David Ruiz is being starved to death — in a hospital. In the United States. The 32-year old member of a Native American tribe has been in a coma since suffering a stroke on New Year’s Eve. Ruiz is on a ventilator. His sister says the man is responsive to external stimuli, but the hospital staff has cut off food and water after declaring him brain dead.
The question of denying nutrition and hydration has been subject to good-faith ethical debate among care providers for some time. But it is usually connected to clearly defined end of life circumstances like cancer or dementia, and is often a byproduct of the will of individual patients: those who consciously refuse food and water, and whose medical powers of attorney proscribe life-saving measures.
In this case, the patient cannot actively refuse. His family wants Ruiz fed and hydrated, but hospital officials have made a unilateral decision. This relegates Ruiz to no more than an actuarial concern, a built-in feature of socialized medicine, one of several points conspicuously avoided when discussing the efficacy of a government-run system.
Socialized Medicine Must Ration Care
First among those points is that a Congress with 3 percent of members who are health professionals lacks the institutional knowledge needed to run a nationwide system. Second is the reality of doing so. While the left often bleats about the disconnect between the United States and other industrialized nations in providing health care, those champions of medical equity nearly never mention the taxes necessary for getting there. American politicians have not suggested revising our tax structure to mirror any in Europe. Instead, they wave off the costs as something “the rich” will pay for, which is mathematically impossible.
Despite tax rates of roughly 40 percent at all levels of income and national sales taxes (the value-added tax, or VAT) of 20 to 25 percent, as well as massive taxes on gasoline and other goods, the cost of “free” is quite expensive — not that many European countries haven’t tried grabbing as much revenue as possible. The result? The old adage about other people’s money is playing out in hospitals across the continent. When those tax rates are not enough, then what? Factor in an aging population and the problem is not one of providing care, it’s one of math.
We’re a society in which roughly half the population has no federal tax liability and 20 percent of wage-earners pay nearly 90 percent of federal income taxes. At some point, it is worth asking how much of one person’s money is another person entitled to receive? But no one on the left is asking. If anything, the question is dismissed as irrelevant. Instead, advocates go the emotional route, beating the drum of health care at the expense of others as some inalienable right. That’s now how it works.
The systems in Europe and elsewhere function––to the extent that they function––by citizens accepting that the ship only moves when everyone grabs an oar. In America, we not only have a large population watching others row, we also have demands that those people row harder. This, of course, ignores a third factor: the cultural element. If, for example, you want a Danish-type system––and whatever else you do, don’t call Denmark socialist––then you need plans to both impose Danish-style taxes and make this country demographically look like Denmark.
Health Outcomes, Systems, and Habits
The internet is full of breathless articles on health outcomes in the United States versus those of other industrialized countries. By contrast, there is a shortage of material on the health habits that contribute to lousy results. When people engage in a litany of unhealthy behaviors, it’s a bit much to expect medical professionals to miraculously undo the cumulative damage.
Europeans smoke more than Americans, but they also walk more, eat less, have less stressful work lives, and take more vacations. When you factor in cause and effect, the results about disparities in outcomes look more like foreseeable consequences than the failure of our health care system.
Still, the money question does not simply go away because healthier lifestyle choices may be more common there than here. More common does not mean everybody participates, and in the United Kingdom, the calorie police are hard at work.
The idea of government-imposed calorie limits will sound great to some and authoritarian to others, but it should be surprising to absolutely no one. When government officials control health care dollars and services, you can be sure they will take a vested interest in your day to day life. It is reminiscent of the fantastical Orwellian world of the future, where government cameras were deployed to peek into windows and watch people’s every move.
The European model relies on saying “no” to questions Americans believe can only be answered with “yes.” We’ve already seen how the parents of two dying children in England were barred from using their own money to try experimental courses of action. Were the cases of Alfie Evans and Charlie Gard outliers because of how the state handled them, or because the rest of us heard about them? In Belgium and the Netherlands, euthanizing the mentally ill has become reality. This isn’t individuals or family members making informed decisions; this is medical professionals ending the lives of non-terminal patients.
At the other end of the spectrum, the world’s top cancer hospitals are in the United States and the only question is how many are on a given top-ten list. Better treatment leads to higher survival rates, but even here, the question of money is a consideration––what is the cost-benefit ratio of spending $200,000 to buy an additional four months of living?
For Ruiz, the cost of care is unknown. So is how long he would need it and whether treatment would even work. What is known is that his family’s wishes are overruled.
