Thursday, June 18, 2009
Political Mayhem Thursday: Health Care
I'll admit that I still don't much understand the Obama health care proposals. They include a lot of things that McCain's plan featured as well: More efficient record-keeping, more preventative medicine, and lower overhead.
First, critics of the Obama plan need to accept one thing-- that it does not mandate European-style single-payer health care. In fact, it primarily seeks to expand the availability of health insurance from private insurerers. However (and this is the most controversial part right now) Obama want to allow a public insurance plan that would compete with the others. Essentially, this would be an extension of Medicare-- that is, people could buy into the public Medicare system that presently covers only older Americans.
The advantage of this is obvious. Medicare would compete with the private insurers, making them more efficient. Coverage would be also be expanded so that many more people would have insurance.
Is this a good idea?
First, critics of the Obama plan need to accept one thing-- that it does not mandate European-style single-payer health care. In fact, it primarily seeks to expand the availability of health insurance from private insurerers. However (and this is the most controversial part right now) Obama want to allow a public insurance plan that would compete with the others. Essentially, this would be an extension of Medicare-- that is, people could buy into the public Medicare system that presently covers only older Americans.
The advantage of this is obvious. Medicare would compete with the private insurers, making them more efficient. Coverage would be also be expanded so that many more people would have insurance.
Is this a good idea?
Comments:
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Has competing with DHL, UPS and FedEx made the USPS more efficient?
There is a reason that Federal Law will NOT allow private couriers to price their services similar to the USPS...
There is a reason that Federal Law will NOT allow private couriers to price their services similar to the USPS...
# posted by 
: 7:23 AM
: 7:23 AM
Mailing things really fast with a tracking number is not a public right.
Some things are not about "efficiency." Some things are about maximizing the good of a society because we believe in ideals. This is why we have public education, public military (security is pretty important to a functioning society), public courts, etc. Those who favor expanding the capacity of the government to ensure health care for more, if not all, Americans, feel health care is essential to maximizing the good of society (and, with health care, I'd argue this good entails both ideals and economics).
[But here I am "accepting" that the private sector is de facto more "efficient" than the public sector, which I do not agree with. I just think that's a separate debate.]
Some things are not about "efficiency." Some things are about maximizing the good of a society because we believe in ideals. This is why we have public education, public military (security is pretty important to a functioning society), public courts, etc. Those who favor expanding the capacity of the government to ensure health care for more, if not all, Americans, feel health care is essential to maximizing the good of society (and, with health care, I'd argue this good entails both ideals and economics).
[But here I am "accepting" that the private sector is de facto more "efficient" than the public sector, which I do not agree with. I just think that's a separate debate.]
# posted by : 7:34 AM
: 7:34 AM
To clarify fully: I'd like to have this debate be about ethics, not economics. Let's pretend we all agree with the first post above, and move on. What if that's not the point?
# posted by : 7:49 AM
: 7:49 AM
SOME THOUGHTS
PART ONE: a right to health care?
1. If health care is a right (guaranteed under the DOI or Constitution or Bill or Rights or the 9th Amendment or some penumbra thereof), then isn't a right to equal health care under the law also present? Therefore, isn't it the duty of the government to provide the best health care available to all its citizens?
Health care as an inalienable right is just NOT sustainable fiscally or morally defensible. And the above "right to health care" formulation is a recipe for economic disaster.
Do we need reform? Yes. While health care is not an inalienable right conferred upon humanity from the Creator, for a myriad of reasons, it is in the interest of a community to provide health care for citizens who cannot afford it. NO arguments there--but the health care debate couched in the language of "natural rights" is demagogic and dangerous.
-----
Preview
PART TWO: why any discussion of reform, if we seek to be intellectually honest, must also be a discussion of the ultimate progressive goal of one-payer universal health care.
PART THREE: how one-payer as a vehicle to ration care and deal with the ultimate unsustainability of our current regime might actually be a decent solution--although you will never see it sold as such.
PART ONE: a right to health care?
1. If health care is a right (guaranteed under the DOI or Constitution or Bill or Rights or the 9th Amendment or some penumbra thereof), then isn't a right to equal health care under the law also present? Therefore, isn't it the duty of the government to provide the best health care available to all its citizens?
Health care as an inalienable right is just NOT sustainable fiscally or morally defensible. And the above "right to health care" formulation is a recipe for economic disaster.
Do we need reform? Yes. While health care is not an inalienable right conferred upon humanity from the Creator, for a myriad of reasons, it is in the interest of a community to provide health care for citizens who cannot afford it. NO arguments there--but the health care debate couched in the language of "natural rights" is demagogic and dangerous.
-----
Preview
PART TWO: why any discussion of reform, if we seek to be intellectually honest, must also be a discussion of the ultimate progressive goal of one-payer universal health care.
PART THREE: how one-payer as a vehicle to ration care and deal with the ultimate unsustainability of our current regime might actually be a decent solution--although you will never see it sold as such.
