Personality and health care *UPDATED*

I was thinking about government care today, not in terms of dollars and cents, but in terms of the human factor.  Government health care imagines that all people will respond to situations in the same way, both physically and emotionally.  But that’s not how people are.

The medicine that makes one person feel wonderful has another person retching miserably — yet government health care usually comes complete with a limited list of available medications.  While one person responds fabulously to a procedure, another may get no benefit at all — yet government health care, in the interests of efficiency, always ends up dialing down the available range of health care options.

And then there are the personalities.  I’m not even talking about the bad habits, whether smoking, drug abuse, too much chocolate, etc.  I’m talking about people’s fundamental beliefs about their own health.

One sweet old lady I know is a true hypochondriac, constantly searching for the next illness.  Bundled in with that emotional baggage are genuine health problems, so that the doctors always have to take her complaints seriously.  She costs her insurance company a staggering fortunate.

Another sweet old lady I know is in complete denial, and that’s true despite her genuine health problems.  Because she refuses to deal with symptoms as they arise, everything with her is serious by the time she gets to the emergency room.  She also costs her insurance company a staggering fortune.

I don’t see how government health care which, in the absence of competition, inevitably boils down to one-size-fits-all treatments, fixes the problems inherent with these (and so many other) personality types.  This is going to be especially true with an aging population, when there are going to be increasing numbers of charmingly eccentrinc sweet old ladies and dear old men.

As you have probably guessed, today I had a run in with the health care system and a sweet little old person.  The health care provided was humane, thoughtful — and, but for the personalities involved, should have been unnecessary.

I’m tired, grumpy, and treating myself to my own drug of choice:  chocolate ice cream and the love of a good dog.

UPDATEThis article about Donald Berwick, whom Obama chose to head the Centers for Medicare and Medicaid Services perfectly describes how America is being pushed into the “patients as cogs” model.  The premise is that Berwick is completely in love with Britain’s National Health Service (something with which those enrolled in and suffer from the NHS might disagree):

Berwick has called NHS a “global treasure,” saying he is “a romantic about NHS. I love it.” It’s no coincidence that this centrally planned, government-run health care system appeals to a Harvard-educated pediatrician who views patients not as individuals, but as members of collective “units of concern” defined by age, disease or socioeconomic status. Berwick has criticized the use of new life-saving technologies and wants non-physician “primary care providers” to ration care by controlling access to specialists and diagnostic tests to reduce each “unit’s” per-capita costs. He has also characterized aggressive interventions in terminally ill patients as “assaults,” not heroic attempts to extend their lives.

This is a radical departure from the focus on individual patients and their private relationship with doctors of their choice that have made American medicine the best in the world. And while Berwick was among the first to introduce industrial-style quality controls in 3,000 American hospitals, which by all accounts has been a huge success in improving patient care, his rigidly ideological view that America’s health system should mimic Britain’s NHS is inimical to the preservation of individual freedom and high-quality care. His nomination should be decisively rejected by the Senate. Americans live longer, healthier lives than Brits precisely because government bureaucrats have not been in charge of their health care for the past 60 years. If confirmed by the Senate, Berwick will define that quality down to British standards. That would not be choosing well.

The problem, of course, as my experiences yesterday showed — and as every socialist experiment in the world proves — individuals are not cogs.  The only way to treat them as such is to dehumanize them to the point at which the unthinkable — mass murder — eventually becomes thinkable.  That is, I don’t think any socialist regime every starts out intending to commit mass murder.  It just eventually makes sense when the cogs won’t cooperate.
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  • FunkyPhD

    You’ll probably remember how, a few months back, there was a meme on Facebook saying (something like) “no one should die because they cannot afford health care and no one should go broke because they get sick.”  Really?  What about the morbidly obese middle-aged man who refuses to moderate his eating and to exercise?  What about the drunk driver who paralyzes himself in a single-car accident?  What about the alcoholic who doesn’t stop drinking after receiving a liver transplant (e.g. John Phillips of The Mamas and the Papas)?  The IV drug abuser who gets hepatitis C?  The left, as usual, operates under the dreamily romantic notion that people who get seriously ill are all struck down by a cruel fate early in life and in otherwise perfect health (like Bobby Goldsboro’s “Honey” and Jennifer in Erich Segal’s Love Story), when, in fact, most life-threatening diseases are either the result of extreme age or egregiously risky behavior, like overeating and never exercising.
    The worst thing about the NHS-style health care the Obami want for all of us, though, is that it eliminates a potentially potent financial incentive for taking care of one’s body.  If I’m a good driver, I get a discount on my auto insurance.  Shouldn’t I get a discount for exercising and eating right?  I know, current insurance doesn’t allow for that either–but it should; doing so would make health insurance cheaper.  What Obama has done is an absolute nightmare for this country.  As Mark Steyn has repeatedly noted, NHS-style health care fundamentally–and perhaps irretrievably–alters the relationship between the citizen and the state.  Get ready for even more out-of-control drinking, eating, and other unhealthy habits, especially among the young in this country as the meaning and extent of this ill-considered step takes hold.

