A Provocation From James Pinkerton: Playing God — Whose Lives Are These Anyway?


This is the second installment in James P. Pinkerton‘s provocative health care policy series for The Washington Note.
Pinkerton is a contributor to the Fox News Channel and a policy blogger. Pinkerton is also fellow at the New America Foundation, and contributing editor at The American Conservative magazine.
“Playing God.” We all know the phrase, because we all know the temptation. That is, we know the temptation to make decisions for others – even the most profound decisions of life and death.
Remember the play/movie “Whose Life Is It Anyway?” It was a poignant tale of a man, paralyzed from the neck down in an accident, who wants to end his life. Such “death with dignity”-type assisted-suicide cases are controversial and the stuff of great drama, because those with power are able to determine the life, or death, of those without power.
But an even larger issue is the great drama of medicine – who is healed and who is not, who lives and who dies. The elites prefer the dry phrase “health care” over the evocative word “medicine”; it is their way of lulling us to sleep while they make decisions for us. So the elites prefer that we not discuss Serious Medicine, and whether or not we all get it, because any such discussion would get in the way of elite planning.
And the elites, of course, are all planning to spend less on medicine. They know that for every individual like the character who wants to die (played by Richard Dreyfuss in the 1981 film), there are 100, or a 1000, who want to live – and that costs money.
So the question for today: Do the Powers That Be think that we are worth saving, or do they think that it’s cheaper to get rid of us? The answer would seem to be the latter. That’s the consensus emerging from the self-appointed and self-reinforcing circle of “experts” who have occupied the commanding heights of “health care policy” and related fields of arcana, such as “bioethics.” The mantra of The Experts is simple and oft-repeated: Cut back on care, do less, save money – in keeping with an overall Green-inflected sense of the limits to growth, of the limits on human potential.
And so we have “a duty to die and get out of the way,” as former Colorado governor Richard Lamm revealingly asserted back in 1984. Few have been so candid since, but one maven of that school, Peter Orszag – a leading Democratic voice on health and fiscal policy for years, now director of the Obama administration’s Office of Management and Budget – has long argued for the rationing and restriction of health care. Here’s one snippet of his argument, as noted by Peter Ferrara in the pages of National Review:

Future increases in spending could be moderated if costly new medical services were adopted more selectively in the future than they have been in the past, and if the diffusion of existing costly services was slowed.

