Monday, October 15, 2012

National Triage

In medicine there is a need to manage your resources, time, material, even who responds because your ability to respond and treat are finite. An ER in even a metropolitan area can get overwhelmed with 5 critical casualties. Imagine if a bus were to crash and 30-35 critical casualties were reported. That can stress a whole COUNTY. Every doctor that works in an ER must be a master of multitasking, and must be a leader of first order. When someone comes in that can quite frankly wait, they can and do because your job is not to do the best for a few patients, but to do the most good for the most number of people.

 We have a name for this. It is called Triage, which is a French word which means "to sort". We have various categories. Immediate: must be seen right now or they'll die. They go right to the front of the line, regardless of how long someone else is waiting. Delayed: they can wait. The time they can wait is dependent on the severity, but they're not in danger of just dropping dead in the next hour or so. Minimal: these ate the people that you can hold off treating for up to a day. Not only are they not in danger of dying, but they might actually be fine if you don't treat them. Expectant: they're either dead, or about to be. Either you don't have the resources to help them, or more likely they're so far gone that NOBODY can help them.  You DO NOTHING for these patients.  To waste resources on those you can not help is a losing proposition.  Even when dealing with just one patient your priorities are clear.  You can not waste resources and time stitching up a small cut on an eyebrow while the patient chokes to death.   

But this principle can, and more importantly should be applied on the national stage.  We are spending over $1T a year more than we take in.  If we were to view money as the lifeblood that the organs of the government depend on, that deficit is a hemorrhage we can not sustain.  On a patient, this kind of loss would quickly lead to shock and death.  Economically the idea is the same.  We are hemorrhaging money.  It doesn't really matter where its going, you can essentially argue that its not being used properly.  One could even argue that the economic reactions can even be argued to be the first sign of compensative shock.  We can handle it right now.  Anyone that has ever worked a trauma will tell you that when it goes to noncompensative shock, you lose control quickly, before going into unrecoverable shock and death.

The Government only has X amount of money.  We have to ask ourselves, very seriously, what do we want.  Do we want an awesome military?  Ok.  Do we want universal healthcare?  That can be done too.  Do you want free, 1st rate top of the line public schools (elementary through college)?  That can be done too.  You can also have a "safety net" that is so large no one falls through the cracks. . . Do you want to have a thriving economy with innovation and limited government controls?  Do you want "social" programs to help any number of people. You can do one of all of these things, but you can not even closely do them all.  you can't even do most.  Indeed you really can only do one, maybe two.

So what do you do?  Well I am clearly biased.  A strong military is essential.  The it is clear that the only reason that the Democratic Socialist countries can do all the wonderful things (at least according to the American Left) that they do is because they have outsourced their military spending to. . . America.  Not just NATO countries but pretty bunch all countries that were even notionally aligned with America in the Cold War.  Great.  We're the world wide force for stability.  I actually have no problem with that.  The problem is that now we want all those thing that the Democratic Socialists say is so great, and the only way to pay for it is to gut the military.

It is being shown now that even those western European countries can't afford those awesome benefits anymore.  If they can not afford it, what hope have we?  The point is simple.  Pick your battles.  What do you want?  Make sure you're clear on what you want and how you want to get it.  In doing so you also have to be honest with what you have.  The more debt we have, the less options we have. It is clear that regardless of how the election goes the next four years may become very painful.  We're going to have very finite resources.

It is clear that if we go the path we're on, forget about "gutting" medicare, it won't exist.  How many seniors will be thrown over the cliff when there simply isn't any money for the program?  What will that do to they young?  College will be impossible for everyone, because no one can get student loans.  If you think the housing market is bad now, what do you think will happen when the dollar isn't worth the paper its printed on?  Unlike a Hollywood movie simply shocking a patient won't bring them back (in reality that almost never works).  If the lifeblood is all over the ground, how is that going to do the organs any good?  If the organs of state start to shut down, how long does it take before the body as a whole dies?

The patient is bleeding.  How do you plan to staunch the flow? 

1 comment:

harp1034 said...

Kick the can down the road. When push comes to shove those responsible will be either dead or long gone from office. Hey it didn't happen on my watch!