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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