It is an interesting article but if one were to try to draw an analogy between it and the current health care financing debate, and in particular if one attempts to draw and an analogy between it and the Obama administration's attempts to orchestrate a change in the US medical care financing, it would be a false one.
The implication that rationing might be applied in the future, under an Obama heath plan, and is not applied now, without it, is the problem with the analogy. The implication that the Hypocratic oath is not routinely violated *now* in the medical community for profit, and that, if we are not careful under an Obama plan it *might* be, is the problem with the analogy. You see, right now we are seeing a kind of game theoretical, "milking" of the medical consumer and a failure of the ethics upon which the oath is based. We are paying too much *now* for the care we receive and the effect on the distribution of care has serious detrimental consequences relative to the purpose of the system and what's worse, reduces the effectiveness of medical intervention itself. People have even died from it. To be fair, we must not characterize the medical community completely as totally profit oriented. In fact, I believe that many, and even most, doctors' commitment to the Hypocratic oath is more than superficial. But they are often put into untenable positions in the game theoretical world of modern economics. And, again to be fair, we must realize that they (the medical community in aggregate including its managers) have failed to supply the US with modern medical care value in accordance with demonstrated international standards with respect to the developed world. Our medical care, when looked at from a value point of view, is simply substandard. We have to be honest with each other. The world is watching. It is that way because of the success of the economic power elite's use of an ideologically motivated and very destructive conservative political movement, which promolgated an irrational belief in market mechanism as the *only* answer, and fostered an irrational fear of regulation. They used this political movement, fostered it and invested in it, in order to remove constraints on their power. They have attacked the press, the legal system, government regulation, and even education. Why? Because they attack any check on their unbridled power. This has produced unintended consequences and has had disastrous consequences for American competitiveness in a host of areas (not the least of which is manufacturing, and as we have seen corporate financing), but also in medical care and may soon even extend to education if the conservatives ideologues end up having their way. In the end, like the famed hindu proverb, the scorpian stings the frog and may also die from it unless we can save them. Business is coming around to the democratic view because they know that their game is at stake. The mechanism of the destructive effect is to deligititimize strict ethical standards in favor of a wink and the nod that acknowledges "the way the game is played" - a kind of Machevelian or Kissingerian realpolitic mapped onto business ethics and a kind of hail Mary hope that the "market mechanism" will result in the "right things done for the wrong reason". Those left trying to hold the line have a choice between ethical behavior and economic suicide or "bending the rules" and surviving economically. You saw it in finance, you see it in manufacturing, and it is the same in health care. This program has failed and is destroying the United States in many areas - one of them being health care. Ultimately behind all of these is the ethical crisis that Obama has described and that is being currently modeled in modern economic theory. If you look at the current meltdown in the financial system and the problems with totally privatized medical care the parallels are stunning. Check out a recent article in the July-August Harvard Business Review titled "The End of Rational Economics" (It is not even about medical care) It says in part: "We are now paying a terrible price for our unblinking faith in the power of the invisible hand. We're painfully blinking awake to the falsity of standard economic theory - that human beings are capable of always making rational decisions and that markets and institutions in the aggregate are healthy self regulating. If assumptions about the way things are supposed to work have failed us in the hyper-rational world of Wall Street what damage have they done in other institutions and organizations that are also made up of fallible less-than logical people." The "invisible hand" refers to market forces. Remember, this is the Harvard Business Review, not some socialist diatribe. Another quote from the article: "A few years ago, my colleagues and I found that most individuals, operating on their own and given the opportunity, will cheat - but just a little bit, all the while indulging in rationalization that allow them to live with themselves." >From another article in the same issue: "Government's role in business is still emerging, but it's clear that companies worldwide can no longer operate independent of regulatory concerns." And from still another: "As the United States strives to recover form the current economic crisis, its going to discover an unpleasant fact: The competitiveness problem of the 1980s and the early 1990s