Monday, July 09, 2012

The Nature of the Disease

Cuba, a lovely Communist paradise, which millionaire leftists like Michael Moore and Steven Spielberg have told us has health care vastly superior to our own, is experiencing an outbreak of cholera. There are at least 15 dead and a thousand sick, but the advanced Cuban health care system is on the case. The authorities have banned any mention of "cholera" and doctors are putting down “acute respiratory insufficiency” as the cause of death for the epidemic.

But there's no need to sneer at Cuba for handling the problem the way that all governments handle problems-- by denying that it exists. According to the Cuban government, there is no serious cholera outbreak. According to the European Union, there's no Eurozone meltdown. According to Obama, the private sector is doing just fine.

Accountability and government bureaucracies don't go together. When the latter are put in charge of health care, then cholera patients end up doing just as fine as the private sector while the bosses smile and offer themselves another pay raise. That is how euthanasia happens in the UK's NHS, the envy of six-figure bureaucrats and seven-figure activists on this side of the ocean. Difficult patients are just set aside, denied food and water, and allowed to be just "fine" until they die.

The problem with putting the government in charge of things is that the government is very bad at "things". Put the same people responsible for a 15 trillion dollar deficit, a pandemic of debt, in charge of health care and, before you know it, we'll have a cholera outbreak to call our own.

Cholera was one of two virulent pathogens to emerge out of Indonesia is the sixties. The seventh pandemic came out of Indonesia in 1961 just as Barack Hussein Obama came squalling out of his mother's womb. By 1971, as Obama moved to Hawaii, cholera came to Africa. In 2008 it swept the kleptocracy of Zimbabwe, even as Obama was preparing to turn the United States into another Zimbabwe. Now it has taken root in the Republic of Cuba, whose advanced health care botched the treatment of Hugo Chavez, who might seriously be reconsidering the whole socialism thing, and is equally inept at fighting cholera.

The last major cholera outbreak in the United States took place almost exactly one-hundred years ago. Today the vast majority of cholera cases in the country are brought in from outside by foreign travelers. And these days we have a lot of those poor huddled masses yearning to cough up some TB, steal some copper, apply for food stamps and vote the Democratic Party ticket. While we probably won't face a pandemic for some time, the collectivization of health care under government authority will leave us equally ill-equipped to face it when it does come.

The government collectivization of health care shifts us from a system where medical professionals diagnose and treat individual diseases to a national system that focuses on prevention and education gimmicks as cost-cutting measures. The collectivist health care system is interested in healthy workers, not in patient care. Its bosses have their own profit-and-loss ratios and count on keeping people from getting sick. If they do get sick, it is assumed that it is their own fault because they ate too much or ate the wrong things or didn't exercise enough or just got too old.

Government health care is a lot like the health insurance industry. Most of the money is spent on offices where bureaucrats measure the cost of care, pinch pennies, deny treatments and study the arcane knowledge, not of medicine, but of the bureaucracy that manages medicine.

The difference between the two is that the financials on government health care are much more unsustainable, the accountability is utterly lacking and the cruelty and apathy are much greater. Few private businessmen still believe that they 'own' other people and that their lives can be disposed of, but that attitude is second nature to government officials who not only believe it, but who are obligated to function that way, They are not mere businessmen, but the custodians of the lives of hundreds of millions of people.

That is the nightmarish essence of government health care. That is the nature of the disease.

Agriculture in the Soviet Union broke down because the means of production were under the control of a vast army of bureaucrats who understood nothing about farming and whose jobs and survival depended on constantly generating new ideas to improve agriculture and covering up their failures. Toward the end of the Soviet Union, the USSR had gone deep into debt buying American wheat even while the overseers at the former "Breadbasket of Europe" were reporting record harvests.

Political projects, unlike business projects, can never fail. The shovel-ready projects are always digging, the stimulus plans are always stimulating, and we are always on the way up-- no matter how low we go. Businesses measure success and failure in money. Governments don't have that metric. A project doesn't fail on the financials and it doesn't fail when it does not achieve its goals or any goals. It only fails when its failure, actual or imagined, is used by the opposition to successfully embarrass those associated with the project.

In a one-party state or a one-party media, there can be no failure. Actual horrific failures can and do occur, but they are not acknowledged except as a mechanism for replacing one generation of politicians with the new generation of incompetents, thieves and buffoons. Nothing ever gets better because improving things is not a function of the system, nor does the system have any capacity for improving things except by short-circuiting it through temporary bouts of micromanagement or a crisis that invests the people in the system with a temporary sense of urgency to get things done.

Why is Cuba's health care system superior? Because it's socialist. The reasoning is a closed loop and it is the same closed loop that is used to defend ObamaCare. It's not just the label, it's the reasoning behind it that says that the way to improve the delivery of a product or service is by building a vast delivery infrastructure around it to measure and dispense it in the best way possible. Such a system must be superior in its performance because it is modern and scientific. Therefore, it works even when the cholera cases are piling up.

