Nationalized Health Care

July 22nd, 2009

There are several problems with a federal takeover of health care.  Some of these problems are issues of pragmatism, but they are largely issues of philosophy.

The first problem is that doing so worsens the logical contradiction that already exists within the welfare state.  The federal government is going to take, by force or coercion, my money to give it to someone else on the grounds that it is “the moral” thing to do.  One cannot commit an immoral act in order to be moral.  Yes, taking my money by force or coercion is immoral – it is theft.  It is a legal theft, a legal plunder, to be sure, but it is still theft.

Every tyrant in the history of the world has justified his usurpations on moral grounds.  None of them has ever said “Well, I’m just a bad guy and this is what I do.”  Without exception, they have justified the worst barbarities on the moral grounds that it was done “for the public good.”  Mao, Stalin, and Hitler together murdered more than 100 million people in a span of about 40 years.  It was done, of course, for the public good.  I don’t imagine that the people they put to death would agree with them, but then again, they did not really have the power to disagree.

No, I’m not saying that nationalized health care is equivalent to mass murder.  The issue is that the justification for one is identical to the justification for the other.  There is a difference only in degree, not in principle.  The folly of the thief here is that he has justified his immoral use of force on the same grounds that the murderers to follow will use to justify the extermination of the thief.  Ultimately, it comes down to who is willing to use more force to obtain his ends, and the murderer will always triumph over the thief.

Bernie Madoff is going to prison for the rest of his life, as he should be.  But the people who sent him there can tell you, with a straight face, that there is nothing wrong with Social Security.  The only difference between what Madoff did and what the federal government has been doing since the 1930s is that the federal government has made it legal for itself to do so and illegal for everyone else.

If I do not have a right to steal, then I cannot confer that which does not exist.  I may think you are a swell guy and deserving of a Ferrari 525i, but if I do not have one to give you, it stands to reason that I cannot give you one.  None of us has the right to steal.  Therefore, even if a majority of us votes to give this “right” to the government, we cannot confer that which we do not possess.  So, what is it that we have given the government, if not a right?  In a word, power.  More power is a dangerous thing to give to an entity that already has a monopoly on the use of force.

There is nothing inherently wrong with the belief that we should take care of each other, but the means to that end is just as important as the end itself.  We all impose moral obligations upon ourselves daily (or at least I hope we do).  Again, there is nothing wrong with that.  However, when we seek to impose those drives on others by using force or coercion, we cede the moral high ground and become despots.

The purpose of having a moral code to begin with is so that we may have a guide to help us with our day-to-day decisions.  When that moral code contains contradictions, for example by declaring that theft is both moral and immoral, it is no longer useful as a guide.

One of the chief complaints about the current state of health care delivery is that there is a shortage of it.  Under a nationalized system, the shortage will get worse, and not merely because more people will make a more frequent use of it.  In speaking with colleagues, doctors, respiratory and physical therapists, and others, I anticipate that somewhere between 20% and 40% of those of us involved in health care delivery are just going to walk away from it and find new careers or retire.

According to the American Association of Colleges of Nursing, there is a nationwide shortage of over 100,000 RNs as of 2007, a number which is expected to grow to over 250,000 within the next 10 or 12 years.  And this figure does not take into account the large numbers of us that are going to quit under a nationalized system.

As with nearly everything else the government does, under a nationalized system, staffing at the highest levels is going to be accomplished through political patronage.  At the lower and middle levels, staffing is as likely to be done through patronage as it is through competence and experience.

We are being wooed with the notion that a nationalized plan will give everyone equal access to quality health care.  It will not.  Those with political clout will get great health services, and those without it will get what is left over.  George Orwell’s words from Animal Farmwould seem prophetic if the story had not been an allegory of the rise of the communists in Russia:  “All animals are equal, but some are more equal than others.”  That phrase was used by those with power to justify why they could have good food and warm lodgings while the workers had to suffer rations and barn life.  It will be used here to justify why congresscritters and judges can go to Bethesda or some equivalent, and why we will all be forced into the equivalent of the local county/charity hospital.

