Podcast:

Progressive Americans have this much going for them: they can, without any reservations, second thoughts (or perhaps even first thoughts), enthusiastically and wholeheartedly support Obamacare’s individual mandate. For them, the individual mandate is an unalloyed good. Not only does it enable Obamacare to proceed, thus giving the government unprecedented control over every aspect of American healthcare, but it also establishes the authority of the government to control the economic activity of individuals. This new authority will come in very handy as our leaders continue working toward redistributive justice. So if you’re a Progressive, what’s not to like about the individual mandate?

Conservative Americans do not have it so easy. In principle, of course, the very idea of an individual mandate is constitutional heresy to a conservative, since it violates not only the letter but the very spirit of the Constitution. This is why, over the past three years, opposing the individual mandate has become for conservatives a more fundamental litmus test than opposing abortion. Accordingly, it is conservatives who have launched the constitutional challenge to the individual mandate, and who have now succeeded in bringing it before the Supreme Court, and who have based their chief strategy for bringing down Obamacare on the idea that the Supremes will agree with them about it.

DrRich, like most conservatives, is aghast at the idea that the Court might actually find the individual mandate to be compatible with the Constitution. Such an expansion of the power of the Central Authority over the lives of individuals will essentially gut the main idea behind our founding, and send us even more rapidly down the path toward tyranny.

But as he contemplates how he might feel on the day the Supreme Court finally strikes down the individual mandate, DrRich can’t help conjuring up the last scene from The Graduate. In that scene, Dustin Hoffman, who has just burst into the church and fought through a horde of wedding guests to grab his girl from the altar, and, with her in tow, has fought his way past the stunned groom and back through the angry crowd, and having at last jumped with her onto a city bus, is now sitting breathlessly, his hard-won love at his side, as the bus pulls away leaving their pursuers behind. And as that last scene fades, his look of elation at finally winning his heart’s desire gradually slackens, and transforms into a look of utter panic, a look that silently beseeches, “Now what?” Or, perhaps, “What have I done?”

DrRich thinks that’s what will happen to Republicans on the day the individual mandate is declared unconstitutional.

There is a reason, dear reader, that Mitt Romney, Newt Gingrich, and the Heritage Foundation, all of whom claim to be conservatives, at one time or another supported something very much like Obama’s individual mandate. That reason is: it is very difficult to conceive of a workable, market-based solution to our healthcare mess without one.

Any scheme for reforming healthcare that is based on private health insurance will fail if a substantial proportion of the population declines to purchase health insurance. Whether people have chosen to acquire health insurance or not, they will still get sick. And when the uninsured get sick there are only two choices.

The first choice is to refuse them care. Libertarians have no problem with this. They believe that if you want some healthcare, you should pay for it yourself. If you choose not to buy health insurance, or otherwise fail to make arrangements to pay for healthcare should it turn out that you need some (as well you might, if you engage in all the activities and abuse all the substances that libertarians say is your right), well, that’s too bad for you. Let your painful and untimely demise serve as an object lesson to everyone else, so that perhaps they will make better personal choices. Most non-libertarians, however, find this option abhorrent.

The second choice is to take care of the uninsured anyway. If you do that, not only do you drive up the cost of health insurance for people who have chosen to buy it, but you also create a huge incentive for people to not buy it in the first place.

This is why Republicans or conservatives who have thought deeply about healthcare reform (Gingrich, the Heritage Foundation), or who have actually instituted healthcare reform (Romney), will often settle upon a solution that incorporates something very much like President Obama’s individual mandate. Unless everyone is strongly “incented” to buy health insurance, a market-based healthcare system will collapse.

More to the point, Republicans ought to recognize that, while it seems to have wound up that way, the individual mandate in Obamacare did not start out as a sneaky way to undermine the Constitution. It was, in fact, a necessary concession to the more conservative of the Democratic members of Congress. President Obama and his minions (or handlers, depending on which talk show hosts you listen to) are on record as saying that their real goal is a single-payer, government-controlled healthcare system. And there is no reason in a single-payer, government-controlled healthcare system to invoke anything like an individual mandate to purchase insurance. The President would have been quite happy without any individual mandate, if he could have gotten his way in the first place.

The individual mandate was inserted into Obamacare purely as a necessary component of healthcare reforms that are ostensibly based on private health insurance, which is the only kind of reform the President could possibly get through even a Democratic Congress in 2010.

If the Supreme Court declares the individual mandate to be constitutional (which will violate everything DrRich holds dear about America), then it’s a huge win for Obamacare.

But if they declare it unconstitutional, that will trigger the Republican’s real problems.

Republicans, Democrats and federal judges all seem to agree that without the individual mandate, Obamacare is infeasible. The moment the mandate is declared unconstitutional, Obamacare disappears.

And this will create a “Graduate” moment. There the Republicans will be, sitting on the bus with the healthcare system they have just saved from the handsome-but-arrogant groom who had Big Plans for it, and heading to – where?  They can’t just go back to the old healthcare system; we’re past that. The health insurance industry has made it plain that their business model is broken, which is why they acceded to and even campaigned for Obamacare (a system under which they are to become federally-regulated public utilities) in the first place. Should Republicans institute their own market-based healthcare reforms? Good idea! But what do they do about the people who choose not to buy private insurance, now that they have had mandates to purchase declared unconstitutional? And even if they have an answer to that question (which they do not), do they have a plan ready to go, one that can be implemented quickly, before the healthcare system implodes? (Remember, Republicans, you will be dealing with a health insurance industry that has run out its string, and that will be at least angry if not panicked at the demise of its public-utility end-game.)

As it happens, DrRich himself has proposed a fix for the healthcare system that addresses all these problems – a system that is based on individual choice and incorporates private insurance, and at the same time covers everyone without any individual mandate, and controls healthcare costs to boot. The details are entirely irrelevant at the moment, and DrRich will not bore his readers with them now. (If you’re interested you can buy a copy of his book in Kindle format for five bucks, or if that’s too steep you can read an outline of his plan here for free.) The point is that workable solutions to our healthcare problems are indeed imaginable. The likes of DrRich has imagined such a thing, and so have others. But Republican candidates for President, and Republican congressional leaders, are not creating these solutions. Instead, they are steering us into a blind alley.

Here is what DrRich fears. When the individual mandate is declared unconstitutional next June, the Republican celebration will last all of 7.5 minutes. The insurance industry will make it very clear very quickly that they simply will no longer be able to function, and to have any hope of survival they will have to resume cherrypicking healthy patients, massively increasing premiums, denying recommended care, and dropping subscribers when they get sick. Even with these drastic steps, they will say, there’s no guarantee that health insurance will still be available for most Americans in a year or two. And at the time these astounding revelations are made, the Republicans won’t even be finished choosing a nominee, let alone be able to articulate a coherent plan for replacing Obamacare. By Independence Day panic will reign across the land.

The President will then make a speech. He will say, “We tried, America. In the spirit of bipartisanship we tried to give Republicans a system of market-based healthcare reforms, just like they say they wanted. But that kind of system requires an individual mandate, and our misguided friends on the right have now shot the individual mandate through the head. And when the American people ask those same Republicans who brought this disaster upon us, “Now what?” the American people get no answer. The Republicans are quite good at destroying healthcare solutions, but are hopeless when it comes to creating them. And you can hear for yourselves what the health insurers are now threatening to do to all of us when we get sick. It will be just like it was before, but much, much worse.

“We tried, America. We tried to create a market-based healthcare system that would be fair to all. But the Republicans, caring for nothing but their own selfish political fortunes, have blocked our efforts, and have left us all for dead.

“Fortunately, in a few short months you will be able to exercise your God-given right as Americans to choose. If you want to, you can vote into office the Republicans, the people who have traded your healthcare security and that of your family in favor of the chaos we are all witnessing today. Or you can re-elect me, and you can give me a Congress I can work with, and let us try to salvage something good from the ruins of the glorious reforms we fought so hard for the last time. Let us try to give you the best healthcare system that is still possible, given the new constraints the Republicans have now made for us. While you and I might not have started out wanting a healthcare system run entirely by the government, today our choice is either that, or the chaos, pain, suffering, disability and death that, thanks to the good offices of the Republicans and their friends in the health insurance industry, are now staring us in the face. But this is not the first time Americans have stared evil in the face. We have done it before, and we have always prevailed.

“We tried, America. We tried – but the Republicans denied, and babies died.

“My fellow Americans, in November you will have the opportunity to say no to the forces of evil, and to set this travesty right. I know the heart of Americans, and I know that you will do the right thing, not only for your own sake, but for the sake of your children, and your grandchildren, and generations of Americans yet unborn.*”

And when President Obama is finished laying out his argument, the Republican nominee, whoever he or she turns out to be, won’t know whether to cry, “Oops!” or “Nein, nein, nein!”

____

*DrRich is a conservative but also a capitalist, and so his speechwriting services are available to the highest bidder. Mr. Obama, mutual “friends” in the DOJ have proven adept at tracking DrRich down when necessary, and will know how to contact him.

Podcast:

Rachel Maddow, in a discussion related to the provision of abortion services, once proposed that we (society) should invoke the Amish Bus Driver Rule whenever medical professionals invoke their personal convictions in refusing to provide legal medical services.

The Amish Bus Driver Rule goes like this: If you’re Amish, and therefore have religious convictions against internal combustion engines, then you have disqualified yourself for employment as a bus driver. (Presumably Ms. Maddow would not apply the Amish Bus Driver Rule to everyone, since it would disqualify, for instance, Al Gore from utilizing horseless carriages and other fossil-fueled contrivances.)

The Amish Bus Driver Rule would do far more than merely render it OK for doctors to perform abortions and other ethically controversial (but legal) medical services. The ABDR would obligate physicians to provide such services, whatever their personal moral or religious convictions.

The reason DrRich brings this up is not because he considers Rachel Maddow to be the giver of rules for the left, or for the government, or even for MSNBC. Rather, he brings it up because the Amish Bus Driver Rule is entirely compatible with Progressive medical ethics, and therefore it has a pretty good chance, sooner or later, of becoming the official policy of our new healthcare system.

To spell it out: Once you agree to accept from the government a license to practice medicine, and thus accept a privileged and restricted position within our society, then you are naturally obligated to provide any medical services, approved by the government, that you are called upon to provide. In particular, you are obligated to check your personal  – and most especially, your religious – convictions at the door. If you are unwilling to carry out this obligation, then, like the Amish bus driver, you have disqualified yourself from that privileged position. Go do some other job that does not violate your prissy sensibilities.

This logic is eminently simple. In fact, it can be reduced to an elementary syllogism:

Premise 1: Society awards physicians an exclusive license to provide legitimate medical services.

Premise 2: Society deems certain medical services such as abortion, assisted suicide or euthanasia to be legitimate medical services.

Conclusion: Therefore, all licensed physicians are obligated to provide these services.

Many conservatives will be nearly apoplectic over the idea that doctors who are morally opposed to life-ending medical activities must either agree to perform those activities (once society decides they are legitimate medical services) or leave the profession. But conservatives, proud of their self-described tradition of acting on the basis of hard data and cold logic (unlike those silly liberals who let simple emotions rule them), find themselves in this instance stymied by the very foundation of logic – the syllogism. They are hoisted on their own petard.

Indeed, doctors who object to having to provide life-ending medical services find themselves in quite a fix, and what’s more, it is a fix that has resulted from the actions of their own profession.

When we are faced with a syllogism whose internal logic is unassailable, but whose conclusion we strongly believe to be wrong, then Aristotle (him again!) teaches us to check our premises. But when we do so, in this case we quickly see that while both premises may “feel” wrong to many physicians, in 2010 they are indeed correct. And therefore, so is the conclusion.

