Government is the problem

Kevin Murphy, one of Patterico’s “jurors,” has just put into a few paragraphs a big part of the problem some people — including me — have with the various federal health care reform plans:

Government is DIFFERENT

Filed under: Uncategorized — Kevin Murphy @ 11:24 am

Throughout the healthcare debate (and over the years on other issues) we hear the refrain “but we’re just replacing an industry bureaucrat with a government bureaucrat”.  This is true except that it isn’t really truth.

Government is DIFFERENT.

If I owe a billion dollars to General Motors or AIG or Bill Gates himself, they cannot (legally) send some armed men to my house in the middle of the night and drag me away to some dungeon and hold me until I settle up. 

Government can and often does just this, sometimes for very trivial reasons (parking tickets, overdue library books, etc). Government is force.   It has a monopoly on force.  While there are some very good reasons for that monopoly, everything that government does has behind it at least the implied threat of men with guns.  Try not paying income tax and you’ll see what I mean.

So, a government bureaucrat is much different than an industry bureaucrat.   More different still if there is no private alternative.  Consider the local school system without private schools.  Or package delivery with only the post office.  Or transportation with only city buses.  Or medicine with only government doctors.

Which is what the people who talk about “just replacing one bureaucrat for another” really want. 

Medicine at the point of a gun.

As you go through the various proposals, what you find is that all of them say that the current private insurance network will be retained, even strengthened. That’s just a sop to get government-mandated health care control passed; at least a few of the more honest Democrats — or those who forgot that the cameras were rolling — have admitted as much. The New York Times tells us that the “death panels” story was just a false rumor:

False ‘Death Panel’ Rumor Has Some Familiar Roots


WASHINGTON — The stubborn yet false rumor that President Obama’s health care proposals would create government-sponsored “death panels” to decide which patients were worthy of living seemed to arise from nowhere in recent weeks.

Advanced even this week by Republican stalwarts including the party’s last vice-presidential nominee, Sarah Palin, and Charles E. Grassley, the veteran Iowa senator, the nature of the assertion nonetheless seemed reminiscent of the modern-day viral Internet campaigns that dogged Mr. Obama last year, falsely calling him a Muslim and questioning his nationality.

But the rumor — which has come up at Congressional town-hall-style meetings this week in spite of an avalanche of reports laying out why it was false — was not born of anonymous e-mailers, partisan bloggers or stealthy cyberconspiracy theorists. Rather, it has a far more mainstream provenance, openly emanating months ago from many of the same pundits and conservative media outlets that were central in defeating President Bill Clinton’s health care proposals 16 years ago, including the editorial board of The Washington Times, the American Spectator magazine and Betsy McCaughey, whose 1994 health care critique made her a star of the conservative movement (and ultimately, New York’s lieutenant governor).

There is nothing in any of the legislative proposals that would call for the creation of death panels or any other governmental body that would cut off care for the critically ill as a cost-cutting measure.

But over the course of the past few months, early, stated fears from anti-abortion conservatives that Mr. Obama would pursue a pro-abortion, pro-euthanasia agenda, combined with twisted accounts of actual legislative proposals that would provide financing for optional consultations with doctors about hospice care and other “end of life” services, fed the rumor to the point where it overcame the debate.

On Thursday, Mr. Grassley said in a statement that he and others in the small group of senators that was trying to negotiate a health care plan had dropped any “end of life” proposals from consideration.

A pending House bill has language authorizing Medicare to finance beneficiaries’ consultations with professionals on whether to authorize aggressive and potentially life-saving interventions later in life.

Though the consultations would be voluntary, and a similar provision passed in Congress last year without such a furor, Mr. Grassley said it was being dropped in the Senate “because of the way they could be misinterpreted and implemented incorrectly.”

Yet, there it was, on the front page of today’s Philadelphia Inquirer:

Panel scraps end-of-life provision

Talk about “death panels” had been widely dismissed, but it remained a lightning rod in the health debate. By Christi Parsons and Andrew Zajac, Chicago Tribune

WASHINGTON – A Senate panel has decided to scrap the part of its health-care bill that has given rise to fears of government “death panels” in recent days, with one lawmaker suggesting that the proposal was just confusing. The Senate Finance Committee is taking the idea of “end-of-life care consultations” with doctors off the table as it works to craft its version of health-care legislation, a Democratic committee aide said yesterday.

Sen. Charles E. Grassley of Iowa, the ranking Republican on the committee, said the panel dropped the idea because it could be “misinterpreted or implemented incorrectly.”