“There are just too many poor people without access to quality, preventative care,” we are told.  Unfortunately, this is largely not the case.  The problem is not one of availability but one of education.  Pregnant teenagers will likely never avail themselves of good neonatal care, and much of the information is already available for free and widely known:  at the very least, take folic acid supplements (it prevents spina bifida), do not smoke, do not drink alcohol, do not use any drug unless you are specifically told that it is safe.

Obesity and obesity-related illnesses (diabetes, heart disease, circulatory disorders, hypertension) are epidemic.  We all know this.  People do not get obese because of a lack of health care.  People do not develop diabetes because of a lack of health care.  People do not get emphysema (now called COPD – chronic obstructive pulmonary disorder) because of a lack of health care.  People do not get AIDS/HIV or any other STD because of a lack of health care.  Obama, Pelosi, and Reid are not going to sprinkle magic pixie dust and make these things go away.  No government program is ever going to solve problems related to ignorance or apathy.

“What about the children?”  The most important thing we can do medically for children has already been done:  vaccination programs.  Vaccination programs are available, at no cost to the indigent, to every child in every state and territory in this republic.  The second most important medical thing we can do for kids is also already done:  nutritional programs.  Breakfast and lunch programs are in place in every school district in every state and territory in the republic.  If Mom and Dad permit their wee ones to gorge on chips and ice cream and soda pop and sit around playing video games and not studying once they get home from school, well, no nationalized health care system is going to fix that.

According to the World Health Organization and UNICEF, infectious disease and malnutrition are the leading causes of child mortality world-wide.  The programs I mentioned above, in combination with WIC, already address those issues here.  We do not need another government program to implement what has already been implemented. No government program is ever going to overcome ignorance and apathy.  No government program is ever going take care of the children of ignorant and apathetic parents.

I recently had a 20 year old patient who was admitted for diabetic crisis (officially called “Diabetic KetoAcidosis – DKA for short – a potentially fatal diabetic condition brought on by overconsuming carbohydrates).  Her blood sugar was over 800 when she was admitted (the normal range for blood sugar is 70-120).  She has been diabetic since she was 10 or 11.  Before I got to work (I work 7P-7A), the hospital nutritionist spoke with this patient about diet.  The day shift nurse from whom I received this patient spoke with her about diet.  While making rounds at the start of shift, I spoke with her about diet.  Less than an hour later, she asked me if I would heat up the supper that her boyfriend had brought her from outside the hospital.  I opened the styrofoam container and found potatoes, macaroni, carrots, and meatloaf.  A person with a healthy and functional pancreas should not eat that many carbohydrates in one meal, let alone someone admitted for DKA.  While this is perhaps the worst case of ignorance/apathy I have had as a nurse, ignorance and apathy bring more people into my care than everything else combined.

In addition to the ignorant and apathetic, we have those who get admitted for specious reasons (usually claiming “chest pain”) simply so they can get narcotics like Vicodin, morphine, Dilaudid, and Demerol around the clock.

Far from solving problems like these, nationalized health care is likely to make these problems grow.  “Oh well, I can do whatever I want because ‘they’ will take care of me.”  People who don’t have to be responsible usually won’t be.

At the end of the day, nationalized health care is going to be about power and control, not about health care delivery.  As I indicated earlier, power is a dangerous thing to give to an entity that already has a monopoly on the use of force.  While powerful governments are not always abusive (yet), all abusive governments are powerful.  We’ve gone far enough down that road.  It is time to turn the wheel.


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21 Responses to “Nationalized Health Care”



  1. Larry |

    Brian
    Bravo, absolutely on target. Best articulation of my thoughts I’ve seen to date. You’re comparing of Obama’s efforts to similar historic events is so very true.
    Obama and his efforts to put the Federal Government in charge of all aspects of our lives could very well mark the beginning of Europe 1930 all over again.


  2. doris |

    Just so you know, Brian, the Gov. is already taking your money involuntarily. Unless you are one of those guys who pay their taxes happily, which I highly doubt. Too late, bro, done and redone. It will just be more taxes for those making over $280,000. I don’t think you fit that criteria, or do nurses make a lot more than I think? Won’t affect me either.They do need to make health insurance more reasonably priced, nothing more, nothing less. Get on with that promise, please, Mr. Obama. Also,folks have been doing immoral things in the name of morality forever, ask any father who has killed a man who harmed his family, I would, too, in the right circumstances.


