Are doctors who complain about medicare just whiners?
We all know that society needs good government.
Government maintains order, protects private property, and wins wars.
Shouldn’t it also manage and distribute something as precious as health care?
Many people think that single payer health care is the only moral and just way to provide care.
If we judge society by how it treats its most vulnerable citizens, then we must have government play a central role in providing care.
Medicare and Baking
We can capture single payer health care with two analogies: baking a cake and raising a child. People might recognize cakes and kids from complexity theory, and they would be wrong. This is different.
Baking With Passion
Imagine you are born foodie. You have a passion for the smell, taste, and preparation of food. You take courses and perform at the top of your class.
Eventually, you travel to a distant land, learn from the best bakers, and return home as a certified doctor of bakery (with huge student debts of course).
A small town in Iceland needs cakes desperately. So you start a bakery there. The government provides all the ingredients. You just bake and serve cakes to the community.
You bake like mad: late at night, all weekend, and on holidays. People love your cakes, and you love baking. Your baking improves as you adjust cakes based on the needs of your community.
After 10 months, a woman with a suit and clipboard shows up. She reminds you of Professor Umbridge, from Hogwarts. She has come from the government and is there to help.
The cost of flour, eggs, and sugar have spiked in your community. She says that ingredients will now be delivered in blocks, once a month, based on comparable per capita cake usage in other communities across the province.
The government will factor in the average increase in the number of cake eaters, including demographic changes in cake consumption. Everyone knows that older people eat more cake, because they have more free time to do so.
As a baker, you find this all a bit odd. You care most about baking great cakes, exactly the way people like them.
The government suit seems more interested in eggs and flour. However, your observation of oddity soon passes, as your passion for baking drives you to provide cakes.
More Cakes, Please
After a few months, your community has grown faster than average. People love your cakes, and high cake consumption creates more babies per capita.
Other towns hear about your cakes. Soon people sell their homes and move to your community.
At the same time, people start asking for the new, high-protein, keto-cakes, which require three eggs instead of only one per batch.
So you buy the latest, high-tech egg cracker to help you keep up. Based on demand for cakes, you hire two servers, a baker-apprentice, and begin plans for expansion.
Unfortunately, you run out of eggs. Hungry customers must stand in line until the government sends more eggs. But they only wait a day or so, at first. Cake eaters are polite people.
Then you run out of milk. And flour. Soon you are running out of everything by mid-month.
Help Arrives
The woman with the suit returns. She checks the temperature of your fridge, measures the width of your shop door, and comments on the need for your wheelchair ramp to have adhesive grips. Simple ramps are not safe.
You thank her and ask about the eggs, milk, and flour. Isn’t that why she came to help?
“Yes, about that…“, she says.
“We see that that you are not choosing eggs wisely. This is cake negligence. Clearly you have no respect for your social cake contract, which binds you to the needs of community as a whole, not just individual cake eaters.
Furthermore, you cannot hire cake servers. Bakers must serve each customer themselves or forfeit payment. We will not tolerate innovation or a ‘low rules‘ environment.
And that egg cracker you purchased has clearly made your job easier. So the government will be decreasing the amount of flour it sends. You can buy the extra flour yourself.
Also, we will be sending you a checklist of baking best practices. We will measure your baking performance by sampling how well your customers eat the cakes you give them.
You must enter daily customer body weights into the electronic cake record.
Studies show that daily weights serve as surrogate for cake consumption, which indicates your proficiency as a baker.
We expect you to keep careful notes on every step you take in baking cakes, including all the steps you considered taking but did not think applied to the particular cake in question.
Great bakers maintain continuing baking education courses. So we will track your hours of baking classes to maintain your baker’s licence.
Oh, and one final thing…
We have instituted baking peer review. Don’t be surprised if a Celtic baker drops by to assess how well you bake for your Icelandic community.”
Satisfaction Survey
The next day, you receive a Bakers’ Satisfaction Survey from the Icelandic Bakers’ Association. It asks:
- How satisfied do you feel as a baker?
- Would you recommend baking as a career to young foodies?
- Do you have any plans to retire in the next 10 years?
The Essential Ingredient
We could go on: a continuous stream of newspaper articles about bad bakers; Icelandic politicians slandering bakers and inciting envy amongst voters against elite bakers; new legislation about baking without any input from bakers; and more.
But even with all that, this analogy is still too simple. Health care is complex, more like raising a child.
Central planning of health care is like government trying to ‘help’ you parent. How many lullabies did you sing at bedtime? Did you document your bedtime routine? Did you follow a bedtime best practices checklist?
We must bake cakes before distributing them. Before we can build a system that offers cakes to everyone regardless of ability to pay, we must know the essential ingredient of great cakes.
A Priceless Commodity
Great cakes start with a passion for baking. The desire to bake is internal to the baker. It is a gift to the community.
And the desire is fragile. The passion to bake survives when bakers bake things that their customers love to eat.
There are one thousand ways to crush the passion to bake. Once gone, it might be impossible to reclaim.
