now needs regulating.

Health care is now high on that list.  What was once an honorable and sometimes mystical occasion of healing (or voodoo mumbo-jumbo depending on your perspective) has turned into a multi-billion dollar Frankenstein, spiraling out of control and terrorizing the villagers.  Simply put, it must therefore be time to grab the hay rakes and torches.

However, there will be much less difference between big insurance company insurance and big government insurance than most people think.  Both rely upon the premise that they must pay out less in claims than they receive in premiums or taxes.  Both must rely upon some principle of exclusion to keep this balance.  Both must rely upon an army of bureaucrats.  And both must continue to exist with a finite amount of money.

For we all know that there are always limits on health care spending, no matter the system. Spending, and the care that it purchases, will always be rationed in one form or another. But, the essential difference can be explained as follows.

Imagine two deserving patients, A&B, in a given area who both need some form of treatment to keep on living. In light of the finite number of dollars mentioned above, assume that there are only enough recourses, whether public or private, to treat one of them.

A is an 86 year old retired burlesque dancer. She has been a smoker and drinker for most of her life (“No ice cubes darlin’, they’ll only anger the gin”), and has suffered a whole host of chronic conditions. She also keeps multiple cats.

B is a 22 year old female in otherwise good physical condition with no redeeming vices. She also loves Jesus.

For purely medical reasons, most physicians would triage A&B and conclude that the treatment would be wasted upon patient A. B would stand a much better chance of survival and would be well just in time to attend Chastity Weekend. Medically, Tabby and Mr. Whiskers will need to find a new sugar momma.

Now, assume the same triage from an economic perspective.  Given the same facts, and given limited resources, we can reach the exact same conclusion economically.

In both scenarios, we have reached the critical point of health care. Assuming that everyone is equally entitled to treatment, but there will always be insufficient funds to give everyone all of the treatment they need or want, WHO then will make the decision?  As we’ve seen lately, there is plenty of fallacy to go around. Liberals, always mistrustful of the profit motive, view government as essentially benevolent in these cases. Although they would be sad that there was not enough money to pay for everyone’s treatment (as well as government subsidized temporary housing for A’s lovely cats), they would have no problem allowing a balding, middle-aged, brown-bagging bureaucrat who lives with his mother to make the decision.

Libertarian sorts, equally mistrustful of government in any form, view the “market” as somehow self-limiting enough to guarantee some form of fairness.  They would allow the same bureaucrat employed by the insurance company to make the decision.

Neither side, of course, acknowledges that they are engaging in the same fallacy.  What we lack is not more charts, graphs, or rhetoric, but sufficient moral, social, political, and economic courage to say “NO” to one side or another. Our political will , long accustomed to granting special status and privileges to every toddler who wants another cookie, is simply too tired to tell anyone that there are limitations on health care spending no matter what system we finally endorse.  We have, in this sense, sorely failed our citizenry as a whole by avoiding the brave decision to endorse either a fully public or wholly private health insurance system.

If we have succeeded in one thing it’s the spread of long term suffering to our entire populace, regardless of race, creed, color, or cat fancy.

Imagine A is your Grandma.

12 Responses leave one →
  1. July 2, 2009

    Hoot and palaver? You want all of the readers of the Moose to believe that you are 75 years old, don’t you? Get off my lawn kid and turn town that gan blastit rock and roll music!
    Nice article though…like an older Jonathan Swift.

  2. Mankindof permalink
    July 9, 2009

    First, I love “hoot and palaver.” Fine work.

    Second, there is at least one obvious difference between a big governmental insurance plan and a big insurance company insurance plan. Namely that the private company’s only goal is profit. By contrast, the government is at worst merely inept, but at best is directed for a greater good. In other words, a government healthcare agency (1) hopefully won’t be looking for as many ways to soak us for money because its profit margin will necessarily be slim, and (2) it could conceivably use its clout to effect changes in the medical industry. These are just two things I thought of off the top of my head, and are two things the private insurance industry is absolutely disinclined to do.

  3. WES permalink
    July 9, 2009

    Respectfully I must disagree. Government, and “its” view of the populace is essentially neutral. However, the grave danger of government, as we’ve seen with thousands of programs that either dont; work or have outlived their usefulness, is its inherent drive toward self preservation and expansion. Once any govenrment program starts, it is difficult as hell to get rid of it, even if the evidence is conclusive that the program is doing considerable harm. All government programs sadly feed on the premise that they must get at least as much money next year as this year, so there is little incentive to be efficient.
    However, your 2nd point about forcing standards on the medical industry is valid. Granted, the medical and drug lobby will oppose many changes, but I think only the federal government has enough muscle to force its will on them.

