The System

A psychiatrist at our hospital speaking before a conference today about an expensive procedure, mentioned with some disapproval that two procedures had been done at once when only one might have been necessary because of cost considerations. Ignore for a moment the physical cost to the patient of going through brain surgery a second time – which to my mind should be a powerful factor in the decision-making – and stay focused on that dollar cost. The good doctor said “We still work in a system where money is an important factor.”

I wondered what countries he was thinking of where money isn’t an important factor.

I have said many times before that if you brought these examples of bad progressive thinking out in the open, they would immediately recognise that of course there isn’t some magical place where medical costs are not counted. They didn’t mean that. But they do. The dominant unexamined idea is that in Canada, France, Germany, Denmark – all those civilised countries – doctors decide what the patient needs, write an order, and someone goes and does it.

This in turn drives the idea that of course the US can afford to sign on to a system like that. Why, other countries do it all the time, and they’re not broke. We’re richer, so we must be able to afford it. If we can’t find the money lying around, it must mean that 1. Someone somewhere is sucking up all the money unfairly and/or 2. The society has a failure of moral will to do what is eminently possible. Well, both those things are possible, of course. But it might be good to consider other possibilities, based on clearer thinking.

Lots of people really do believe these unreasonable things. It is not unfair to make the accusation, because the truth leaks out of even the nicest and most knowledgeable people at times.