Category: Health Care

Political Healing Is Not Physical Healing

So, I was wrong with my prediction on the ACA. I was correct that if the mandate went down, all of it would go. But Chief Justice Roberts agreed that the mandate acts as a tax. Okay.

There are still other problems. Eugene Robinson highlights them, although not intentionally.

The political impact of Thursday’s stunning Supreme Court decision on health-care reform is clear — good for President Obama and the Democrats, bad for Mitt Romney and the Republicans — but fleeting, and thus secondary. Much more important is what the ruling means in the long term for the physical and moral health of the nation.

I find the idea that this is an improvement to our nation’s “moral health” ridiculous and offensive. It’s the simplistic view that opposition to the ACA is opposition to the claimed goals. It’s the pretense that opposition is founded on an “I got mine, so screw you” idea. It’s hackish. Opposition guarantees no such intention, and maybe I’m foolish, but granting the government more power to use force against individuals is hardly an improvement in our moral health.

All but lost in the commentary about the court’s 5 to 4 ruling, with Chief Justice John G. Roberts Jr. unexpectedly joining the majority, is that the Affordable Care Act was intended as just a beginning. We have far to go, but at least we’re on our way.

Obama’s great achievement is not any one element of the health-care reform law — not even the now-upheld “individual mandate,” which compels individuals to have health insurance or pay a fine. The important thing is the law’s underlying assumption that every American, rich or poor, should have access to adequate health care.

But that’s not the issue. The important thing is how well the law will achieve its aims. Will it? Which unintended consequences will result? What will it cost in trade-offs? Early evidence suggests a strong “no” for the first question, which should raise further concerns about questions two and three.

Here, we don’t even get to the first question. Mr. Robinson is endorsing the Do Something theory of government. This is Something, so it must be good. It’s untethered from outcome. We’ve merely expressed the right feelings that every American should have access to adequate health care. That isn’t a solution to a problem that exists in large part because of previous feelings-premised public policy solutions. The ACA is not the only way to try to achieve the real goal of reform and improving health care access and outcomes. The ACA merely doubles down on the existing structural problems. When government is failing, ordering more government is hardly a credible solution.

As I wrote in my prediction, tying insurance to employment is inefficient and stupid. Our current unemployment rate is an excellent indicator of a flaw in the policy. Mr. Robinson gets at this:

Most working-age Americans who have health insurance obtained it through their employers. But this is a haphazard and inefficient delivery route that puts U.S. businesses at a disadvantage against foreign competitors, most of which shoulder no such burden. Tying health insurance to the workplace also distorts the labor market and discourages entrepreneurship by forcing some employees to stay where they are — even in dead-end jobs — rather than give up health insurance.

With this acknowledged, it appears the only way to endorse the ACA is to focus on the important thing, the good feelings. The ACA will work to untie insurance from employment, but only because it makes the burden of employer-provided insurance so onerous. It pushes people into public options. That’s aiming for single-payer without having the political courage to admit the aim. Such lack of courage does not suggest good outcomes when the inevitable financial crisis from the ACA results. And now, because this reform was so ham-fisted and clueless, no one will have the political capital necessary to reform the reform.

Rather than seek a radical reshaping of the health-care system, Obama pushed through a set of relatively modest reforms that will expand insurance coverage to a large number of the uninsured — about 30 million — but still not all. He also tried to use free-market forces to “bend the curve” of rising costs, slowing but not halting their rise.

The ACA doesn’t try to use free-market forces. It attempts to manipulate them, at best, and pretend they don’t exist, at worst. It’s the idea that prices can be mandated, that supply and demand are fully malleable with political will. It’s neither an honest nor an intelligent attempt by the Congress and President Obama. It will fail. The only questions are how soon, who will be harmed, and what will we do in response.