We all know that bigger is better. The more people you put behind the lines to work out the logistics and decide who lives and dies and the exact schedule for Item D of Subsection 728 of Function Y, the better the system will work and the happier the people will be. It is a fallacy that never goes away because turning every human affair into a factory where no one does anything useful seems so reasonable. It's how so much of our society works. And that is the nature of the disease.

The bigger a system gets, the less capable of performing a function it becomes. The more detached a system is from its direct function, the more it exists not for the sake of the function, but for its own sake. Such a system can be called a disease or a cancer, but it's also like cholera, an infection of the system that leads to massive waste and eventually the death of the system.

During the ObamaCare debate, Keith Olbermann insisted that the debate was a matter of life and death. And it is. Universalizing the delivery of a service through a central government system drastically worsens the quality and value of the service.

If you doubt that, consider the decreasing quality of the educational system as it became more centralized and universalized. Now imagine an average quality of health care as bad as the average quality of education. Imagine a system based on fraud and cover-ups, rife with resource shortfalls, where the staff is unhappy, the doctors and nurses barely know what they're doing and most of their efforts are dedicated to trying to keep up with the latest government quality initiatives which can never be met.

We have bits and pieces of that system in place already, but there are countries that have the whole awful shebang. World powers where patients die pleading for a drink of water and modern socialist utopias battling a disease whose name they dare not speak. There is no escaping those results with a commission or two. There is no use putting the best and brightest experts in a room and getting them to author some thousand- page monstrosity that will fix the problem. You can't cure a disease with more of the same disease.

Free things are nice to have, but they are also very expensive. Not only do they cost three times as much as a comparable service, but they are so bad that it is hard to find a service to compare them to.

Walmart is cheap and the products are worth what you pay for them, because even the same brand names sell cheaper and poorer-quality versions of the same products to the giant retailer. That is how it works. Walmart squeezes the manufacturer and the supplier and, under the iron law of human affairs, they struggle to maintain consistent profits by providing a cheaper and worse product.

Now imagine the government as a giant Walmart with offices full of useless employees, armies of unnecessary executives, stores that spend hundreds of millions on advertising without once ever turning a profit. Imagine the quality of products and services that such an infrastructure will provide. Imagine what comes out the other end after the manufacturers and suppliers have been squeezed to cut costs as much as possible.

Those are your government services. That will be your health care if the Cuban cholera follows the Indonesian cholera to America. That is the nature of the disease.


LemonLimeMoon said...

Obama care will be like the rest of the policies. A failure. Sadly we will suffer because of it.

Keliata said...

It took a view minutes to asorb you're last sentence but it is something that nobody has addressed before.


OT slightly

"World powers where patients die pleading for a drink of water..."

My 18-year old cat died this morning. Instead of taking her to the vet for "closing intervention" I chose something that few people are aware of, animal hospice care. I took care of her to the end giving her sips of water when she refused to eat.

No way would I deny her that.

She died peacefully in her sleep--she wasn't put to sleep. But friends and coworkers acted like I was a monster for providing palliative in home care when I should have put her to sleep.

This health care reform might well result in human beings being "put to sleep" or involve "closing intervention."

Sad. Just as animal medicine is turning to less drastic and traumatic deaths I fear the govenment could start pushing euthananasia, using words like putting to sleep and closing intervention.

This country is heading down a dangerous road.

Ex-Dissident said...

Actually Keliata, hospice is very popular now for humans in the USA. A whole legion of hospice specialists is being generated and promoted through government sponsored projects. I remember a time when we used to fight for someone's life instead of talking about nature taking its course. I do not mean to imply that what you did was wrong and that you mistreated your cat, I think just the opposite. You treated your dying cat as gently as you could. However, hospice for humans will likely take the most cost effective form: whether that be a lethal injection or denying food and water to a dying man.

Mr ED said...

As usual an eleoquent, well reasoned piece from one of the best minds in the blogosphere. These are all notable observations and ones that are painfully true, but from whence do these fallacies originate and how do they become in any way acceptable as workable and sustainable? What is the path that takes reasonable, intelligent human beings and turns them into wilfully self-deluded fools, convinced of every Leftist grand scheme and, more importantly, the needed apocalyptic vision which always lies underneath each scheme, supporting the scheme and preventing the scheme from being crushed under its own illogic, incoherrence and invariably disasterous results?

Even something like science, which by its very nature should be immune from the deluded fantasies of the grand schemers, falls prey to the latest desired Leftist meme (globull warming, climate change, bogus "studies" of all stripes, ad nauseum). How can this be so? What is it that convinces modern, intelligent human beings to jettison their critical thinking skills and their experiences in the world of reality and willfully put on the Leftist blinders so that each manicured and truncated facet of the Leftist vision looks reasonable and functional?

There is absolutely no doubt that any society controlled by the Leftist body of lies will eventually fall under its own weight, it always does. And with that fall comes the required rebuilding of society structured along very un-Leftist lines grounded in reality. So why is it that there are so many new, willing accolytes to the destructive, inhuman disaster of Liberalism/Communism/Socialism each time it gets rolling again? How do so many people become detached from reality and fall prey to the fantasist lies of the Leftist over and over again?

That is the question that demands an answer.

Joan McDaniel said...