  3. Tom |

    Brian, I agree in theory with much of what you say. I don’t like the idea of government agents with badges and guns having the power to seize my property if they think I haven’t paid the taxes mandated by some distant government. I think people should be self-reliant and responsible for their own lives. It seems logical to me that free people living in a democracy and with a free economy, able to act in their own best interest as they perceive it, are the most productive, creative, and happy. In theory.

    You know social contract philosophy as well or better than I do, and you know that the theoretical alternative is a state of nature — where humans lead lives of conflict that are “solitary, poor, nasty, brutish, and short.” The strongest survive, the weakest perish or are enslaved.

    There’s a middle ground between the absolute authority of one powerful ruler and the bloody struggle of a state of nature. Human beings have to live together in some form of organized structure. All give up some freedoms, and all accept some obligations. Civil rights are guaranteed, and natural rights are protected. Given the size and complexity of our society, I think the arrangement we’ve arrived at over time is close to the best possible. Maybe it has deteriorated somewhat over time, maybe too much is expected of the most productive and too much demanded by the least productive — but the arguments and disagreements are at the margins.

    Personally, I wouldn’t want to start from scratch with some new kind of social contract unless I could be guaranteed that I and everyone I care about would be among the survivors of the transition.


  4. Brian |

    Doris, the refrain “because we’ve always done it, we should keep doing it” is not a justification for continuing to do it. By this logic, there would never have been a revolutionary war against England, there would never have been a ratification of the 13th amendment (outlawing slavery), or indeed a great many things which most people now take for granted.

    Part of the reason health care is as expensive as it is now is because of the government programs (MedicAid and MediCare) that are already in place. Medicare/MedicAid pay doctors/hospitals about 30% less than private insurance companies pay. So, in order to make up for what they lose through government care, they have to charge more to the private payers, making insurance even more out of reach for those that don’t make much money. In short, the government has a partial monopoly with which private interests cannot compete.

    Obama has already told so many whoppers, why on earth do you continue to believe that it is only “the rich” that he is going to tax? A tax on producers is ultimately a tax on everyone, including you. As I indicated above, a nationalized plan is going to make worse that which is already bad, due largely to what government has already done. So the solution is to do more of what has already failed? That is irrational and insane. Insanity could be defined as doing the same thing over and over, yet expecting different results with each iteration.

    Tom, Rousseau was perhaps one of the biggest proponents of the social contract theory (well, so were Marx and Engels). The problem with it is that free people can only be bound to what they agree to do. Social contract theory holds that you are legally bound to obligations that you would never agree to privately. It is involuntary servitude, which was outlawed in this country in 1866. Social contract theory is antithetical to civilization. Social contract theory, ultimately, is an offshoot philosophy of the Divine Right of Kings. The only difference is that instead of a single sovereign, the “sovereign” is the amorphous, ambiguous masses to whom you must swear fealty or be imprisoned or fined or both.

    The purpose of a republican, limited government is to protect the rights of minorities from the excesses of the majority. The smallest minority in the world is the individual. A government which initiates force against a minority (the “rich” in this case) is despotic.

    If a person doesn’t like his circumstance today, he is free to change it if he wishes. He has no legitimate authority to force or coerce anyone else into changing theirs to suit his own wants and desires or perceived needs. If you don’t have as much money as you like, start your own business. There are dozens of businesses whose start-up costs are negligible and whose potential for wealth are great. The Pampered Chef, Mary Kay, and AmWay all come to mind, though there are dozens, if not hundreds, of others that are good. Join a real estate investment club and learn from people that have already done it. Forcing another person to accommodate your lifestyle is utterly repugnant.


  5. Tom |

    If a person doesn’t like his circumstances today, he certainly is free to change them. However, that freedom exists within the context of our political system, or “social contract” if you wish. Some authority has to protect citizens against crime, enforce the contracts that make their businesses possible, put out the fires if their homes or businesses catch fire, defend the nation against internal and external threats, provide for the common good through highways and organization of air traffic — the list is long. All of that is done by governments at various levels, and we wouldn’t survive long without them. For all of that we have to pay taxes, of course.