  4. William permalink
    July 9, 2009

    The goverment is run by the company. Profit mongers raid Washington and state captials like 5th graders breaking open piggy banks. We, “The People” allow this to contiune through pure and simple apathy. We vote for the same people over and over and they all tell us they will address the same things. Taxes, Health care , education. Yet these things never get better. Any program that is run by a curput goverment will be curupt and not work for the people. If we want real change to the health care system in america we need to change the people that r working to solve the problem. Having the same old three men in room system will not allow for any real change. Right now the goverment is talking about health care and each step of the way the insurance instute of America is sending out its soilders, in what they see as a war for profits. They dress up there disagreements with goverment insurasnce in fancy terms to further dulite the airwaves, propaganda at its core, and never allow the change that would make a huge differnce come to the forefront of the conversation on healthcare. I truly hope that Presdient Obama is the voice in the dark leading the way, but for now I count myself as one of some 30-50 million people without health insurance praying for real change to a system that leaves me behind.

  5. Stinker permalink
    July 9, 2009

    The assessment of the libertarian position is mostly correct–excepting that we have nothing like a free market in health care. So allowing the ‘market’ to make decisions can’t happen as you point out with the cookies.

    This comment is particularly dumb, mankindof:
    “…the private company’s only goal is profit. By contrast, the government is at worst merely inept, but at best is directed for a greater good.”

    Why are we assuming governments direct efforts for a greater good? Or, if they do, the this greater good is even knowable and so effort can be thus directed?

    What is the greater good from Iraq, or the TSA, or Tuskegee, or torture and rendition or a thousand things? This is impossibly naive jackassery.

  6. Stinker permalink
    July 9, 2009

    Forgot to mention: bailouts. TARP. Joe Arpaio. China. Russia. New Jersey.

    Governments acting for greater good: pfaugh!

  7. December 12, 2009

    @Stinker: I didn’t write that we should assume governments direct efforts toward the greater good. I wrote that that’s a best case scenario. Before you criticize one of my statements as being “dumb,” perhaps you should work on your reading comprehension.

    Also, this will seem like a nit-picky point, but I also didn’t suggest that “governments” (plural, generic) do anything at all. I wrote about our government specifically. The reason I make the distinction is because despite your obviously jaded views on the matter, and unlike your examples of China and Russia, our government is us. Of the people and by the people. We are our government. Not that I like the current incarnation, but that speaks more toward the apathy of good people, not to some sinister cohesive force (The Government, or The Man) set in opposition to the rest of us.

    Your example of TARP is, however, appropriate. It’s also an example of the first half of my “dumb” statement: our government is sometimes (*sigh* often) inept. that doesn’t mean that the intention wasn’t toward a greater societal good.

    You’re right that “greater good” is a nebulous concept, and in many situations may be unknowable. But that rebuts nothing in my original point, which was that a company will always always always primarily look to its own benefit, whereas our government does not. Unlike a company, it is not a singular entity with a singular purpose (profit). In a best case scenario, instead of looking only at its own profits, our government would attempt to provide the most benefit to the most people — the exact opposite of what a private company does. At worst, though, the government gets bogged down in special interest politics, and agency capture ensures that real benefits get distributed to a concentrated group of people, or the government simply fucks things up (a la FEMA after Katrina). Which is still better than a company attempting to fleece us for as much of our money as regulations will allow it to.

  8. Jego permalink
    December 12, 2009

    Oh, it’s a fair sting for the reading comprehension; touche.

    Ah, yes: our government. The folks who broke the economy and now can’t fix it, the folks who brought you the strong dollar policy, Vietnam, Iraq, Afghanistan, Amtrak–that government.

    Your contention that ‘our government is us’ is odd to me. It’s a nice platitude, and certainly people like to think that. I don’t see how it’s true in any important sense. What argumentary force are you looking for here? It’s sort of true in California and Ohio on a state level where we vote on legislation directly. That’s not the case on the federal level.

    Your assertion that a company will always look primarily (always always always, you say) to its own benefit whereas our government does not. Bullshit. This is a seductive narrative, but it relies on a couple of ideas that don’t make any sense. To start with,
    1. Companies perform actions.
    2. Governments perform actions.

    But neither of those are true. People perform actions. A company or a government can’t do anything at all since they don’t have limbs or volition. Of course, we use the catch-all ‘government’ or ‘company’ when we want to talk about our perception of action and so we say “New York State lowered the tax on widgets!” when really, Harvey Anydude, popular state legislator rammed it through and got people in the legislature to vote for it.

    So let’s correct those two bad ideas and replace them with one good idea:
    A. People perform actions.

