Saul Bellow once wrote that if philosophers wanted to see the unintended consequences of their ideas, they should pervert them beforehand. The same goes for creatures much further down the intellectual food chain: journalists.
When a few days ago I criticized a provision in the proposed health-care legislation that I thought would lead to heartless limitations on end-of-life care—it was removed from the Senate bill two days later—I should not have been surprised that I was denounced by liberals and praised by conservatives. But not only was I surprised, I was tickled.
I have never thought of Limbaugh as much more than a bloviating bully, but I now consider him on par with Matthew Arnold.
For here was none other than Rush Limbaugh defending me on his radio show against liberals who claimed that I was joining up with the insurance companies and allying myself with Sarah Palin and the right-wing hack Betsy McCaughey. Never mind that I never mentioned “death panels” and refuted McCaughey
Limbaugh, whom I have never thought much more than a bloviating bully but who I now consider on a par with Matthew Arnold, reminded my detractors that I was a “huge lib” and “big-time pro-national health care.” You bet I am, Rushbo. He went on to say that "[Siegel] thinks the second greatest sin in America after slavery is we don't have national health care.” I’m all choked up. Of course I do. He did say that “I don’t know who Lee Siegel is” and “I didn’t click on the bio.” Well, he is incredibly busy. But he went on to direct readers to my article anyway. Take that, my bien-pensant liberal buddies.
Of course Limbaugh was playing up my liberal commitments to make a nonsensical ideological point, which was that if liberals have doubts about Obama’s plan, then it has to be bad. In this he was echoing the liberals’ own charge that if any liberal criticizes Obama’s plan, then he could not possibly support it.
But such is the topsy-turvy effect of the polarizing dynamic driving the health-care “debate,” that even as Limbaugh was being as ham-handed as my liberal detractors, he was, for a fleeting second, doing what few people seem able to do this summer. He was heeding St. Thomas Aquinas’ excellent advice: “When you meet a contradiction, make a distinction.”
In other words, to worry, as I still do, that Obama and his team are too much under the spell of behavioral economics, which will lead to callous rationing despite all the best intentions, does not meant that I support the shameful rationing that insurance companies now practice. It is not a contradiction. It means that I hope for health-care legislation that will put an end to insurance companies’ bottom-line conduct without resorting to the same measures to fund itself. That’s called a distinction.
Government cannot be in the business of deciding which tests and procedures a person can choose to try to save his life. This is not just an end-of-life issue. Only the biggest naif or the most servile ideologue could argue that doctors know with certainty which tests and procedures will work beforehand for any patient. People with high cholesterol try statin after statin before finding the one that will work—if they ever do. Emotionally troubled people spend months trying to find an effective drug—if they ever do. Blood in your urine? You will have to take one urine test after another because bladder cancer is hard to detect in its early stages—and because of that fact, you will have to undergo several other kinds of tests, too. And in the end if a kidney stone was all you had, would you, looking back, have foregone any of the tests? Should government have not allowed them?
Nevertheless, the idea that too many tests and procedures are at the core of our health-care crisis has now become the conventional wisdom. On TV, a “health reporter” will display chart after chart showing viewers how many billions of dollars the country will save if people stop “trying to live forever,” although in truth—and with a few obvious exceptions, like unnecessary full-body CT scans—no one can quantify which potentially life-saving test and procedure will work and which won’t. No one can quantify who that one out of 100, or one out of 1,000 patients will be. But the dreadedness of using too much expensive technology is still the banality of the day. And yet I don’t hear anyone saying that we should close down the casinos because only some people win.
In fact, the debate has now taken a ridiculous turn. Since government is so dysfunctional that neither side can give an inch over health care, the fashionable insight has been to blame the American people themselves for getting sick. You now get doctor-pundits on TV—as they discuss a solution to the nation’s health-care crisis before the cameras, the TV doctors' patients are frantically calling their answering services—telling us that the real culprits are obesity and stress.
So even as commercial society wastes precious resources by employing every type of expensive technology available to stimulate every possible human appetite—targeting the weakest and most vulnerable people: i.e. the ones without health care—it’s the prey’s fault for succumbing, not the predator’s for preying. Even as we are in the midst of rising foreclosures and unemployment, these TV stoics tell us that we should not allow our stress to bankrupt the health-care system. Anxiety is becoming unpatriotic. The “experts” should be ashamed of themselves.
But the experts’ presence in the proposed health-care bills is what has people worried. Obama speaks again and again of panels of experts who will decide what tests and procedures are appropriate and what are not. Yet once the Pandora’s box of medical technology has been opened, you cannot close it by fiat.
May I, no expert, suggest a different idea from the floor?
A vast initiative of making ordinary Americans themselves experts in available medical tests and procedures, similar to JFK’s giant project of making Americans aware of the importance of physical fitness. Instead of remote panels deciding your medical fate, you come armed with the facts and determine your course of treatment with your doctor. The education could start—slowly and judiciously—in high school, in the same way students now learn about sex and hygiene.
No doubt some liberal Beltway journalist, jumping up and down like an excited dachshund at the prospect of rubbing against Rahm Emanuel’s leg—access to a journalist is like graft to a politician—will come yapping after me with charts and statistics. But he’ll have to get past Rush first.
Lee Siegel has written about culture and politics and is the author of three books:Falling Upwards: Essays in Defense of the Imagination; Not Remotely Controlled: Notes on Television; and, most recently,Against the Machine: Being Human in the Age of the Electronic Mob. In 2002, he received a National Magazine Award for reviews and criticism.