    You seem not to want government to exist, but there’s no alternative. Your arguments, as I said, are at the margins. Should government provide for the welfare of the least fortunate, and if so to what extent? Should the government defend the rights of all, even the smallest minorities when threatened by the majority? Should the government regulate private and commercial activities, and if so, which ones and to what degree? And on and on. The answers to all these questions, at least for most people, is yes. The issues relate to how much, for the most part.

    I submit that the democracy we have — not the one we might have in a perfect world — works pretty well, especially compared to the systems found in other large and complex nations (spare me comparisons to Switzerland, et al.).


  6. Brian |

    Tom, all of those things you cited are for the common good. Everyone has a reasonable expectation of the benefits of such things. That is not true of what is now commonly referred to as welfare. One need not qualify for anything to be able to benefit from an interstate highway system, or a military that protects us, or police and courts to arrest and confine highwaymen and murderers.

    To believe in the welfare state, you must necessarily believe that you must commit an unethical act in order to undertake an ethical one. In other words, you must contradict your beliefs in order to support your beliefs.

    The only thing we have available to us is our rational mind. We do not see, hear, or smell particularly well. We cannot run very fast. We have no claws or sharp teeth. Most of our food must be cleaned and cooked to be able to eat it. We have only our ability to reason, to think rationally. I will not abdicate the only useful tool I have at my disposal for any reason or emotion. You shouldn’t either.


  7. Anonymous |

    Oh boy, I’m in deep dodo now, just my rational mind? Is it sexist of a woman to say, Brian, w.t.f.? Apparently, you don’t know any women, so you think we are existing by our rational minds? Emotions pretty much rule our world, in case you hadn’t noticed.

    We must pay taxes or have nothing, except what we can horde in our backwoods shacks, existence only, with no taxes or Government. I hate to pay taxes, but I am afraid I don’t really care if the millionaires will fund this fiasco, and not me and you.


  8. doris |

    That was not supposed to be anonymous, it was me, my Windows 98 hates me. Rightfully so. Old crap.


  9. Harvey |

    Brian,

    Ayn Rand may be gone from this world but you seem to have captured her spirit as well as anyone I’ve ever read. A perfect philosophy will always have its nitpickers and detractors but that makes it no less perfect.


  10. Brian |

    Doris, every achievement that has benefited man has been the product of an initial rational thought. There may have been passion to motivate it, but it was rational thought that made it come into existence. To deny that is to deny the one thing that separates humans from all other animals. I believe I have a soul, but I KNOW I have a rational mind.

    The darkest periods of human history have been those ruled by emotion and irrationality. Do you think it a coincidence that the Dark Ages ended with the Renaissance (translated literally from French as a “rebirth,” a rebirth of rational thought) in the 16th ad 17th centuries? It was the Renaissance that made possible the philosophies of people you have never heard of and probably don’t care about, but which have made your life as easy as it is. The philosophy of Rousseau, Marx, and Engels, which you espouse whether or not your realize it, have resulted in more human misery than everything in the history of the world, and mostly in the brief span of about the last 90 years. The greatest failing of all three of those philosophers is fundamental: they had no grasp of basic human nature as it relates to microeconomics.

    It has been only the briefest forays into rational thought that have produced great societies: Athens, Rome, ancient Persia, the United States, and for a brief period, the United Kingdom.

    I have NEVER stated, anywhere, that we should not pay taxes. The only just system of taxation is the use tax. There are good arguments to be made pro and con for import taxes and duties. I lean towards the “pro” side on duties.

    I have never griped once about the taxes on tobacco, alcohol, gasoline, or sales tax. I may not like them much, but they are honest taxes that anyone can figure out and pay easily. I can even disagree with the way the money collected via those taxes is spent and still be in agreement with the justice of those taxes.

    Yes, we do need government, and we do need taxes, but only for things which all of us may benefit from: a military, a police force and judges, regulation of currency, border protection, and a few other things.