    Your impression of companies versus governments is naive–have you worked at management levels in a large corporate environment? You assert that a company is a singular entity with a singular purpose: profit. That’s simply not true. There are other purposes that companies work for: Not being evil is Google’s, and they really mean it. Power is another purpose. Some businesses eke out these tiny little margins and have tremendous power which is what the managers of the company really want. And before Roy gets all ‘Dude, they’re Dr. Evil!’ on us, power might mean control of an industry for control’s sake. It might mean having heavy influence over a town simply because such influence is entertaining. People perform actions. What you’re talking about is sort of a high school level of understanding of business and government. I know you’re a very smart guy–maybe you’re just trying to write to a wider audience and not getting into the details.

    People perform actions, and one of the main complaints I have about government is that If an individual’s actions are ill-suited to the world in government, the program can be expanded until it starts to work–and this is typically the rule. if an individual’s actions are ill-suited to the world in business, that individual fails in that business. So long as they are not a crony of government, the business fails and the individual starts over again or goes to live in a van down by the river.

    Look at the size of the Department of Agriculture. Government regulatory efforts for monetary policy have been failing at their stated aims for decades–but the blame never goes with the group. Rather, the size of the bureaucracy grows in an attempt (seen in the best light) to get the program working. And here’s a problem: people perform actions to get themselves promoted and rarely if ever worry about the shareholder or the taxpayer. If you launch a daring new program and expand your boss’s empire by another 40 seats, you will be rewarded with the trappings of career: titles, salary and exposure. Even if it doesn’t work. I’m fine with that in private industry–waste all the damn money you want–you’ve no responsibility to use it in ‘good’ ways assuming those are knowable. In private industry, the incompetent get fired eventually. But in government, it’s not the bureaucrat’s money and it’s pretty tough to get fired. I mean, Barney Frank really helped to break the banking system and people keep electing him. To say nothing of the office workers in federal employ.

    I’m not quite sure what’s so bad about the pursuit of profits anyway, but we can leave that for some other time.

    There’s no sinister cohesive force (OK, maybe Goldman) that’s trying to keep everybody down. The fact that people perform actions designed to get them promoted, richer or more powerful is itself the disease. In business, these people can fail–and they do, all the time. It’s all on a nice voluntary basis and if you fuck up, oh well. People have insurance. There are backup vendors. These protections do not exist when government is driving the bus. The only cure is to keep government as small as possible to keep these tendencies as small as possible.

    You claim that in the worst case scenario, the government gets bogged down with politics and they either fuck things up or benefits go to a concentrated group of people. I’d like you to explain that statement a bit more since your statement leads one to imagine all kinds of things where the government fucking things up is worse than a company attempting to fleece ‘us’. USA Today ran a nice piece about how at the beginning of the recession, 14% of federal employees made over $100K and now, 19% make over 100K. These quotes are cool:

    Defense Department civilian employees earning $150,000 or more increased from 1,868 in December 2007 to 10,100 in June 2009, the most recent figure available.
    When the recession started, the Transportation Department had only one person earning a salary of $170,000 or more. Eighteen months later, 1,690 employees had salaries above $170,000.

    Are you feeling 5% better served, Dan? Are you feeling like you’re the government?

  9. Roy permalink
    December 13, 2009

    “And before Roy gets all ‘Dude, they’re Dr. Evil!’ on us…”


    They are not all Dr. Evil (although I do believe that Warren Buffet has a skinless cat and the CEO of United Healthcare has an “Evil” moonbase) but they do have profit as a legal motive…I believe that if a public company does anything intentional that would forgo profit for their shareholders that action (performed by people) would be illegal. Please correct this if I am wrong.

    I love you guys!

  10. Jego permalink
    December 13, 2009

    Roy, that’s simply not correct. Here’s your quick fact check: do corporations make charitable donations? Yes, corporations make charitable donations. Does that reduce shareholder profit? Yes, it reduces shareholder profit.

    Here’s another one: do banks pay gigantic bonuses? Yes, to some employees. Could those bonuses be lessened by $5 each and have no effect on the employee motivation but increase shareholder profits? Is $5 of revenue denied to shareholders? Yes.

    See it?

  11. Roy permalink
    December 14, 2009

    Well, I guess it will be back to the Dr. Evil thing now…

    Is there not something in the code that demands an attempt to maximize profit in a publicly traded company? Or is it really just what the shareholders demand? Not being silly here but I am simply ignorant tof the matter.

  12. December 15, 2009

    Hmm, lots to catch up on.