Central planners change the provision of health care by dictating its distribution. They crush the passion to care in the process.
Great care starts with the passion inside the physician. When doctors complain about government run medicine, they are not just whining. They are trying to protect the essential ingredient of great care.
There is a class of theoretical academics who despise the reality of baking cakes.
They have their ideologically “ virtuous” intellectual theory of how cakes should be baked and distributed and intend to impose it on society without really caring how their ideas actually affect bakers and consumers.
Their virtuous status makes them impervious to criticism no I matter how negative the outcome…the unforeseen negative
outcome being, obviously , the fault of the bakers and consumers.
They then send in that inspector with the clip board / iPad with its bake wisely guide lines and protocols to oversee the guilty parties and bring them to heel.
The ultimate judge of a cake maker’s product is the consuming customer…not the government, not the advising academics with no skin in the game ( they don’t get tarred and feathered if their theories don’t pan out…instead they get promoted and go on power point lecture tours) , nor the baker’s peers…its the customer !
Well said, Andris.
I especially liked your comment about academics “…who despise the reality of baking cakes.”
Thanks again for taking time to read and comment!
Cheers
An apt metaphor which clearly clarifies the sad state of Practicing Medicine with a Passion in today’s bureaucratic and uncompassionate world.
Thanks Don! Well put.
Hmm…socialized medicine, doing the most good for the most people. What happens if you don’t fall into the most people category?
Exactly!
What if you aren’t one of the chosen who get care?
I am so tired of people trumpeting great care. It’s like a survivor of the Titanic chortling about the cozy blankets, tasty snacks, and strong handsome sailors who rescued her.
We need to focus on care at the margins. We cannot provide a life-saving service and congratulate ourselves on how we do for the average patient. It’s either life-saving or it is not.
Thanks for posting a comment!
“Central planners change the provision of health care by dictating its distribution. They crush the passion to care in the process.”
They also make sure that the bakers are blamed for decisions made by central planners…
Precisely. First rule: blame someone else. It also helps if those you plan to blame are on record as not liking what you planned. This serves as evidence of subterfuge.
Great to hear from you, Paul! I hope you are well and trying to raise eyebrows by saying what others are too scared to mention.
Cheers
Great analogy Shawn and agree completely with all the comments.
Those Icelandic Central Planners have much to answer for huh Shawn?
It seems they have honed their skills for deception, evasion and obfuscation so finely that they have convinced even themselves that they are always right and by extension the bakers and customers are wrong. Even if these Central Planners were bakers themselves in the past they have long ago lost the skills and their passion for baking.
Generally Icelandic Central Planners avoid mixing with bakers or customers – except those who have been carefully preselected because they agree without question with the Central Planner’s pronouncements. If by chance an Icelandic Central Planner, during a brief sojourn from their Ivory Tower, encounters a baker or customer who has the impertinence to disagree with them The Central Planner will deflect/ignore/delete/mute/block that individual as required. Thus the Icelandic Central Planner can maintain his/her equilibrium and will not be troubled by doubts sure in the knowledge they are (and always will be) correct.
The above is an abridged excerpt from the Iceland Central Planner’s Manual “Tips for dealing with difficult bakers” and ” How to get promoted from Icelandic Central Planner to Icelandic Politician”
Haha! This is brilliant, Helen. Thanks for sharing.
I really like your point about insulating oneself from outside opinion. I was just reading about how the CPSO and the OMA were dominated by academics who were deemed ‘reasonable’ by government at different times in the 80s and 90s. Of course, this would invite a take-over by a bunch of bedside trouble-makers. But then things would slide back.
We need to find ways to help everyone understand what’s at stake. I believe government — politicians, bureaucrats, regulators — could maintain a decent system if they were ALL committed to being referees, not players. Even then, we’d still have a system with very little innovation or choice, but not necessarily so. The trouble is that every person employed in the Gatekeeper industry feels that they need to make their mark, to demonstrate that they have accomplished something good. Then we all suffer for it for decades until some brave party undoes the program.
Thanks so much for taking time to read and post a comment!
You got the analogy wrong, Shawn. The bakers buy their own flour, eggs, and supplies. The Overseers just exist to comment and complain– and cut what they pay for cakes when they run out of money somewhere else.
Great comment, Jodie. For community care, you are absolutely right for most of the care we provide!
Thanks for raising the point.
Cheers
Best thing you’ve written Shawn 🙂
Clearly a labour of love. Thank God the government didn’t send you an editor to ‘help’.
Wow! Thanks Matt. Really appreciate this.
Sorry for the late reply. Was working on a lecture. Really appreciate you reading it.
Yes, thank God government didn’t come to help — too funny!
Be well,
S
Perhaps more allegory than simple metaphor here.
Every visit to your blog gives opportunity to bathe in the intellectual passion which you (and your readers) create …. and makes me appreciate even more what a privilege I enjoy.
Wow. Very nice of you to say this, Mike! Thank you.
I am so glad that you pointed out the comments. Readers especially love the comments: It’s where the passion comes alive.
Thanks again. Great to hear from you!
Cheers