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Clintonians versus Gekkonians As noted, there are two enabling visions - two general schools of thought - that promote the covert rationing of health care. Both allow rationing activities to go forward openly, freely, and often profitably, while maintaining a cloak of "no limits." School of Thought # 1 - The Clintonians This school of thought is the one most commonly espoused by
government officials, politicians, public health officials, and other
health care policy makers, as well as most liberals. We have taken the
liberty of naming this school of thought after the individuals who have,
thus far, done the most to advance its basic premises. Clintonians believe that the root cause for all the problems in our health care system lies in human weaknesses (specifically, in too many greedy doctors using too much expensive technology). The fix for these problems therefore rests in setting public policy and promulgating governmental regulations to hold that greed in check. From a philosophical point of view Clintonians believe in Original Sin, in the essential evil in man – if you give a fellow too much freedom, he’ll probably do something bad. |
The Clintonians’ point of view is amply supported by the undeniable fact that that the traditional fee-for-service health care system has institutionalized the natural human greed of physicians. Under that system, the more technology doctors use and the more procedures they order, the more money they make. Indeed, it simply cannot be denied that this system fosters profligacy, waste and the overutilization of expensive resources.
According to the Clintonian school, the greed inherent in our health care system is only underscored by the fact that millions of Americans have been shut out of the system altogether. Where is the cry of outrage from our “compassionate” physicians over the high number of uninsured? The lack of quality in our present health care system is further underscored by the embarrassingly high infant mortality rate in the U.S., and our lagging life-expectancy rate compared to some other developed countries. Again, where is the professional outrage? Clearly there is a fundamental problem with our health care system, a problem that stems from the misguided incentives and maladjusted motivations of health care practitioners and other profiteers.
Politicians and public policymakers naturally gravitate toward the Clintonian school of thought, since its basic premise is that the problem with health care results from misguided incentives coupled with human greed. This premise obviously places the solution squarely in the hands of policymakers, who can do the job with new, stricter regulations and more enforcement muscle.
School of thought # 2 - The Gekkonians
This school of thought is usually espoused by the insurance industry, health care executives, many physicians, and most proponents of a free-enterprise economy, including most conservatives. We have named it after Gordon Gekko, the character in the movie Wall Street, whose chief operating philosophy was that greed is good.
Its basic premise is that the open marketplace generally offers the best solution to society’s problems. Philosophically speaking, Gekkonians believe in the essential goodness of man – give a fellow his freedom, and just watch the good things flow.
Gekkonians assert that the health care crisis stems directly from the fact that, while doctors may be good at practicing medicine (or maybe they’re not), they’re no businessmen. And health care is simply a business, like any other economic enterprise.
Leave it up to the doctors, and they’ll forever practice medicine the way they did in 1910 – hundreds of thousands of independent guildsmen, each running their own shop, duplicating expensive services, multiplying inefficiencies, and shutting out the competition. No wonder the health care system is such an inefficient, wasteful mess. Instead, the health care industry should be treated as a market, just like any other market, and not as some sacred, protected economic sphere.
Let those who know how to run a business run the business of health care, and let the doctors practice medicine (under the guidance, of course, of the fiscally adept). Bring the efficiencies of the for-profit, free enterprise system to the health care industry, and the health care crisis will take care of itself.
Clintonians v. Gekkonians
At first glance, the Clintonians and the Gekkonians would seem to have little in common. The Clintonians believe that too much greed is the problem, so the health care crisis can only be solved by regulations to hold that greed in check. The Gekkonians, on the other hand, propose to allow market incentives (or, if you will, greed) to solve the health care crisis by reducing artificial constraints on the market (i.e., by reducing governmental regulations).
A closer look, however, reveals that these two schools of thought actually have very much in common; certainly enough to explain why Clintonians and Gekkonians can often be seen forming alliances with one another in their efforts to reform the system.
First, both schools of thought are based firmly on the American myth of health care. There ought to be no limits on what Americans should ultimately expect from their health care system. Thus, our health care crisis is due solely to too much waste and fraud within the health care system. While one school tends to blame the waste and fraud on greed and the other on incompetence, the basic problem according to both schools is the inefficient use of resources. We’ve already seen the fatal limitations of the “waste and fraud” hypothesis. But still (as we’ve noted several times already), it is attractive to suppose that enough waste exists in the system to make rationing unnecessary.
As a direct result of the “waste and fraud” hypothesis, both schools of thought are able to assert that the underlying problem with health care is one of “system.” For the Clintonians, the traditional health care system allows, and even encourages, greedy health care workers to rip off the public. For the Gekkonians, our medieval, guild-like health care system discourages competition and stifles efficiency. Either way, the problem is in the system, so the solution is simply to fix the system (either through regulatory means, or market-based means). Since the problem is merely systematic, there is no reason to question our underlying premises, and thus no reason to question our American health care myth. Both schools of thought leave the myth entirely unchallenged and intact.
These two schools of thought have one more common feature that deserves prominent mention. In each, the primary solution to the health care crisis requires limiting the capacity of doctors to behave as independent agents. In one case this is to be done by regulatory means in order to stifle physician greed; in the other it is to be done by the marketplace in order to eliminate physician inefficiency. But either way the primary goal, the number one priority, is to control physician behavior. To the extent that controlling physicians’ behavior prevents them from being greedy or inefficient, that’s good. But to the extent that controlling their behavior prevents them from fulfilling their role as advocates for their patients, that’s very, very bad.
Thus does each school of thought provide a serviceable “cover” for activities that, if subconscious collusion were not the operational imperative, would quickly be seen for what they are – rationing activities. Indeed, understanding these two schools of thought allows us to comprehend the secret language of covert rationing. For rationing behavior is virtually always couched in terms of one school of thought or the other.
So far in the race to control our hearts and minds, neither school of thought has clearly predominated. In 1993 and 1994, the “heyday” of the Clintons’ health care reform efforts, the Clintonians were clearly in the driver’s seat. Then, when the Clinton plan went down to overwhelming defeat, the Gekkonians rapidly took the fore. Now it would appear that the public is beginning to sour on health care run by the ostensible “free market,” and the Clintonians are making a strong comeback. It isn’t likely that either school of thought will be vanquished in the near future.
But such a “horse race” scenario is a gross oversimplification. As we will see, many forms of covert rationing are supported by both schools of thought, and the “race” has been characterized more by collusion than collision. In any case, for doctors and patients struggling in the trenches, it doesn’t much matter which school of thought represents the paradigm of the day. And whichever one is providing the “cover” at any given point in time, covert rationing in any guise renders the pursuit of health care exceedingly difficult, frustrating and dangerous.
Next - Clintionians v. Gekkonians: Skirmish of the '90s
Surviving the Health Care System is adapted with permission from YourDoctorintheFamily.com
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