    @Roy: you’re thinking of several things. The laws are state-based, not federal, so each state is slightly different. I think most states impose the same duties on the Board of Directors and on the officers of the company. Both owe a duty of care and a duty of loyalty. Basically, they have to do what’s in the best interest of the corporation, and do so with ordinary care and prudence. That doesn’t necessarily mean they may never forgo profit. And it’s a nebulous standard. If you bring a shareholder derivative suit against the Board of Directors, you have to prove that someone acting with ordinary care and prudence would not have done whatever boneheaded thing the Board agreed to do. If the Board decided to hire Carrot Top to be CEO for $1 billion per year, you might win. If the Board merely chose to make cars that don’t sell very well, you’ll probably lose.

    @Jego, what you pointed out is that the best interests of the corp. are not always direct profit. Charitable donations are generally seen as purchasing good will, which benefits the corporation in several ways (hypothetically). Paying executives lots of money ostensibly keeps talented officers from going to the competition, which is in the best interests of the corporation.

    So bottom line is that the the Board and the officers must do what’s in the best interests of the company, which is sometimes defined as other than strict monetary profit. And this, Jego, is more or less what I was getting at. These duties are statutory; the officers must put the company’s good first. In contrast, as one example, the enabling statute creating a gubment agency like, say, VA, will list all of the societal good we’re trying to accomplish by creating the beast. Lots of mamby pamby things like “Whereas, our veterans are a vital resource in the fight against poor fashion sense,” etc. I know, I know, the agencies hardly ever live up to the intended ideals, but my point basically amounts to this: corps. have to look out for themselves, agencies have to look out for constituents, and while neither type of body accomplishes either goal very well, we’ve given corps. a long time to fuck up health care, so maybe it’s not a bad idea to let a gov’t body try to fuck it up.

    Also, please keep in mind that my original post was really just making one point about Wes’s original article, which is that there is a difference between a governmental insurance plan and a private corporation’s insurance plan. I wasn’t trying to lay out a full-throated advocacy for the public option health plan (although I do, hesitantly support it). Wes seemed to be saying there’s no difference (or very little difference), and I wanted to point out the difference of purpose.

    @Jego, as for the rest of your criticisms, yeah, okay, kinda. I over-simplified everything about corps. and gov’ts, sure. Because, again, I was originally trying to make one small point, not launch a detailed discussion of the pros and cons of a gov’t-run health care option. But I think the truth is somewhere between the “governments/companies perform actions” and your proposed “people perform actions.” The reality is that a “body” performs actions (in the above context). A Board of Directors, as a singular group, votes and decides and issues and hires and fires, etc. etc. The officers of the company get together and decide collectively on a course of action for the company. And then the company, as a legal and singular entity, performs an action. Sure, in layman’s terms, V.P. of Douchebaggery Bill Smith took it on himself to start some new ill-advised program that costs the company billions of dollars, but in a legal sense, as an officer of the company, he’s an agent. Which means, the company DID act. It’s Bill Smith’s fault, but the company did a thing, and its effects were felt by people on the street, as though the corp. was a singular entity.

    Same deal with governments. Specifically in this context, an administrative agency. It’s not that the U.S. Congress, SCOTUS, and the President together performed an action. An agency performs actions; it’s the Secretary of Nutlicking, telling the undersecretaries to trickle down his policies, and the appropriate people-cogs within the agency doing their respective tasks, that ultimately results in, say, a new regulation promulgated by the Dept. of Nutlicking.

    Laid out like this, it’s the poor schmuck on the street who feels the effect of an “action” by the agency or corporation. So these bodies do perform actions in a practical sense. And now, I’ll finally tie all this together. The reason this is important is that the government is us, corporations are not.

    Yes, it’s an idealistic and probably naive notion. Nevertheless. I don’t like what the Dept. of Nutlicking has done? I can run for office, get into the government, and start changing things at the DoN. Or I can organize voters to get rid of the fucktards who put Bob Dickwad in charge of the agency. The only thing stopping any of us from being directly involved in the decisions is the choice to get involved. But I can’t just join a Board of Directors, or become an officer of the company. I’m not saying these bodies are diametrically opposed; agency policymakers are appointed, not voted into position, and shareholders vote on Board members. So there’s some overlap. But to get involved in policymaking at a company, I have to buy a shit-ton of stock, or convince a majority of shareholders to vote me onto the Board, or convince the Board to make me an officer. But the gubment, well, shit, I’m already part of that machine, by virtue of being a citizen. So that’s basically what I meant by “the government is us.”

    Now, bottom line, regarding Wes’s original article: do I think a gov’t agency would do a good job offering me a public health insurance policy, compared to a private corporation? Would I be better off in that scenario?

    Fuckt if I know. I lean toward “yes,” but maybe I’m stupidly optimistic.

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