THCB welcomes back our solid pal, the erudite Michael Millenson, for whom the sun doesn’t shine if there’s no wisecrack in the wings. Now leading a consulting firm specializing in health care quality projects, Michael is a former Chicago Trib reporter with 3 Pulitzer nominations to his credit. Michael’s groundbreaking 1997 book Demanding Medical Excellence was one of the first to call attention to the problems addressed by the Quality and Safety movements. Enjoy.
As wildfires sweep Southern California, I have been surprised that homeowners in some of the most affluent and staunchly Republican enclaves in the state have not protested the widespread deployment of government workers bearing fire hoses and driving ambulances. The pain of watching one’s life possessions burn to a crisp must almost be matched by the pain of watching tax dollars wasted on a task that private, for-profit firefighters could surely perform more cheaply and more effectively. Yet not even the richest of the fire-torn refugees has expressed regret over government intervention in their rescue.
It’s important to remember that wildfires in California are a
foreseeable event, just like hurricanes in the Southeast, blizzards in
the Upper Midwest or – to switch from the cosmic to the quotidian –
illness or accidents befalling individuals. In bumper sticker terms,
stuff happens. If one believes in the marketplace, then it should be up
to individuals knowingly facing risk, not the government, to either
take prudent steps to protect themselves or face the consequences.
If, after all, one believes that Medicare should be privatized, then
one also implicitly believes that the old, frail and infirm should be
left to their fate if they chose a health plan adequate to finance the
flu but with coverage too meager for multiple myeloma. Economists call
this a “market signal,” meaning that it’s supposed to scare everyone
else into acting like Rational Economic Man rather than like actual
human beings. Similarly, if your health savings account is exhausted
before your medical needs, that should teach the guy in the next
cubicle to quit wasting money on a big mortgage and sock away something
for a possible stroke.
Given the Republican allegiance to the marketplace, should not
California taxpayers send fire engines to rescue only those whose home
insurance covers full replacement cost – Rational Economic Man — and
the “deserving poor” who, clutching tax returns in hand, can prove they
couldn’t afford the premiums? The question answers itself.
Firmly held convictions about the importance of individual
responsibility seem to melt away when the flames approach our house,
the winds howl outside our window, the snow drifts trap our car or
disease strikes our family. The marketplace does some things very well,
but responding swiftly to rescue those who cannot rescue themselves is
not one of them.
Fire, wind, rain, snow and illness can strike any of us, regardless of
political beliefs. Paying taxes to protect the vulnerable from
devastation is not a step down the slippery slope of socialism but a
reaffirmation of a basic human commitment. As our nation tries to build
a consensus for sweeping health care reform, perhaps the California
fires can reignite a recognition that Rational Economic Man is a straw
figure and that community and compassion are the values that truly
Michael Millenson (firstname.lastname@example.org) is the President of Health Quality Advisors LLC in Highland Park, IL.