For Democrats, the decision was an apparent acknowledgment that the provision had become a lightning rod for critics of their proposed overhaul of the health-care system. Democratic lawmakers and President Obama are trying to extend health insurance to more Americans, rein in costs, and make other changes.

So, something that didn’t exist in the first place was removed, huh? Tell me how that makes sense! Well, it’s pretty easy to see how they existed. The language of the proposal never called for panels to urge people to forsake end-of-life care which would cost a lot of money just to keep people alive a few more months; not even Peter Singer would be dumb enough to write that into the proposed legislation. But §1233 was in there, and even though its actual provisions could be innocuous enough, people were more worried about what they could become, as opposed to what they actually were. Donald Douglas wrote


There’s also a second strand of debate on “end-of-life” counseling, which is sounds less dramatic than “euthanasia,” but in some respects comes pretty close to it. Charles Lane addresses the issue in his piece, “Undue Influence: The House Bill Skews End-of-Life Counsel.” Looking at the House bill, Lane argues:

Section 1233 … addresses compassionate goals in disconcerting proximity to fiscal ones. Supporters protest that they’re just trying to facilitate choice — even if patients opt for expensive life-prolonging care. I think they protest too much: If it’s all about obviating suffering, emotional or physical, what’s it doing in a measure to “bend the curve” on health-care costs?

Though not mandatory, as some on the right have claimed, the consultations envisioned in Section 1233 aren’t quite “purely voluntary,” as Rep. Sander M. Levin (D-Mich.) asserts. To me, “purely voluntary” means “not unless the patient requests one.” Section 1233, however, lets doctors initiate the chat and gives them an incentive — money — to do so. Indeed, that’s an incentive to insist.

Patients may refuse without penalty, but many will bow to white-coated authority. Once they’re in the meeting, the bill does permit “formulation” of a plug-pulling order right then and there. So when Rep. Earl Blumenauer (D-Ore.) denies that Section 1233 would “place senior citizens in situations where they feel pressured to sign end-of-life directives that they would not otherwise sign,” I don’t think he’s being realistic.

What’s more, Section 1233 dictates, at some length, the content of the consultation. The doctor “shall” discuss “advanced care planning, including key questions and considerations, important steps, and suggested people to talk to”; “an explanation of . . . living wills and durable powers of attorney, and their uses” (even though these are legal, not medical, instruments); and “a list of national and State-specific resources to assist consumers and their families.” The doctor “shall” explain that Medicare pays for hospice care (hint, hint).

Top administration officials have been developing a policy known as “The Complete Lives System.” The model provides the theoretical basis for President Obama’s plan for the rationaliztion of elderly care.

There is a lot in Section 1233 (beginning on page 424 of HR 3200), which I assume will now be deleted, which raised concerns. Look at the language, and ask yourself a question: is this designed to inform elderly patients what services are available, or is the purpose to tell them that at some point they would be too great a drain on government resources?

‘‘(D) The provision by the practitioner of a list of national and State-specific resources to assist consumers and their families with advance care planning, including the national toll-free hotline, the advance care planning clearinghouses, and State legal service organizations (including those funded through the Older Americans Act of 1965).

To me, this gobbledygook could be read either way. But a whole lot of people don’t trust the government to use it in a benign way. We have too much of a practical example right in front of us. While the federal government is borrowing money like crazy, most state governments are restricted by balanced budget requirements, and most of them are having to cut services in response to decreased tax revenues. The public can see what the states must do in the face of limited dollars; why would the public believe that a concern for limited funds would never impact the kind of care they would receive? The fact that in the Netherlands, Europe’s usual frontrunner in liberal social legislation, the law allowing voluntary euthanasia for terminally ill, elderly patients has been frequently applied to allow doctors to take such decisions, and led to thousands of involuntary euthanasia deaths has not gone unnoticed. Let me be blunt here: to the people providing the funding for medical care, it is in their financial interest that a patient die sooner rather than later, and stop being a drain on financial resources. As Mr Murphy noted at the beginning, government power is force. I don’t know if there are any studies on this, but it would not surprise me if Americans were uniquely distrustful of government among people living in free nations. What I find surprising is that so many of our friends on the left, people continually yelling “Bush lied, people died,” would place so much trust in the government looking out for the interest of individuals just because we have a different president; no matter how much they may like and trust Barack Obama, he leaves office on 20 January 2017 in the worst case scenario (20 January 2013 in the best case.) There will eventually be another president our friends on the left don’t like or trust. As for me, whether liberal or conservative, I trust no politician with putting the welfare of the individual above the cost to the government.


