Tuesday, April 13, 2010

Not Just a Thought: Under ObamaCare, Nurses will become Doctors

Consider the following facts:

* When government provides public education, we tend to get illiterate students and decaying schools at increasing cost to the taxpayer.

* When the government provides public roads we tend to get frequent traffic jams on roads that, in many cases, are impassable if not downright dangerous.

* When government provides public rail service (see Amtrak), we tend to get poor service, frequent crashes, and a business that hemorrhages taxpayer money.

So, what would happen if the government were to provide free pizza or health insurance to all?

To answer, one could integrate fundamental principles in economics, politics, and morality with observations from history and contemporary society and draw an obvious generalization:

Private enterprise, driven by the profit motive and competition, will tend to produce the highest quality goods and services in abundant quantities at the cheapest possible price. On the other hand, government, which has no competition and has little or no incentive to control costs or enhance quality, will naturally tend to produce the poorest quality goods and services in the smallest possible quantity at the highest possible price.

However, modern intellectuals, paralyzed by pragmatism, would not proffer such a generalization. They would answer something like the following:

"I don't know, and no one can know. However, the idea of free pizza and health care feels good to me, so let's try something. When we observe the results of our actions, we will get back to you, and if it doesn't 'work', we will try something else to get free pizza and health care."

If you think that is ridiculous, consider the following report:

Facing a public still wary of his massive health care overhaul, President Obama urged Americans not to judge the nearly $1 trillion legislation he signed into law last week until the reforms take hold.

He continued: "It's been a week, folks. So, before we find out if people like health care reform, we should wait to see what happens when we put it into place. Just a thought." [emphasis mine]

Well, actually, no Obama, it is not a "thought." Such a statement represents, at best, an evasion of at least all the accumulated knowledge in economics and history.

This example provides a tidy demonstration of the epistemological disease which grips modern intellectuals and is destroying our country: the disease of pragmatism. What advocates of reason and freedom must grasp is that we are at war philosophically, not just politically - something I have blogged about extensively.

The Internet Encyclopedia of Philosophy entry on Dewey describes his pragmatism as follows:

On this view [pragmatism], inquiry should not be understood as consisting of a mind passively observing the world and drawing from this ideas that if true correspond to reality, but rather as a process which initiates with a check or obstacle to successful human action, proceeds to active manipulation of the environment to test hypotheses, and issues in a re-adaptation of organism to environment that allows once again for human action to proceed.

Ayn Rand said that pragmatism holds:

that philosophy must be practical and that practicality consists of dispensing with all absolute principles and standards—that there is no such thing as objective reality or permanent truth—that truth is that which works, and its validity can be judged only by its consequences—that no facts can be known with certainty in advance, and anything may be tried by rule-of-thumb—that reality is not firm, but fluid and “indeterminate”...

Quoting Dr. Leonard Peikoff:

In the whirling Heraclitean flux which is the pragmatist’s universe, there are no absolutes. There are no facts, no fixed laws of logic, no certainty, no objectivity.

There are no facts, only provisional “hypotheses” which for the moment facilitate human action. There are no fixed laws of logic, only mutable “conventions,” without any basis in reality.

In other words, belief that the health care bill will cause some outcome is merely a "provisional hypothesis." Obama is waiting for results, and then and only then will we know if it worked.

Yet, earlier, I relied on a generalization to predict that government health care will result in poorer quality, a claim already confirmed by this article, which reports that given the expected doctor shortages, nurses are expected to essentially replace doctors:

For years, nurse practitioners have been playing a bigger role in the nation's health care, especially in regions with few doctors. With 32 million more Americans gaining health insurance within a few years, the health care overhaul is putting more money into nurse-managed clinics.

Those newly insured patients will be looking for doctors and may find nurses instead.

Ayn Rand made another observation related to pragmatism that seems hyperbolic but is not. She said that the pragmatist holds that "whatever one wishes to be true, is true, whatever one wishes to exist, does exist, provided it works or makes one feel better." Now consider this fantasy offered by Obama in the earlier article:

"This health care tax is pro-jobs, it's pro-business and it starts this year," Obama said.

Someone should have asked him how he can know that? After all, the program has only had a week to work...


Stella Zawistowski said...

Nurses doing the job of doctors is not, in and of itself, a bad thing. It is, for example, a very good thing for retail health clinics to offer care from a nurse practitioner for routine health problems at cheaper prices than a doctor. In a free market, prices would provide a signal to patients that they might want to see a nurse if all they have is a sore throat, freeing up doctors to spend time treating patients who have harder-to-solve medical problems.

But, of course, it is a very bad thing for nurses to do the work that ONLY a doctor should perform -- and that could very well happen under ObamaCare. If millions of extra patients are suddenly demanding to see doctors for every ailment, no matter how small, then some of those patients are going to be pushed to nurses -- and you can bet the decision for WHICH patients are pushed to nurses isn't going to be based on the medical merits of the case.

Doug Reich said...

Excellent point! Thank you.