Well, I'm sure Septimus would like this to be about ethics and not economics because the economics don't support Obama's plan. Look, it isn't real competition. The public option will be heavily subsidized by taxpayer money, making it cheaper (regardless of whether it offers better service or not) and eventually the government will be able to say (wrongly) that they have the best option because it is the cheapest and most affordable. Obama's plan may not be a single payer system, but the whole point is to move to a single payer system in the future. It is the groundwork for exactly that.
So, on to Septimus' point. Why would that be bad? Why would a single payer systembe ethically wrong? Well, I think a real good indication is to look to Europe and Canada and places where it has been tried. You know what we've seen over the past 10-20 years in those countries? Increasing privitization of health care. Skyrocketing costs of government run care along with a basic lack of services for some people has meant that these bastions of socialized medicine have begun to turn some portion of their health care system back over to private companies. Why would we want to do something that Europe has already tried and decided didn't work? Why do we want to stand in the face of emperical evidence and ignore it?
So, on to Septimus' point. Why would that be bad? Why would a single payer systembe ethically wrong? Well, I think a real good indication is to look to Europe and Canada and places where it has been tried. You know what we've seen over the past 10-20 years in those countries? Increasing privitization of health care. Skyrocketing costs of government run care along with a basic lack of services for some people has meant that these bastions of socialized medicine have begun to turn some portion of their health care system back over to private companies. Why would we want to do something that Europe has already tried and decided didn't work? Why do we want to stand in the face of emperical evidence and ignore it?
# posted by : 10:06 AM
: 10:06 AM
Anon 6:23--
The answer to your question, "has competition with DHL, UPS and FedEx made the USPS more efficient?" is a resounding yes. The postal service takes no subsidy from the government-- all revenue is from postage and other postal income. Since 1971, it has become 139% more efficient, in fact, and that is the time period in which it has faced competition.
Moreover, I don't think many people think that competition in the delivery business is a bad thing. That was a strange analogy.
As to health care, one of the anomolies in that area is that Medicare is much more efficient than the private sector, in terms of a much lower overhead. Much of that efficiency, of course, is a function of size.
The answer to your question, "has competition with DHL, UPS and FedEx made the USPS more efficient?" is a resounding yes. The postal service takes no subsidy from the government-- all revenue is from postage and other postal income. Since 1971, it has become 139% more efficient, in fact, and that is the time period in which it has faced competition.
Moreover, I don't think many people think that competition in the delivery business is a bad thing. That was a strange analogy.
As to health care, one of the anomolies in that area is that Medicare is much more efficient than the private sector, in terms of a much lower overhead. Much of that efficiency, of course, is a function of size.
PART TWO: why any discussion of reform, if we seek to be intellectually honest, must also be a discussion of the ultimate progressive goal of one-payer universal health care.
Quoting the President:
But we also know that there are those who will try and scuttle this opportunity no matter what - who will use the same scare tactics and fear-mongering that's worked in the past. They'll give dire warnings about socialized medicine and government takeovers; long lines and rationed care; decisions made by bureaucrats and not doctors.
I hate it when those people show up. They are always up to no good. Their goal is always the same: work against the public interest for the special interests.
An Aside: this president engages in this brand of straw man sophistry way too much. This is a continuing disappointment for me. While I continue to like him and wish him the best, I desperately wish he would abandon this low road of public discourse.
The REAL POINT:
Why do we conservatives worry that this is the first step to socialized medicine (a single-payer system)?
Here is one very personal reason: every thoughtful liberal I have ever met has eventually admitted to me that European-style or Canadian-style national health care is exactly what they wanted--if not now, eventually.
Why? In general, my liberal friends tend to see government guaranteed universal health care as the "smart" and humane solution. My experience is that they tend to view the popular aversion to this idea as less enlightened citizens who are blind to their own interests (and some actually believe in the conspiracy of "those" who are out to mislead and terrorize voters into compliance).
Click on to your nearest progressive website and you will find discontent that the President is not asking for the whole enchilada right now--tempered by the consolation that this half-measure is merely what is politically possible--for now. But, rest assured, they tell us, we're gonna get there.
For a recent example of this, see Bernie Sanders in the Christian Science Monitor: http://www.csmonitor.com/2009/0616/p09s01-coop.html
Moreover, National Health Care was a staple in every Democratic platform for many many years.
The President, who fancies himself an honest man steeped in nuance, ought to deal with this question more frankly.
But don't blame conservatives for viewing this latest installment of a long running national drama in the context of a much larger philosophical-slash-political discussion.
Quoting the President:
But we also know that there are those who will try and scuttle this opportunity no matter what - who will use the same scare tactics and fear-mongering that's worked in the past. They'll give dire warnings about socialized medicine and government takeovers; long lines and rationed care; decisions made by bureaucrats and not doctors.
I hate it when those people show up. They are always up to no good. Their goal is always the same: work against the public interest for the special interests.
