Sunday, June 16, 2019

ACS surgery thread reply

ACS Surgery Discussion Forum regarding recent AMA statement on health care as a human right.  The objectivism trolls had hijacked the thread.  This was my poorly received response:

Dear Dr X(and those of similar vein)-

I must respond to your impassioned excoriation of the idea that healthcare is a "human right" (scare quotes rendered as a show of respect to you) in the name of the dignity of surgeon labor.

Your initial salvo is an interesting mashup/admixture of both the Declaration of Independence (We hold these truths to be self-evident, that all men are created equal, that they are endowed by their Creator with certain unalienable Rights, that among these are Life, Liberty and the pursuit of Happiness) with the US Constitution (i.e. 5th and 14th Amendments prohibiting deprivation of property without due process).  Your inclusion of "property" (my scare quotes, my turn) is interesting, to say the least. Similar arguments were made in the infamous Lochner vs New York case of 1905 that upheld the "right" of a bakery to violate employment laws that limited the number of hours a baker could work in a week, under the auspices of honoring the sacredness of the contract.  Similar arguments were made, most infamously, and perhaps more familiarly, in the Dred Scott decision of 1857, using the same due process, right to property arguments. Dred Scott was merely the "possession" of John Emerson (an army surgeon, imagine that!) and therefore had no recourse to the noble, high fidelity rhetoric contained within the holy writ of the US constitution.  John C Calhoun made similar arguments during the nullification debates decades earlier.

But let's not spend too much time nosing around in Supreme Court history.  Your argument mounts an army of straw men to fight a battle you will never see.  No one is dragging Dr X out of bed at 7 am to operate all day long on an endless list of self pay patients.  No one is mandating uncompensated labor. This has never happened in your life. And if it has (bad call draw, bad weekend ER luck) then universal healthcare would have made such future events impossible.  Which begs the question: what is it you are going on about again? What is your point? Universal health care would guarantee that you are compensated for every operation you do. Do you just not like the idea of people getting "free care"?  Do you turn away Medicare patients? Did you know that most people on Medicaid work? Your diatribe about free care and uncompensated physician labor only seems applicable to the current status quo, i.e when self pay patients show up with appendicitis.   A world of universal health care would obviate the existential pain you seem to be suffering from regarding the dignity of physician labor. Your gnawing angst about a future world of…...too many patients being covered by insurance seems to be..….at odds with what you originally purport to fear. As someone said earlier in this thread, 50% of healthcare is provided by that horrible, totalitarian "government" you demonize.  Ask recipients of medicare, of VA benefits, of Tricare how they feel about the care they receive. You may receive a higher reimbursement from private insurance but that's only after the population at large has had their paychecks and wallets picked over by marauding bands of parasitical insurance companies and third party administrators.

Yuval Harari has a fascinating new book out called Sapiens, a historical review of our human species.  One of his themes is this idea of there being "imaginary orders" that humans collectively agree upon. Think of all organized religion, the divine mandate of kings, feudalism, master/slave relationships, race hierarchies, and then, post Enlightenment, the idea of individual human rights and government of the people and by the people.  None of these ideas has any basis in empirical or mathematical reality. They are all necessary figments of the human imagination that we have at one time or another collectively internalized as truth. Thus, there is order and structure to our lives at certain points in history. The ideas derive their power not from some transcendent unassailable Truth but simply from the collective societal decision to assent to their tenets.

The point of this little digression is to say that imaginary orders, in general, are somewhat arbitrary and can be altered as time passes and circumstances of human existence change.  Human rights in the era of authoritarian monarchy, nascent democracy, and mercantilist empire were thought to include, at the very least, a guarantee toward life, liberty and the pursuit of happiness.  But that doesn't mean Thomas Jefferson stumbled upon some sort of special theory of relativity of political philosophy. In the context of his time, his writings rang true (and still do for the most part).  But that doesn't mean he had the ability to foresee the eternal unfolding of human history. Further, we do ourselves no favors by limiting our views on human rights to those of an 18th century American slave owner.  I have a more expansionary perspective on what ought to be deemed necessary and proper to all living souls. Human rights is a living, evolutionary concept.

In the context of a  21st century America, an America that is unquestionably the wealthiest, most powerful nation in the history of nation states, a nation that spends more on its military exploits every year than the next 10 countries combined,  where millions of men and women avoid basic health care due to high deductible private plans or go uninsured entirely, where medical bills represent the number one etiology of personal bankruptcy, where life expectancy has fallen vs the rest of the world, where the USA alone among advanced democracies remains the one nation that does not guarantee universal health care, in this particular context, I aver that health care belongs in the pantheon of human rights.

This is my imaginary order.  For what is liberty if you are afraid to take a new job or start a new business for fear of losing your employer based health care plan?  What is the pursuit of happiness without having the right to obtain the medicine and care needed to mitigate illness and pain? What is the right to life without having the ability to afford the necessary measures to amplify, maintain and heal the body in which you reside?

Too much of this thread is dominated by a juvenile Ayn Randian rhetoric that treats the modern world of resources in purely zero sum terms.  As if provision of food necessitates breaking into Dr Leonard's pantry in the middle of the night or armed bandits raiding the neighborhood grocery store.  (How about simply paying the populace----in the era of 3% unemployment--- a living wage so they can afford to buy their own groceries.) As if doctors are remanded by state police and forced to perform procedures on the unworthy, the lazy, unentitled. (How about instead legislating universal care, whether in the form of single payer or one of the hybrid systems used by Germany, France et al) This world of abundance and wealth is both a blessing and a curse.  Our lives are enriched and made comfortable by its spoils but it is also the dark mirror that reflects our basest, most selfish instincts.

I would urge many of you to break out of your cloistered intellectual dead ends.  Put down the Atlas Shrugged. Read about alternative solutions. Expand your minds.  Your hearts will follow.

No comments: