FEB. 22, 2000

Proponents of collectivist systems, under which goods and services are doled out by the government "for the good of the many," habitually assert that under such a system "all people are equal."

Observing how such a system really worked in Stalin's Russia, George Orwell created the metaphor "Animal Farm," in which the cardinal rule of the revolution, painted on the barn wall — "All animals are equal" — is altered one night after the pigs have moved into the farmer's house and started sitting up at night, drinking whisky and smoking cigars.

Lo and behold, the horses and sheep awaken one morning, and the rule has been extended with some fresh paint. It now reads: "All animals are equal ... but some are more equal than others."

And that's what the rule always said, the pigs insist.

American medical care today operates in a nether world between the free market and collectivism. Hillarycare having been temporarily abandoned, the rich and powerful are still allowed to have private physicians on call. But when most Americans show up at an emergency room their treatment is prioritized according to their medical needs — a sorting process known to the medical profession as "triage."

So far so good. Few doctors would want to treat a cash customer for an ingrown toenail while a destitute patient lies bleeding to death outside. And William Hale, chief executive officer of Clark County's tax-subsidized University Medical Center, re-asserted Thursday "UMC remains committed to serving all patients equally, whether or not they are associated with the hospital."

But if Mr. Hale were Bill Clinton, it might behoove us at this point to ask him to define "equal."

In a Feb. 10 memo written by Evie Black, administrative assistant to Kay Clayton, western regional director of UMC's storefront "Quick Care" emergency rooms, and forwarded to "Officer Supervisors; Unit Coordinators," Ms. Black makes it clear that Clark County commissioners (who serve as the county-funded hospital's board of trustees) have something in common with Mr. Orwell's whisky-swilling pigs — they seem to be animals of the "more equal" variety.

"In case I wasn't clear," Ms. Black wrote, "please make sure these County Commissioners are triaged before other patients when they come into your clinic. They should be showing you their badges which will help to identify who they are. Please notify your staff so this procedure is implemented!"

And it's not just the political poobahs. Hospital chief Hale admits his staff was also looking for ways to "expedite the process for all employees of UMC" to be provided care ahead of routine patients, "so they can get back to work."

As though the employers of the hospital's other patients wouldn't like to see their health problems dealt with promptly, so they can return to work.

Naturally, everyone up to Bruce Woodbury, chairman of the Clark County Commission, denies they ever saw or heard of or approved this memo, or its preferential policy. And now that it's been exposed it will probably be quietly buried. It was silly in the first place — at their salaries and with their enviably comprehensive health plans, it's unlikely the county commissioners will experience much trouble receiving prompt attention at far more upscale medical venues than the echoing UMC emergency room, with its knife wounds and overdoses.

But this echo of the kind of "superior treatment for party members" bitterly remembered by survivors of communist Russia does remind us how quickly tax-funded "public service" operations can be politicized.

In a free market, it's the customer who no one wants to keep waiting, since he or she pays the bills. (Imagine waiting three hours for service at McDonald's.) But when health care is seen as "free" because it's "paid for by someone else," the long lines of those who choose the "free" emergency rooms over a family doctor (who actually expects his bills to be paid) soon stretch out the door, and the "customer" is soon seen as nothing but an inconvenient burden, while it's the politicians with their wads of dough who have to be kept happy.

If UMC staff find it too time-consuming to be treated in their own facilities, what does that tell us?

Existing ER personnel in Las Vegas do admirable work. What the emergency rooms of this fast-growing city need to do is add staff and capacity. But why would hospital managements do that if they lose money on the enterprise, what with Medicare and Medicaid and even the private insurance companies now paying them 40 cents on the dollar if they're lucky?

In a true free market, new doctors' offices and free-standing ERs with extended hours and bright neon signage would soon spring up to fill this void, advertising: "Charity patients seen for life-threatening emergencies only: Attention guaranteed within 10 minutes for customers paying cash — plus free frequent flier miles."

But in "capitalist" America today, where most states have enacted "compassionate" statutes mandating unlimited medical charity, that would probably be illegal, wouldn't it?

~~~o~~~

Vin Suprynowicz is assistant editorial page editor of the Las Vegas Review-Journal.
His new book, Send in the Waco Killers is available at $24.95 postpaid from
Mountain Media, P.O. Box 271122, Las Vegas, Nev. 89127; or by dialing 1-800-244-2224