Stanley Feld M.D.,FACP,MACE
Obamacare has been a failed attempt at social engineering.
As I have said previously President Obama and his administration have backed off and are continuing to back off many of the deadlines in the law.
Many of Obamacare’s new ideas are ideological utopia. Theses ideas cannot work in system that is dependent on physician judgment and interpersonal patient/physician relationships.
Social engineering’s goal is to eliminate judgment (craftsmanship) and reduce production of goods and services to a commodity production.
I believe the origin of the dysfunctional healthcare system began with government intervention over the last 60 years.
I want to start with some basic points. The delivery of medical care should be between physicians delivering medical care and surgical care to patients. Without physicians or patients there is no need for a healthcare system.
The two main participants (physicians and patients) have a large responsibility to the healthcare system in order to have good outcomes. The patients’ responsibility in the system has been constantly ignored by healthcare policy wonk.
Patients should exercise, must not become obese, do not do dangerous things that could injure themselves, don’t smoke, diligently take their recommend medicine and follow their physicians orders.
Eighty (80%) of the healthcare dollars are spent on the complications of chronic disease. Much of this expense could be avoid if patients were responsible for the care of their health and avoid the onset of chronic diseases and their complications.
At the beginning of the 20th century the United States was growing rapidly. It was believed that our institutions could not handle this growth adequately.
Social engineering of our industries, manufacturing and political systems became the fad of the day in the early 20th century.
What is social engineering?
“Social engineering is a discipline in social science that refers to efforts to influence particular attitudes and social behaviors on a large scale, whether by governments, media or private groups in order to produce desired characteristics in a target population.”
The discipline of social engineering attempts to manipulate a population of people by manipulation of norms and ideas using tools available to institutions whether it is a government, the media or an industry.
The goal was to modernize social systems that where outmoded in the society that existed in the late 19th and early 20th century in order “to achieve the intelligent management of Earth’s resources and human capital with the highest levels of freedom, prosperity, and happiness within a population.”
The obvious question is who has the authority to manipulate the behavior of billions of people?
The wrong decision-making can affect the safety and survival of literally billions of people.
In a democracy, in which the government should be by the people and for the people, the government should act as a surrogate for the people and not an authority that rules the people.
When something doesn’t work for the people, the government must change to express the will of the people.
In the last 60 years progressives have been enamored with social engineering. However, most of our government’s attempts at social engineering have been a failure.
Universal Health Care”, “Single Payer”, “National Health Insurance”, “Socialized Medicine” are all terms invented in an attempt to social engineer America’s healthcare system. These terms aim is to social engineer the healthcare system so that physicians’ and their patients’ relinquish their autonomy to government control for the sake of the common good.
The unspoken promise to the people is that the healthcare system will be free to the people.
Progressive’s claim that healthcare is a right! Healthcare is rather an individual’s responsibility!
Nothing is free!
Socialized medicine eliminates the need for an individual to be responsible to maintain health and to comply with treatment. The government will take care of us if we get sick.
The people have soundly rejected socialized medicine’s terms and intentions. The present government is ignoring the will of the people.
The result is a mistrust for our elected officials (establishment) and a chaotic and joke-book of candidates on both the Democratic and Republican side.
Who should determine the common good? Who should determine actual good for consumers? The obvious answer to me is the consumer and not some ideology or its attempt at social engineering.
Max Weber was a Prussian 20th century political philosopher. He laid the foundation for modern sociology and the need for social engineering.
However Max Weber was one of the first to proclaim,
“Bureaucratic administration means fundamentally the exercise of control of institutions on the basis of knowledge. This is the feature of bureaucracy which makes it sound specifically rational.”
However, Weber also recognized the limitations of bureaucracy. He observed that the goal of a rational bureaucracy was more often elusive than realized, if it is ever realized.
In the early 20th century Frederick Taylor was the leading proponent of scientific management, also called Taylorism. Scientific management is an extension of social engineering.
Taylorism includes the important parts of today’s industrial engineering and management.
“The elements of industrial engineering include analysis; synthesis; logic; rationality; empiricism; work ethic; efficiency and elimination of waste; standardization of best practices; disdain for tradition preserved merely for its own sake or to protect the social status of particular workers with particular skill sets;
The last sentence is exactly what the Obama administration is trying to do to the healthcare system. It is trying to turn the practice and art of medicine into a commodity control by the government.
The major criticism of Taylorism had been;
“for turning the worker into an "automan" or "machine." Due to techniques employed with scientific management, employees claim to have become overworked and were hostile to the process.”
Consumers are presently experiencing this same reaction from physicians in their response to Obamacare.
Indeed the healthcare system must become more efficient. It can become more efficient with improvements in some processes.
However, a process that causes consumers to be more responsible for their health and the treatment of their chronic diseases must accompany the improved processes.
The expensive creation of bureaucracy that measures physician behavior in inefficient ways and decides on inadequate payment leads to the hostile reaction to the process and increased inefficiency.
Consumers and not the government should drive the healthcare system.
Ronald Reagan said in a 1964 speech long before he was president, “No government ever voluntarily reduces itself in size. Government programs, once launched, never disappear. Actually, a government bureau is the nearest thing to eternal life we’ll ever see on this earth!”
The bureaucracy by ever expanding has given unelected officials the authority to social engineer the healthcare system. The public’s will is marginalized and the central government increases its control over the public’s healthcare decision making.
Obamacare is not working out very well because it is an enormous task to force physicians and consumers to participate in a program that marginalizes the two most important stakeholders, physicians and consumers.
There is little chance that Obamacare will work as intended. Consumers are not interested in becoming commodities.
The opinions expressed in the blog “Repairing The Healthcare System” are, mine and mine alone.
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