With Terri Schiavo close to death as I write, let me say that what I say here is not going to affect the outcome. She is going to die. But so are 50 million unborn infants this year and every year, worldwide. For them, there are no headlines.
There are representative cases that, for unpredictable reasons, do get headlines. The Schiavo case is one. Such cases are important as representative cases that point to where we are headed: judicially, morally, and economically.
Terri Schiavo is going to die because the state is paying for her, and it wants off the hook. But it does not want to admit defeat, so it will not allow private parties to pick up the feeding tube and thereby pick up the tab. Such an action would challenge the state’s monopolistic authority to provide life or deny it.
This is not stated publicly. To do so would point out that all those who rely on Medicare and Medicaid, or who will be pressured into the system soon, and whose families may find themselves in similar financial circumstances, are going to get the plug pulled when red ink overwhelms the Medicare system.
Euthanasia is cost effective, assuming that God is not the Accountant.
THE TRIAGE EQUATION
Jude Wanniski quoted a rhetorical hand grenade tossed by Daniel Henninger in a Wall Street Journal column.
In 25 years, the baby boomers will be on the cusp of 85, becoming what a physician friend has called “history’s healthiest generation of Alzheimer’s patients.” As the tsunami of red ink collapses the struts beneath the tar-paper shacks of Medicare and Social Security (which the Congressional elders say isn’t broken) the “scarce resource” argument will re-emerge, with soothing persuasiveness, for triaging the most ill among us, very old or very young.
Mr. Henninger has used the correct word: triage. In a military battlefield hospital, doctors make a three-part decision in each case, identifying: (1) those who will survive without treatment, (2) those who will not survive with treatment, and (3) those who may survive with treatment but will die without it. The third group gets treatment. This is the reality of scarce resources. At zero price, there is more demand than supply.
The tsunami of red ink really is going to collapse the struts beneath the tar-paper shacks of Medicare and Social Security. Those who favor these tax-funded struts and are paying today for millions of old people who live in these tar-paper shacks, do not want to admit this publicly. They do not want to admit that Terri Schiavo is the poster child of Medicare triage. But she is.
So, they hide behind legality: court authority, state’s rights, no federal interference. No federal interference? Their self-delusion is matched only by their hypocrisy. Most of them have spent their entire adult lives demanding more federal interference. But the bills are about to come due. The issue now is: Who pays? The guy behind the tree, of course.
RIGHT TO LIFE = OBLIGATION TO PAY
There are no free lunches. This is the scarce resource issue.
To say that Terri Schiavo has a right to life is to say that someone else has a legal obligation to pay to keep her alive.
The obligation to pay is an inescapable concept. It is never a matter of “obligation to pay vs. no obligation to pay.” It is always a question of “who has the obligation to pay and which jurisdiction of civil government has the obligation to say who has the obligation to pay.”
The horror of the Schiavo case is not that the state has pulled out the feeding tubes. The state was paying for those tubes. He who pays the piper calls the tune. To deny this is to adopt tooth-fairy economics and ultimately tyranny. The state must be under law to spend money in predictable ways. If it is not under law, then the politicians will take our money and spend it on anything they choose.
The horror of the Schiavo case is that the state will not allow anyone else to pay in order to stick the feeding tube back in. Police are arresting people who attempt to give her water.
Nobody on either side wants to put the issue in these stark terms. The pro-Schiavo forces want tooth-fairy economics, and the anti-Schiavo forces want to reduce the red ink, which is not good public positioning for advocates of the healer state.
Schiavo’s defenders are not willing to say up-front: “The state has a legal obligation to put the tube back in.” That would make them appear to be advocates of socialized medicine. They do not want to appear in public as advocates of socialized medicine.
Schiavo’s executioners are not saying up front: “If you become a vegetable, we will vote for those who will pull the plug on you, so you had better stay healthy enough to feed yourself.” That announcement would make it appear as though the state will run cost-benefit analyses on you if you crap out in the Alzheimer’s game, which of course it will. This is the rogue elephant in the living room.
“You can’t put a price on life,” we hear moralists say: sometimes pro-lifers and sometimes pro-welfare statists. This phrase is utter nonsense.
We put a price on life every time we buy a life insurance policy or a health insurance policy. That price is a matter of enforceable legal contracts.