didn't really go away. It was hidden during the bubble years behind a mirage of prosperity and all the while the country's industrial base continued to erode. Now, the U.S. will finally have to take the problem seriously. Rebuilding its wealth-generating machine - that is, restoring the ability of enterprises to develop and manufacture high-technology products in America - is the only way the country can hope to pay down its enormous deficits and maintain, let alone raise, its citizens' standard of living." All of these problems are interlinked and one cannot be solved without the other. We need a reworking of our understanding of the "commons". Bill Moyers had it right in the end: "I'm going out telling the story that I think is the biggest story of our time: how the right-wing media has become a partisan propaganda arm of the Republican National Committee. We have an ideological press that's interested in the election of Republicans, and a mainstream press that's interested in the bottom line. Therefore, we don't have a vigilant, independent press whose interest is the American people." http://en.wikipedia.org/wiki/Bill_Moyers. In order to regain our competitiveness, one thing among many we need is government intervention in the medical system. We need it and we need to get moving on it. In general, we need to rebuild the American commons. Don't take my word for it - read the Harvard Business Reveiw: "Governments are often uniquely positioned to mobilize and coordinate the efforts of the numerous organizations needed to confront these huge challenges." What is being advocated is not Socialism. That is just another example of the Republican ideologues setting fire to the "commons". No one is advocating socialism. What is being advocated is intervention in the market mechanism with regulation and where necessary the challenging of the assumption that business, if it diverges from public interest, will remain unmolested by government. Make a game without rules and referees and you get just that. What is being advocated, in fact - instead of the lies - is a cooperative relationship between government and business with a real - and an improved *ethical* standard being put in place to underpin the alliance. Contrary to the implication in the article, it is the Obama agenda that is trying to *restore* the functioning of the Hypocratic oath and ethics in general and deliver, with all its complexity, modern medical care service in a way that is characterized by excellence. It is in fact, a whiff of brilliance the likes of which we rarely see in America. From the looks of the lunatics on TV worried about Obama "indoctrinating" their children (I mean it is ridiculous) the plan is at risk and in fact may go down. The real effect, if the goals of the opponents to this agenda are totally realized, will be a return to the mask of unbridled individualism behind which lies the corporate profit behemoth unfettered and unembarrassed and frankly, just playing by the rules that our abdication has left them with. In fact, the problem is our irrational behavior and we must act rationally now in our own interests. Eliminating the threat of government control is like removing the major competitor from the arena. Modern economics, which is founded in part on game theory, and has transcended the simple models that are rampant in ideological approaches, have concluded the the real economic picture is much more complicated and that a smart and changing mix of government intervention and market mechanisms are needed. We must not let our government representatives abandon the field. A transparent, government supervised, financing option for medical care can be a *very* effective check and signal the end of "business as usual" and in fact the competitive force that it can bring will be staggering. The likely effect, if it is carried out carefully, is the reemergence of successful managerial decisions in the private sector (as the rules will have changed: Why foul if your are going to get penalized?) and, due to the efficiencies of market driven organizations, the eventual victory of those organization over their government counterparts with the eventual elimination of the need, in fact, for a "government option". What is needed is not only successful regulation. What is needed in addition is the political awareness of the liberal component of American polity that, as in foreign policy, if we retire from the field, disaster for all will surely follow for all. To paraphrase the saying in the old days: "We must all hang together, because if we don't we shall surely hang separately" On Sep 4, 2:38 am, Don Johnson <[email protected]> wrote: > This is a very interesting article. I'm not suggesting we'll end up > with something like this but it certainly makes for chilling reading. > One major problem with current doctors(according to Dr. Emanuel) is > the Hippocratic Oath. It's all very coldly logical and would be very > effective in reducing costs I believe. If I got to keep the > sweetheart health care our law makers get I'd probably vote for it > myself. > > http://online.wsj.com/article/SB1000142405297020370660457437446328009... > > How 'bout you? > > dj --~--~---------~--~----~------------~-------~--~----~ You received this message because you are subscribed to the Google Groups ""Minds Eye"" group. 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