An Aside: this president engages in this brand of straw man sophistry way too much. This is a continuing disappointment for me. While I continue to like him and wish him the best, I desperately wish he would abandon this low road of public discourse.
The REAL POINT:
Why do we conservatives worry that this is the first step to socialized medicine (a single-payer system)?
Here is one very personal reason: every thoughtful liberal I have ever met has eventually admitted to me that European-style or Canadian-style national health care is exactly what they wanted--if not now, eventually.
Why? In general, my liberal friends tend to see government guaranteed universal health care as the "smart" and humane solution. My experience is that they tend to view the popular aversion to this idea as less enlightened citizens who are blind to their own interests (and some actually believe in the conspiracy of "those" who are out to mislead and terrorize voters into compliance).
Click on to your nearest progressive website and you will find discontent that the President is not asking for the whole enchilada right now--tempered by the consolation that this half-measure is merely what is politically possible--for now. But, rest assured, they tell us, we're gonna get there.
For a recent example of this, see Bernie Sanders in the Christian Science Monitor: http://www.csmonitor.com/2009/0616/p09s01-coop.html
Moreover, National Health Care was a staple in every Democratic platform for many many years.
The President, who fancies himself an honest man steeped in nuance, ought to deal with this question more frankly.
But don't blame conservatives for viewing this latest installment of a long running national drama in the context of a much larger philosophical-slash-political discussion.
Why make it about economics or ethics? A private system benefits the wealthy who can use greater resources (money) to monopolize a standard of care they deny to others. The problem isn't lack of access. That's a symptom. It's not costs or rights or any of that. Those are ancillary.
It's about class!
As long as there is a chance for a privatized system where profit drives health care decisions, those decisions favor the wealthy. The bourgeoise dream of being wealthy, and led by this illusion resist change. The poor are politically disenfranchised and accept a Faustian deal with insurance because health care is inelastic, in neoclassical terms. Insurance exploits us all, the system generates large profits for those at the top, and the standard of care for the vast majority drops while increasing for the few.
The aristocracy is maintained, and society keeps chugging along.
It's about class!
As long as there is a chance for a privatized system where profit drives health care decisions, those decisions favor the wealthy. The bourgeoise dream of being wealthy, and led by this illusion resist change. The poor are politically disenfranchised and accept a Faustian deal with insurance because health care is inelastic, in neoclassical terms. Insurance exploits us all, the system generates large profits for those at the top, and the standard of care for the vast majority drops while increasing for the few.
The aristocracy is maintained, and society keeps chugging along.
PART THREE: how one-payer as a vehicle to ration care and deal with the ultimate unsustainability of our current regime might actually be a decent solution--although you will never see it sold as such.
Quoting the President:
Health care reform is no longer just a moral imperative, it's a fiscal imperative.
He is right, of course. The health care debate has shifted beneath our feet.
Why? The Party is Over.
One day, we will look back wistfully on this moment and recall our privileged status regarding health care in America. Although we have NOT spent a lot of time appreciating the wonder of the current system, the vast majority of us have been privy to the best-trained physicians, the most advanced medical technologies, and the most comprehensive network of doctors and facilities ever assembled in the annals of medical history.
Those days are necessarily coming to a close.
Why? Not merely because the "Radicals have taken over." True, Barack Obama and his brain trust seem intent on finally fulfilling the ancient New Deal promise of national health care, which has always portended a leveling effect on the quality of care--but that fact is merely incidental to this story. This inevitable change is NOT driven primarily by the "social justice" side of the political ledger--or, as the President characterizes it, "the moral imperative."
For decades, we have been very close to totally deaf to the sad refrain of "forty million uninsured" fellow citizens. Why so unresponsive? Partly because the claim is something of a distorted and transparent political manipulation, but mainly because the vast majority of us were thriving under the status quo. We are not a blindly utilitarian society, but when the great bulk of the citizenry are prospering under a given regime, they are loath to sacrifice their advantage for a disadvantaged minority. In that regard, nothing has changed. Collective compassion will not be the impetus for the massive change in the offing.
What is different this time?
The UNSUSTAINABLE rising costs. As a society, we CANNOT afford to pay for health care through government agency anymore than we can afford our current system of health care as an employee benefit.
Ironically, we are victims of our own success. The wonders of medical research and development and production have outdistanced our financial resources. Most of us do NOT assume we are inherently deserving of the very best and most-advanced products in our consumer culture. We make choices commensurate with our ability to pay.
The obvious solution is cost control, which means rationing care, which means the Golden Age of carte blanche health care is concluding.
How we get there remains undetermined, but the ultimate destination is certain.
We can no longer enjoy unlimited health care regardless of our ability to pay. Socialized medicine is one way to control this economic problem. Socialized medicine is a perhaps less painful way to inaugurate the era of limits.
Having said that, I still cannot support this plan at this time. I would like to wait for a moment when there is more political equity and, therefore, more honesty and more bipartisan buy-in.
