The triage of money – the cost of free

Health care confusion

 2012-12-26 intensive-care

American Democrats, Canadian liberals and socialists all over the world like to get righteously indignant when conservatives of any stripe use the expression “Death panels.”  Yet, in Canada today there is a case in front of the Supreme Court about just that. They will decide who can decide over matters of life and death. Relatives, doctors or ‘independent’ (i.e.: government) organizations such as the “Consent and Capacity Board” of Ontario. All you leftists please note, that this is NOT a death panel. This is absolutely clear from the fact that it is not called that way.
What the Supreme Court will have to make a decision about is whether the doctors or the CCB can have the power to overrule the wishes of the patient or their representatives.

You can read The Globe’s take on the case and the CBC’s, but the essence is this:

Hassan Rasouli, a devout Shia immigrant from Iran “has been on a ventilator and feeding tube for the past two years at Sunnybrook Hospital in Toronto, after bacterial meningitis destroyed parts of his brain following surgery for a brain tumour.”

The doctors say his case is hopeless; the family has faith in his ability to recover. They clearly do not have enough faith to believe that he can recover without the very expensive hospital care but they do have faith in the courts to decide that the Canadian taxpayers should pay for it indefinitely. It is not clear how much faith these devout Muslims have in their own God, but since Allah did not yet express his wishes and intentions, for now the case is in human courts.

The CBC coverage of the issue has a very interesting tweet-stream from the courtroom that was obviously turned into a forum for political interest groups to champion their pet causes. The comments are also instructive.

The world of decisions – a system of triage

The case is about decisions, or to be precise, a decision about who can make decisions.
In the real world, lots of decisions have to be made. Hospitals have to be built, the cleaning lady’s salary must be set, cleaning supplies are to be bought, nurses must be paid, operating times need to be allocated. Hospitals have to decide which doctors to hire, the ministry (the system) have to decide how much to pay them, regulators of the system have to decide what to cover. All of these decisions come with a price tag. NOTHING IS FREE, except, maybe the time of volunteers here and there.

In theory we can say that these decisions can be debated, in practice we cannot. That is the nature of delegation. We cannot have a referendum on every case, every procedure and every medicine, every particular minute of waiting time, or any individual life for that matter. The only thing that can be debated is the role of the decision makers.
I really do not like anything run by the government, but we have to understand that any decision affecting the system has far reaching consequences.
We have ‘X’dollars in our budget for health care. If we put the money ‘here’, we may not have enough to put ‘there’. The money can be allocated in many ways. We have long waiting times in emergency rooms, waiting lists for some procedures, we have considerations about the optimal frequency for some screening tests and about the scope of services to be included in the list of ‘free’ services. Dental care is out, sex change operations are in. Breast enhancement is out, but labiaplasty is in, provided that the procedure is performed by a gynecologist who is convinced that it is necessary.
The point I am trying to make is NOT that the decisions are arbitrary, but that they have consequences.
Two million dollars spent on a hopelessly comatose patient may be spent better somewhere else. It may reduce waiting times for other procedures. It may save the life of someone who would otherwise die waiting for an operation.
If it was your money, nobody could or should question how it is spent, but the money is not yours. Once we agreed to give up the right to be responsible for our own decisions, we have to accept whatever decision our surrogate decision makers make. If we do not want to make hard decisions about our own lives, our delegates must.

The only problems with decisions are trade-offs and consequences. Those who like to shy away from decisions do so because they do not want the trade-offs or do not want to face the consequences, because they are afraid of making bad decisions. Isn’t it wonderful when someone promises to free us from this burden? Isn’t it lucky to have politicians doing exactly that? They take our money, and make all the decisions for us. In the case of Canadian Health care, just to be sure, they even forbid us to make decisions for ourselves.

Once they have our money and the responsibility to make decisions, they do make decisions, and the real cost to us is not the money we pay through our taxes but the very freedom to make the decisions ourselves.

The cost of free is freedom

In the article, a doctor says:
“Right now [health care professionals are being] constrained to being only informants and not decision-makers. The pendulum has swung to the family making demands that at many, many levels are unrealistic or illogical or even futile,”

The good doctors clearly wish to have more power. They would like to have the power to make rational decisions in a system of unlimited demands over limited resources. If we had a free market health care system, this wouldn’t be an issue. They would be happy to offer the services as long as you (or your insurance company) would be willing to pay for it. Your demand for their services would not be a drain on their resources but an incentive to provide the service. In a free market, you would be the customer.

Someone commented on the Instragram controversy about all the ‘free’ stuff on the internet saying that “if you’re not paying for it, you’re the product.”
This is what the system is about. This is what ANY government service is about. If you are not paying for it, you are the product. You only exist in the system so that profit can be extracted from the real customer – the one who pays – the government. The fact that the money ultimately comes from you does not matter. The existence of the intermediary makes it irrelevant. The customer of the state financed services is the state itself and the most important ‘good’ they are buying is the loyalty of the service providers.
How much they are producing (health care, education, whatever) does not depend on the needs of the product (you) but on the will of the ruling class and the political power of those who can influence it. I tried to illustrate this fact with my very first post, the story of my broken clavicle. I FELT like a product in the machinery of government services.