    Stealing money from Peter to give to Paul, no matter the reason, is immoral, and no just government undertakes it. I’ll even go one further and say that it is not Christian to advocate such things. I don’t recall Christ ever saying, even once, that we should take up the sword to bring about “social justice.” Self defense is another matter, and there are dozens of references in the NT to it being justifiable.

    The fundamental question you must ask yourself is “Why is it that theft is immoral?”. If it is immoral and wrong at the level of the individual, what makes it moral and good at the level of the mob?

    Finally, what do you have against the wealthy? What has any wealthy person ever done to you? Taxing “the rich” is arbitrary. For most, “the rich” comprises anyone that has more money than they do. Frankly, I don’t care who has more money than I do. And to be honest, it isn’t any of my business (or yours) who makes more or has more than I do. Your income is between you, your employer, your spouse, and God. Nobody, for any reason, has any right at all to know how much money you make, not even the government. Actually, it is most especially none of the government’s business. If you wish to divulge your income, that’s your decision to make. If you do not wish to do so, it is immoral to compel you to divulge it. Even more than being immoral, it is rude in the extreme.

    I’m being as earnest as I can be when I say that you need to talk to your pastor or a councilor about such a destructive jealousy. You’re a lovely woman, and this jealousy diminishes you.

    More on pragmatism:
    Roughly 25% of all health care dollars spent in this country are spent on the last year of life of the elderly. That will be the first group of people to be denied access to health care. I don’t recall the number off the top of my head, but the next group of recipients of a large proportion of health care money includes two people I hold in very high esteem: the first was a patient (and former coworker) of mine recently (when you and I met for the first time); the other would probably be a patient of mine if I could get the job I wanted at the clinic across the street from Brookshire’s near the hospital where I work. You know both of these people well. This group will also be largely denied health care, and the reason is that it costs so much money to take care of them.


  11. Brian |

    Harvey, thank you for your kind words.


  12. doris |

    I am not jealous of the wealthy, just don’t care about them, they are doing ok, so why worry? I am not jealous of any entity, and I am surprised you thought so. I just don’t care how he funds anything as long as people who can’t afford it don’t suffer. Thats my point, not jealousy. I totally agree with you about the fair tax, I love that idea. I was joking about the rational thinking, lol. You take yourself waaaaaay too serious, you are a lovely person, too, except for that. I have heard of all those guys, not stupid just, ignorant, joking.


  13. doris |

    I don’t have a pastor or a counselor, not since high school, and don’t plan on getting one. Jealousy is definitely not my problem. Robin Hood wasn’t such a bad guy, was he?


  14. Tabbi |

    I heard about the self assisted euthanasia clinics in Switzerland, I would drop my insurance if they would legalize that here. NO PROBLEM for the taxpayers then, it could be funded by the money I, and others like me spend, every pay period for our so-called wonderful insurance. Yeah, I know, I could have prevented all the things wrong with me, and still could, I am not asking for anyone to do anything for me, I know its ALL my fault, but there are people, who honestly do try to be healthy and still suffer from disease, and fall in the cracks where they make too much for government assisted medical programs, yet, they can’t quite pay for the insurance that is out there for all of us to purchase. For those Americans who still don’t get it, if I can get up off of my lazy a** every day and go to work and hobble around on 8 toes, and make a living and try to pay for medicine and insurance, to take care of my own self, THEY CAN TOO. Disgruntled very much with the system that is in place, where anybody who does not speak English, or has 12 illegitemate kids can get free insurance, (NOT FREE TO THE WORKING OF USA), and free food, but, the elderly, and disabled, and just friggin tired of working citizens, have to work until they are 95 as greeters at Wal-mart, or wiping off tables in McDonald’s where the afore mentioned, non-taxpayers will soon be able to use their LONESTAR cards to purchase BIG MACS. I really don’t know what the answer is, but I wish some of you smarter, more politically minded folks, (you know who you are) would rally, lobby, whatever it is you guys do, and make it right.


  15. Brian |

    Doris, Robin Hood stole from the government that had already once stolen the money from the people that earned it.