Quoting the President:
Health care reform is no longer just a moral imperative, it's a fiscal imperative.
He is right, of course. The health care debate has shifted beneath our feet.
Why? The Party is Over.
One day, we will look back wistfully on this moment and recall our privileged status regarding health care in America. Although we have NOT spent a lot of time appreciating the wonder of the current system, the vast majority of us have been privy to the best-trained physicians, the most advanced medical technologies, and the most comprehensive network of doctors and facilities ever assembled in the annals of medical history.
Those days are necessarily coming to a close.
Why? Not merely because the "Radicals have taken over." True, Barack Obama and his brain trust seem intent on finally fulfilling the ancient New Deal promise of national health care, which has always portended a leveling effect on the quality of care--but that fact is merely incidental to this story. This inevitable change is NOT driven primarily by the "social justice" side of the political ledger--or, as the President characterizes it, "the moral imperative."
For decades, we have been very close to totally deaf to the sad refrain of "forty million uninsured" fellow citizens. Why so unresponsive? Partly because the claim is something of a distorted and transparent political manipulation, but mainly because the vast majority of us were thriving under the status quo. We are not a blindly utilitarian society, but when the great bulk of the citizenry are prospering under a given regime, they are loath to sacrifice their advantage for a disadvantaged minority. In that regard, nothing has changed. Collective compassion will not be the impetus for the massive change in the offing.
What is different this time?
The UNSUSTAINABLE rising costs. As a society, we CANNOT afford to pay for health care through government agency anymore than we can afford our current system of health care as an employee benefit.
Ironically, we are victims of our own success. The wonders of medical research and development and production have outdistanced our financial resources. Most of us do NOT assume we are inherently deserving of the very best and most-advanced products in our consumer culture. We make choices commensurate with our ability to pay.
The obvious solution is cost control, which means rationing care, which means the Golden Age of carte blanche health care is concluding.
How we get there remains undetermined, but the ultimate destination is certain.
We can no longer enjoy unlimited health care regardless of our ability to pay. Socialized medicine is one way to control this economic problem. Socialized medicine is a perhaps less painful way to inaugurate the era of limits.
Having said that, I still cannot support this plan at this time. I would like to wait for a moment when there is more political equity and, therefore, more honesty and more bipartisan buy-in.
This isn't about ethics. It's about economics. But if you want to talk about ethics, we can. I don't think it is ethical to force everyone in America to be liable to everyone who doesn't have health insurance. I think that all Christians, however, should help in whatever way they can to improve health care. I particularly admire the Catholic church for setting up so many hospitals across America that offer health care. I don't think it is the government's responsibility to take care of its citizens, I think that future abuses can occur when things like that happen. However, I do feel that it is the responsibility of every Christian to help others when they need health care.
# posted by : 11:44 AM
: 11:44 AM
"Where profit drives health care decisions."
So why would we prefer a government system where cost drives health care decisions? Why is it better to have a socialized system where your local health board decides what medicines can be afforded and which can't and then simply says that the government will not pay for certain drugs? Why is it preferable to have a system where cutting edge cancer drugs are routinely not given to dying cancer patients because the government has decided that the cost outweighs the benefit?
If anything, socialized medicine makes the class problem worse. The poor are stuck with the decisions of the government buerocracy in charge of deciding which drugs can be afforded and which can't. But the rich will just get additional private insurance, or they will do what people do in Canada and Europe now...can you guess what that is...hold on for it...THEY WILL COME TO AMERICA (or since we wont be doing it anymore some other forward thinking nation) TO GET TREATMENT!
So why would we prefer a government system where cost drives health care decisions? Why is it better to have a socialized system where your local health board decides what medicines can be afforded and which can't and then simply says that the government will not pay for certain drugs? Why is it preferable to have a system where cutting edge cancer drugs are routinely not given to dying cancer patients because the government has decided that the cost outweighs the benefit?
If anything, socialized medicine makes the class problem worse. The poor are stuck with the decisions of the government buerocracy in charge of deciding which drugs can be afforded and which can't. But the rich will just get additional private insurance, or they will do what people do in Canada and Europe now...can you guess what that is...hold on for it...THEY WILL COME TO AMERICA (or since we wont be doing it anymore some other forward thinking nation) TO GET TREATMENT!
# posted by : 11:44 AM
: 11:44 AM
RRL--
There is no doubt that health care in the US is great for the very rich.
What is sad is that we are content with that. It makes it seem like our society exists to serve the very rich.
There is no doubt that health care in the US is great for the very rich.
What is sad is that we are content with that. It makes it seem like our society exists to serve the very rich.
# posted by : 11:55 AM
: 11:55 AM
Anon:
Health care in America is actually pretty good for pretty much everybody. You get sick, you go to the hospital, they treat you. In fact, there is little question that the quality of care in this country is among the highest in the world.
What people complain about is the access to care or the cost of care. So, I'm sure socialized medicine will fix that, right?
