Post No. 188a: A Country Has to Know Its Limitations

In one of our earliest posts back in 2008, we examined some of the issues which might potentially arise should the federal government become further involved in the healthcare of its citizens. Since then, The Patient Protection and Affordable Care Act was passed. Now that it is scheduled to take effect, it is back in the news for a variety of reasons. Although some of the original proposals in 2008 did not make their way into the legislation, we thought it worthwhile to revisit some of the points we made at that time.


© 2008 and 2013, the Institute for Applied Common Sense

On November 30, 2008, shortly after Sen. Obama’s election, we asked our readers whether any governmental entity should have the responsibility to provide healthcare for its citizens.

We invited our readers to provide their views on the subject, prior to our putting forth an argument as to why no government entity should have that responsibility, except perhaps in the case of veterans, or those injured during the course of service for the nation. (Since that time, we have also considered the inclusion of children below a certain age, since they have very little role in making decisions about their health until they are much closer to adulthood.)

It led to a very lively and stimulating exchange. Even a cursory examination of the comments in connection with Post No. 68d reveals the diversity and passion of opinion regarding this subject.

Is it really the government's responsibility to ensure the good health of, and the provision of health care facilities and treatment to, its citizens? Why do so many citizens feel that it is something which the government, at some level, should provide? Is there a reasonable expectation on the part of the taxpayers that health care is a "service" due them by virtue of their current level of tax contribution?

What responsibility should be placed on the citizens themselves to make the "best efforts" to maintain their health, and utilize the very latest in scientific knowledge about health risks, particularly nutrition, and the detrimental consequences associated with certain behaviors? Should citizens be required to show that they engaged, or failed to engage, in certain behaviors, prior to being extended heath care benefits by the government?

We indicated that we would generate some thoughts after entertaining those of others. Here are five arguments which can be advanced to support the notion that we should not have a national healthcare system, or perhaps that America is not yet ready to have such a system.

1. All relationships are about expectations. An argument can be made that the American public has an unreasonable expectation about what it takes to manage and operate a large organization and its accompanying bureaucracy. Most interestingly, those who have never run a large organization seem to think that they have all the answers. The criticism of the various executives, associated with the Big Three American Automakers, suggests to us that we as a nation do not fully comprehend the complexities and difficulties associated with management of a large organization in an everchanging, global environment. We are apparently “qualified” to criticize others who do not achieve the results that we expect.

2. In contemplating a national healthcare system, it appears that most proponents suggest that it provide benefits to all of our nation’s citizens, namely 300 million people. We do not have the capability to manage anything involving 300 million people. We don’t do it with respect to the other “essentials” of civilized life, food, housing, clothing, or education, which are arguably more simplistic in nature, and which at least have components around which we can wrap our arms. What makes us think that we can do it with respect to arguably the most complex of issues, namely human health? To borrow a phrase from Dirty Harry, “A country has to know its limitations.”

3. We do not have anyone, or any board or committee for that matter, with the capabilities, sophistication, and experience to manage a 300 million recipient organization. Furthermore, as noted earlier, as an organization grows in size, its sense of “reality” changes to ensure the advancement of its interests and its continued survival. We’re setting ourselves up for failure and unnecessary criticism.

4. Any system delivering services to 300 million people will undoubtedly parcel out its services in unfair and inequitable ways during the course of the execution of its policies. It’s not like an engine with simple, mechanical, moving parts. Humans do not function in accordance with the rules of physics. They’re emotional, and they have minds of their own. No one has yet discovered how to manage emotion. At least in the military, they understand what needs to be done to craft humans into fungible, interchangeable units, for management purposes, and even they have difficulties.

5. What makes us think that we can devise a system to provide benefits or services to recipients who essentially do whatever they want or desire to do, from a health perspective, and then have an expectation that the system should address the negative ramifications flowing therefrom? It doesn’t make sense. What makes us believe that we can “herd cats,” each with their own goals, motivations, and selfish interests, and deliver some nebulous, unspecified level of service resulting in what we refer to as “good health?” As a general proposition, Americans are not “sufficiently motivated” to maintain a state of good health. We don’t want it badly enough. The only proven way to get humans to adhere to a policy or approach is to force/ prod them, or have them buy into it voluntarily.

Although some ambitious and very thoughtful suggestions were put forth in your comments, no one, who responded to our challenge about reforming the health care system, really explained how they planned to address the uncertainties and complexities associated with the human side of the equation, and each individual’s responsibility to the system.

As a practical matter, it can’t be done in America, at least not under our current political philosophy. Any attempt in that regard will be regarded as socialist, or even worse, communist, in nature. As we all saw during the most recent election, we can’t have that.

This is a country built on social Darwinism or survival of the fittest. If you happen to be one of the fittest and you survive, kudos to you. If you are one of the not so fit, we leave it you to fend on your own, perhaps with the gratuitous assistance of non-profits, the religious community, and the kindness of others. Many in our country feel that if we assist the not so fit, or guarantee certain things to the masses, we play into their weaknesses and thus become enabling agents.

This is neither a culture nor governance model which has as its goal the equal treatment of its citizens or the equality of the services or opportunities available to them. It is a culture that simply guarantees that each individual citizen has a chance to pursue whatever they might so desire. That has nothing to do with results.

We don’t guarantee results in America.

Simply put, a national healthcare system does not fit within our governance model, nor does it fit within our cultural philosophy. This is not to suggest that it should not, just that it does not. It’s just that it would require a significant paradigm shift in our way of thinking about our role as citizens.

Don’t you think?

© 2008 and 2013, the Institute for Applied Common Sense