Unfortunately, this is the system the majority of us wanted. A majority that will keep asking for other people’s money until it runs out and we all end up in misery.
How can we tell to this majority “YOU ASKED FOR THIS, now LIVE WITH IT!” How can we tell them that “If you want to live like sheep, you should be prepared for the slaughter!”

We spent a few centuries to build a world where we can have control over our lives just to slowly give it up now out of sheer laziness and cowardliness.

The real problem for me is not the sheep, the suicidal stupidity of the political left but their usurpation of power, their ability to drag the rest of us down with them.

The real problem with this case is that it does not matter what the outcome is, either way will just take us one step closer to the abyss. Either we will hand over even more power over our lives to the system, or we push it one step closer to bankruptcy and politically motivated irrational decisions with increased level of overall rationing of services. There is no good outcome possible.

The questions

….I didn’t see anybody asking. I am not trying to be flippant, regardless of the way the questions are asked, they should be subject to some serious discussions.

  • “Speaking with reporters, Rasouli’s wife, Parichehr Salasel, said she was a physician who had practised for 30 years in Iran, where she had never seen a doctor who told a patient there is no hope.”
    If the Iranian system is so clearly superior to ours, why exactly did they come here?
    It was pointed out in the court that they are devout Muslims. Could it be that we are witnessing Health-care Jihad? That this whole case is an act of self-sacrifice through which they are trying to nudge our system on the way to become as amazing as the Iranian one?
  • If she practiced medicine in Iran for 30 years, they must be recent immigrants. One must wonder, how much did they actually pay into the system from which they now expect unlimited resources?
  • When our good friends in the Iranian media (the ones interviewing our natives about our concentration camps) are reporting on the case, what will the headline be?
    Canada spent millions on keeping brain-dead Iranian expatriate alive on life support
    Jewish doctors want to kill devout Muslim in Ontario hospital’?

……just wondering……………..

7 replies on “The triage of money – the cost of free”

  1. Most unfortunately, these expat Iranians do not appear to have, or want, the freedom to choose to whom they will give their health care business, unless they were to pack up and move to the USA and raise the necessary funds from those who are sympathetic to their choices. Or perhaps move back to Iran? Single payer = single decision maker.
    • zorkthehun says:
      An hour after posting this, as I was driving to see a friend, I already had second thoughts. Not about the general message, but the tone. That it may be seen as harsh and heartless.
      My post is NOT about the people or this particular case. I understand the pain, I understand the position. My post is about the system in which these problems, these outcomes are not only predictable, but inevitable.
      The source of my frustration are the people who are asking for it. We have a bad system that needs to be changed and this is not the case that will change it. If anything, it will make it even more entrenched.
    • EimaiSkorpios says:
      Does it really matter who these people are when the real issue is medical incompetence or malpractice culpability? If the law says we will cover them then we have to cover them. If we don’t like the law, let’s vote to change it. But we don’t seem to do very much of that. Low voter turnout means people don’t care and the majority of those who do seem to love socialism. So the issue isn’t that the Rasoulis are newly-arrived Iranian Muslims, it is really all about something else … isn’t it.

      Digression: Actually, as long as a hospital in the U.S. is receiving any public funding, they can not turn away patients. If you can’t afford the care — in the majority of cases mind you, because there are always exceptions — you will still receive it at a minimal cost or the hospital will write it off. If, however, the hospital treats you and turns a routine operation into a nightmare as a result of incompetence or malpractice, there won’t be any plug-puller hovering over your bed. To the contrary, everything will be done to mitigate the disaster. In the United States, the patient is still the customer with a great deal of clout. Once Obamacare settles in and gets comfortable, it will be just like Canada where democratic ideas are the stuff of debate but democracy is suspended when it’s time for our betters to make decisions for us. And we seem to like it that way.

      A little more digression: The average family in the U.S. pays about $5.5K a year for superb health care and health providers compete for their customers. I know, I lived and worked there for almost 7 years. We pay an average of about $4.5K PER PERSON to be treated like liabilities and receive lousy care. And we still have to pay for our dental and eye care. Hello!

  2. EimaiSkorpios says:
    Well, from my perspective, here is the game-changer: What if the doctors at this hospital were responsible for this man’s condition as the result of a botched surgery or post-surgical care? What if the man’s wife, also a physician, argued vehemently with the medical staff with respect to the correct treatment for his contracted bacterial meningitis and it turned out she was right and they were wrong? What then?

    I’m no champion of any if the players in this farce but I do believe in responsibility and I do believe these doctors are responsible for Rasouli’s condition, regardless of who he is or what his legal status may be.

    Here’s and excerpt from the Metro News site ( ) that tells more than the others want to tell us:

    Begin excerpt:

    Hassan Rasouli’s downward spiral from healthy man in his late 50s building a new engineering consulting business in Toronto to bedridden patient in what doctors called a “permanent vegetative state” unfolded with startling swiftness.