Premise 1 asserts that the physicians’ primary obligations are defined by a contract between themselves and society – or (let’s be frank) the state.

Until just a few years ago doctors could have legitimately objected to this assertion, since from the time of the ancient Greeks the physician’s prime obligation was defined by a direct covenant between themselves and the individual patient. And the precepts of medical ethics that governed the behavior of physicians were focused entirely on sanctifying that doctor-patient relationship. Those ethical precepts took precedence over everything else, like ethical precepts are meant to do, and at least in principle superseded all other authority down through the ages.

But alas, modern doctors don’t hold to such things anymore. And in recent years they have made their departure from their ancient ethical principles, and from the traditional doctor-patient relationship, fully explicit and quite formal.  They have done this to such an extent that they can no longer even aspire to the relatively minor sin of hypocrisy.  (Say what you will about hypocrites. At least they espouse firm principles which they can then violate.)

It is clear, of course, that doctors do not work for their patients anymore. Instead, they now work for the government and the government-regulated insurance companies. Still, this new kind of working relationship does not necessarily have to wreck medical ethics or the doctor-patient relationship, were it managed thoughtfully. But rather than figure out how to preserve their professional obligations within a new economic paradigm, the medical profession instead has chosen to issue a revised set of ethical precepts “for a new millennium,” aimed at adjusting what were supposed to have been (and had been, for the prior two millennia) timeless principles, in order to comport with the changing needs of society.  And so, of its own accord, the medical profession has abandoned its foundational ethical precepts, and thereby has abandoned the classic doctor-patient relationship – the very thing which defined the practice of medicine to be a professional endeavor in the first place. The medical profession has redefined itself by a new obligation to the changeable needs of the collective, instead of its old obligation to the expectations of the individual patients who place their lives in their hands.

In short, the profession of medicine has formally and voluntarily converted itself into a primarily contractual enterprise (i.e., as contractors for the government and government proxies), instead of a primarily ethical enterprise between themselves and their patients.

And so, whereas Premise 1 could have been easily cast aside just a few years ago (which is why it still “feels” wrong to a lot of doctors), today it is entirely legitimate.

Premise 2 recognizes certain life-ending activities to be legitimate medical services. Abortion, of course, has been legal in the U.S. for several decades. Since many of his readers will quibble with the assertion that abortion is life-ending, DrRich has decided to make Premise 2 somewhat forward looking, and so he has included the other two life-ending actions which will very likely become legitimate, approved “medical services” in the foreseeable future.

The medical profession not too many decades ago was quite clear on the ethical status of life-ending actions taken by physicians. Such actions in all their forms were proscribed. The Hippocratic Oath forbids taking actions intended to end life, and specifically calls out abortion as one of those  forbidden actions. But the Hippocratic Oath (like the Declaration of Independence and the Constitution) has become merely quaint in our modern, advanced society.

One of the reasons DrRich appreciated the Hippocratic Oath, when it was recited at his medical school graduation way back in a different era, was that it so clearly reflected non-religious standards. Yes, it blustered on about Asclepius and Hygieia and so on, but even the ancient Greeks didn’t really take their gods seriously. The Oath invoked the gods in the same manner in which, some assert, our founders invoked the Creator in the Declaration of Independence. Whether or not they were actually asserting that our foundational principles come directly from a being named God, they were making a very powerful statement. At the very least, they were saying, “We hold these principles to be so fundamental to the essence of man that to violate them would violate our very reason to exist. They are our bedrock, and to challenge them would be fatal to our enterprise. Here we draw our line in the sand, and we will defend this line to our deaths.”

The Hippocratic Oath was kind of like that.

The Hippocratic invocation against physicians ending innocent life was a clear line in the sand, and its purpose was a practical one rather than a religious one. For, in order to legally take an innocent life, we are required to say either that sometimes it is perfectly OK to kill an innocent human being, or that for some reason (because, for instance, at such-and-such a stage of fetal development the potential human is not yet viable) a particular innocent life is not really a human being after all. If it is sometimes perfectly OK to kill an innocent human being, our society is terminally corrupt. On the other hand, if society has the temerity to define “human being” in such a way as to meet its exigencies of the moment (beyond the most conservative possible definition suggested by nature, that is, the point where sperm and the egg combine to form a new life entity), it will necessarily be a fundamentally arbitrary definition. And once society undertakes to define human life arbitrarily, then there is nothing to stop society from changing that arbitrary definition as expediency requires.

Wise Hippocrates (DrRich suspects), foreseeing that mankind was likely to continue with its periodic spurts of genocidal indignation against this or that sub-human subset of our species, and seeing that it would be fatal to the medical profession to allow its special arts to be turned toward aiding such efforts, and realizing that it would be impossible, once physicians engaged in any small but legitimized taking of innocent life, to keep from escalating those activities if the needs of a society under duress demanded it, came to the conclusion that the profession required an absolute proscription here. This proscription was not a religious statement, but a practical and entirely secular one, based on a long and thoughtful observation of human nature, and aimed at keeping the medical profession focused on its real mission (caring for individual patients) rather than becoming an instrument of societal or political imperatives. And for over two thousand years the medical profession followed this line of reasoning.

The Hippocratic Oath has not been read aloud during medical school graduation ceremonies for decades now. The reason it was dropped has nothing to do with the usual claptrap you hear about not wanting to swear to Greek gods anymore. It has to do with the fact that doctors no longer subscribe to the content. It is no coincidence that the oath disappeared from the program in very short order during the 1970s, right after the Rowe v. Wade decision.  In any case, over the past few decades many physicians – possibly a majority – have quite gotten over their queasiness about taking actions that either a) end innocent life, or b) admit that society has the right to define arbitrarily what it means by “human life.” And the ones who still object to such actions are in dire risk of becoming the Amish bus drivers of healthcare.

