An unwelcome plug for socialized medicine with a Shaw Festival play

Shaw Festival programs usually include a few lines about the play from its director. In fact — and this is entirely off the subject — we commend the Shaw for continuing to give us classy-looking programs with well-written, thoughtful essays about the plays (in contrast to Stratford Festival programs, whose meager content is delivered on cheap paper).

But the paragraphs from Morris Panych, the director of Bernard Shaw’s The Doctor’s Dilemma at the Shaw Festival this season, weren’t in the usual vein. Mr. Panych (whose show we enthusiastically recommend, see this post) seems to think that Shaw’s play helps make a case for government-run medical services.  His remarks hardly mention the play, discussing mostly the supposed glories of the Canadian public health system.  We don’t see it.

In the Shaw Festival

First, the play itself hardly supports a case for socialized medicine. The problem in the play is how to allocate scarce medical resources: whether Sir Colenso should give a slot in his tuberculosis clinic to (a) a brilliant young artist or (b) a selfless, lovable old medical school friend. Frankly, though, Shaw’s premise — that Sir Colenso had to make a choice and that one of these two men had to die — doesn’t seem very plausible, however useful it might have been to Shaw as a plot device. If Sir Colenso could take on one additional t.b. patient (at first he claimed he couldn’t even do that), why not two? The point applies more broadly: health care isn’t a zero-sum game; the supply of medical services isn’t fixed and limited.

How often do choices like this really happen other than at the difficult extremities of medical practice (one thinks of kidney transplants and the battlefield triage decisions in Gone with the Wind)? The play’s “dilemma” is a straw man. Surely bona fide zero-sum treatment choices like Sir Colenso’s are rare. There’s no reason why they should drive policy-making.

Shaw Festival director (and playwright) Morris Panych. Being a talented dramatist and a director doesn't give one the right to push one's views about socialized medicine on theater patrons.

At any rate, how could any nationalized health care system have resolved Sir Colenso’s “dilemma” any better than he did? Mr. Panych says that “doctors should face no dilemmas” — that “society” should make such decisions. But “society” is an elusive personage. What Mr. Panych really means is that who-shall-live-and-who-shall-die decisions like Sir Colenso’s should be taken away from doctors (and their patients) and given to bureaucrats at government health agencies. Personally, we think doctors represent “society” better than bureaucrats, and we can’t imagine why anyone would think that the latter would be better at resolving difficult moral dilemmas than the former. People don’t acquire Solomonic wisdom by becoming tenured civil servants — generally it’s the opposite.

If Shaw meant The Doctor’s Dilemma as an indictment of private medicine, he failed. It’s just a hilarious send-up of flawed men who happen to be doctors. What comedy doesn’t rely on the follies, vanities, pretensions, and eccentricities of our fellow men? Doctors are as likely to be hyper-idealistic, glory-seeking, greedy, and foolish as the rest of us. But the fact that we have to get medical care from imperfect people hardly suggests that it should be managed by other imperfect people who happen to be government bureaucrats.

Why, to those on the political left, do flaws in human nature always serve as a pretext for taking decisions away from ordinary people and turning them over to unaccountable bureaucracies? We like to think well of people, and we’d like to think that folks on the left really believe people will be better off with socialized medicine. But we can’t. We suspect instead that they’re driven by elitist irritation at the idea that ordinary people should be “allowed” to make such important decisions for themselves — and that they’re addicted to telling other people what they can and can’t do.

Dr. Donald Berwick

Unfortunately, our own President seems to fall into that camp, as he’s just appointed a fellow to run Medicaid and Medicare who believes fervently in the rationing of medical services. Americans in general aren’t ready to let health-care bureaucrats decide when a person is too old and feeble to justify spending money on, but Dr. Donald Berwick is more than ready to do that, and lots besides. He worships the British system with romantic fervor and wants to replicate it here as quickly as possible.

Our fellow Americans should know that there’s no point in writing to our senators to suggest that they disapprove of the nomination of Dr. Donald Berwick for this job, because our President has evaded Senate consideration of Dr. Berwick by making a recess appointment (here’s one of the many news stories); he distrusts not only the wisdom and judgment of his fellow Americans, but also that of the men and women they have elected to the United States Senate. The President simply can’t resist telling people what they have to accept.