Now that puts the hay down where the horse can get it. New medical services should be “adopted more selectively,” and “the diffusion of existing costly services [should be] slowed.” Got that? In other words, ordinary people would lose out on medical care – and deliberately so. One can only ask: Shouldn’t these policy-choices be discussed more openly? Shouldn’t the citizens and health-stakeholders of this country get more of a say – instead of being spin-doctored into scarcity masquerading as “universality”?
Today’s elites don’t think that decision-making should be shared. Of course, elites never want to share power. That’s why they’re elites.
Yet surely the rich have nothing to fear from Obamacare, they might be telling themselves. And in the short run, there’s no need for, say, Steve Jobs to worry, because as he demonstrated earlier this year, he has a blank check for his own health care.
But in the long run, Jobs and everyone else, no matter how rich, should be worrying – because the trajectory of future health-care research is being flattened. Of course, the Orszagian health-care rationers will deny they are cutting back on research and, subsequently, development. We are just controlling costs, they say.
But history shows that R&D comes from within big surpluses, from surpluses that allow scientists and engineers to noodle around on blue-sky projects. That was the story, for example, of Bell Labs, established by AT&T in 1925. “Ma Bell” was reaping monopoly profits in those days, and so it could afford to let Bell Labs employees delve into abstruse projects, many of which had little to do with the humble telephone.
The non-bottom line byproduct of this flush funding was six Nobel Prizes – including the 1997 Nobel Prize for Physics won by Steven Chu, now Secretary of Energy. But until the megacompany was broken up by anti-trusters in 1984, AT&T obviously thought it benefited from its expenditures on Bell Labs; its scientists developed everything from the transistor to the laser, from UNIX to radio astronomy. The generous benefit to all humanity from this nominally for-profit enterprise has been incalculable.
By contrast, the phone companies today are lean-and-mean profit machines; they are mostly marketing operations, and so the forward progress in telecommunications is now coming from elsewhere, from the super-profits generated by companies such as Apple and Google, which carry on the Bell Labs tradition.
The point is this: Be it electronics or health care, the money needed to fund R&D – and then to build the momentum needed for mass production – can come only from an initial surplus. And such mass production, of course, eventually leads to a dramatic lowering of costs. That’s the rule of technological development: New things are expensive, until they get cheap. No way around it. And so if we are cheap in the beginning, as a matter of policy, not only will we neglect discovery and innovation, but we will never get to the point where we can bring down the per-unit cost. In being cheap, we will simply have less.
So let’s take an illustrative example from recent medical history: AIDS. Is AIDS medicine expensive? Sure it is. But how much was AIDS costing us when it was cutting people down in the prime of their lives? How much output and creativity was lost when Halston died? Or Keith Haring? Or Steve Rubell? Or Stewart McKinney? Or Ryan White, the unlucky recipient of a tainted blood transfusion who died in 1990 at the age of 18: Who knows what he would have done with his life?
Those losses were bad enough. Fortunately, nobody in authority said that AIDS victims had “a duty to die and get out of the way.” Instead, as a civilization we faced up to the challenge and spent what it took to address the epidemic. Medical research complexes, such as NIH, functioned the way Bell Labs once functioned; they threw money at smart people, confident that the human brain would eventually solve the riddle of HIV. Out of that riddle-solving came new treatments, such as AZT, which cost billions to develop, but which can now be retailed relatively cheaply. And so today, in the West at least, AIDS is a chronic problem, but not a mass-killer.
And so anyone who cares about Serious Medicine – which is to say, anyone who cares about the actual stuff of medicine, and about actually helping people, as opposed to the abstractions of “health care policy” – should be alarmed by the downward spiral of the debate in Washington DC these days. Orzsag & Co. are working to “control costs,” even in advance of cost-control legislation. Their latest tactic has been to jawbone Big Medicine into “voluntary” price reductions so that the Obama administration can declare victory on cost control.
But ask yourself: Isn’t it obvious that if medical players know they will be getting less, they will then be doing less? Shouldn’t we be figuring out how to incentivize, mandate, or otherwise encourage medical science to do more, not less?
Thus allegations made by Kimberly Strassel in her Wall Street Journal column on Friday command our attention. Strassel asserts that health care lobbyists are more loyal to cost-controllers in Washington than they are to their own outside-the-Beltway employers – who, being capitalists, obviously want bigger and better. But inside the Beltway, health care has been waylaid by Club of Rome-type growth-limiters, as well as fiscal bean-counters, focused on the shortest of medical short terms. As Strassel puts it:

Health-care lobbying has been turned on its head: The new cabal of Democratic lobbyists does not exist to protect the industry from Congress. It exists to present Democratic ultimatums to business.

If Strassel is correct – and I don’t doubt that there are differing opinions and conclusions, and we should all hear them – then the true long-term interests of Americans are being mocked. Our future well-being is being cynically sacrificed on the altar of phony claims about the next few fiscal years.
Because make no mistake: If we spend less now on health care, we will get less health in the future. More people will die or be disabled before their time, and that will be costly, indeed.
But those who want “play God” will be satisfied, because they will have had the pleasure of toying and tinkering with the rest of us.
— James Pinkerton


20 comments on “A Provocation From James Pinkerton: Playing God — Whose Lives Are These Anyway?

  1. Mr.Murder says:

    Having been denied coverage from insurance I paid for and eventually terminated, I’ll tell you this, I will NOT pay money out to an edifice who pays people with no medical training whatsoever to deny me care.
    I’ll pay in blood or bullets before I do.