So Premise 2 clearly expresses the actual default position of the medical profession today. While, for many physicians, it (like Premise 1) “feels” wrong, Premise 2 stands on its own merits.

Thus, like it or not, almost entirely due to the “evolution” of the profession of medicine itself rather than to any externally imposed changes, our syllogism appears entirely correct.

The implications are quite disturbing, and go far beyond the mere prospect of forcing pro-life doctors to either get with the program or get out. For what this syllogism really says is that the state will determine which medical actions are legitimate (or to be more specific, ethical), and that physicians being (through their own voluntary capitulation) mere contractors working at the pleasure of the state, are thus obligated to just shut up and sing. To say it more plainly, what is medically ethical is to be determined by the state, and individual doctors (except for the ones acting as collaborators and spokespersons for the state, whose job will be to make the ethical pronouncements seem medically legitimate), will have nothing to say about it.

When we view the history of mankind, we see that when the sovereign state is the entity which determines what is ethical, there is always hell to pay.

History teaches us that the state is sovereign not because it is inherently the most ethical entity within a social construct, or an ethical entity in any sense at all.  Sovereignty is determined by power, not ethics. Indeed, the most useful definition of “sovereign power” is: that power which has the ultimate ability to impose its will by the application of violence. The state is inherently a political and power-based entity, whose survival depends on manipulating the political landscape and the ability to threaten (or exert) adequate violence whenever required. Such a beast is inherently poor at ethics.

DrRich happens to believe that American society is essentially good, and constitutes the most ethical large and sustained social system that has yet been devised by mankind. Yet when pressed by economics, war, political strife, manifest destiny or a myriad of other stresses, even our government has behaved dismally and frankly unethically, and has done so on numerous occasions throughout its history. One merely needs to consider slavery, the Dred Scott decision, the Mexican-American war, the treatment of native Americans, World War II internment camps, and the Tuskegee study (DrRich ignores more recent history here to avoid stirring up still-fresh controversies) to get a taste of what kinds of government behavior we in our culture are capable of justifying to ourselves when under duress. (To put this in perspective, of course, other highly-developed Western cultures during the past century, where powerful sovereign authorities assumed the right to define ethical actions, performed atrocities that cause ours to pale in comparison. But this mitigation merely reinforces DrRich’s main point.)

As DrRich has been fond of pointing out on this blog, the need to find ways to ration American healthcare covertly has created extreme duress within our healthcare system, and within the government and the insurance companies responsible for administering it. And as a result covert rationing has already produced deeply and widely distributed behaviors that are harmful, inefficient, unfair and yes, frankly unethical, which affect every aspect of American healthcare.  Ceding to the state – desperate to ration healthcare in any manner it can get away with – the right to define what is medically ethical, and assigning to doctors the obligation of simply obeying, sounds to DrRich like a prescription for catastrophe.

And in this way, Progressive medical ethics has brought us to a very dangerous juncture.

Podcast:

DrRich has now read large portions of the “Patient Protection and Affordable Care Act,” i.e., Obamacare. He finds in it the very essence of Progressivism.  To understand Obamacare, then, we must understand the basics of Progressive thought.

DrRich has always found American Progressives to be a bit enigmatic. He has found much of their behavior to be persistently, almost defiantly, illogical and counterproductive to the rights Americans hold dear, rights which Progressives themselves also insist they revere – in particular, our inalienable rights to life, liberty and the pursuit of happiness.

As long as 20 years ago, DrRich had developed a sneaking suspicion that Progressives, their protests to the contrary notwithstanding, never really bought into the “inalienable” thing. On this point, he concluded, they were prevaricators. Since by then it was beginning to look like the Progressives were going to be running things for a while, it occurred to DrRich that it would be a good idea to understand what they really think, and what their agenda really was. And so, after much time and study and contemplation, DrRich developed his theory of Progressive thought, which he is now pleased to share with his readers so that they, in turn, might better understand Obamacare.

The Roots of Progressivism

When DrRich began his study of Progressives he did not quite know where to begin. So he decided to proceed, like Descartes before him, from the simplest and most irreducible of truths. Namely, that Progressives are really, really smart – or think they are. We know this because all the professors in all the best Ivy League schools are Progressives.

From this simple truth we can deduce that, whatever it is that Progressives are actually up to, it must have its roots in the writings of The Philosopher.

And sure enough, it was not at all difficult to discover the roots of Progressivism within the teachings of Aristotle.

Aristotle tells us that man is innately a political animal, an animal with an inherent propensity to gather into increasingly complex communities. The essence of man, according to Aristotle, is society.

The formation of complex societies is what defines mankind; it is what differentiates man from the rest of the animal kingdom. Hence, because man is defined by society, society is inherently on a higher plane of importance than the individual. Individuals are entirely beholden to and dependent upon and subservient to the society to which they belong. Indeed, they are defined as individuals by their place within that society. Without society, a man is just an ape (with a persistently infantile face).

In this sense, “socialism” is reduced quite simply to a philosophy in which society – the collective – takes precedence over the individual. Furthermore, the precedence of the collective over the individual is not something we can simply choose to accept or reject; it is the very essence of mankind. It is nature. It is just the way it is.

So, as you can see, Aristotle nailed Progressivism.

Clearly, while the name “progressivism” has only been around for a century or so (and we will shortly see from whence the name came), its roots are a very old idea. This idea, in fact, was the normal way of looking at the relationship between individuals and society until just a few hundred years ago, when humanists began to cautiously explore the radical notion that individuals (rather than the collective) constitute the fundamental unit of humanity. The new humanist heresy – which declared the primacy of the individual – was for a long time called “liberalism” (a term whose meaning has, recently, drastically changed, and is now a synonym for what had always been its opposite). Classical liberalism reached its zenith, DrRich thinks, a mere two and a half centuries after its painful birth, with the Declaration of Independence and the Constitution of the United States.