The ACA and the Future of Infant Circumcision

I’ve made the argument that a government-run single-payer health care system in America would not automatically result in non-therapeutic infant circumcision rates comparable to other Western nations (e.g. United Kingdom), probably most directly here. I stand by that for the reasons I’ve stated. But now that the Affordable Care Act has been upheld by the Supreme Court, I want to explore a possible (though unlikely) unintended consequence of encouraging the government to control more health care.

As I understand it, the government has now been given what amounts to unlimited power to incentivize (i.e. compel) activity to achieve a public policy goal where some (or many) may prefer inactivity. Congress merely needs to establish a “Do X or Pay T” regulatory scheme. Many, although not a majority of Americans, approve of this for health care. This is presumably a statement on the value of the goal rather than an explicit endorsement of the means. But the means matter.

Extending this thinking, what now prevents the Congress from implementing “Circumcise your newborn son or Pay a Tax”? It now has that power. And the logic is no different. Congressman Brad Sherman endorsed the political thinking that would encourage such a policy during last year’s discussion of the San Francisco ballot initiative. He declared that “Congress has a legitimate interest in making sure that a practice that appears to reduce disease and health care costs remains available to parents”.

I do not believe this is politically likely. With any extension of this newly-expanded power, Congress will need the political cover to pass a new tax. They swore the ACA wasn’t a tax, though, so lying is an option. They’re politicians, after all. It would still face challenges. But it is possible, and we’ve seen the lengths to which politicians will fall over themselves to avoid offending the status quo on non-therapeutic infant circumcision.

I think my argument holds up. If nothing else, the ACA almost certainly slows future progress on ending this violation of male children. Cultural circumcision has a new god in the perceived¹ reduction in future health care costs. There are means available within government control to pursue that. If we get further “reform”, it’s likely to offer even more control to the government. That is a problem. This seems obvious to me. As long as the government has a power and a willingness to ignore facts, the possibility of consequences exists, both intended and unintended. We should be careful which methods we endorse.

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¹ The time value of money must be included. A dollar spent today on health care is not the same as a dollar that might be spent twenty, thirty, or more years from today. The number of adult circumcisions needed would have to be greater than it is to justify this public purse argument. It still wouldn’t be ethical to circumcise healthy infants, of course.

Five Year Olds Believe in Free Lunches

With the Supreme Court expected to rule on “Obamacare” (i.e. PPACA) tomorrow, I want to consider this reddit thread asking to explain it to a 5-year-old. There’s a long list of what PPACA does, and will do, if the Supreme Court upholds it. Some may be wise, while others are surely not. The overwhelming point, though, is that none of this is free. Consider this, for example:

Employers need to list the benefits they provided to employees on their tax forms.

That costs money. Even if the change is minor, computer systems have to be reprogrammed and tested. Multiply that across every employer in the U.S. How much productivity is being consumed by this instead of something else that may provide more wealth? What improved health outcomes will this generate?

Or consider:

It creates a new 10% tax on indoor tanning booths. ( Citation: Page 923, sec. 5000B )
…

A new tax on pharmaceutical companies.

A new tax on the purchase of medical devices.

A new tax on insurance companies based on their market share. Basically, the more of the market they control, the more they’ll get taxed.

Those taxes are taxes on consumers. I suspect many people reading the list, and maybe its author, don’t grasp that. All taxes are on individuals. Consumers will pay higher costs or receive fewer services.

The real beauty of the list comes when the author injects opinion.

The biggest thing opponents of the bill have against it is the mandate. They claim that it forces people to buy insurance, and forcing people to buy something is unconstitutional. …

Yes.

… Personally, I take the opposite view, as it’s not telling people to buy a specific thing, just to have a specific type of thing, just like a part of the money we pay in taxes pays for the police and firemen who protect us, this would have us paying to ensure doctors can treat us for illness and injury.

I don’t see the distinction between buy and have when the only way to get a thing is for someone to buy it. This is the “I like it” and “by whatever means” arguments in favor of constitutionality.