Well, the problem most people identify is that you go to the doctor in America, get treatment and then you fight with your health insurance provider about whether it is covered. Socialized medicine solves that. The government will now tell you up front that you can't have that costly procedure. You're not worth it. So, no need to haggle over whether it is covered AFTER you've already been treated and you're healthy. The government will let you know right up front whether they have determined that you're worth helping.
Well, what about the uninsured folks? The folks who can't get treatment in this country? Who are these people? My buddy has zero insurance. None. He got sick, went to the hospital, and they ran a myriad of tests. They eventually, after several days, diagnosed him with diabetes. He stayed for another week while they stabilized him. And then they released him. Now, did he get a big bill. Yes. But he also got treatment. But socialized medicine is free!! Well, at least it is free in the sense that I don't write a check when I actually go to the doctor. I just write a bigger check every spring when I pay my taxes. So, that is a different form of free.
And my biggest problem with socialized medicine isn't about economics or the ethics of treatment. It is about freedom. It is about the risk that is inherent in granting power to a select group of elites that control an ever greater portion of my everyday life. It is about taking choices out of my hands and putting them in the hands of an allegedly benevolent government, no matter what party they are from.
I'm serious about this, everyone I know who reads 1984 or Brave New World concludes very quickly that those places would be bad places to live. Well, it is a zero-sum game. Every bit of freedom we give away is just an opportunity for them to be more involved in our lives. The government pays for healthcare, so the government realizes that it costs more to treat fat people, so the government puts everyone on a diet, but they find out that some people cheat, so they put cameras in your house, in your office, in restaurants, to watch you. To make sure you can't cheat.
Sound familiar...
And I'm not a kook, or a conspiracy theorist, these things aren't that crazy. Look at CCTV in Britain. Look at New York banning trans fats and threatening to eliminate salt.
Health care in America is actually pretty good for pretty much everybody. You get sick, you go to the hospital, they treat you. In fact, there is little question that the quality of care in this country is among the highest in the world.
What people complain about is the access to care or the cost of care. So, I'm sure socialized medicine will fix that, right?
Well, the problem most people identify is that you go to the doctor in America, get treatment and then you fight with your health insurance provider about whether it is covered. Socialized medicine solves that. The government will now tell you up front that you can't have that costly procedure. You're not worth it. So, no need to haggle over whether it is covered AFTER you've already been treated and you're healthy. The government will let you know right up front whether they have determined that you're worth helping.
Well, what about the uninsured folks? The folks who can't get treatment in this country? Who are these people? My buddy has zero insurance. None. He got sick, went to the hospital, and they ran a myriad of tests. They eventually, after several days, diagnosed him with diabetes. He stayed for another week while they stabilized him. And then they released him. Now, did he get a big bill. Yes. But he also got treatment. But socialized medicine is free!! Well, at least it is free in the sense that I don't write a check when I actually go to the doctor. I just write a bigger check every spring when I pay my taxes. So, that is a different form of free.
And my biggest problem with socialized medicine isn't about economics or the ethics of treatment. It is about freedom. It is about the risk that is inherent in granting power to a select group of elites that control an ever greater portion of my everyday life. It is about taking choices out of my hands and putting them in the hands of an allegedly benevolent government, no matter what party they are from.
I'm serious about this, everyone I know who reads 1984 or Brave New World concludes very quickly that those places would be bad places to live. Well, it is a zero-sum game. Every bit of freedom we give away is just an opportunity for them to be more involved in our lives. The government pays for healthcare, so the government realizes that it costs more to treat fat people, so the government puts everyone on a diet, but they find out that some people cheat, so they put cameras in your house, in your office, in restaurants, to watch you. To make sure you can't cheat.
Sound familiar...
And I'm not a kook, or a conspiracy theorist, these things aren't that crazy. Look at CCTV in Britain. Look at New York banning trans fats and threatening to eliminate salt.
# posted by : 12:20 PM
: 12:20 PM
U.S.A. #1! U.S.A. #1! Er, no. RRL, much as I know you are a respected expert in the fields of litigation, rock guitar, and smoking, I think on this one I will look to the people at Johns Hopkins, who say that the US health care system does not provide the best care.
Ironically, given your fervent support of smoking and delusion that health care in the US is the best in the world, it is our low smoking rate that apparently even keeps us in the ballpark.
Ironically, given your fervent support of smoking and delusion that health care in the US is the best in the world, it is our low smoking rate that apparently even keeps us in the ballpark.
# posted by : 12:26 PM
: 12:26 PM
Anon:
Thank you for the kind words about my expertise in litigation (questionable), rock guitar (the 'Tundo), and smoking. However, you also forgot my expertise in the Real World Road Rules Challenges and on teen dramas (Dawson's Creek, Felicity, The OC, etc.).
I read that article. I think it says we are the best in some areas and not the best in some areas. Which I think mirrors my statement exactly, which was that the quality of care is "among" the best in the world, not that it is unequivocally the best.
