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Medical Logic and Illogic Michael Arnold Glueck, M.D., and Robert J. Cihak, M.D., The Medicine Men Logic is not a subject much taught in our schools anymore. But you don't need much more than common sense to realize that, when premises are wrong and reasoning is faulty, good things do not ensue.
Our example today is a health care reform proposal put forth by Democrat Washington State senator Jim Kastama. In a December 18 op-ed in the Tacoma News-Tribune, "Health Care Reform Requires Tough Cost-Benefit Approach," Senator Kastama concedes that his Health Care Recovery Act has but a slim chance of passage.
With this assessment we happily concur and would be quite content to forget all about it except that his fallacious premises, poor reasoning and potentially devastating conclusions are so common among politicians that they rate at least a moment's unanaesthetized dissection.
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America's health care problem, according to Sen. Kastama, is that "We simply spend too much money for our health care compared to other countries." To quote the brilliantly intuitive logician Tonto, in his reply to the Lone Ranger when they found themselves surrounded by hostile Indians: "What you mean 'we,' paleface?"
"We" are not other countries. "We" are 300 million human beings with our own needs and problems. Medicine deals in life and death. Our lives. Our deaths.
To argue that something is wrong because we spend more than others on health care and to go on to cite flawed statistics and misleading studies to prove that others get more for their money is worse than meaningless – it's pernicious. And while some public health measures are based on collective benefits, the value of most medical care is measured not by "us," but by "you" and "me."
Sen. Kastama, however, seems to feel that all our wealth, not just the money spent on health care, is a collective possession to be spent by politicians and their surrogates. He claims, with approval, that these unnamed countries discipline their health care systems by supposedly taking the matter out of the hands of both the politicians and the insurance companies. "Instead, they create an objective, independent agency of health care experts whose sole focus is to design a health care plan that is both affordable and comprehensive ... they live within a budget."
But who sets the budget? The politicians, in case you hadn't guessed.
And what happens when availability and affordability don't connect? The politicians try to offload their responsibility by having their hired experts prioritize. Notes Sen. Kastama: "This leads them to make tough decisions."
And how would these experts decide which treatments and drugs get priority? "Evidence-based medicine" and "rigorous cost-benefit analysis" to determine "whether the cost is worth the benefit to the public." These experiments amount to medical-cost-accounting exercises and calculations that are quickly outdated and can't possibly consider all the evidence available, much less all the human suffering and benefits.
These decisions typically translate into longer waiting times for patients.
And how, apart from personal political clout, do the employees of this agency get and keep the jobs that permit them to determine the medical fates of other citizens?
Sen. Kastama claims to reject "simplistic solutions" to the health care cost crisis, including socialized medicine. His own solution: Simply let the experts do the rationing – so the politicians don't get so much of the blame. He doesn't say how or whether he would keep his fellow politicians from exercising executive privilege and jumping to the front of the medical waiting list.
But in truth, there is no health care crisis at all as Sen. Kastama defines it. We have no more idea what is the "right" amount to spend on health care than we know the "right" amount to spend on cars, computers, cakes or concerts. Perhaps we ought to be spending more on these or other good things, perhaps less. In your own health, there is no "we" – only individuals who inhabit the only bodies we're going to get and that we want to keep alive and functioning.
At this point, it is tempting to speculate on how such thinking survives generation after generation. Rather than quote those who have done this much better than I could, I suggest a few questions.
First, before coming up with even the most modest suggestion for the redemption of the medical system, ask yourself whether you would care to live under the change – or entrust your child to it.
Second, ask yourself how you would feel if your government told you what medical care you could or couldn't get, even when you spend your own money. If you haven't experienced this form of dictatorship, ask William Delashmit, who was denied eye surgery to cure blindness when Medicare would not pay for use of the laser machine needed to treat his eye. Medicare then also prohibited him from paying for the machine himself.
Third, ask why federal and state politicians continue to vote for government programs and insurance laws that foster "the world owes me a living" entitlement attitude. This encourages the "medical gluttony" described by Dr. Del Meyer of MedicalTuesday.net and creates demands on the system costing hundreds of billions of dollars. Also ask your elected officials why they hyper-regulate medical care, costing additional hundreds of billions.
Finally, ask what the politicians might do with the money that "we" save on health care. If they can't come up with any better uses – or if you suspect that they'll simply waste it – then get a system that encourages you and your physician to decide what's best for you and your family.
For starters, think about having your own, personal and private Health Savings Account (HSA).
Editor's Note: Robert J. Cihak wrote this week's column. Contact Drs. Glueck and Cihak by e-mail. Robert J. Cihak, M.D., is a Senior Fellow and Board Member of the Discovery Institute and a past president of the Association of American Physicians and Surgeons. Michael Arnold Glueck, M.D., is a multiple-award-winning writer who comments on medical-legal issues.
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