I expect the Supreme Court to strike down the mandate. I suspect the rest will go down, as well, because it’s the least controversial and problematic path if the mandate goes. The rest of the act needs the mandate to achieve the remaining cost savings (that it won’t actually achieve, even with the mandate). The least “activist” thing to do is for the Court to let Congress start over.

None of this is to suggest that we should do a victory dance in favor of the old status quo if the mandate goes down. We need reform within health care. Such as untying insurance from employment, which our current unemployment rate suggests would be wise. We won’t get responsible reform, because we’ll get more rent-seeking like PPACA instead. But if Congress has to start over, there’s a chance, however small.

Link via Wil Wheaton, who should heed his own “Don’t Be A Dick” suggestion. Blaming the constitutional challenge to PPACA on “the Koch Brothers and their Tea Party Rubes” as an attempt to “get the Supreme Court to take away” what PPACA legislates is dickish partisanship. Calling one’s opponents names and implying they’re stupid merely based on group affiliation is being a dick.

Underpants Gnome Legislating

In this recent post, The Two Obfuscations of Obamacare, Jason Kuznicki explains the basic arguments against the law in the context of its (lack of) constitutionality. I agree with it all. This is the best part of the post:

As a thought experiment: Suppose we levy a tax on everyone. You can get out of it by spending two days a week breaking rocks in a quarry, in leg irons. The beneficiary is a multinational mining corporation.

It’s just a tax, I’m sure you’ll have to admit — not a penalty in any sense at all. And it’s certainly within the federal government’s power to regulate the mining industry. No one doubts that, do they? So the whole thing gets a pass, constitutionally. Right?

On a related note, I find it amusing when the law’s supporters demand that opponents call it something other than “Obamacare.” I’ll echo a sentiment I read somewhere that questioned this demand because, if the law is so wonderful, why shouldn’t its supporters be happy to have President Obama forever linked with this supposed improvement? That doesn’t advance the debate, but it’s also a fair comment. And, as Jason points out in the comments to his post, the official name of the law is dishonest. Getting outcomes is more complex than legislating an industry as if it’s a vending machine that gives us what we want when we insert our dollar bill. “Affordable” lacks context, since it’s a subjective concept. The plan to get there is preposterous magical thinking.

Just Wait Until Government Gets Involved

I’ve mentioned a few times in my Twitter feed that I started playing hockey this fall for the first time. I’ve played a handful of games already, sustaining some form of injury in more than half of them. It hasn’t deterred me because I’ve discovered a love for the game. Unfortunately, though, my latest injury may be something more than a nagging reflection of my out-of-shape 36-year-old body. I fell in my most recent game, landing awkwardly on my wrist and hand. It’s now stiff, swollen and a strange shade of orange. After a few days, I finally acknowledged that machismo isn’t the best way to deal with it. So, today I went to the doctor.

I had to answer biographical questions with no bearing on getting an x-ray. I had to provide a photo id to be scanned, allegedly to prevent insurance fraud, as required by federal law. My doctor had to give me a prescription for extra-strength Advil, which I declined, if I wanted to take one pill instead of several. I’m sure there were other laws being followed that did not add to my medical care. What will it be like when the government gets involved?

When I get the bill for my doctor’s consultation and the x-ray services, I will be responsible for 100% of it in my high deductible health insurance plan because I haven’t met my deductible. I find that acceptable because I intentionally signed up for my plan. The deductible matches the cumulative annual premium for my previous policy. What will happen to my preferred plan since it is unlikely to include what Congress decides I need because it doesn’t provide a full range of services included for “free”?

The key, though, is my ability to get the care I needed. I scheduled my appointment yesterday afternoon, saw my doctor this morning, and got x-rays taken on a walk-up outpatient basis immediately after that. I’ll know tomorrow whether I’ve fractured anything. I have no doubt that I’ll be able to quickly receive any additional treatment I may need. Our current medical system costs money, but that timeline is not free. Congress is too far removed from individuals to determine that the trade-off between those two is incorrectly balanced. I doubt it cares. The potential outcome concerns me.

Why Do We Tie Employers to Sickbeds?