And, I agree, USA #1!! Always. God bless America.
Thank you for the kind words about my expertise in litigation (questionable), rock guitar (the 'Tundo), and smoking. However, you also forgot my expertise in the Real World Road Rules Challenges and on teen dramas (Dawson's Creek, Felicity, The OC, etc.).
I read that article. I think it says we are the best in some areas and not the best in some areas. Which I think mirrors my statement exactly, which was that the quality of care is "among" the best in the world, not that it is unequivocally the best.
And, I agree, USA #1!! Always. God bless America.
# posted by : 2:17 PM
: 2:17 PM
No, it's bankrupted USPS. Which is exactly what a public option would do to private insurance and why we'll never get one, or effective health care reform. Because there's no way in hell even a profoundly incompetent insurance lobby would allow that, and they're nowhere near incompetent.
Seriously thoug, the private options are hideously inefficient, offer miserable coverage/customer service, and only really work when you don't need them. I have doctors in my family, and did you know that it takes 1 staff person per doctor just to deal with the various, myriad forms of insurance? What do we have to lose exactly?
Personally, my insurance bureaucrats are real jerks. I say this as someone with several chronic (genetic) health conditions. Did you know that DNA is a preexisting condition? I did. It's some pretty funny stuff.
Insurance company: "We can't insure x (your only health problem)"
Me: "Why not?"
Insurance company: "Preexisting"
Me: "I was born this way"
Insurance company: "Sucks to be born, call us next time you get a cold."
I think Lane has a good point. (But I have to say the Marxism is coming on a little strong) Everything works just fine if you're rich. If only...
Seriously thoug, the private options are hideously inefficient, offer miserable coverage/customer service, and only really work when you don't need them. I have doctors in my family, and did you know that it takes 1 staff person per doctor just to deal with the various, myriad forms of insurance? What do we have to lose exactly?
Personally, my insurance bureaucrats are real jerks. I say this as someone with several chronic (genetic) health conditions. Did you know that DNA is a preexisting condition? I did. It's some pretty funny stuff.
Insurance company: "We can't insure x (your only health problem)"
Me: "Why not?"
Insurance company: "Preexisting"
Me: "I was born this way"
Insurance company: "Sucks to be born, call us next time you get a cold."
I think Lane has a good point. (But I have to say the Marxism is coming on a little strong) Everything works just fine if you're rich. If only...
# posted by : 2:25 PM
: 2:25 PM
Well, it does concede that we are the best in not smoking, I guess. But not so great in the other areas.
If the voices in this debate reflected the self-interest of the great majority of Americans, there would be overwhelming support for a very different health care system. However, money and lobbying results in an unyielding concern for the very rich, instead.
If the voices in this debate reflected the self-interest of the great majority of Americans, there would be overwhelming support for a very different health care system. However, money and lobbying results in an unyielding concern for the very rich, instead.
# posted by : 2:53 PM
: 2:53 PM
I think there are several issues to address with this argument. First, what does "health care" entail exactly? Does it include extensive health coverage for all possible problems, or does it unqualified access to basic preventative medicine and checkups, or is it somewhere in between? We need to define what it is we're seeking before we take steps to accomplish it. Second, I think it's ridiculous to take steps toward improving America's health care coverage while also passing legislation that contributes to our declining health. I'm speaking mostly in terms of the farm bills that subsidize corn production, making the unhealthiest foods the cheapest and most economical to grow and consume. You can't have both or nothing will get accomplished. Third, I feel that the fundamental flaw in the private insurance model is that it's based on providing as little coverage as possible in order to keep profits up, which is antithetical to the idea of providing as much access as possible to the people. Economists will tell you that government exists to fill market gaps, and I would argue that this is a perfect example of a market gap. Some say that health care is a function of the free market, and that people who are uninsured or underinsured are that way as a result of poor financial decision-making, which may be correct in some cases, but as one commenter pointed out, having genetic conditions isn't a choice, and health care just costs a lot for some people no matter what their level of income is. I'm not going to breech the subject of whether or not health care is a fundamental human right, because I don't think it's necessary to come to that conclusion in order to mandate health coverage for all Americans.
Fantastic debate today, and I'm happy that it hasn't only been framed as an economic discussion. A few responses:
AWF: who couched health care "in the language of 'natural rights''? I certainly didn't and wouldn't. I said it is a public right, in order to maximize the good of society -- this means economic efficiency (sick people don't work), but also more abstract ideals such as equity that we'll always been working towards, never attaining.
I'll second Justin's good point that the role of government is to fill in the gaps left open by the private sector; private higher education (of which I have been fortunate to partake) is great, but most cannot afford it, so public higher education (of which I have also partaken) gives access to good quality education.
I really do think the most apt analogy for health care is education. At least up to 12th grade, public education in this country is quite good. it's far from perfect, and it's horribly unequal, and I'd love to see a lot of reform...but, a kid from random rural high school or PS 27 can still work hard and get into Stanford. It needs to be improved, but it's decent.