  16. Brian |

    Tabbi, just because your health is your responsibility doesn’t mean it is your fault that you are ill. In some cases it might be, and others not. But it is still your responsibility, just as my knee, hips, and shoulders are mine.

    Doris, you’d better care about where he gets the money. Eventually, you could be one of “the rich” just by the government arbitrarily changing the definition of “rich.” You may scoff, but it happens all of the time. And please don’t say “it couldn’t happen here.” It already has – it just hasn’t reached you…yet.

    Go back and reread what I wrote about inflation and see if you can come up with a scenario of how what the Federal Reserve is doing to our money is materially affecting health care delivery. Remember that the more the supply of money is inflated, the more poor that will be created.


  17. Tabbi |

    I would also like to add that the news where I work is that Mr. Obama is going to take the 50 million or so that Medicare alots to the Home Health Care Industry away from them. Now, honestly, how does that help? That just means that those folks that have been prematurely discharged from the hospital because the insurance refused to pay will have a higher mortality rate and a higher return trip to the hospital rate. WHY? Because there will be no one to take care of them at home bec the Home Health companies will have to shut down as they won’t have Medicare as a pay source any longer which is primarily who pays for those services. The secondary insurances that those folks on Medicare have chosen, mostly suck. I know because I have to fight with them on a daily basis to get authorization to see these homebound people who got kicked out of the hospital and still require services such as wound care, physical therapy, occupational therapy, speech therapy, assistance with bathing, dressing, grooming…etc.


  18. Brian Bagent |

    Tabbi, surely you understand that this is simply a first step in rationing health care. I’m sure you’re aware that much of what your agency does is related to “quality of life” as opposed to “life sustaining.” That is certain to be a line of demarcation for what the federal government is going to be willing to spend on health care.

    You are going to have the same decision to make in a couple years that I will be making. Rule number 1 from nursing school: you are YOUR patient’s advocate. If you are taking care of the chronically ill or the elderly, the game is set up for you to fail. This proposed system is going to fail. You can prolong the failure of the system, and thus prolong the suffering of many, or you can accelerate the failure of the system by removing your consent to work within it. You won’t have to actively fight against it, you merely have to refuse to participate in it.


  19. doris |

    Sad to say, Brian, I am beginning to agree with you. Yeah, I said it. You may have a point about the national healthcare. I was for it, but it sort of sounds suckie. But you must admit our system desires a lot? Maybe not exactly Gov. intervention, but what? Hey, if you can solve it, please do. Tabbi,you are not responsible for your illness. If anyone is, it is your parents, but remember, when we work out and diet and try really hard, you lose toes and pieces of feet? Really suckie. Brian, how can the average Joe, not the plumber, afford insurance, plus the at least 20% owed for a hospital bill? Most don’t pay that part, seems unfair and ludicrous that we, if self paying, pay waaaay more than the insurance companies for the same care. Why does a tylenol cost 28.00 at the hospital? Things have gotten out of the realm of reality. I wish, yes I know naive, Obama would do something to fix it, but not by taxing anyone more than already necessary. A quandry, for sure.


  20. Brianna |

    “Is it sexist of a woman to say, Brian, w.t.f.? Apparently, you don’t know any women, so you think we are existing by our rational minds? Emotions pretty much rule our world, in case you hadn’t noticed. ”

    Point of order Doris. I am a woman and an aerospace engineer; my rational mind is precisely what I am living by, and I would be doing a disservice to my current and future employers if I tried to survive by anything else (just try to build a launch vehicle using emotion!) I realize this was a pretty peripheral point in the debate, but it was not one I could allow myself to pass by.

    As for health care Brian, you’re absolutely right; somebody mentioned Rand here (another woman who was a strong advocate of the rational mind), and your points line up pretty exactly with hers. It was something I struggled with for a long time, precisely BECAUSE there are people who have really done their best, and have fallen through the cracks through no fault of their own. But you are right: injustice cannot be corrected by injustice, and misfortune does not entitle you to commit theft. I have nothing against the idea of helping these people through voluntary charity, but it does have to be voluntary.


  21. doris |

    Sorry, Brianna, I was joking.


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