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.
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