Before the Law
The key difference between a profession based on human law and those founded on natural law is which system each obeys. Lawyers speak to the world of men. Doctors, engineers, scientists and mathematicians speak to the world of nature. Lawyers conjure before men to compel other men using human agents. Doctors use the laws of physics and chemistry to alter their patient's conditions. They act through physics, chemistry and reality. Their agents are natural processes, not legal ones.
Dr. Zane F. Pollard, an opthalmologist, describes the clash between the two worlds in a Wall Street Journal article. Dr. Pollard treated a child under Medicaid, used by Obamacare to treat low income patients. Pollard filled out the Medicaid form for a planned procedure and operated. But Dr. Pollard had to update his approach based on new information and adjusted his surgery accordingly with complete success. The patient's vision problem was corrected.
It was medical triumph but a bureaucratic disaster. He describes what happened.
I recently operated on a child with strabismus (crossed eyes). This child was covered by Medicaid. I was required to obtain surgical pre-authorization using a Current Procedural Terminology, or CPT, code for medical identification and billing purposes. The CPT code identified the particular procedure to be performed. Medicaid approved my surgical plan, and the surgery was scheduled. ...
Every surgeon must have the option to modify and change a surgical plan according to actual anatomical findings that only become apparent during surgery. ... The physician should not be denied payment simply because of a rigid government requirement to follow only the pre-approved plan. ...
However, because I filed for payment using the different CPT code for the surgery I actually performed, Medicaid was not willing to adjust its protocol. The government denied all payment ... Eventually I gave up fighting what had obviously become a losing battle.
It was frustrating to him, besides being a seemingly pointless waste of time. If this is a typical experience, it is no coincidence that more and more doctors are withdrawing from the Medicaid program. In Medicaid the doctor doesn't work for the patient, he works for Medicaid. But the surgical glitch was not an isolated example. Dr. Pollard notes the problem permeates all therapy, including medication:
My patient's glaucoma had been well controlled by a particular eye drop dispensed in a bottle available only in one size containing a dosage that would last for two months. Medicaid regulations only allowed the pharmacy to fill a prescription for a one-month supply. Medicaid did not want to approve my prescription.
Other medications in one-month sizes were available, except they were of the wrong kind. The pharmacist suggested Pollard prescribe what was allowed rather than indicated. The medical solution was to prescribe a two month supply of the right medicine. The bureaucratic solution was to supply two one month bottles of the wrong medicine.
The pharmacist asked me if I would change the prescription to order another Medicaid-approved medication that would satisfy the one-month-only supply policy. I refused because my patient's ocular pressure was well controlled by the particular medicine I had requested. Her vision was preserved because of that drug's effectiveness. Only after numerous contentious calls with the pharmacist and Medicaid was I able to obtain the prescription. Why should a physician have to struggle with the government for the most effective care for a patient?
In the natural world the edicts of men mean nothing. King Canute demonstrated to his courtiers that the waves would not stop at the monarch's command. He knew that in the universe the only writ that matters are the laws of physics; natural laws and mathematics reign supreme. But in the world of lawyers, physics means nothing. What is real is what is written on the paper. The legal truth reigns supreme, no matter how much it is at variance with the facts. You might think for example, that the solution to the aircraft security problem is to find and destroy al-Qaeda. But you would be wrong. The real answer is to compel all air travelers to purchase TSA-sized contact lens, lotion or toothpaste carry-on containers.
Since the world has both kinds of people, men in their wisdom put lawyers in charge of forms and doctors in charge of patients. The surpassing genius of Obamacare lies in reversing the arrangement so the lawyers are put in charge of approving treatments and the doctors are occupied in filling out forms. The potential for disaster in this new system is manifest. Yet it cannot even be questioned because Obamacare is the "law of the land". It is such a definite reality that its own reality cannot even be impeached.
James Taranto points out, Obamacare is an example of the continuously mutating immutable. It is an Eternal Law good until next week.
What does it mean to leave the law "unchanged" when the Supreme Court has already struck down parts of it and the administration has declined to follow or enforce others? That's not a salient question for immediate electoral purposes; in terms of voting intention, "left unchanged" can be taken as a statement of support for the Democrats. But even if the statutory language proves resistant to any effort at modification, there will be a new administration after 2016. That could mean more discretionary (or extralegal) changes and perhaps the end of ObamaCare as we know it.
Taranto concludes: "President Obama keeps insisting the debate over ObamaCare is 'over.' That declaration, wish, exhortation or command does not correspond with reality." It doesn't have to correspond to reality. It need only conform to an interpretation of a piece of paper. Once you have control of the "law of the land", who cares about reality?
Western society's obsession with paper has reached absurd heights. Just now the UN Security Council has imposed sanctions on the Boko Haram. "The UN Security Council has approved sanctions against the Nigerian militant group Boko Haram, five weeks after it kidnapped more than 200 schoolgirls. It will now be added to a list of al-Qaeda-linked organisations subject to an arms embargo and asset freeze." Do they actually think the Boko are planning on going to Davos? No not really. Even the UN is not that stupid. It may have some indirect long term effect on discouraging financial supporters, yet it will do nothing to save the schoolgirls. Still, it's what they can do with a piece of paper and a piece of paper is all they have.
Our touching faith in laws is matched by a surpassing contempt for physics. Nigeria has just admitted that drones it acquired from Israel to hunt down the terrorists were never operational, never maintained, never provided with spare parts and simply don't work. Probably it has no qualified operators either, even though there are almost certainly any number of officials drawing salaries as "official" drone pilots and mechanics. "Legally" Nigeria is probably awash with drone operators. In actually the number may be zero. But it's the 'legal' that counts.
In a way the "sanctions" are like Dr. Pollard's medication problem. You can't have the drones, which work. But you can legally have the UN sanctions, even though they don't work.
The West is slightly better off, but not by much. The West lives, not under the sun of natural law, but under the rule of lawyers. While 0.6% of Americans are lawyers, 41% of all Congressmen are attorneys. Officials in Washington are 68X more likely than the general population to be lawyers. Take the president for example; he's a lawyer. But that's still not enough. As Dr. Pollard notes, it won't be over until medicine is practiced by lawyers and bureaucrats.
And then things will be perfect. Legally.
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Article printed from Belmont Club: https://pjmedia.com/richardfernandez
URL to article: https://pjmedia.com/richardfernandez/2014/5/22/before-the-law