But to Progressives, classical liberalism has always been an aberration. Despite what America’s founding documents might say, society takes precedence over the individual. It takes this precedence by way of the very essence of mankind, as was taught by The Philosopher, and so it cannot be otherwise.

The Progressive Program

The Progressive Program – the thing that makes Progressives progressive – is to develop the perfect society. This program is not optional; it is dictated by the nature of mankind.

Since society is what defines mankind, it follows, as the night follows the day, that the program of mankind, the purpose, the work, the essence of mankind, is to create the perfect society.

The perfect society has two basic requirements. First, it must meet all the basic needs of the individuals within that society (such as food, clothing, shelter, sanitation, and health), without which individuals will always be tempted to engage in the counterproductive behavior of striving for things. Second, the social order must be of such a nature that it can persist, theoretically forever, without fundamental change. Indeed, the very notion of perfection implies that any change, of any type, is bad, since it will necessarily constitute a movement away from perfection.

The perfect society therefore requires complete stability. This would include (at a minimum) a stable population size, the preservation of natural resources and the earth’s environment (indeed, when one hears the word “sustainability,” one is listening to Progressive gospel), the careful management of the economy, and the careful control – if not suppression – of unplanned innovations. This latter refers both to material (or scientific) innovations, and innovations of thought, either of which will always threaten hard-won societal stability.

The perfection of society is the paramount work of mankind, so any method which may help in achieving this perfection is to be embraced; none discounted out of hand. The only considerations one must make in choosing methods of action are: Is this method practicable? And: Is this method more likely to be successful, or counterproductive? These two questions fully define Progressive ethics.

So that’s DrRich’s theory of Progressivism and the Progressive Program. While it is only a theory, DrRich hereby asserts that his formulation is correct.

He makes this assertion for the purpose of advancing the debate and inviting argument. If any of his readers have a better explanation of Progressivism, one that more successfully fits the facts and explains the otherwise difficult-to-explain behaviors we’ve seen from Progressives in recent years, why, DrRich will be delighted to hear it. If it is convincing, DrRich will cheerfully abandon his own theory and adopt yours.

But to accomplish this feat, your theory of Progressivism will have to offer a more successful explanation of the following Progressive behavioral phenomena than DrRich’s theory does:

Individuals and Groups Within Progressivism

While Progressivism by definition places individuals in a subservient position to society, this is not to say that individuals are merely interchangeable cogs in a great machine, or entirely analogous to worker bees in a hive. DrRich’s prior sarcasms aside, Progressive society is not the Borg.

Indeed, individuals within a Progressive society are differentiatable, and can be publicly celebrated or castigated as individuals. But to a great extent the potential worth of an individual is pre-determined by the group to which the individual belongs. Group identity in Progressive society is critically important, as it provides the only feasible means by which the leadership of Progressive societies can attempt to control and direct individual behaviors.

(Group identity is so critically important to Progressive thought that it has been given a special name – “Diversity” – and has been designated as the Cardinal Virtue, from which all the other, subsidiary, virtues – faith, hope, charity and the like – must necessarily spring.)

And so, to stand out as individuals, individuals must stand out as a member of their group, and the manner in which they stand out must fundamentally reflect the assigned essence of their group. So, for instance, Al Sharpton and Jesse Jackson are celebrated individuals, whose accomplishments nicely reflect their assigned group identities. In contrast, Clarence Thomas and Thomas Sowell are not celebrated by Progressives, and indeed are castigated as abominations, because their individual accomplishments do not reflect their assigned group identities.

Therefore, while individuals within Progressive societies can achieve a certain level of importance, individual importance is merely of tertiary concern, rather than primary or even secondary concern. Individuals can become officially “important” only if their importance reflects the essence of their assigned group; and the importance of the assigned group (the secondary concern), in turn, is proportional to its ability to advance the Progressive Program in general (which, of course, is the primary concern).

While individuals have the potential of rising to a state of importance within Progressivism, the vast majority of individuals will never actually do so. The great masses of individuals will be regarded by society as featureless members of their group, and will be treated accordingly. And the status of a particular group is always subject to change, given the extant needs of the leadership class. Certain groups (e.g. labor unions) may be exulted by the leadership, while others (e.g. the elderly, the white males, or the fat) will be devalued. Yet other groups (e.g. illegal aliens) may be celebrated by the leadership at one point in time (when, for instance, it behooves Progressive leaders to acquire voting rights for them before 2012), but then may be dismissed at some other point in time (in 2013, for instance, after the critical votes have been gathered, and now the group just represents large volumes of mouths to feed and healthcare to consume).

Good and Evil In Progressivism

Many Progressive intellectuals are fond of saying there are no absolutes, and so there is no such thing as inherent good and inherent evil. These intellectuals are wrong, even from within the Progressive paradigm. Because the Progressive Program – which, again, is to achieve a perfect society – is the innate agenda for mankind, there indeed exists a standard by which one can determine good and evil.

“Good” is anything which advances the Progressive Program; and “evil” is anything which threatens it.

Anyone who doubts the existence of good and evil within the Progressive Program need only observe the scores of behaviors and figures of speech which are condemned as unrelentingly evil by Progressives, with all the certainty and fervor of a Jonathan Edwards.

Accordingly, individuals who hinder the Progressive Program are a danger to mankind’s very essence. They are evil, and must be rehabilitated or eliminated.

Progressivism and the Leadership Class

Despite its lip service to the contrary, Progressivism is not egalitarian, even in theory.

The duty of mankind is to strive for the perfect society. The chief tool by which mankind is to achieve this program is man’s intellect and logic. It is axiomatic that only a minority of people will have the intellect and logic necessary to direct the program of mankind. Therefore, Progressivism fundamentally relies on an elite corps of individuals to guide our progress toward a perfect society. The perfect society will not just happen, it must be engineered by those who are gifted enough to lead.

