I’ve finally figured out what politics is all about. You know
that guy you sometimes end up sitting next to in a bar or get
stuck with at a party? He knows everything about everything.
He’ll tell you how the big guys control everything, it’s all one
big racket, you can’t believe anything you read in the
newspapers, it’s all going to come out some day, you mark my
word. You roll your eyes and try to jab him with a little irony
here and there, but it’s no use. You’re the naïve one. He’s got
all the inside dope.
Well take enough of those people, put them all together until
they vote themselves into a majority, and that’s what we call
“politics.”
All this came home to the other day listening to President Obama
talk about health care. He made some remark about how doctors
perform a lot of unnecessary operations like tonsillectomies just
to make money off them. That’s supposedly what’s wrong with the
healthcare system — too many doctors making too much money.
(This week it’s the insurance companies refusing to pay for these
unnecessary operations.) So we’re going to appoint a federal
panel “insulated from special interests” that will set prices and
solve everything. (The New York Times repeated this
tonsillectomy fable in an editorial, which only shows they attend
the same parties as the President.)
He’s kidding, right? Doctors undertaking unnecessary procedures
in order to make extra money?
Here’s an example. A couple of years ago I broke my finger and
went to an orthopedic specialist. He looked at my finger, took an
x-ray, and every five minutes he went over in a corner and
started mumbling to himself. I thought he was kind of crazy until
I realized he was talking into a tape recorder. He finally told
me that every single diagnosis and decision he makes in his
office has to be put on tape and sent down to Alabama, where
housewives spent their days earning extra money by transcribing
it all into written records. (The best doctors probably have
voice-recognition systems by now.) I visited a urologist recently
and he was doing the same thing. All this is done for one reason
— to defend against lawsuits.
Sure doctors perform a lot of unnecessary procedures these days.
Probably the best example is Caesarian sections, which now
constitute one-third of all live births. In 1970 it was 4
percent. Most doctors don’t like C-sections and generally regard
them as a last resort because the procedure has its own risks. A
2006 study in the Lancet concluded that above 15 percent
Caesarians seem to do more hard than good. Yet doctors now
perform them routinely. Why? Because they know they’ll be
sued for tens of millions of dollars if they don’t.
The Caesarian epidemic has occurred because for years trial
lawyers feasted on the victims of cerebral palsy. CP is a
horrible condition and its victims make dramatic trial witnesses,
painfully lolling in their wheelchairs and talking almost
indecipherably. John Edwards became a multimillionaire by
“channeling” CP victims before juries.
No one knew what caused CP when triall lawyers began their
assault and no one knows today. But the lawyers managed to
convince judges and juries around the country that it was because
doctors weren’t performing C-sections. Doctors disputed the
diagnosis but after a few dozen $50-million verdicts they gave
up. “Alright,” they said, “we’ll do whatever you want.” And as a
result, the incidence of cerebral palsy has not dropped one
bit. It was 0.2 percent of all live births in 1965 and
remains there today. CP may be caused by genetic defects or
trauma or injury during pregnancy, no one knows. But one thing we
know for sure is that medical malpractice has nothing to do with
it. However, doctors will continue to perform Caesarians at their
alarming rate in order to avoid trouble.
That’s the way things now go in the medical profession. Ever
since trial lawyers and politicians decided to become doctors in
their spare time, medical knowledge has taken a back seat. Obama
argues that increased healthcare spending constitutes a “crisis,”
but who says that’s true? It may be just the mark of an affluent
society. What do people value more than their health? Twenty
years ago you saw people hobbling around all the time on aching
knees and hips. Today Americans spend $11 billion annually on
500,000 knee replacements and $7 billion on 200,000 hip
replacements. Is this a “crisis” that has to be solved? Should we
be spending money instead on trips to the Bahamas or video games?
Medicine costs more today because it does more. I was just
reading Robert Stone’s Prime Green, a memoir of the
1960s, in which he suffered from blurred vision and went to the
Stanford Medical School clinic, where some of the best doctors in
the world drilled two holes in his skull to find out whether he
has a brain tumor. (He didn’t.) That was before MRIs. Yet in 1993
Hillary Clinton was telling us about all the money “wasted” on
high-tech equipment in the U.S. Every hospital in America wanted
its own MRI machine while in Canada they got by with four for the
whole country. Is this the amateur hour or what?
Politics thrives on people who don’t know what they’re talking
about. Look what’s happened in energy. Any electrical engineer
will tell you that windmills are the most useless instruments
imaginable for generating reliable electricity. They’re
intermittent, unpredictable, very difficult to incorporate onto
the grid and require constant back up from other sources. Yet
what are we building today? Windmills upon windmills upon
windmills. Why? Because politicians around the country who
couldn’t tell a volt from an ampere have decided to pass
“renewable portfolio standards” requiring that utilities buy
power from windmills and solar collectors. The laws of physics
will be overcome by legislative fiat.
Now that the scapegoating of doctors has worn thin, the Obama
Administration is targeting the insurance companies. Nancy Pelosi
has instructed her fellow Democrats to “put them in the bull’s
eye” while selling the government takeover to their constituents
this month. Yet at the same time, the Administration has made the
wonderful discovery that people who take big risks with their
health by smoking, drinking or overeating run up large medical
bills! There’s even talk of taxing fattening foods and somehow
making people pay for their bad habits.
So what do you think insurance companies been doing all along? In
the old days, before politics took over, insurance companies
carefully vetted health insurance applicants, quizzing them about
their drinking, smoking and lifestyle habits and setting premiums
accordingly. Then politicians decided this constituted
“discrimination.” It wasn’t fair that people who were overweight
or wouldn’t stop smoking had to pay higher rates. So they
invented “community ratings,” whereby everybody paid the same
thing no matter what their age, habits or previous medical
conditions. This not only encouraged people to continue drinking,
smoking and overeating, it also allowed them to wait until
they got sick before applying for insurance. All this
obliterated actuarial practices and raised everyone’s rates — so
that the Obama administration now has to “step in” and set things
right.
Every country has two “establishments:” 1) the people who
practice their craft for a living, understand their job, and know
what it is they’re doing; and 2) the political class, which
generally consists of people skilled at revving up crowds by not
knowing what they’re talking about. How a country prospers
depends on which of these groups gets to run things.
All this reminds me of a marvelous interview a New York
Times reporter did in China in the 1970s when capitalistic
management practices were just supplanting the old Communist
system. The reporter was visiting a factory where the new
business manager still had to share responsibility with a
representative from “The Party.”
“Who makes the decisions around here about what gets done?” asked
the reporter.
“I do,” said the factory manager.
“I do,” said the Communist Party member.
“Who decides what workers get assigned to what tasks and how much
they get paid?” he asked.
“I do,” said the factory manager.
“I do,” said the Party member.
“What happens if something goes wrong?” the reporter then asked.
“Who gets the blame?”
“I do,” said the factory manager.
“He does,” said the Party member.
This instructive pantomime will soon be playing at your local
doctor’s office.
