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Why America Hates Universal Health Care: The Real Reason

March 20th, 2010 - 10:02 am

[I originally published this essay in December of last year, before I started blogging for PJM. I was planning to write a new last-minute plea for sanity as we approach the zero hour for the health care vote in Congress -- but I inevitably ended up just re-phrasing the ideas contained in my original essay. So rather than repeat myself, I present below a reprise of what many have said is the one and only essay you'll ever need to read about universal health care.]


I watch the debate over health care with amazement. A million words are spoken on the topic with every passing minute, and as far as I can tell no one has ever addressed the real issue that’s upsetting everyone.

So, rather than wait in vain for someone else to finally speak the honest truth about the single-payer system, I’ll just have to do it myself.

Let’s Get Blunt

America should listen to Dr. Earl Sunderhaus. ASAP. Because he holds the key to the health-care debate.

Who? you might ask. Never heard of him.

    Dr. Earl Sunderhaus

I hadn’t heard of him either until I saw a brief article last month in the Raleigh News & Observer with the unsubtle headline “Blunt doctor gets in trouble.”

The article detailed the travails of an elderly North Carolina eye doctor named Earl Sunderhaus who opened a 21st-century Pandora’s Box when he poked a patient in the thigh and informed her that she was too fat. Insulted, the patient complained to the state medical board, and now the doctor might lose his license.

But Sunderhaus was not about to back down:

Sunderhaus notified The News & Observer that he was about to be “screwed” by the medical board. He admitted he told the patient that thick eyeglasses would not cause her to go blind “but her thick thighs and diabetes would.”

“I poked her thigh to emphasize that diabetes is the leading cause of blindness,” he said Thursday. “People have got to accept criticism without getting their bowels in an uproar.”

He then upped the ante by threatening to counter-sue the medical board.

A follow-up article in the Asheville Citizen-Times gave more details about the eccentric doctor, who has notions that range from the kooky (disband the DEA, compulsory vasectomies) to the enlightened. Turns out Dr. Sunderhaus wasn’t merely poking this one patient in particular, but rather poking an entire nation of patients just like her:

“They are chastising me for telling her she should lose some weight because it is raising the cost of health care and it is also bad for her children and she is going to end up with diabetes,” Sunderhaus said. “I had to take three days out of my practice and go down to Raleigh, losing income, just because somebody didn’t like that I told her that she was fat.”

The patient complained that Sunderhaus poked her thigh and told her she was fat, and scolded her as irresponsible for being unemployed and relying on taxpayers to pay for another pregnancy.

“I told her the thick glasses were not going to blind her, she would go blind because of her thick thighs because diabetes is the No. 1 cause of blindness in this country,” Sunderhaus said.

Sunderhaus said he feels it is his responsibility as a physician to tell his patients to live healthier lives and that obesity and diabetes are costing the country millions of dollars.

“Telling this lady that she is fat is the truth, and it’s for her own good health,” Sunderhaus said. “She should be taking better care of herself, and it will be cheaper for us as a society.”

And to drive home his point, he poked the North Carolina Medical Board too,

“I’m the type of guy who can tell them to stick it up their butt because I am 77 years old, and if they don’t let me practice, I’ll just quit.”

Eccentricities aside, Dr. Sunderhaus has spoken the unspeakable, and by so doing has changed the frame of the health-care debate.

Because millions of Americans are secretly thinking the exact same thing as Dr. Sunderhaus and I: Why should we be forced to pay for the costs of other people’s irresponsibility?

Proponents of the single-payer national health plan can’t understand why anyone would want to oppose the faultless idea of universal health care. It’s completely egalitarian, it’s altruistic, and it’s free, they say. What’s not to like?

“Free” is an illusion — but that’s not the point

Well, opponents of universal health care have focused on one particular objection to the idea, conclusively demonstrating that it’s not free at all. It’s “free” only in that the government inserts itself as a middleman into the payment system, so that you pay for your health care indirectly in the form of higher taxes to the government which then turns around and gives the money to doctors and hospitals — rather than individuals paying the doctors and hospitals directly. It just looks “free” on the surface. But someone has to pay for the medical care, and under the single-payer concept, that someone is Uncle Sam. But since Uncle Sam gets all his money from American taxpayers … you end up footing the bill anyway, and also footing the bill of a vast new government bureaucracy.

The argument then devolves into the minutiae of which system is more efficient and cost-effective: The current cumbersome HMO system, which still feels overpriced despite the theory that “market dynamics” should keep costs reasonable; or a new system dependent on government red tape, which long experience suggests will be even more cumbersome, less efficient, and ultimately more expensive overall than the flawed free-market system.

And that’s pretty much where the discussion over health care has stalled: If we have to have a middleman unnecessarily taking a cut of our doctor payments, should that middleman be a private company like an HMO — or should it be the government?

To my mind, that question is actually irrelevant. Because there’s a much deeper philosophical objection to “socialized medicine” that is so un-PC that it is rarely if ever voiced in public. And for that reason, the opponents of socialized medicine never even mention the real flaw in the concept that nags the unconscious of most Americans:

Not all ailments are equal.

Blame: the final taboo

A built-in false assumption with the health-care debate is that sickness is always no-fault sickness. It’s never socially acceptable to assign blame for people’s medical problems — especially blame on the patient.

But I’m not afraid to confess that I’m a judgmental person. And I’m pretty confident that most Americans who oppose socialized medicine share this same judgment: that some people are partly or entirely to blame for their unwellness.

I’m perfectly willing to provide subsidized health care to people who are suffering due to no fault of their own. But in those cases — which, unfortunately, constitute perhaps a majority of all cases — where the unwellness is a consequence of the patient’s own misdeeds, bad habits, or stupid choices, I feel a deep-seated resentment that the rest of us should pick up the tab to fix medical problems that never should have happened in the first place.

I’m speaking specifically of medical problems caused by:

• Obesity
• Cigarette smoking
• Alcohol abuse
• Reckless behavior
• Criminal activity
• Unprotected promiscuous sex
• Use of illicit drugs
• Cultural traditions
• Bad diets

Now, I really don’t care if you overeat, smoke like a chimney, hump like a bunny or forget to lock the safety mechanism on your pistol as you jam it in your waistband. Fine by me. And as a laissez-faire social-libertarian live-and-let-live kind of person, I would never under normal circumstances condemn anyone for any of the behaviors listed above. That is: Until the bill for your stupidity shows up in my mailbox. Then suddenly, I’m forced to care about what you do, because I’m being forced to pay for the consequences.

Reluctant busybodies

What I don’t like about the very concept of universal health care is that it compels me to become my brother’s keeper and insert myself into the moral decisions of his life. I’d rather grant each person maximum freedom. I’d prefer to let people make whatever choices they want, however stupid or dangerous I may deem those choices to be. Just so long as you take responsibility for your actions, and you reap the consequences and pay for them yourself — hey, be as foolish or hedonistic or selfish or thoughtless as you like. Not my business.

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