There’s no easy way to give a sufficient account of this letter to Andrew Sullivan, posted under the theme “The View From Your Sickbed.”  I’ll do what I can, but give it a quick read to understand the details.

Bascially, a 33-year-old woman died after overdosing on Tlyenol, a problem further complicated by lupus. In the rush to give her care, the hospital didn’t get the woman’s new insurance information, so it worked under the assumption that the liver transplant she needed to survive wasn’t covered.  Her insurance from her previous job didn’t cover a tansplant, while her insurance from her current job did. The hospital lost time figuring out solutions to a problem it didn’t really have.

This is all unfortunate, no less so from the apparent inevitability of her death suggested in the reader’s e-mail.  But I wouldn’t get here from the facts provided, as the e-mailer did:

But, if there was a universal healthcare plan in place, all of that would have been unnecessary. This woman’s condition and treatment wouldn’t have been contingent on just what was and was not covered by her particular plan, and the simple fact she had recently changed jobs would not have confused what options were available, and a bureaucracy would not have come between her and her doctor.

This conclusion leaves unquestioned the assumptions upon which our current system is built.  Specifically, if we didn’t tie health insurance to employment, this woman may have had consistent coverage on her own, relevant to her unique health considerations.  This may have avoided the situation she encountered due to the hospital’s out-of-date records.

We need reform, but not the reform currently offered.  Regardless, we will never get the process correct until we break from the narrative that demands we accept that the road to peril started at the point and with the cause(s) most convenient to a preferred explanation.

Post script: For the purpose of this post, I’ve intentionally ignored the privacy and data management issues involved in a universal health care plan capable of solving this problem.

Single-Payer and Circumcision in America

In my second response to Hanna Rosin’s posts on circumcision at The Daily Dish, I closed with this:

As a circumcised male, why do I care whether circumcision is mandated by the government or merely by my parents? The result – forced circumcision – is the same for me. Basically, Rosin engages in the “if you don’t like circumcision, don’t circumcise your son” defense. This is wrong. The case against circumcision centers on the boy as a (healthy) human being, not the boy as a son of parents making a choice.

This is the core of the ethical refutation of prophylactic infant male circumcision. Proxy consent cannot be justified on any grounds because the surgery is unnecessary, permanent, and carries an inherent risk of damage beyond what is deemed acceptable. On the last point, remember that no one considers the boy’s potential future disagreement with society’s definition of acceptable.

Ms. Rosin’s passage that prompted my comment involved the question of government-mandated circumcision. The CDC is not recommending that, of course. My point stands because, to the circumcised child, an influenced decision is no better than a required non-decision if he does not wish to be circumcised. But it does raise an interesting point for the current debate over health insurance reform that I’ve attempted to make in the past. From Ed Morrissey:

I’m neutral on the issue of circumcision, which has become a controversial practice, but find this idea of interventions very, very odd. In the first place, circumcision does not provide an immunity to STDs, not AIDS or anything else. Studies indicate that circumcised males may have less danger of acquiring an infection, but as the NYT points out, that’s from heterosexual relations — a very minor channel of AIDS communication in the US. Men have much better choices than circumcision for avoiding HIV infection, including the use of condoms (still not a perfect defense, but better than circumcision), refraining from intravenous drug use with shared needles, avoiding high-risk sexual practices altogether, and so on.

Why should the CDC push circumcision at all? The government has no business being in the middle of that decision. Under ObamaCare, however, when the government starts paying more and more of the health-care tab, they will point to ambiguous cost savings down the road — in this and other cases, decades down the road — to pressure Americans into surrendering their choices now. [ed. note: surrendering the choices of their children]

Apart from unnecessarily cluttering the single-payer issue with the “ObamaCare” phrase, this is exactly right, I think. How often do we need to see the public health community ramble on about the cost-benefit analysis “proving” that the net effect of prophylactic infant male circumcision is positive? How many lies pretending that non-essential and non-functional are synonyms will be necessary before we accept that not everyone shares the same view about what individuals should do and have, when those same people so often prove that they mistake their opinion for fact? Those people are at least as likely to make it to positions of power as anyone who considers the child’s lack of need and possible future objections.