  • David Foster

    “Get ready for even more out-of-control drinking, eating, and other unhealthy habits, especially among the young in this country”….I’m actually more concerned about the complementary problem: government use of its power over healthcare to micromanage individual behavior.

  • Bookworm

    I wonder, David, whether FunkyPhD isn’t correct.  After all, in England, the ne plus ultra of socialized medicine, the British are the sickest people in Europe, thanks not just to bad health care, but to exceptionally lousy living habits:  more drugs, more alcohol, more unhealthy food, less exercise, etc.  They’re a disaster and that’s probably precisely because of the moral hazard problem that arises with too little risk.

  • JKB

    This reminds me of a the movie “Ordinary Decent Criminal.”  Kevin Spacey plays Michael, an Irish criminal, who toys with the Guard.  In one scene, he is smashing one of his crews hand in a car door to determine if he stole some gold from the crew.  After deciding the guy just had bad luck, Michael sends him to the hospital and asks him if he is on the national health program so his emergency room care won’t cost him anything.
    Thinking about it, the movie is a real indictment of the British socialist system.  Michael has two houses for the two sisters he has kids by free and clear because when the city tore down their tenement they barricaded themselves until the Lord Mayor comes and on his knees begs them to vacate with the promise of free houses.  Michael and one of his crew stand in line to get their welfare complaining some weeks they wouldn’t eat with out it, then go out, put on masks and the crew robs the welfare office.

  • pst314

    “chocolate ice cream and the love of a good dog”
    Sounds like good therapy.

  • Bill Smith

    I highly recommend the dog. They are excellent listeners.

  • Jose

    Years ago in the UK there was uproar about the NHS providing tattoo removals. 

    Those with tattoos countered that they had made a single mistake, perhaps while drunk, and that removal improved their job prospects and potential standard of living.   Further more, no one had been complaining about long term care provided to emphysema patients, whose condition usually resulted from a lifetime of abusing their health.

    I thought logic was on their side, but I never heard what the outcome was.

    We’ll probably be dealing with the same issue here before long.

  • garyp


    Dealing with patients (I have worked in cancer care for 20 years) is an art, more than a science.

    Most health care providers are good people that really try to do their best for their patients.  Even when controlled by bureaucrats (as in govt medical facilities) most retain the “patient first” attitude…for a while.

    Eventually, some long-term employees in any bureaucratic system mostly give up and turn into DMV types.  The most important change, under govt health care, however, is that, under the guise of “results based medicine” the art of medicine is lost.  Medical providers are not just encouraged to use drugs and treatments that are most effective (i.e. work for most patients, most of the time), they are often prohibited from doing anything that is not in the “approved” list of procedures or medicines.

    Ultimately, the govt must ration care.  Some goods have an unlimited demand.  Medical care is one.  If it is free, the demand will expand beyond what any system can supply.  The result is rationing.  In Canada, rationing is accomplished mostly by waiting lists.  For example, their cancer centers only take so many patients suffering from each type of cancer per month.  If you have a cancer that usually doesn’t respond to treatment, you may wait many months (and die in the interim) because they don’t want to waste precious resourses on people who probably won’t respond.  (Note the probably, just because the average patient doesn’t respond well, doesn’t mean you don’t have the occasional “miracle” cure.  However, no one can predict who the responders will be without treating everyone.  Expensive, but otherwise you condemn patients to death based on average responses.)

    In England, it is all about the money.  If you annual treatment costs more than 40K pounds (about $60K), you are too expensive to treat.  People who have my cancer are routinely denied a treatment that has, in my case, added “many years” (in my doctor’s terms) to my life and resulted in a pretty much complete response.  Even if you can afford the chemotherapy (the most expensive part of treatment) you are cut off from all other services if you pay for the chemo.  They call it “topping up.”  You either take what care they will provide (and die) or pay for all your care, not just the part that is too expensive (the chemo).  I guess that is done to ensure that you either die per govt directive  (and eliminate all expense for the NHS) or you pay for everything (and eliminate all expense for the NHS).

    We will adopt one of these two approaches (probably the Canadian approach because it is more subtle) to ration care.  We are moving that way as Medicare and Medicaid patients are already losing access to doctors as fewer and fewer physicians will see these patients (due to poor reimbursement).  So they wait longer to see doctors and their conditions go from treatable to hopeless while they wait.

    Those of us at the end of our lives, like myself, are, I think, the lucky ones.  What America will be like in twenty years is impossible to know but certainly does not seem, to me anyway, to be moving towards a better country.  Austerity is coming, and that doesn’t concern me.  We can lower our standard of living significantly and still be the luckiest people in the world.  However, I think we are headed to “serfdom” (see Hayak’s book, The Road to Serfdom for what that means) and we will lose control of our lives, our bodies and our possessions.  Without economic freedom there cannot be political freedom.   The Golden Rule is “he who controls the gold, rules.”  Cynical, but true.  Good luck to all. 


  • Ymarsakar

    <B>government use of its power over healthcare to micromanage individual behavior.</b>
    I suspect they will micromanage individual behavior in order to keep their slave classes mired in poor education, poor health, and even worse habits.
    That way, they can recruit even more people into Leftist cult by saying, “look, see how bad you are, we can help”.