The lack of egalitarianism in Progressive thought is illustrated by the special treatment accorded to the elite corps. The leadership class must be nurtured and valued by society. Furthermore, it must be given special privileges which others in society do not have. Because their work is so critical to the essential program, the elite must be removed from worry over the mundane necessities of life. That is, providing the leadership class with certain luxuries and privileges, and even freedom from having to follow all the rules that apply to the masses, is therefore not hypocrisy, but is an essential good. It redounds to the benefit of the Program.

Anyone who has not noticed recent glaring examples of this “different standard” for the Progressive elite should consider activating their “durable power of attorney” forthwith, so that a more alert individual can manage their affairs.

Progressivism and the Unwashed Masses

It goes without saying that, if left to their own devices, the populace would devolve into some primitive societal arrangement (such as capitalism) in which individuals would spend all their time striving to improve their own individual situations, even at the expense of others.

This means that the great unwashed masses must be “managed.”

Ideally, the best way to manage the population is through education, and so all efforts must be made – through formal education and by controlling the public media – to indoctrinate the population to the great benefits of the Progressive agenda, to the natural duty and obligation of all men and women to work within society to realize the Progressive Program, and to the inherent evil of all the alternatives. Since education will never be sufficient, the unwashed masses may need to be controlled through pacification (i.e., attempting to meet all their basic needs, so as to eliminate their impulse to strive). If this fails, they must be controlled through coercion, intimidation, peer-pressure, or (as a last resort or to serve as an object lesson) violence.

Fundamentally, the Progressive Program relies on all members of the great unwashed to subsume their own individual needs to the needs of the collective. That is, the Progressive Program requires a fundamental change in human nature. This change will never be forthcoming, and so Progressives are apparently doomed to be frustrated in their efforts. (However, as we will see shortly, Progressives ultimately have the answer to this problem, as well.)

So, despite their frequent hymns of praise to the worthiness of the common man, Progressives invariably develop an underlying contempt toward the unwashed masses. It is not difficult to spot this contempt if one is alert to it.

Progressivism and Politics

Under the Progressive Program, just like Aristotle says, mankind is essentially a political animal. In fact, the Progressive Program can only be achieved by political action. This means that politics – and to be clearer, political control – is the fundamental work of Progressives. Without politics, without political control, there is nothing. To lose political power is oblivion.

This attitude toward politics is in stark contrast to the attitude of conservatives, for whom government (and therefore politics) is merely a necessary evil, with which one must occasionally contend, when it cannot be avoided, as a part of life. For most conservatives politics is an afterthought.

For Progressives, politics is everything, the essence of human behavior. And it is worth any cost, any desperate measure, to maintain political control. Indeed, to fail to lie, cheat and steal in order to keep political control would be unethical.

Progressivism and Religion

Progressives have a natural adversity to organized religion. For one thing, religions tend to give a higher priority to some supernatural entity (and worse, to an afterlife), than to mankind’s “true” imperative, which is to achieve a perfect society right here on earth. However, since religious leaders can be readily coerced to serve the needs of the state (and always have been), this is not an insurmountable problem.

The real difficulty with organized religion is that the major ones stress the importance of the individual (since individual salvation, or individual enlightenment, is the major theme of the big religions). Under progressivism the inherent importance of individuals is necessarily subsumed by the importance of the collective, so by focusing the ultimate meaning of life on the individual, traditional religions become a major threat to Progressivism.

Apparently realizing that abolishing religion is far too difficult a task, Progressives have adopted the long-term strategy of infiltrating and co-opting religious establishments, and by means of introducing new ideas – such as group salvation, and the concept of social justice as a religious imperative – rendering religion, this “opiate of the masses,” less incompatible with the Progressive Program.

Progressivism and Eugenics

Since World War II, the enthusiasm with which Progressives publicly embrace the idea of eugenics has become muted. But eugenics is, in fact, inherently bound to Progressivism. One way or another, a perfect society will require far more perfect citizens than we have today. Indeed, the seething contempt with which Progressives regard the current genetic pool that comprises the unwashed masses is often difficult for them to suppress.

To a large extent, modern Progressivism was born as an offshoot of Darwinism. The idea that society could be perfected, and the idea that mankind could be perfected, were two sides of the same notion. And early Progressives unabashedly embraced both of these ideas, such that the idea of “culling the herd” became extraordinarily attractive to them – and they said so. Theodore Roosevelt, Woodrow Wilson, Bertrand Russell, H. G. Wells, and Margaret Sanger (the founder, as it happens, of Planned Parenthood) are only the most well-known Progressives who extolled the idea of eugenics.

But public support of eugenics among Progressives has become quite subdued, ever since the Nazis committed their atrocities explicitly in the name of achieving societal perfection.

One can argue, of course, whether the recent Progressive support of such activities as late-term abortions, or creating human embryos for experimentation, are partially aimed at desensitizing the public for future efforts to “guide” a more favorable genetic makeup for the population. Either way, DrRich reminds his readers of the history of Progressivism in this regard, and of the inherent attractiveness of eugenics to the Progressive Program, and urges them to remain alert.

Progressivism and Environmentalism

Radical environmentalism and the Progressive Program are not perfectly compatible. But they are close.

Radical environmentalists believe that humanity is a plague upon Planet Earth. Everything man has done since the day he first learned to cultivate crops (and thus for the first time became a different kind of animal) has been bad. And anything which delays, halts or reverses the sins mankind has perpetrated upon sacred Gaia, since that day he first departed from Nature, is a good thing. So the radical environmentalists are in favor of strong central governments which will control the behaviors of individuals (and which might ultimately drastically reduce or eliminate the human population).

Progressives are certainly on board with controlling man’s effect on the environment, but (in most cases) they are not in favor of returning mankind to a hunter/gatherer condition (since most Progressives do not view this condition as the embodiment of a perfect society). Rather, they view the environmental movement – in particular, the Global Warming Theory – as a good way to get the populace to give them the power they need to carry out their Progressive Program. So Progressives have completely embraced the Global Warming Theory as a means to their own political end. Accordingly they have declared man-made global warming to be settled science, and they suppress any efforts to study it further.