  2. Arun says:

    Paul Krugman reminds us of the corruption in the think-tanks:


  3. tequila says:

    Good Lord. Is there any commenter who thinks less
    creatively and blathers more extensively than
    Pinkerton? If this is thoughtful conservatism, give
    me Glenn Beck — at least he knows he’s just a
    rabble-rouser and we are spared the posing of a
    think-tank op-ed writer posing as a tribune of the
    people while defending enormous health care


  4. FP says:

    The generous funding of Bell Labs by AT&T in the period before
    the consent decree and for some time after was a consequence
    of AT&T being a regulated monopoly. Until 1984, AT&T’s
    surpluses were determined by government tariff regulations,
    and AT&T’s expenditures where substantially determined by
    political considerations ranging from providing employment
    where it mattered to state and Federal legislators, to supporting
    national defense goals through R&D. That same AT&T had the
    power to control what could be attached to its network, to the
    point of in effect forcing most users to rent its ponderous
    devices. Users had little to no choice choice in devices, tariffs,
    and terms of use. Translated to medicine, that AT&T was like a
    national HMO with one-size-fits-all treatments and an
    immovable bureaucracy, and with a gold-plated research arm
    that looked very good in Washington but did not matter much to
    everyday quality of care. I doubt that is what James Pinkerton
    wants to see. And I don’t see the substantial private sector
    surpluses of for-profit health insurers, hospitals, or pharma
    going to much fundamental research. Instead, all the
    fundamental biomedical research there is (and there is probably
    less fundamental reseach than there should be) is paid by our
    Federal income taxes and by a few private foundations (and thus,
    indirectly, by the tax deductions on charitable giving).


  5. questions says:

    (insert smiley emoticon here!)


  6. Dan Kervick says:

    “I’m glad the script writers didn’t read you first! Somehow, “Soylent Black is sick, old, Republican white people” lacks the punch of the original!”
    I don’t know. Can’t you just see Glenn Beck with a red bandana around his neck, yelling that out on the 18th green at the Old South Country Club?


  7. questions says:

    Hey, Dan,
    I’m glad the script writers didn’t read you first! Somehow, “Soylent Black is sick, old, Republican white people” lacks the punch of the original! Besides, no one could live on that diet! (insert smiley emoticon here!)


  8. Dan Kervick says:

    I hear Obama has a secret plan to deny medical care to a lot of sick, old, Republican white people and turn their remains into Soylent Black.
    Seriously, although questions pretty much covered all this, Pinkerton seems to be going out of his way to promote hysterical fears of the meaning of “cost-cutting”. But the post following Pinkerton’s shows the administration’s estimates of the areas of the economy that will show the strongest job growth in the coming years. Since four of the areas are in health care, I don’t see the slightest indication that they are planning to cut back on the overall provision of health care, or undermine the US’s competitive strength in health and medical research and related industries.
    However, I do note that they do not appear to be estimating a lot of job growth in the insurance industry, or among red tape manufacturers.


  9. John Fullerton says:

    This article is drivel. It’s like the attacks on Sotomayor. He’s got nuthin’ He should consult a wise Latina. He should be working at a restaurant.


  10. jhm says:

    I won’t claim to be the sharpest knife in the drawer, but the last
    few paragraphs of this, which presumably contain the point the
    author is trying to make, literally make no sense. I can;t even say
    whether I agree, although his tone persuades me that I do not.
    Is it too much to ask that the essayists given space here do
    potential readers the courtesy of making cogent arguments?


  11. ron says:

    I read Washington Note because normally it’s a way to avoid either side’s repetitive talking points. How many times did he use the word “elites”? I dozed off.


  12. Arun says:

    Other writers have pointed out the problems in this article, so I need not repeat them, merely say, hear, hear! It is good to encounter the sloppy thinking so it can be countered; but it is also a sad thing.
    Also think, did Ma Bell give you the Internet? No. It was DARPA and CERN.