I did some research and found neighboring Haiti is having a return of Cholera. It killed thousands after the earthquake. Transmission is primarily by the fecal contamination of food and water caused by poor sanitation. That means there are not water treatment plants in the Liberal Utopia of Cuba.
Their Health care must be great because treatment is IV Fluid and increased fluids to prevent dehydration.
Says a whole lot about the lack of humane conditions in Cuba. Liberal Paradise.

Daniel Greenfield @ the Sultan Knish blog said...

KA, I'm sorry for your loss and yes that is already coming through the door as "Quality of Life"

Mr. Ed, science isn't immune. The scientific method properly practiced is, but what most people think of as science is modernism, bigger and shinier operations. And those are a part of the problem.

We're not really facing the hippie 'back to nature' life, though that is in its ideological DNA, we're facing the big government left. Their best weapon is the promise of scientific government, all operations under one roof

Joan, there's a soap shortage in Cuba too. A meltdown may be coming.

civil westman said...

Another cogent and correct analysis, Daniel. Here are a few thoughts I shared with Fareed Zakaria in response to his encomium to government health systems:

Fact: most feared diseases present no symptoms until they are far advanced (cardiovascular disease and cancer).
Fact: if one lives long enough (and doesn't die from something else), one will acquire one or both of these diseases
Fact: there are few available screening tests (safe and inexpensive enough to be provided to all) for early detection of these diseases.
Fact: lifestyle choices are major factors in causation of these diseases. Though that knowledge is widespread, it little impacts behavior. Doctors have limited influence on such behaviors.

Fact: The very notion of indemnity insurance fails for health services. Unlike fire insurance, where there is only a risk one's house will burn down; there is a certainty one's body will do so.
Fact: As Lester Thoreau explained in 1978 ("Medicine versus Economics"), we can easily consume 25% of the total lifetime wealth production of just about everyone during the last 6 months of life - since everyone is now a candidate for a final catastrophic illness - we cannot afford all the marginally beneficial care we know how to give. The demand for marginally-beneficial care is infinite. Resources to pay for it is not.
Fact: Like it or not, the cost of a given medical service is not reducible. The only way to reduce global cost is to limit services. This will result in rolling political fights for what remains 'covered.' The media will be presenting 'the disease of the month club' to increase the political capital of disease interest groups. It will be ugly and wearing.

- This suggests one may indemnify only against the premature occurrence of certain diseases. Beyond that, one must save for what will be near certain future costs. Currently, at end of life, Medicare beneficiaries may spend large amounts of other people's money. To make a long story short, I propose that it is more just that decisions be made individually by patients with savings with their doctors as to how to allocate the patient's resources. That is, how much to marginally extend life vs. how much to leave to my progeny. In my view, that is far more just than arbitrary rationing decisions by cold, distant bureaucracies.

- To accomplish this, I propose a system like that in Switzerland. Yes, government is involved. It does only 3 things, however, and competition does the rest. There are 70 private insurance companies in Switzerland which compete on price and panel of doctors and hospitals.
1. universal mandate
2. community rating
3. each insurance company must offer at least one policy with a maximum deductible of 2000CHF

The government subsidizes purchase of policies for the 3% of the population which cannot afford insurance.

Result: Care every bit as good as in the US - with better objective outcomes, minimal waiting, individual care decisions between patient and physician, minimal bureaucratic nonsense and waste, and per capita cost of 58% of in the US. That is because the Swiss system is dedicated to individual liberty and actually providing good care to its citizens. It is not about creating a system of total government diktat. It is not 'of the government, for the government and by the government' in service of the radical egalitarianism which has become the animus of the US federal government.

A role for government? Sure. Three rules, not 2000+ pages of law, tens of thousands of pages of regulation and armies of bureaucrats. The result of Obamacare will be shrunken freedoms, vastly increased costs, long queues, and equality of dissatisfaction for all, except, of course, the nomenklatura.

Edward Cline said...

Family Security Matters carried this wake-up call about the growing shortage of doctors, and the coming crunch on those that choose to remain socialized serfs of the State:

And how many of those who choose to remain socialized serfs of the State will remain in the business once they experience what it's like to be, well, slaves? The ones who choose to remain are not doctors I'd trust the health and well-being of my cat to.

LemonLimeMoon said...

@ Keliate:
I am so sorry to hear about the loss of your friend. Its like losing family.

Anonymous said...

dr. knish,

i'm glad america got a second opinion from you. unfortunately, dr. obama is already sewing america's vagina shut

-- spanky

NeeNee said...

Mr. ED: " How do so many people become detached from reality and fall prey to the fantasist lies of the Leftist over and over again?"

Why? At the root of all this is that the majority of Americans

Rush Limbaugh recently quoted statistics for various programs & issues: 8 million people on disability today, at a yearly cost of $8 billion dollars. . . vs. 1985 when just 3.7 million were on disability. Link to year-by-year chart here:

In under 30 years, have occupations gotten 2 1/2 times more dangerous?? Is that what we're supposed to believe?

"The ideal citizen to Barack Obama is someone who is totally dependent on government, has no independent thought, and no independent life. Whatever is needed, there's something in Washington where you can go to get it."

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