Liberty and Medicine

Sunday, April 29, 2007

When judges try themselves: the problem of socialised medicine.

I want to paint a scenario for you. Imagine a privately owned hospital, owned by a for profit corporation. At this hospital numerous premature infants die. The reason for the death is that the corporation did not maintain the ageing plumbing system and it was infested with a bacteria. The tap water literally killed the weakest patients and made many others sick.

Of course parents are traumatized over this matter. And as they would be expected to do they demanded that the hospital tell them what happened and why. The hospital refuses to do this. And the reason is that the corporation has a policy forbidding the revelation of such information to the parents. A top official of the corporation is asked why this information was keep secret and he says that public disclosure of this incident was not needed since the bacteria did not pose a threat to most people. It did post a threat to some however but not most.

In addition he says that secrecy over the deaths were warranted because they happened over a year ago. He also says that it was warranted to sweep this under the carpet because he didn’t think it would happen again. And if the public knew that several dozen babies became ill due to bad plumbing, with four deaths, they would “get the message” the hospital posed a “widespread risk”.

Under those conditions what do you think will be said about the private provision of health care by a profit-making corporation? Would you be surprised if there was an outcry that the hospital be nationalized with its supervision turned over to the State?

Something like this did happen at the Ste.-Justine Hospital. The pseudomonas bacteria was growing in the plumbing system. Four infants died as a result and 50 became ill. The hospital was not owned by a corporation but is part of the socialized health care system in Canada. And administrators refused to tell parents the cause of death because laws imposed by the State forbade them sharing such information with parents.

The public health department director said that it was fine to keep this information under wraps because it didn’t threatened everyone, had been over with, wasn’t going to happen again, and because he didn't want parents thinking the hospital “is a place full of germs and danger.”

In this case the government covered up for one of their own hospitals that was killing patients due to bacteria that was allowed to grow in a water system that had not been adequately maintained. Not maintaining things is another way that socialized medicine can “hold down costs” in its drive to prove it is cheaper than private care. Of course cheaper care is not necessarily better care or even equally sufficient care. And in this case it was deadly care.

Socialized health care in Canada is State-owned health care. The State is the corporate owner of national health services. So the owner basically enacted a law ordering another brach of the same entity to hide information that would embarrass the owners.

A private hospital acting the same way, with corporate owners making similar remarks, would be in for some serious legal scrutiny by the State. And a rule imposed by owners, mandating keeping the cause of deaths secret, would be deemed a cover-up. In the private market the parents of the dead infants would have a major law suit against the corporate owners.

If it were shown the hospital neglected maintenance in order to hold down costs, and then hid the truth from the parents, it would be unlikely this hospital would win any sympathy from a judge or jury. And there would be a State legal investigation regarding this neglect.

In this case the entity that is responsible for protecting people’s rights is the same entity that owns and operates the health system. That doesn’t bother advocates of socialized health care one bit. But it does worry me.

If this had been a private company no one would accept as valid the idea that one arm of the company is considered an “unbiased” judge of other branches of the same company. If McDonalds accidentally poisoned a few dozen children and then hid the information most people would want an independent investigation. If the matter goes to court, and it would, we’d also want a judge who is not employed by McDonalds.

How do you get this sort of independent investigation with a socialist enterprise? The State owns the health care service. The State sets the rules by which the service operates. If something goes wrong the State investigates the service. If a legal case is made the State judges the facts

To understand the problem consider a sport which has players interacting with one another. The game has some rules to it. And on the game field there is a referee. The referee observes the players, adjudicates disputes, and makes sure that the basic rules of the game are followed. His job is to be an independent judge of the conduct of the players.

But what if the referee were also a player in the game? Immediately problems are created. How can a player in the game be expected to judge the conduct of other players. And what if he is not just a player judging whether others are playing according to the rules but is also allowed to make up the rules as he goes along? Better yet he can make one set of rules for himself when he’s playing and another set of rules for others.

This is precisely what happens with a socialist enterprise. It is owned by the State. It has become a player in the game. But the State makes the rules by which everyone is playing and it judges whether people are playing fairly or not. As a player in the game it has a tendency to make one set of rules for itself and another set of rules for everyone else. It rigs the game in a dishonest fashion.

If a real game were played like this you would see players quitting and walking off the field. How can you honestly compete on the field when some players have special rules for themselves? If the referee can have his services purchased how can he fairly judge disputes? He can’t. If the referee is actually playing in the game how can he fairly judge disputes? He can’t.

When the referee joins the games he not only distorts the process of the game but he ceases to be an effective referee. The one task that justified his existence in the first place is neglected out of necessity as he becomes intertwined with the task of being a game player.

In normal judicial matters a judge is removed from cases if he has a personal stake in the matter. It is known, that even with judges of integrity, that it is often difficult to judge honestly when one is involved with the litigants. A judge would not be allowed to sit on the bench in a case involving his own mother.

But socialism requires this to happen. It makes the State not only the referee in the game but a player as well. The judge in the case is directly linked to specific players in the game. He can write rules that favor his team as he goes along. If referees started scoring goals in a game people would be upset. Yet they seem unable to see the problem of having the referee in social interactions, the State, playing directly in that game to the benefit of one team over another.

This case in Canada showed that the State is a poor referee or judge in matters involving itself. State bureaucracy has repeatedly been shown to be unable to honestly judge its own activities. But socialism inherently creates this conflict of interest. It makes the referee a team member and allows him to pass judgement on his own actions. And the results of a game played in that manner are bad for everyone except the referee in question.

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