  13. questions says:

    Oh my, this piece is muddled. I’ll touch on a few things and leave the rest to others.
    First, on doing things to control costs: cost control isn’t necessarily about letting expensive patients die rather than receive treatment. And it isn’t likely that large numbers of patients will fail to receive lifesaving treatment when it’s available. Individual doctors, nurses, and families will still feel compelled to offer treatment in many situations of “declining return on the investment” (how’s that for a phrase!).
    Costs can be controlled by: not pathologizing every single bodily and emotional state such that every person needs to be on several expensive drugs that we find out later are ineffective and even counterproductive. Look at the history of disease creation, drug intervention, and OOPS, maybe we shouldn’t have done that. Pain killers that kill patients, hormone replacement therapy, cancer drugs that don’t extend life, full body scans that lead to invasive tests for what are actually normal variations in morphology, antidepressants that are no more effective than talk therapy (but seem to lead to more suicides) — all of these “treatments” should have been evaluated dispassionately long before they were marketed.
    Sometimes doing less is doing more.
    There are, as I posted elsewhere, perverse incentives to deny care and prevention all over the medical system. Regulation from the outside (from government, that is) can deal with those incentives that stem from free rider problems (the idea that some other insurance company might gain from your investment stops being a problem if all companies are required to invest in prevention).
    Forcing a better testing set up on drug innovators will keep the people at large from being guinea pigs in massive drug tests. (HRT was a massive drug test on unsuspecting women.)
    So, Mr. Pinkerton, costs can be controlled in some ways without setting up execution centers for the aged. And even Obama’s grandmother can have her hip replaced despite her age and health. Costs need to be shifted to allow this, but there’s room.
    Much drug R and D is carried out by universities that then sell the work to drug companies for commercialization. The drug companies carry out very little original research. University profs work for pennies compared to executives at large corporations. Fund the sciences at the university level, and there will be plenty of innovation. Tenure, conferences, grad students, labs, libraries, and a named parking space are all a prof needs! Fund the research at enough different “kinds” of universities and there will be diverse input and so diverse output as well. The academic system can be pushed to reward outside-the-box thinking.
    AIDS funding happened not because of some great R and D system, but because the activists were amazingly well-organized and really pushed Congress on the money issue. Political organization counts in disease research. Also, AIDS is more of a singular disease than cancer, and its singularity may well be responsible for the number of reasonably effective drugs available. Diseases vary, and so success in treatment varies.
    And on “Playing God” as a phrase — lead in playground dirt, proximity to garbage dumps, highways and airports, proximity to factories and hog farms, breathing in the crap of modern life, drinking the crap of modern life, eating the crap of modern life…talk about “playing God” when we dump our crap on certain segments of society and not on others. Hospice care is such a small segment of the God-game.


  14. Franklin says:

    This piece about rationing is a crock.
    Are you saying that we DON’T have rationing now??
    45 mill. have NO insurance. The absence of insurance creates a kind of rationing.
    For those who have private insurance there are people called “insurance adjusters” (as Pinkerton knows) — many of whom have no medical training — who can give a thumbs up or down to certain kind of treatment, or treatment by certain kinds of doctors, etc.
    We have health care rationing know.
    Every health care system is going to have some rationing. The question is whether these decisions should be made by boards filled with medical professionals weighing the best available medical evidence; or whether we should incorporate the private insurance model writ large where stockholder value and profit margins are weighed against the health of policy holders.
    And as far as pandering about the “elites” — I mean seriously, this isn’t a Fake News audience.
    Pinkerton himself is a Stanford grad and he works for a THINK-TANK!!
    I mean come on, Pinkerton!
    Ultimately, he shouldn’t be ashamed of his ELITE education, or his affiliation with an ELITE Washington Think-Tank.
    He should be ashamed of his bogus framing of this issue.


