Monday, October 5, 2009

Making N.I.C.E. [Bob]


In the third installment of his Space Trilogy series, That Hideous Strength, C. S. Lewis' main character (Mark Studdock) was seduced with the promise of joining the inner ring of a powerful English society that used questionable tactics to establish an "efficient" state bureaucracy run by controllers who saw themselves as being a cut above the rest of the world. The name of the society Mark yearned to join was the National Institute of Co-ordinated Experiments -- N.I.C.E.

Lewis described N.I.C.E. as:
"the first fruits of that constructive fusion between state and laboratory on which so many thoughtful people base their hopes for a better world. It was to be free from almost all the tiresome restraints ... which have hitherto hampered research in this country. It was also largely free from the restraints of economy ..."
This, in fictional form, was the epitome of what Lewis feared would become a socio-political reality. Some of his reviewers begged to differ. The New York Times described That Hideous Strength as "superlatively nonsensical excitement, challenging implications," while Time magazine called it a "well-written, fast-paced satirical fantasy." That was in 1946.

Fast forward to 2009.

John C. Goodman, writing in National Review (September 21, 2009), reports on the contemporary British health commission:
"which currently recommends against any treatment that costs more than $45,000 to save a year of life. Because of [the commission], British cancer patients are denied access to drugs that are routinely available in the U.S. and on the European continent, and thousands die prematurely."
The name of the commission is the National Institute for Health and Clinical Excellence, but the Brits refer to it by the more commonly recognized acronym: N.I.C.E.

I wish I could make this stuff up. In fact, when I read it I assumed that Mr. Goodman had made it up. He didn't. But the creepy stuff doesn't stop there.

The reason Mr. Goodman cited this fact was because N.I.C.E., according to former Senator Tom Daschle, is the model on which we should base American health care reform. He says so in his book, Critical: What We Can Do About The Health-Care Crisis. And, barring the inconvenience of paying those pesky income taxes that only those of us who are not driven to work in a limousine should have to bear, the good Senator would have been the one overseeing our American N.I.C.E. guys. Instead, we have HHS Secretary Kathleen Sebelius who, under the plan being offered, will not only fill that role but also be the one to decide which pool of federal funding may, or may not (?), be used to fund abortions.

So, yes, Sarah Palin's hyperbolic comments about "death panels" in the health care reform bill being considered were not accurate. But that said, and given the ideology and bureaucratic impulses of our current cast of political characters, does anyone truly doubt that, as Jay and Serge pointed out in Podcast #19, there will be rationing? When resources are limited and controlling costs is the reason the reform is being pushed in the first place, this will be the inevitable result. Someone will be charged with responsibility of deciding who gets what. Someone like Mark Studdock.

And that is a hideous strength for anyone to wield.

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3 comments:

  1. Simply stellar, Bob! what a great piece.

    ReplyDelete
  2. A bit late to the party, but: rationing by beaurocrats happens any time that you're not paying out of pocket.

    Paying for insurance in the USA is annually paying an amount set at it's worth to keep you alive, as decided by beaurocrats. And if you go too far over that they will do everything in their power to cut your insurance. Not because they're evil, but because they can't afford to keep paying for it.

    It's a consequence of capitalism that level of care is decided by how much you're worth; it's not just a socialistic nightmare.

    The British are overwhelmingly more happy with the NHS than we are (although I'm out of country at the moment) with insurers and providers in the US.

    I agree with the general statement that rationing shouldn't happen (although it seems to be unavoidable with finite resources); but as you wuite rightly pointed out the NHS is not what's on offer in the current proposal, and even if it were I'm not sure that would be a bad thing. I'm sure we would do it much better than the Brits.

    Is it worse to let people die by 'death panel' than let them die by denying them insurance? To me both are horrific.

    ReplyDelete

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