The triage of money - the cost of free
American Democrats, Canadian liberals and socialists all over the world like to get righteously indignant when conservatives of any stripe use the expression “Death panels.” Yet, in Canada today there is a case in front of the Supreme Court about just that. They will decide who can decide over matters of life and death. Relatives, doctors or ‘independent’ (i.e.: government) organizations such as the “Consent and Capacity Board” of Ontario. All you leftists please note, that this is NOT a death panel. This is absolutely clear from the fact that it is not called that way. What the Supreme Court will have to make a decision about is whether the doctors or the CCB can have the power to overrule the wishes of the patient or their representatives.
You can read The Globe’s take on the case and the CBC’s, but the essence is this:
Hassan Rasouli, a devout Shia immigrant from Iran “has been on a ventilator and feeding tube for the past two years at Sunnybrook Hospital in Toronto, after bacterial meningitis destroyed parts of his brain following surgery for a brain tumour.”
The doctors say his case is hopeless; the family has faith in his ability to recover. They clearly do not have enough faith to believe that he can recover without the very expensive hospital care but they do have faith in the courts to decide that the Canadian taxpayers should pay for it indefinitely. It is not clear how much faith these devout Muslims have in their own God, but since Allah did not yet express his wishes and intentions, for now the case is in human courts.
The CBC coverage of the issue has a very interesting tweet-stream from the courtroom that was obviously turned into a forum for political interest groups to champion their pet causes. The comments are also instructive.
The world of decisions - a system of triage
The case is about decisions, or to be precise, a decision about who can make decisions. In the real world, lots of decisions have to be made. Hospitals have to be built, the cleaning lady’s salary must be set, cleaning supplies are to be bought, nurses must be paid, operating times need to be allocated. Hospitals have to decide which doctors to hire, the ministry (the system) have to decide how much to pay them, regulators of the system have to decide what to cover. All of these decisions come with a price tag. NOTHING IS FREE, except, maybe the time of volunteers here and there.
In theory we can say that these decisions can be debated, in practice we cannot. That is the nature of delegation. We cannot have a referendum on every case, every procedure and every medicine, every particular minute of waiting time, or any individual life for that matter. The only thing that can be debated is the role of the decision makers. I really do not like anything run by the government, but we have to understand that any decision affecting the system has far reaching consequences. We have ‘X’dollars in our budget for health care. If we put the money ‘here’, we may not have enough to put ‘there’. The money can be allocated in many ways. We have long waiting times in emergency rooms, waiting lists for some procedures, we have considerations about the optimal frequency for some screening tests and about the scope of services to be included in the list of ‘free’ services. Dental care is out, sex change operations are in. Breast enhancement is out, but labiaplasty is in, provided that the procedure is performed by a gynecologist who is convinced that it is necessary. The point I am trying to make is NOT that the decisions are arbitrary, but that they have consequences. Two million dollars spent on a hopelessly comatose patient may be spent better somewhere else. It may reduce waiting times for other procedures. It may save the life of someone who would otherwise die waiting for an operation. If it was your money, nobody could or should question how it is spent, but the money is not yours. Once we agreed to give up the right to be responsible for our own decisions, we have to accept whatever decision our surrogate decision makers make. If we do not want to make hard decisions about our own lives, our delegates must.
The only problems with decisions are trade-offs and consequences. Those who like to shy away from decisions do so because they do not want the trade-offs or do not want to face the consequences, because they are afraid of making bad decisions. Isn’t it wonderful when someone promises to free us from this burden? Isn’t it lucky to have politicians doing exactly that? They take our money, and make all the decisions for us. In the case of Canadian Health care, just to be sure, they even forbid us to make decisions for ourselves.
Once they have our money and the responsibility to make decisions, they do make decisions, and the real cost to us is not the money we pay through our taxes but the very freedom to make the decisions ourselves.
The cost of free is freedom
In the article, a doctor says: “Right now [health care professionals are being] constrained to being only informants and not decision-makers. The pendulum has swung to the family making demands that at many, many levels are unrealistic or illogical or even futile,”
The good doctors clearly wish to have more power. They would like to have the power to make rational decisions in a system of unlimited demands over limited resources. If we had a free market health care system, this wouldn’t be an issue. They would be happy to offer the services as long as you (or your insurance company) would be willing to pay for it. Your demand for their services would not be a drain on their resources but an incentive to provide the service. In a free market, you would be the customer.
Someone commented on the Instragram controversy about all the ‘free’ stuff on the internet saying that “if you’re not paying for it, you’re the product.” This is what the system is about. This is what ANY government service is about. If you are not paying for it, you are the product. You only exist in the system so that profit can be extracted from the real customer – the one who pays – the government. The fact that the money ultimately comes from you does not matter. The existence of the intermediary makes it irrelevant. The customer of the state financed services is the state itself and the most important ‘good’ they are buying is the loyalty of the service providers. How much they are producing (health care, education, whatever) does not depend on the needs of the product (you) but on the will of the ruling class and the political power of those who can influence it. I tried to illustrate this fact with my very first post, the story of my broken clavicle. I FELT like a product in the machinery of government services.
Unfortunately, this is the system the majority of us wanted. A majority that will keep asking for other people’s money until it runs out and we all end up in misery. How can we tell to this majority “YOU ASKED FOR THIS, now LIVE WITH IT!” How can we tell them that “If you want to live like sheep, you should be prepared for the slaughter!”
We spent a few centuries to build a world where we can have control over our lives just to slowly give it up now out of sheer laziness and cowardliness.
The real problem for me is not the sheep, the suicidal stupidity of the political left but their usurpation of power, their ability to drag the rest of us down with them.
The real problem with this case is that it does not matter what the outcome is, either way will just take us one step closer to the abyss. Either we will hand over even more power over our lives to the system, or we push it one step closer to bankruptcy and politically motivated irrational decisions with increased level of overall rationing of services. There is no good outcome possible.
The questions
….I didn’t see anybody asking. I am not trying to be flippant, regardless of the way the questions are asked, they should be subject to some serious discussions.
“Speaking with reporters, Rasouli's wife, Parichehr Salasel, said she was a physician who had practised for 30 years in Iran, where she had never seen a doctor who told a patient there is no hope.” If the Iranian system is so clearly superior to ours, why exactly did they come here? It was pointed out in the court that they are devout Muslims. Could it be that we are witnessing Health-care Jihad? That this whole case is an act of self-sacrifice through which they are trying to nudge our system on the way to become as amazing as the Iranian one?
If she practiced medicine in Iran for 30 years, they must be recent immigrants. One must wonder, how much did they actually pay into the system from which they now expect unlimited resources?
When our good friends in the Iranian media (the ones interviewing our natives about our concentration camps) are reporting on the case, what will the headline be? ‘Canada spent millions on keeping brain-dead Iranian expatriate alive on life support’ or ‘Jewish doctors want to kill devout Muslim in Ontario hospital’?
……just wondering……………..