Fortunately, the tide of history is against Mr. Panych (and our President), whether they realize it or not. By coincidence, a few days after we saw this superb play at the Shaw, the British government announced that it intended to reorganize the National Health Service and to shift control of England’s annual health budget from the centralized bureaucracy to local general practitioners. According to the New York Times, the new plan would give the bulk of the budgeted moneys to the doctors and let them decide how to spend the money for services their patients need from hospitals and other providers. We wish the Brits luck and hope our President pays attention.

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8 CommentsLeave a comment

  1. Mr. Juillien:

    Not sure what you mean when you say that COBRA, at $550 per month, is prohibitively expensive. That’s the actual economic cost of health insurance, more or less, whether you pay it yourself or whether your employer pays it or whether the government pays it. Personally, I pay $350 per month for health insurance, and my employer pays the balance, which I know is considerably more than $200 per month. So I must say that the $550 per month ($6600 per year) you pay for health insurance doesn’t seem terribly shocking — seems in fact reasonable, especially as I’m aware that health insurance in some areas costs well over $10,000 per year.

    Deborah:

    Feel free to speak for me anytime! Why should we be looking to the government to provide us with necessities of life? We all have to eat, and clothe ourselves, and put a roof over our heads; those things are our own responsibility, first and foremost. Those of us able to work don’t (or at least shouldn’t) look to the government for food, clothes, and shelter, even though those needs are even more immediate and acute than health care. So why should we look to the government for health care?

    My car payments come to $4500 per year, plus $1500 for car insurance, our food bill is probably $5000 per year (we really should keep track), we probably spend $2000 per year on clothes, and our mortgage payments and taxes come to $16,000 per year. Compared to such expenses, which I don’t think are out of the ordinary, what then is so outrageous about people’s having to pay $6600 per year for their own routine and emergency medical care? Why shouldn’t I expect to bear it myself (if I can, of course; ensuring care for the poor and infirm is a different matter altogether) along with our other basic living expenses? I have a contingency plan in case I should become disabled or lose my job; why shouldn’t other people?

    One of the most obvious, and simplest, health care reforms would have been to permit individuals like us to deduct our payments for health insurance premiums, instead of making payments deductible only to employers. But I don’t think the Obama administration or its allies in Congress even considered it. Their preference has always been to disguise the true economic cost of health care, to obfuscate the question of who ultimately is paying it, and, above all, to enlarge the ability of government officials who are accountable to no one to tell American citizens what they have to do and how much they have to pay for it. The fundamental issues here are (a) personal responsibility and (b) individual freedom, values that mean nothing to the current governing crowd.

  2. Mr. Juillien:

    Not sure what you mean when you say that COBRA, at $550 per month, is prohibitively expensive. That’s the actual economic cost of health insurance, more or less, whether you pay it yourself or whether your employer pays it or whether the government pays it. Personally, I pay $350 per month for health insurance, and my employer pays the balance, which I know is considerably more than $200 per month. So I must say that the $550 per month ($6600 per year) you pay for health insurance doesn’t seem terribly shocking — seems in fact reasonable, especially as I’m aware that health insurance in some areas costs well over $10,000 per year.

    Deborah:

    Feel free to speak for me anytime! Why should we be looking to the government to provide us with necessities of life? We all have to eat, and clothe ourselves, and put a roof over our heads; those things are our own responsibility, first and foremost. Those of us able to work don’t (or at least shouldn’t) look to the government for food, clothes, and shelter, even though those needs are even more immediate and acute than health care. So why should we look to the government for health care?

    My car payments come to $4500 per year, plus $1500 for car insurance, our food bill is probably $5000 per year (we really should keep track), we probably spend $2000 per year on clothes, and our mortgage payments and taxes come to $16,000 per year. Compared to such expenses, which I don’t think are out of the ordinary, what then is so outrageous about people’s having to pay $6600 per year for their own routine and emergency medical care? Why shouldn’t I expect to bear it myself (if I can, of course; ensuring care for the poor and infirm is a different matter altogether) along with our other basic living expenses? I have a contingency plan in case I should become disabled or lose my job; why shouldn’t other people?