DrRich is very sorry about this. He suspects that global warming is happening, and concedes that human behavior may be playing a role, and is saddened that this scientific question has been absorbed into the Progressive agenda in such a way that we are not allowed to find out what’s really going on.

Progressivism and the Great American Experiment

Unlike any other nation in the history of mankind, the United States was not founded because of geography, race, religion or ethnicity. It was founded on an idea. It was founded on the still-radical idea that individual autonomy – the individual’s God-given right to life, liberty, and the pursuit of happiness – is the chief Fact of humankind, and that the only legitimate role of government is to create an environment in which individuals can enjoy those rights to the fullest extent possible.

One can see immediately that the Great American Experiment – which awards primacy to individual autonomy – is fundamentally incompatible with Progressivism. But because a majority of Americans still like the ideas expressed in the Declaration of Independence, the Progressives need to play their cards close to their chests. They need to proceed carefully – but relentlessly.

By slowly re-interpreting the Constitution, and slowly addicting a critical mass of Americans to an array of government programs, Progressives are certain they will ultimately prevail. They have been at it for over 100 years, and have come a long way. DrRich cannot tell whether or not we have already passed the Event Horizon, the point beyond which restoring the Great American Experiment will become impossible. But we are at least very close.

In fact, one plausible theory for President Obama’s headlong pursuit of programs and policies which anger the majority of Americans, and which gravely and immanently threaten the political control which is the center of the Progressive universe, is that he sees America as being at the very cusp of that Event Horizon, and believes that one last, small push will gain it, and make the Progressive Program irreversible, whatever might happen in the next election or two.

Progressivism and Healthcare

DrRich does not need to say much about Progressivism and healthcare right now. Many of the posts in this blog have pertained to this very question, as, undoubtedly, will many more.

But to really understand the current American healthcare system, and to understand Obamacare (the future American healthcare system), it is necessary to understand Progressivism. DrRich sincerely hopes that this current post will help a few of his readers understand, if not Progressive thought itself, at least DrRich’s conceptualization of it.

Podcast:

Now that the great campaign to transform the American healthcare system has passed a critical milestone – the passage of President Obama’s healthcare reform legislation – many Americans find themselves confused about what it all means. What just happened here? What will happen to our healthcare insurance? How much will it cost, and who will pay for it? Why does the whole process seem so darned difficult and confusing?

The confusion is quite natural, since, in fact, nobody really understands what the new legislation says. It is common knowledge that only one or two of our legislators actually read the whole 2700 pages, and those who did only read it so they could make trouble for the President at his Bipartisan Healthcare Roundtable this past spring. (You know who you are, Paul Ryan.)

Remember when Nancy Pelosi said, “We have to pass the bill so we can all find out what’s in it,” and all the Republicans jumped all over her for making such a stupid remark? Well, DrRich is here to tell you that Nancy was displaying uncommon wisdom. Because DrRich now has read large parts of the legislation himself, and can say with confidence that the bill is not merely lengthy, convoluted, and difficult to understand. Rather, its meaning is fundamentally indeterminate.

The indeterminacy of the bill’s language was, of course, intentional. It was done so that, for instance, some legislators could be assured that the bill disallowed Federally funded abortions, and other legislators could be assured that the bill encouraged Federally funded abortions, while the actual language of the bill could be construed to bolster either assertion. Therefore, Speaker Pelosi’s silly-sounding statement was not only correct, but also was probably the most insightful commentary on the bill we’ve heard from any public official.

The bill is now being torn into bits by multitudes of officious bureaucrats, and translated into millions of pages of rules, regulations and guidelines, and then key aspects of those new rules, regulations, &c. will be fought over in courts of law. Once all that is finished, we can all find out what was in it. Just like Nancy said.

In the meantime, whatever the details of our new healthcare system turn out to be, there is a certain clear narrative to our ongoing healthcare saga that, once you understand it, will go a long way toward enlightening you about what’s really going on.

And so, as a public service, DrRich will now explain all this to you in a very simple way, so that – whatever jive you’re hearing from politicians or journalists – you will always get it. For, once you understand a few key concepts, this thing is really pretty easy to follow.

The Fundamental Problem

The fundamental problem with American healthcare is this: None of the pools of money we have created (or ever could create) to pay for our healthcare – whether those pools of money reside with the insurance companies or the government or both – can possibly buy all the healthcare that might benefit all Americans. This means we have to ration healthcare (i.e., intentionally withhold at least some beneficial healthcare from at least some of the people who would benefit from it). But because we’re Americans and Americans don’t ration, we (and in particular, our political leaders) are unable to address this need to ration openly and forthrightly. Therefore, the unavoidable rationing is being conducted covertly.

Until now, most of the covert rationing has been overseen by the health insurance industry. This, indeed, from the very beginning was the primary purpose of modern health insurance companies, as determined by Congress itself when it legislated the formation of HMOs. (See the ruling of the U.S. Supreme Court in Pegram et al. v. Herdrich (98-1949), 530 US 211, 2000.) So, when the health insurers engage in cherrypicking patients, denying medically necessary services, coercing doctors to ration at the bedside, retrospectively canceling the policies of patients after they get sick, and doing everything short of dispatching teams of Ninjas in the dark of night to slaughter some of their more expensive subscribers in their sleep, they are not really being evil. They are only carrying out the job that had been assigned to them by our society. Covert rationing is a dirty, thankless job, but somebody’s got to do it.

The major sin of the health insurers is that, despite their Herculean efforts to harness covert rationing to control costs – and despite the wondrous incentive of greater profits if they do so – they have utterly failed in their assignment. Healthcare costs continue to rise at 3 – 4 times the rise in the cost of living, and within the next couple of decades promises to bring our republic to its fiscal knees (even without all the other stuff that’s making our deficit explode).