  1. Read the next cencus form and see the penalties for false reporting, or not reporting at all. I’ve seen anumber of things that look “voluntary”, but read the fine print and they are not so voluntary.

  2. If I owe a billion dollars to General Motors or AIG or Bill Gates himself, they cannot (legally) send some armed men to my house in the middle of the night and drag me away to some dungeon and hold me until I settle up.

    No, but they can refuse to serve you.

    You then make this comment: “Let me be blunt here: to the people providing the funding for medical care, it is in their financial interest that a patient die sooner rather than later, and stop being a drain on financial resources.

    That applies just as much to insurance companies as to the government. Indeed, MORE SO – the government is not driven by the need to make a profit. Which brings us to the interesting point – if, on a cost efficiency basis, it is better to deny a client the recompense to which they are due, and fight it out in court against a sick and bankrupt claiment, possibly offering a smaller settlement – wouldn’t a for-profit company do this?

    Why exactly do you think a for-profit company would obey the law and fufill their contracts when it is cheaper not to?

  3. Because, in the United States, you can sue a private company, but the federal government has sovereign immunity.

    Immunity of the United States From Suit.—Pursuant to the general rule that a sovereign cannot be sued in its own courts, it follows that the judicial power does not extend to suits against the United States unless Congress by general or special enactment consents to suits against the Government. This rule first emanated in embryo form in an obiter dictum by Chief Justice Jay in Chisholm v. Georgia, where he indicated that a suit would not lie against the United States because “there is no power which the courts can call to their aid.” In Cohens v. Virginia, also by way of dictum, Chief Justice Marshal asserted, “the universally received opinion is that no suit can be commenced or prosecuted against the United States.” The issue was more directly in question in United States v. Clarke,where Chief Justice Marshall stated that as the United States is “not suable of common right, the party who institutes such suit must bring his case within the authority of some act of Congress, or the court cannot exercise jurisdiction over it.” He thereupon ruled that the act of May 26, 1830, for the final settlement of land claims in Florida condoned the suit. The doctrine of the exemption of the United States from suit was repeated in various subsequent cases, without discussion or examination. Indeed, it was not until United States v. Lee that the Court examined the rule and the reasons for it, and limited its application accordingly.

    Since suits against the United States can be maintained only by permission, it follows that they can be brought only in the manner prescribed by Congress and subject to the restrictions imposed. Only Congress can take the necessary steps to waive the immunity of the United States from liability for claims, and hence officers of the United States are powerless by their actions either to waive such immunity or to confer jurisdiction on a federal court. Even when authorized, suits can be brought only in designated courts. These rules apply equally to suits by States against the United States. Although an officer acting as a public instrumentality is liable for his own torts, Congress may grant or withhold immunity from suit on behalf of government corporations.

    The Phoenician asked:

    Why exactly do you think a for-profit company would obey the law and fufill their contracts when it is cheaper not to?

    Tort actions exist precisely to make it more expensive to disobey the law or fail to honor a co0ntract. That’s why corporations in general do try to remain within the law.

  4. One of the problems with our tort system is that it is often cheaper to settle a highly-questionable claim out of court than to fight it out and win.

    With so many third-rate lawyers in public office, there is little hope for effective tort reform.

  5. Why exactly do you think a for-profit company would obey the law and fufill their contracts when it is cheaper not to?

    Dana gave one reason, but another is companies are concerned about keeping their reputations. A company that gets a reputation for screwing its customers isn’t going to stay in business very long.

    Look at car insurance. Why should they pay? Same reason. Cheapo car insurance companies tend not to last, because people find out they’re unreliable when it’s time to pay a claim, while the good ones pay in full. I’ve never had a problem with either car or health insurance paying what they were contractually liable for.

    I know you’re somewhat of a cynic, Pho, but in my experience, most businesses are honest because that’s the only way they stay in business long term.

  6. That applies just as much to insurance companies as to the government. Indeed, MORE SO – the government is not driven by the need to make a profit.

    This isn’t really true. It is in the insurance company’s best interest to keep you alive and paying premiums as long as possible. This is why they may pay for some inexpensive procedures and deny claims on the expensive one.

    Once you get to be in your 50s, the government is really playing a roulette game with you regarding Social Security and Medicare, because, by that point, you’ve paid the most in and haven’t received a dime’s worth of benefit from it. If you die at that point, that makes it easier for them. Just ask my dearly departed mother, who died at 58.

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