    He complained to his family doctor of slight hearing loss in his right ear in August 2010.

    That triggered an MRI, which revealed a benign tumour.

    “When the results came back he put the paper on the shelf in the kitchen and went into his room,” recalls daughter Mojgan, a 29-year-old graduate student in urban studies at the University of Waterloo.

    “He didn’t say anything. When my mom came home and read it, I remember she was crying. She’s a doctor and she knew it was a brain operation. For days, everything was silent in the house.”

    The operation went perfectly.

    The aftermath did not.

    “After the surgery I kept saying to the doctors in charge and the nurses in charge, ‘Why his situation got worse instead of having improved,’ and they told me it is normal after the surgery,” says Rasouli’s wife, Parichehr Salasel.

    “It was not normal. But they let him to reach to this point, getting hospital infection which lead to his coma status, and do not try to prevent this simple hospital infection.”

    Within days, Rasouli would be lying in a coma from bacterial meningitis acquired at Sunnybrook.

    “My mind was empty,” Mojgan says. “I was in shock.”

    Doctors were brusquely matter-of-fact with their explanation, she alleged in an interview.

    “They just said, ‘Sorry, he got meningitis from the operation. It happens. We do not know the source. But do you really want your father to stay like this? He’ll never, ever wake up.’ My mom collapsed on the floor.”

    Doctors have insisted in court records that Rasouli’s meningitis has left him with “permanent, severe and diffuse brain damage.”

    End excerpt.

    Now what, folks? Now how do we tell these people we’re sorry for killing their husband and father? Sunnybrook is being sued by many more than just the Rasoulis over almost identical reasons. What about all the people who were murdered by Ontario Hospitals that allowed their standards of hygiene to drop so low that hundreds of innocents, who should still be alive today, perished as a result of complications arising from clostridium difficile infection?

    No, the issue goes much deeper than this one case or the far reaching implications of the Supreme Court’s decision based on the “don’t-confuse-me-with-the-facts” dog and pony show going on right now. We know our Supreme Court is incompetent (the recent “niqab-in-court” non-decision, decision). We know our health system is a failure and run by more bureaucratic incompetents (noun). We know that the doctors in this case just want it to go away and are hoping that the decision will come expeditiously with lots of consensus because Rasouli is a Muslim non-Canadian; thereby setting a precedent to dissolve all their other outstanding litigation. And we know it’s all about culpability and the potential cost of that culpability. We want to perpetuate the “you-can’t-sue-government” attitude in Canada, and if you can, it will take several lifetimes (unless of course you are a First Nations person and then you don’t even have to sue … public largess is showered upon you).

    In this case before the Supreme Court, everybody has a dog in the race whether they realize it or not. If the Canadian people are so stupid as to let this one set precedence without knowing all the details, then I want to be in the cheering section when they go in for a wart removal and end up having their life support terminated with not so much as a, “Ta-ta for now sucker”.

    • zorkthehun says:
      I KNEW IT!!!!
      Thanks David for this information.
      At the end of my post I had a question alluding to this possibility, but I cut it out the last moment because I did not have the facts. The whole story stunk malpractice all over, so I did some research about the possibility/probability of post-operative meningitis and decided in the end to cut the comment.
      A very close friend of ours died due to medical incompetence that the doctor managed to BS his way out of. “It was difficult to diagnose.”
      The problem, as you pointed out, is the “you-can’t-sue-government” attitude which makes it nearly impossible to mount successful malpractice cases.
      This is what government sponsored entities receives for their compliance and servitude – immunity from the consequences of their wrongdoings. What they are asking for in this case is even more power to cover up their own screw ups.
      • EimaiSkorpios says:
        I had a leg up on this one Zork, a friend of mine (an evangelical believe it or not) has been helping advocate of for these people for a couple of years. I know the details very well. So when Canadians decide to leap to judgement, they only do themselves a disservice in the interest of preserving their socialist world. But that ignorance will lead to their own peril.

        The Ontario Healthcare system nearly killed me twice. Once through malpractice and once through insufficient services due to cost cutting at the patient care level. The cost cutting should have been at the bureaucrat level where masses of useless parasites suck the life’s blood from the system. But no one thinks in those terms, do they? That wouldn’t be good socialism, would it?

        The Ontario Healthcare system killed my mother and hundreds of others because they cut patient care to the point that we filled our hospitals with under-trained staff who couldn’t be bothered to take simple hygienic precautions toward cleanliness to stop the transmission of a deadly bacterium. We fought, we yelled, we threatened both physically and legally and we demanded accountability. We even tried to move her to a different hospital but we were fighting a conspiracy of corruption. In the end the family watched her decline and die of an infection she contracted in that damned hospital. No one has been held accountable.

        Yes, this whole case is about everything else but the truth that Canadians are the most lazy and gullible sloths in the hemisphere. Let freedom perish … just give me the free stuff! That should be on our flag for the little time left that we even have one. Let quality, accountability, humanity and honour effervesce as though it never existed … just don’t ask us to get involved!

        No, the Americans are not paying attention and are close on our heels in the race to oblivion.

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