This is the healthcare crisis, and it’s real. We simply cannot actually spend $40 trillion on Medicare patients over the next three or four decades (as we’ve explicitly promised the baby boomers). The only real question is whether we will avoid spending all that money thanks to societal disruption and revolution, or by some more civilized means. (The fiscal implosion of our society would of course finally fix our healthcare crisis. Healthcare, far from being an essential and indispensable human need, actually is a luxury, a recent artifact of our advanced, stable, and affluent culture. Runaway healthcare costs, by bringing down our societal stability, will eventually provide its own cure.) Our current “healthcare reform process,” such as it is, is our stab at a more civilized means of addressing our looming impossible fiscal obligations.

What Is Healthcare Reform Actually Going to Reform?

What we are witnessing today is merely a rather messy changing of the guard. The primary responsibility for covert healthcare rationing is going to shift from the health insurers to the government.

The health insurance industry has run out its string. They have had 15+ years of virtually unfettered opportunity to get healthcare costs under control, and they have utterly failed. Over those 15 years, their attitude has evolved from arrogance to concern to abject fear. They finally and starkly realize that they have no clue as to how to control costs. As DrRich has pointed out for three years, the insurance industry has not been looking to block healthcare reform, but rather, was partnering with the reformers in the hope of finding for themselves a graceful exit strategy. They hope to gain one last windfall in profits and stock prices (from mandates and insurance subsidies for the tens of millions of currently uninsured Americans), and once that happens, they hope to settle into the business of administering, and processing transactions for, government controlled healthcare. That is, the insurers hope to become public utilities, since that’s way better than collapsing into oblivion.

So the overriding aim of healthcare reform, with the complete support of the insurance industry, is to conduct an orderly transfer of the pools of money with which we pay for our healthcare – along with the responsibility of managing “risk” and controlling the cost of care (i.e., covert rationing) – away from private insurers and to the government.

Understanding the Players

Government control of healthcare, of course, is precisely what the Republicans accuse the Democrats of wanting, and what the Democrats angrily deny they want.

Understanding the Republicans. Republicans as a group cling to the quaint notion that competition among insurers is all that is needed to reduce healthcare costs; that given the right market incentives, the insurance industry – in its wisdom – will bring healthcare inflation under control. They utterly fail to hear what the insurance companies themselves have said (by their actions): “No mas!”

The Republicans’ arguments ring hollow. It is useless to protest that the Democrat plans will lead to rationing, when not only do we already have rationing, but covert rationing in fact has been the official cost-cutting “plan” assigned to HMOs for decades now. It is useless to protest that 85% of Americans like their current health insurance, when the fiscal reality is that health insurance will change drastically for all Americans over the next decade or so, whether we change it by design or not. It does not matter that a lot of Americans like the health insurance they have now. Keeping it over the long term is not an option.

To a very large extent (DrRich is sorry to say, what with his conservative leanings and all), with such arguments the Republicans have made themselves nearly irrelevant in the current discussion.

Understanding the Democrats. The Democrats were handed the opportunity of a generation. They had a major advantage that Democrats of the Clinton era did not have: the health insurance industry is finished, and the industry knows it. The insurance industry was not going to let this effort fail.

The chief difficulty remaining for the Democrats is that (for their own survival) they must pretend they are not engineering a government takeover of healthcare, when in fact they are. As we have seen, there is not really much choice here. They must take over healthcare even if they don’t want to (though many of them do), because the health insurance industry is finished. The pretense is necessary, however, because the notion of government-controlled healthcare is not something the people – or even many Democrats – want, or are willing to tolerate.

Like the odious job of rationing healthcare (which they have now inherited in entirety), the Democrats must attempt to keep the complete government takeover of the healthcare system as covert as possible.

Which brings us to the biggest problem of all for the Democrats. They now have to take control of covert healthcare rationing. Covert rationing will be much more difficult for a government-run system than it has been for insurance companies. A government healthcare system will not have the opportunity to incorporate the most effective rationing techniques that have been available to the insurance industry – cherrypicking patients, for instance, or canceling the policies of people who get sick. Nor will the government be able to get away with summarily denying patients needed medical services – a standard tactic of HMOs. This is especially true now that chief Republican intellectuals have called everyone’s attention to the possibility of death panels. The unwashed masses, having been duly alerted to the government’s intentions of withholding life-saving healthcare, will now be on the lookout for “unreasonable” denials of care. Any move by the government to refuse to pay for a particular medical service will have to be supported by extremely convincing clinical data (which itself will be very expensive to collect), and even then Americans may not quietly accept such denials. The “death panel watchdogs” will be alert for every move the government makes, and will be quick to howl an alarm.

So the Democrats have won a huge and historic victory. But they are just beginning to figure out what a tiger they have by the tail.

The Bottom Line

As long as we pretend we don’t have to ration our healthcare, any reforms we invent – whether we do it as Republicans or Democrats – will merely add to the confusion, inefficiency, waste, inequity, and ineffectiveness of our healthcare system. How anyone can think that a process so fundamentally grounded in obfuscation and deception as the one we’ve just witnessed will result in anything good is quite beyond DrRich’s comprehension.

Real reform would require us to:

A) Minimize the necessity of imposed rationing by having patients themselves make as many of the spending decisions as possible, using their own money. (Subsidies could be provided to people who don’t have enough of their own money to pay for routine healthcare.)

B) Provide everyone with a high-deductable, catastrophic insurance product to cover non-routine medical expenses. This is where the necessary rationing would take place, but the rationing would be open, transparent, and determined through a public process.

C) Create a private market for “extra” health insurance for those who choose to supplement the universal catastrophic plan with their own funds.

But of course, any plan that relies on both personal responsibility and open rationing is a non-starter. Which is why we are going to get what we are going to get.