Government Two Sizes Too Big: White Coats in the White House

You’d need a thousand Sagans^[1] to measure the enormity of the federal budget, which is now measured in trillions and trillions of dollars. Might I ask a ridiculous question at this point? What do they do with all that money? I have suggested elsewhere^[2] that the problem is not so much the amount of money they take from us, but how they use it. I’d rather they throw almost all of it in the Potomac River than create government agencies called things like the Alternative Agricultural Research and Commercialization Corporation, the Federal Interagency Committee for the Management of Noxious and Exotic Weeds or the Office of Small and Disadvantaged Business Utilization.

We partly rebelled against King George because he had “erected a multitude of New Offices, and sent hither swarms of Officers to harass our People, and eat out their substance,” but we are mistaken if we do not understand that every government ruled by men will tend towards a tyranny, if God does not restrain it.

The Bible certainly teaches that debt is a curse on a nation:

For the LORD thy God blesseth thee, as he promised thee: and thou shalt lend unto many nations, but thou shalt not borrow; and thou shalt reign over many nations, but they shall not reign over thee. If there be among you a poor man of one of thy brethren within any of thy gates in thy land which the LORD thy God giveth thee, thou shalt not harden thine heart, nor shut thine hand from thy poor brother: But thou shalt open thine hand wide unto him, and shalt surely lend him sufficient for his need, in that which he wanteth. Deuteronomy 15:6-8

The LORD shall open unto thee his good treasure, the heaven to give the rain unto thy land in his season, and to bless all the work of thine hand: and thou shalt lend unto many nations, and thou shalt not borrow. Deuteronomy 28:12

The emphasis on Scripture is not that indebtedness causes the judgment of God on a nation, but is a result of judgment. This passage also shows that lending to someone with a genuine need is not wrong. So when my pro-life friends point to a sin of national debt and say that it is as bad as the killing of unborn children, they have mistaken cause for effect.

Government-too-big tends to dehumanize us, making us more like numbers to be counted than people to be served. Almost any business run like the government will fail. Those old enough to remember the early years of McDonald’s restaurants will remember the strange looks you got from the other side of the counter if you ordered a Big Mac with anything contrary to the advertising catchphrase “Two all-beef patties, special sauce, lettuce, cheese, pickles, onions on a sesame seed bun.” Because they were the only fast food place in town, they figured it wouldn’t matter to us if our fast food for-the-differently-minded meant going to the back of the line and waiting and waiting and waiting.

This is what bureaucracies do. They try to become well-oiled machines. By treating everybody the same way, nobody has to think. The customer becomes subservient to the product. It should have been no surprise to me recently, when I had to “take a number” in a Social Security office branch that could hold no more than six people in the lobby (which also happened to be empty!). It is in the rule book, I am quite sure.

Such “efficiencies” cannot usually withstand competition. By the early 1970s, McDonalds’ inflexibility had become legendary and so Burger King took advantage. First, they created a slogan which is still in use today: Have It Your Way. Then they created their own jingle: “Hold the pickles, hold the lettuce. Special orders don’t upset us. All we ask is that you let us serve it your way!”

McDonalds finally cried “uncle” and gave into the demand by customers that they “have it their way”. The problem with Uncle Sam, however, is that its bureaucracies often exist in areas where there is no competition allowed that can make them cry “uncle”.

When Governor Sarah Palin objected to President Obama’s health care proposal (Obamacare), she expressed what should be obvious to all: demands for efficiency and cost-effectiveness lead to widespread rationing of medical care. In all the debates about whether it is right to require people to carry insurance or require that insurance companies cover pre-existing conditions, no one looked very closely at Mitt Romney’s health care bill (Romneycare). It required the creation of a Health Care Quality and Cost Council (HCQCC), whose recommendations included:

The strategies proposed here are intended to reduce care that is unnecessary, duplicative, and of no or marginal benefit.^[3]

The question we often face is not “What is the best decision in this matter?” but “Whose decision is this to make?^[4] “Who decides whether surgery is necessary or that it is of no benefit? A bureaucrat in Boston or Washington (?!), or a doctor and her patient in Provincetown, Massachusetts?