We put a price on life when we say in marital vows, “in sickness and in health, till death do us part.” That price used to be a matter of enforceable legal contracts. The fact that it is no longer predictably enforceable is a big part of the Schiavo case. Her husband, who is about to become to be ex-husband, has what used to be called a mistress and two children — what used to be called bastards — by her. Times change. Language changes. Laws become unenforced by the courts.
There is always a price on life. The question is: Who pays?
COMING CLEAN PUBLICLY
What I want from the pro-Schiavo people is a signed public document:
We, the undersigned, assert the right of Terri Schiavo to live. This means that someone must pay. We hereby pledge to pay for her care until she dies.
Because we stand on moral principle against socialized medicine and all taxpayer money going to keep people like Terri Schiavo alive, we hereby also pledge to support every other victim like her — every Alzheimer’s patient who can no longer feed himself, every brain-dead victim of a stroke or accident, and every other American in her condition — just as soon as the insurance money runs out and her immediate family has declared bankruptcy. This is a blank check. Representatives of victims may cash it at any time
What I want from the anti-Schiavo people is a signed public document:
We, the undersigned, hereby acknowledge that government-funded medical care has limits, that there are no free lunches in life, and therefore that public authorities must put limits on open-ended fiscal bloodletting, such as Terri Schiavo represents. We call the President to appoint a Medicare Triage Commission, which will lay down guidelines on what kinds of patients will get the plug pulled.
Furthermore, in order to keep the human vegetables of rich families from getting special advantages, we hereby demand that the Schiavo ruling be extended, so that no one with private funds be allowed to keep alive those on whom the state has just pulled the plug.
As John Wayne used to say, “That’ll be the day!”
The pro-Schiavo forces are looking for the tooth-fairy unless they face the implications of what they are saying, namely, that those who maintain life must present the bills for life to someone. Who is to collect payment? Who is to make payment? Who is to enforce payment? Until these issues are faced squarely and publicly, the Schiavo case is just one more emotion-laden opportunity to raise funds by non-profit ministries through posturing.
The anti-Schiavo forces are in the process of publicly abandoning tooth-fairy economics. The tooth fairy is always the state for these people, and she has a pair of pliers. They are beginning to see what the tooth fairy has been doing with those pliers since FDR’s presidency, and they have begun to pay more attention to their teeth.
THE GOOD SAMARITAN WAS AN EXPLOITER!
When I was in graduate school, a pro-welfare state fellow grad student told me that he opposed all private charity. “It makes rich people feel good about themselves.” The issue for him was envy. He would rather see no one helped than see rich people feel good about themselves by helping. In the Stalinist era, there were laws against private charity in the USSR. That grad student was a faithful representative of the Stalinist outlook regarding non-state activities.
So, police are arresting people who want to give Terri Schiavo a drink of water. Such charitable actions would indicate that the state does not have the right to determine who among the legally innocent will live or die. Such lawlessness must be prohibited!
Terri Schiavo is a representative figure for both sides. On the side of Mrs. Schiavo stands a confused group of people who think the state should remain the Good Samaritan. On the side of the courts that have determined that she must die stands a much larger group of people who hate private charity because it makes donors feel good. These people want the state to control charity, so charity must become compulsory. To keep the red-ink tsunami limited, they now demand the right to cut off the losers from the state’s feeding tube. To assert the final authority of the state in matters of life and death, they insist that others not be allowed to pay for a feeding tube with their own money.
The fundamentalist Christians who make up the bulk of Terri Schiavo’s defenders have no social philosophy. They never have. They hate such “academic stuff.” “We love Jesus. We have no time for social philosophy!” They are deeply emotional. They want to Do The Right Thing. Their idea of the Right Thing is to Be Nice — with taxpayers’ money. They are welfare statists for Jesus. What would Jesus do? Raise taxes!
The welfare state secularists who oppose Terri Schiavo’s right to life see the red ink coming. They see that the bankruptcy of the Medicare system could create a massive political reaction against the promises of politicians to provide tax-funded healing at below-market prices. The myth of the state as healer is about to have its feeding tube pulled by a lack of funds. Let it never be! So they are silently admitting that triage must be performed. But nobody in the private sector must be presented with the bill, because the anti-Schiavo people themselves may someday have the bills presented to them for close relatives in her condition. Better to invoke euthanasia by court order. It’s cost-effective, and it also reduces guilt. “Sorry, Doctor, I won’t be paying this bill. I’ll miss momma, of course, but the judge has made his decision. It’s final.”
May God help us all. When the red ink tsunami hits, the state surely won’t.
March 28, 2005