  15. Peter913 says:

    Of course it’s cheaper to get rid of us! No medical bills, SS or Medicare! Of course we have “a duty to die and get out of the way. Do I hear an “Amen!” on that? Come on, how about one Amen? ūüėČ
    The rich have nothing to fear from Obamacare They will just hire a concierge doctor. Say 20 Hamptons’ families pay him $50K each per year to take care of them; a closed practice, like a closed Country Club, Yes? Do I hear 20 “Amens!” on that? Oh, there is a TV Show about this, hmmmmmmm!
    You said: “But those who want “play God” will be satisfied, because they will have had the pleasure of toying and tinkering with the rest of us.”
    James, they are already playing God. How many Martin Luther Kings, etc. have we lost through the abortion of 45 million babies. How many Democratic voters have been lost Madame Pelosi & his Lordship Reid? Can I hear a few Amens on ‘Loves Labors Lost?’ After all it was their Choice.
    But what have we chosen and what will we next choose? How about kill everybody over 70. I’m 66. Gee, I have 4 years left to vote “Democtraic”.
    In a pigs eye I wll!!!


  16. Doubting says:

    To be accurate: “Number of infant deaths: we’re ranked number 28 out of 30. Only Mexico and Turkey are worse!”
    This refers to OECD countries.


  17. JohnH says:

    I love it! “Playing God — Whose Lives Are These Anyway?” Where was Pinkerton when the US government was playing God in Korea, Vietnam, Iraq, and Afghanistan?
    Oh, I get it, people are only supposed to outraged when Washington starts postponing the natural deaths of Americans. But where is the outrage when wedding parties regularly get blown up in Afghanistan? Whose lives were those? Oh, I get it again–THOSE people don’t matter. And exactly why is it that Pinkerton’s life matters?


  18. Ian Kaplan says:

    More pictures of the wonderful dogs please.
    Given what the “conservatives” have done to our country, there is no space for dialog with them. More dog pictures, less right wing blather.


  19. Ben Rosengart says:

    Typical conservatarian claptrap. I love it when Ivy League
    graduates rattle on disparagingly about “elites” — it saves me
    having to wonder whether they’re lying.


  20. Doubting says:

    Not sure if the writer is genuinely ignorant about health care and R&D or if he’s doing it on purpose. (Maybe both.)
    Excessive costs in US health care have nothing to do with high R&D. They have to do with: (1) too few doctors making too much money; (2) excessive medical tests; (3) overpriced medications; (4) inefficient insurance system.
    No one is talking about underfunding NIH and such.
    And do note that most of the research in health care in the US is paid for by the taxpayer, not by big pharma. Pinkerton seems to have no clue what big pharma spends its R&D money on? (Maybe I’ll ask him to name even one great molecule synthesized in the last 10 years.) The comparison with Ma Bell is absurd. Today’s Ma Bell is called Microsoft, and will Pinkerton please tell us what great new discovery we’ve had from MSR? Pinkerton shows no understanding of the changes in unfettered research everywhere in the last quarter century. This idea that it’s the lack of surplus in private industry that has hindered research is plainly false.
    US health care is one of the worst in the industrialized world (WHO ranking: 37) I’ll just mention one number. Number of infant deaths: we’re ranked number 28 out of 30. Only Mexico and Turkey are worse! Our life expectancy is among the lowest. And we’re spending about twice as much as anyone else. So clearly, says Pinkerton, the danger is that we’ll be spending less…
    Other gross factual errors in this article:
    >> Apple and Google, which carry on the Bell Labs tradition.
    Apple??? Hmm, where? Better tell Steve Jobs. He’d love to hear that. Google, too, would be pleased to hear they’re carrying on the Bell Labs tradition, but they ain’t: 80% of the “research” there is specifically tied to projects. Nothing to do with Bell Labs type research.
    >>Because make no mistake: If we spend less now on health care, we will get less health in the future
    Reminder: We’re spending twice as much as anyone else and we are ranked # 37 !
    But, except for the crass ignorance and the flawed logic, nice piece!


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