    One of the most obvious, and simplest, health care reforms would have been to permit individuals like us to deduct our payments for health insurance premiums, instead of making payments deductible only to employers. But I don’t think the Obama administration or its allies in Congress even considered it. Their preference has always been to disguise the true economic cost of health care, to obfuscate the question of who ultimately is paying it, and, above all, to enlarge the ability of government officials who are accountable to no one to tell American citizens what they have to do and how much they have to pay for it. The fundamental issues here are (a) personal responsibility and (b) individual freedom, values that mean nothing to the current governing crowd.

    probably shouldn’t speak for Emsworth here, but my sense is that he is averse to the Canadian or British systems because he does not believe that someone else should be forced to pay for his health care. If so, I’m with him on this. Someone else having to work and earn money so I can get the benefit? Ick. No way.

  3. I probably shouldn’t speak for Emsworth here, but my sense is that he is averse to the Canadian or British systems because he does not believe that someone else should be forced to pay for his health care. If so, I’m with him on this. Someone else having to work and earn money so I can get the benefit? Ick. No way.

  4. Re: <>
    Speak for yourself, Emsworth…many people I know hate our US system precisely because they worry about what happens if someone gets a catastrophic illness. If you are rich enough not to worry about it, then bully for you. But if your health insurance is tied to your job, I hope you don’t get fired and lose that insurance because then you’d be begging for the Canadian or British systems, especially since COBRA is so prohibitively expensive. (I should know, because I’m paying $550 for COBRA monthly.)

  5. But, Ms. Alderson, we Americans like our health care system too! We DON’T experience the horror of having to worry about whether we have the money to get medical treatment for ourselves or our children. The choice ISN’T between socialized medicine and a constant state of fear as to what might happen if one gets sick.

    I enjoyed visiting Entertain This Thought and reading your reviews very much, and will look forward to checking in from time to time. Clearly you see a good deal more theater throughout Ontario than we do — we go to the Shaw and Stratford Festivals but unfortunately only rarely get to shows in Toronto.

  6. We Canadians like and appreciate our health care system. I can’t imagine the horror of having to stop and think about costs when my children were sick. When my son needed surgery for spontaneous pneumothorax (collapsed lung quite common in teenage boys) he got it within a week, while American boys were sitting out a season of basketball waiting to see if their lungs would re-inflate.
    By the way, the father of our health care system, a socialist member of parliament named Tommy Douglas, was voted the Greatest Canadian a couple of years ago. Then a movie was made of the life of Tommy Douglas, starring Micheal Therriault, who is currently playing Peter Pan at the Stratford Festival.

  7. I can’t comment on how DD relates to how health care should be organised, but wrt “We wish the Brits luck” I can say “Thanks, we’re going to need it”. The UK govt is determined to shift to a US-style privatised health system, and destroy the NHS, which in spite of the bureaucracy actually works pretty well. The transfer of funds to GPs is intended to make GP practices into for-profit businesses where managing funds will be more important than treating patients. Every practice will need its own bureaucracy to handle the new responsibilities. Hospitals, currently an integral part of the NHS along with GPs, with regular funding, are being forced to compete for business in an artificial market. Before this transformation started (actually under the previous “Labour” government), hospitals in the UK were dominated by the consultants, the highest level doctors. Now they are increasingly dominated by business managers who decide what the medical staff are to do on the basis of profitability.
    You may not like your President’s health care plans, but let me tell you no one in Britain likes the Americanisation of the NHS, except obviously the health care businesses (often American-owned) that are set to profit. You may wonder how an elected government can carry out policies the electorate hates: the reason I believe is that for most voters the issue is very important but not near enough to top priority to change their vote.

  8. Hear, hear! Thank you for making these points, Emsworth. I was starting to believe that the entire world had gone mad, and that we’d have to pay for it.


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