RRL:
You've made many great points here, and used some of the scare tactics that AWF doesn't like Obama warning the populace about. I can't respond to all (have to get back to that public education I'm receiving), but one of your central points seems to be you don't want to let a government board make decisions for you. Why are you ok with a private board of doctors making the decisions now? People are turned down all the time for health care practices they need to stay alive, let alone be healthy, because of costs. I can't get health care (I have been turned down) except through group plans because of a rare blood disease -- a preexisting I was born with.
While, as someone who studies globalization and international development in the developing world, I share your cynicism towards government and its capacity to do its job well, I just believe it's better than the private sector. Why have we not brought up the endless ethical-legal scandals that the private sector in the last 8 years has shown to be intrinsic to unregulated capitalism? The private sector MIGHT, in some sectors, be more efficient; that doesn't mean it's right.
Lane: the Marxist in me agrees with you, mostly, though I fail to see how your point is not an ethical one. Side point really.
AWF: who couched health care "in the language of 'natural rights''? I certainly didn't and wouldn't. I said it is a public right, in order to maximize the good of society -- this means economic efficiency (sick people don't work), but also more abstract ideals such as equity that we'll always been working towards, never attaining.
I'll second Justin's good point that the role of government is to fill in the gaps left open by the private sector; private higher education (of which I have been fortunate to partake) is great, but most cannot afford it, so public higher education (of which I have also partaken) gives access to good quality education.
I really do think the most apt analogy for health care is education. At least up to 12th grade, public education in this country is quite good. it's far from perfect, and it's horribly unequal, and I'd love to see a lot of reform...but, a kid from random rural high school or PS 27 can still work hard and get into Stanford. It needs to be improved, but it's decent.
RRL:
You've made many great points here, and used some of the scare tactics that AWF doesn't like Obama warning the populace about. I can't respond to all (have to get back to that public education I'm receiving), but one of your central points seems to be you don't want to let a government board make decisions for you. Why are you ok with a private board of doctors making the decisions now? People are turned down all the time for health care practices they need to stay alive, let alone be healthy, because of costs. I can't get health care (I have been turned down) except through group plans because of a rare blood disease -- a preexisting I was born with.
While, as someone who studies globalization and international development in the developing world, I share your cynicism towards government and its capacity to do its job well, I just believe it's better than the private sector. Why have we not brought up the endless ethical-legal scandals that the private sector in the last 8 years has shown to be intrinsic to unregulated capitalism? The private sector MIGHT, in some sectors, be more efficient; that doesn't mean it's right.
Lane: the Marxist in me agrees with you, mostly, though I fail to see how your point is not an ethical one. Side point really.
# posted by : 4:36 PM
: 4:36 PM
Septimus - I have two responses for you:
1. There is a very simple reason I'm willing to allow private insurers to make decisions for me and not the government, and it is called competition. Yes, I may get turned down for coverage by one insurer, but the basic concept of competition means that there should be someone out there that says, "hey, we will cover you." Or, "hey, it will cost you a bit more, but we will cover you." If the government is the sole arbiter in a single payer system then there is NO competition. There isn't even a chance at finding an alternative. The government boards will decide what is best, and that decision is final.
One thing that is constantly not discussed is the effect that regulations on the insurance industry, which were encouraged and lobbied for by the big insurance companies, are having on health care. Waco is a great example. My Uncle Carl used to run an insurance company in town. It was one of about 10 local insurance companies. Used to be that was the way it was almost everywhere. But increasing regulation has squeezed out smaller competitors, thus limiting choices and hurting competition. Maybe the answer is less government and not more.
2. You say, "Why have we not brought up the endless ethical-legal scandals that the private sector in the last 8 years has shown to be intrinsic to unregulated capitalism." Well, I have several thoughts about that sentence, but for the purposes of your broader point, why have you not brought up the entire history of human civilization which shows the endless ethical-legal scandals that exist inside of government and power structures? Sure, corporations can be greedy, but at least capitalism has a way of sorting that out. Governments, or more importantly the people that run them, can be greedy, power hungry, egomaniacal, etc. as well. Why is it that you are so willing to assume the worst in people when the run a company, but so willing to assume the best in people when they run your government?
One last thing, why are there so many people that read Osler's blog with Marxist sympathies? I mean, what are we teaching down at that lawschool man?
Anon - you're just being disingenuous now. That article also says that in the area of cancer prevention we are tops. I mean, you can just ignore that to make your point or you can try to deal with it.
Oh, and smoke 'em if you got 'em.
1. There is a very simple reason I'm willing to allow private insurers to make decisions for me and not the government, and it is called competition. Yes, I may get turned down for coverage by one insurer, but the basic concept of competition means that there should be someone out there that says, "hey, we will cover you." Or, "hey, it will cost you a bit more, but we will cover you." If the government is the sole arbiter in a single payer system then there is NO competition. There isn't even a chance at finding an alternative. The government boards will decide what is best, and that decision is final.
