I don’t like much about Obamacare. But most urgently, I oppose its imposition of anti-American centralized control—in the sense that it is the antithesis of the Founders’ governing philosophy—and hopeless complexity over a huge sector of the American economy, as much about the seizure of raw power as it is about restraining costs.
That’s the NHS model. No, not in the method of its funding but the flawed presumption that bureaucrats somehow know best, a point made very well in by Theodore Dalyrimple’s interesting article about the NHS, entitled “Universal Mediocrity” (my emphasis):
In obeying directives not because they are right but because they are directives, doctors lose their self-respect, their probity, and their intellectual honesty. Gogolian absurdity can result—with a hint of Kafkaesque menace and Orwellian linguistic dishonesty. When the British government decreed that every patient arriving in the emergency room should be admitted to a hospital ward within four hours if admission was necessary (and that hospitals would face fines if they failed to adhere to the rule), traffic jams of ambulances formed outside one famous hospital, with their patients prevented from entering the emergency rooms until the hospital could comply with the directive. Other hospitals redesignated their corridors as wards so that they could claim that patients on stretchers had been admitted in time. In a centralized system, the setting of targets will encourage organized deception, as well as distortion of effort.
In the United States, after President Obama’s health-care law proposed fining hospitals that readmitted too many patients within 30 days of discharge, editorials in the New England Journal of Medicine pointed out the dangers posed by that rule. They omitted to say that when giant bureaucracies set targets for others to reach, they intend not so much to procure improvement as to impose control.
They say that power corrupts and absolute power corrupts absolutely. We already see some of that. But more primarily, it is also the enemy of excellence and innovation. Deprofessionalizing medicine into a technocracy—already in its early stages—will not make our doctors and hospitals better, but instead, equalize increasingly mediocre results.