Spending on end-of-life care in hospitals can be very expensive with little benefit; patients are often more satisfied with less costly hospice care. Medicaid and private insurers would encourage the use of hospice over hospitals…^[5]

Hospice is a place where you go to die, not a place to get better; and I can tell you from experience that when money is the motivator and a third-party is the payer, patients will not be making decisions which  satisfy their own needs and desires but rather those of the “health care system.” The elderly and infirm will be bullied into stopping all efforts to cure or extend life and go someplace where they can die quietly. President Obama twice admitted during a townhall^[6] meeting that health care would be rationed in Obamacare, once when asked about whether he would seek the best care for his own family, if it wasn’t covered in the plan.

Dr. Orrin Devinsky asked:

“If a national health plan was approved and your family participated — and President Obama, if your wife or your daughter became seriously ill and things were not going well, and the plan physicians told you they were doing everything that reasonably could be done, and you sought out opinions from some medical leaders in major centers and they said there’s another option that you should pursue, but it was not covered in the plan, would you potentially sacrifice the health of your family for the greater good of insuring millions, or would you do everything you possibly could as a father and husband to get the best health care and outcome for your family?”

His answer should have been shocking:

“You’re absolutely right that if it’s my family member, if it’s my wife, if it’s my children, if it’s my grandmother, I always want them to get the very best care. But here’s the problem that we have in our current health care system, is that there is a whole bunch of care that’s being provided that every study, every bit of evidence that we have, indicates may not be making us healthier.”

When Jane Sturm asked about whether a pacemaker that had been given to her mother at age 100 would be allowed under his plan (her mother, Hazel Homer, was then 105), the president illustrated the risks of socialized medicine when he tried to play a doctor on TV:

I don’t think that we can make judgments based on people’s spirit. That would be a pretty subjective decision to be making. I think we have to have rules that say that we are going to provide good, quality care for all people—

(Mrs. Sturm) But the money might never have been there for her pacemaker or for your grandmother’s hip replacement.

(The president continued): —Well, and that’s absolutely true. And end-of-life care is one of the most difficult, sensitive decisions we’re going to have to make. I don’t want bureaucracies making those decisions…. But understand that those decisions are already being made in one way or another…what we can do is make sure that at least some of the waste that exists in the system that’s not making anybody’s mom better, that is loading up on additional tests or additional drugs that the evidence shows is not necessarily going to improve care, that at least we can let doctors know, and your mom know, that you know what, maybe this isn’t going to help, maybe you’re better off not having the surgery, but taking the painkiller. (emphasis mine)

Carey’s Horror Story^[7]

Carey Goldberg used to be a reporter for the New York Times. Now she writes about medicine in Massachusetts and elsewhere for NPR. She’s an expert. She knows all about end of life care, because she’s ended one herself. She doesn’t say it that way, of course. She really describes it as something akin to throwing out an old rotten tomato that had sit on the counter too long. In an article she wrote about offing her own mother, she justifies it by telling us that her mother was just “a vegetable.” Her biggest nightmare was that she couldn’t just poison her mother or something. She had to let her mother come home and take nine whole days to die – NINE DAYS! Can you believe the audacity of that old woman (she was 58!) to stay alive that long! She might have lived a lot longer if poor old Carey hadn’t stopped giving her mother anything to eat or drink and finally ordered the nurse to please give her mom enough morphine to kill her and put her out of her misery (the last “her” being Carey’s, not her mother’s).

What does this have to do with big government and Romneycare? Goldberg had confessed to the killing in an article she wrote encouraging her fellow citizens to sign Medical Orders for Life Sustaining Treatment^[8] forms, part of the recommendations by a panel created by Governor Romney called the Massachusetts Expert Panel on End-Of-Life Care, a subcommittee of Romney’s HCQCC. Sarah Palin would rightly call this a death panel.

(Those folks in clean white jackets may not be coming to take you away, but coming to put you away instead.)

(This is Part Seventeen in a series of excerpts from the book, With Christ in the Voting Booth.)