It’s useful to highlight that most countries with an explicitly single-payer health care system have infant male circumcision rates that don’t approach 10%. Of course. But we can’t dismiss that the rates are greater than 0%. We must consider why.

I think the question of why narrows to culture. American culture places a high, irrational value on circumcision and its alleged wonders. Whether it’s the perceived health benefits for diseases that are already unlikely in a normal human state or a fear that schoolmates and sexual partners will laugh at him if he’s normal rather than common, we don’t evaluate circumcision factually. Ms. Rosin demonstrated this when she wrote that calling circumcision surgery is “a bit of an exaggeration.” No, it’s not, but our society possesses a strong anti-curiosity attitude on the topic. As Mr. Morrissey noted, the New York Times article provides all the necessary data to show that the CDC’s thinking is irrational. Yet, it’s picked up by people like Ms. Rosin who uncritically regurgitate only the parts they like and declare the resulting subset of findings uncontroversial. This is the low level of discourse in America surrounding circumcision and children.

If America had implemented a single-payer system at the same time England created its system, we could make a one-to-one comparison and the incidence of circumcision today would likely be close. But we didn’t. Instead, we have 60 additional years of circumcision to defend and justify. We have irrational beliefs to refute, should those holding those beliefs be willing to question them. We have a society that “knows” the foreskin is “just a flap of useless skin” and isn’t interested in hearing anything to the contrary, no matter how logical or based in scientific proof. A majority of our society still believes that the individual child is in the care of his parents for his medical decisions without a thought that this non-therapeutic surgical intervention is (social) experimentation, not medical care. The national discussion becomes about what people want to believe, not what is true. Cost is not a primary concern.

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Patrick Appel posted the Ed Morrissey link at The Daily Dish, where I found it. Mr. Appel writes:

The CDC is thinking of promoting circumcision, not requiring it. Whether or not you agree with the procedure, this controversy has nothing to do with health care reform. If single-payer leads to more circumcision, then how come America has among the highest rates of circumcised men in the world, much higher than most if not all countries with socialized medicine?

Mr. Appel makes the same mistake. The argument isn’t that single-payer leads to more circumcision. The argument is that American single-payer will not lead to a decrease in male circumcision. Either the system will pay or parents will pay. My view is the former because public health officials invariably think about the public rather than the individuals in the collective and politicians do not have the moral framework to say “no” to the inevitable backlash that would occur. Without legal reform recognizing the same rights for boys that we’ve already codified for girls, circumcision will continue in America, regardless of who pays.

I Do Matthew Yglesias’ Homework

Last week, in a post lamenting the not-odd fact that the words and actions of politicians do not match, Matthew Yglesias wrote this:

My personal feeling, the longer I spend in DC and working in the political domain, is that I get better and better at understanding other people’s ideologies. I also feel that people writing about politics often caricature opponents’ views as part of a rhetorical strategy. But I’ve been back-and-forth on the main issues long enough that I’m pretty sure I could switch this blog’s point of view and do a credible job of offering critiques-from-the-right of the progressive liberal health reform movement and the progressive liberal approach to domestic policy generally. One happy consequence of this is that I find the stubborn persistence of principled disagreement less mystifying than I once did, and have a greater appreciation for what I now think of as a certain irreducibly Kierkegaardian element to ideological commitment that, in turn, helps explain why so many “normal” people have such fuzzy political views.

The words I placed in bold are important to remember while reading an entry Mr. Yglesias posted¹ yesterday (archived version:

There’s lots of great stuff in this Ed Pilkington story about the dark side of free market health care (via Tomasky) but my favorite bit was this part:

Eventually his lack of motor control interfered with his work to the degree that he was forced to give up his practice. He fell instantly into a catch 22 that he had earlier seen entrap many of his own patients: no work, no health insurance, no treatment.

He remained uninsured and largely untreated for his progressively severe condition for the following 11 years. Blood tests that could have diagnosed him correctly were not done because he couldn’t afford the $200. Having lost his practice, he lost his mansion on the hill and now lives in a one-bedroom apartment in the suburbs. His Porsches have made way for bangers. Many times this erstwhile pillar of the medical establishment had to go without food in order to pay for basic medicines.

This is the kind of thing that makes it so hard for me to take seriously the idea that we can’t have the government give people health care because it might subject them to “rationing.” Depending on the details, it may or may not be correct to believe that any particular government program is being too stingy. But how does giving people nothing at all resolve that problem?

There are two issues here, closely related to Mr. Yglesias’ entry from last week linked above. The initial problem is glaring but only if you follow the link to the Ed Pilkington story. You wouldn’t know this from his excerpt, but the paragraph continues (emphasis mine):

He remained uninsured and largely untreated for his progressively severe condition for the following 11 years. Blood tests that could have diagnosed him correctly were not done because he couldn’t afford the $200. Having lost his practice, he lost his mansion on the hill and now lives in a one-bedroom apartment in the suburbs. His Porsches have made way for bangers. Many times this erstwhile pillar of the medical establishment had to go without food in order to pay for basic medicines. In 2000 Manley finally found the help he needed, at a clinic in Kansas City that acts as a rare safety net for uninsured people. He was swiftly diagnosed with Huntington’s disease, a degenerative genetic illness, and now receives regular medical attention through the clinic.

Mr. Yglesias’ excerpt is an incomplete representation of the complex facts, presumably to make the point – a caricature, if you will – that the free market has failed. But has it really failed?

Mr. Manley probably should’ve saved his money for potential later-life crises rather than buying a new Porsche every year, as the article states he did when his practice was strong. That is a relevant point, but it’s little more than a distraction to the real issue underlying Mr. Yglesias’ belief that everyone has an obligation to pay for everyone’s care, especially where the free market (allegedly) fails. Regardless, we have the system we have, not the one either side wishes. It shouldn’t have taken so long for Mr. Manley to receive the care he needed. Stating this needn’t be considered a concession or profound.

What Mr. Pilkington, and subsequently Mr. Yglesias, failed to explore is the care that Mr. Manley eventually received.

[Dr. Sharon] Lee’s clinic, Family Health Care, is a refuge of last resort. It picks up the pieces of lives left shattered by a health system that has failed them, and tries to glue them back together. It exists largely outside the parameters of formal health provision, raising funds through donations and paying all its 50 staff – Lee included – a flat rate of just $12 an hour.

Unlike Mr. Yglesias, I researched Family Health Care. It took approximately 10 minutes. Mr. Manley is getting care thanks to the “dark side of the free market.” Consider the clinic’s financial profile for 2005-2007:

The clinic receives 0% of its funding from government, meaning that the remaining 100% of its budget comes from the bank accounts of individuals, corporations, and non-profit organizations. Where is the free market failure to provide health care to those in need?

The structure of the American health care and insurance system is idiotic and needs reform. We should talk about that. The article even includes anecdotal stories to suggest problems that need to be addressed within the views of each side’s extremes. But presumably that wouldn’t have made the point for Mr. Pilkington or Mr. Yglesias that government needs to step in to protect the poor from the free market’s alleged failures, which are, we are told, ignored by the mean-spirited right-wing capitalist liars opposed to President Obama’s proposal. A neat, tidy box, indeed. That reaches closer to ideological commitment – propaganda, if you will – than journalism.

Update: I’ve struck the reference to propaganda. This isn’t that. Rather, Mr. Yglesias’ ideological commitment is more likely laziness embracing the appearance of victory.

¹ Normally I refuse to reprint an entire entry because links are survival. In this case, I can think of no other way to make my points.

Always Ask Who Will Pay for Free

In a mostly terrible article on President Obama’s town hall tour in The Washington Post, this:

Randy Rathie, the welder, told Obama that explanations of how reform would be funded have been lacking. “You can’t tell us how you are going to pay for that,” Rathie said. “The only way you are going to get that money is to raise our taxes.”

Obama told Rathie that the money for the changes would come from efficiencies and other savings and from people who make more than $250,000 a year.

The “efficiencies and other savings” canard is pleasant to hear, but debunking that is for another time when the details can be explored. The last claim is the low-hanging fruit I’m aiming for here. How is it not a tax increase to state that people who make more than $250,000 per year will pay for the costs of health insurance “reform”? Because they aren’t The People, somehow, so they don’t count? Even if that could be answered, what obligates those individuals, by mere status as financially successful in the president’s non-cost-of-living-as-a-consideration-view, to pay for the health insurance of those who are not financially successful? And how is it reform to further entrench the mentality that third-party payment is the way to control the costs of medical care?

Taking from those making more than $250,000 – despite their being evil for stealing from the poor, of course – is flawed because it still encourages the mentality that someone else is responsible for taking care of you.

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Also in the article:

He tried to rebut the notion that health-care reform represents a “government takeover,” noting that most people’s coverage would remain what it is today.

“I don’t want government bureaucrats meddling in your health care, but I also don’t want insurance bureaucrats meddling in your health care,” he said.

If someone else pays for your care, be it government or an insurance company, a bureaucrat will “meddle” because that is the entity with the financial incentive to do so. This is neither complicated nor contentious. There is no such thing as “free”. The more we attempt to pretend that is not true by having another pay for what we want, the worse our health care system will become.

Families Consist of Individuals

Via KipEsquire’s Twitter feed, here’s an interesting case about the power of the government to overrule medical decisions made by parental proxy.

A Minnesota judge has ruled a 13-year-old boy with Hodgkin’s lymphoma, a highly treatable form of cancer, must seek medical treatment over his parents’ objections.

In a 58-page ruling Friday, Brown County District Judge John Rodenberg found that Daniel Hauser of Sleepy Eye has been “medically neglected” and is in need of child protection services. Rodenberg said Daniel will stay in the custody of his parents, but Colleen and Anthony Hauser have until May 19 to get an updated chest X-ray for their son and select an oncologist.

Going only this far into the story, I’m inclined to believe that this is wrong because other reports I’ve read state that the boy understands his condition. Thirteen is not objectively too young for the child to consent or refuse. There must be a sufficient standard (the details are difficult and beyond the scope of this entry) to judge the child’s competence in the matter, but if the child passes that, I see no reason to interfere.

Rodenberg wrote that Daniel has only a “rudimentary understanding at best of the risks and benefits of chemotherapy. … he does not believe he is ill currently. The fact is that he is very ill currently.” Because of that and other evidence in the case, Rodenberg ruled there is a “compelling state interest sufficient to override the minor’s genuine opposition.”

Parents act irresponsibly if their child is incapable of deciding and they choose treatment (nutritional supplements and other alternative treatments) with no scientific basis instead of treatment (chemotherapy) with a high success rate. There are no perfect decisions in something as complex as cancer. Still, some level of objective comparison is possible, and success rates show this isn’t close. Doctors say he has a 5 percent chance of survival without chemotherapy and up to 90 percent with it.

A court-appointed attorney for Daniel, Philip Elbert, called the decision unfortunate.

“I feel it’s a blow to families,” he said Friday. “It marginalizes the decisions that parents face every day in regard to their children’s medical care. It really affirms the role that big government is better at making our decisions for us.”

Government has a role to play when people make decisions for another person. Pick a scenario where that qualifier isn’t involved and I will defend an individual’s right to make subjective, possibly fatal decisions for himself. But within that scenario, which applies to medical (and non-medical) decisions parents make for children, the government’s role is legitimate. It must protect the child from neglect and abuse, regardless of parental intention.

This case is similar to the case of Abraham Cherrix. My entry is here.