One thing that is constantly not discussed is the effect that regulations on the insurance industry, which were encouraged and lobbied for by the big insurance companies, are having on health care. Waco is a great example. My Uncle Carl used to run an insurance company in town. It was one of about 10 local insurance companies. Used to be that was the way it was almost everywhere. But increasing regulation has squeezed out smaller competitors, thus limiting choices and hurting competition. Maybe the answer is less government and not more.
2. You say, "Why have we not brought up the endless ethical-legal scandals that the private sector in the last 8 years has shown to be intrinsic to unregulated capitalism." Well, I have several thoughts about that sentence, but for the purposes of your broader point, why have you not brought up the entire history of human civilization which shows the endless ethical-legal scandals that exist inside of government and power structures? Sure, corporations can be greedy, but at least capitalism has a way of sorting that out. Governments, or more importantly the people that run them, can be greedy, power hungry, egomaniacal, etc. as well. Why is it that you are so willing to assume the worst in people when the run a company, but so willing to assume the best in people when they run your government?
One last thing, why are there so many people that read Osler's blog with Marxist sympathies? I mean, what are we teaching down at that lawschool man?
Anon - you're just being disingenuous now. That article also says that in the area of cancer prevention we are tops. I mean, you can just ignore that to make your point or you can try to deal with it.
Oh, and smoke 'em if you got 'em.
# posted by : 5:54 PM
: 5:54 PM
For Clarification:
Who couches health care in the language of natural rights?
President Obama (or at least Candidate Obama) and a lot of well-meaning progressives.
Of course, "natural rights" is more the terminology of my side of the aisle. They say rights. We hear "natural rights."
Septimus--I can agree with you that health care is in the public interest--but I think your use of "rights," if you don't mean the inalienable sort, just confuses the issue.
That is, we have the right to disregard the public interest (we do that all the time). But the rights of the majority are not so clear when we start bumping into the "rights" of other people.
If you really mean "interest," let's say that. "Rights" is an almost sacrosanct concept for folks of my ilk.
Who couches health care in the language of natural rights?
President Obama (or at least Candidate Obama) and a lot of well-meaning progressives.
Of course, "natural rights" is more the terminology of my side of the aisle. They say rights. We hear "natural rights."
Septimus--I can agree with you that health care is in the public interest--but I think your use of "rights," if you don't mean the inalienable sort, just confuses the issue.
That is, we have the right to disregard the public interest (we do that all the time). But the rights of the majority are not so clear when we start bumping into the "rights" of other people.
If you really mean "interest," let's say that. "Rights" is an almost sacrosanct concept for folks of my ilk.
RRL, stop it or I'm going to go down the street and buy a pack of cigarettes, which I haven't done in about four years . . . .
There is plenty I don't understand about our current health care system and I don't claim to know what would be a better one. So far I have been lucky that a) I don't have any severe pre-existing conditions, and b) I've been employed by places that subsidized my health care. I come down on the side of the single-payer system, because I believe a country does have a duty to promote the health of its citizens, but also it seems to me that a single-payer system is just simpler, and that simpler means less waste and fewer employees who need to figure it out and so on.
Maybe I'm wrong, but that's my guess.
The thing I can't get my mind around is this (and I worry about it because I have a job with zero job security): what happens to me if I lose my job and am out of work for a year and get in a terrible accident, or develop some disease? How am I going to pay for treatment? Yes, I can probably get some level of treatment, but I'll get a huge bill for it and have to sell everything I own and can't support my family and . . .
Why should my health care be tied to whether or not I have a job?
(And where are all the women in this conversation? are any of you Anonymouses women?)
There is plenty I don't understand about our current health care system and I don't claim to know what would be a better one. So far I have been lucky that a) I don't have any severe pre-existing conditions, and b) I've been employed by places that subsidized my health care. I come down on the side of the single-payer system, because I believe a country does have a duty to promote the health of its citizens, but also it seems to me that a single-payer system is just simpler, and that simpler means less waste and fewer employees who need to figure it out and so on.
Maybe I'm wrong, but that's my guess.
The thing I can't get my mind around is this (and I worry about it because I have a job with zero job security): what happens to me if I lose my job and am out of work for a year and get in a terrible accident, or develop some disease? How am I going to pay for treatment? Yes, I can probably get some level of treatment, but I'll get a huge bill for it and have to sell everything I own and can't support my family and . . .
Why should my health care be tied to whether or not I have a job?
(And where are all the women in this conversation? are any of you Anonymouses women?)
# posted by : 9:22 PM
: 9:22 PM
RRL:
Health care in America is actually pretty good for pretty much everybody. You get sick, you go to the hospital, they treat you
Health care goes a lot further than getting sick. A big part of health care is (or should be) preventing that from happening, through things like vaccinations, checkups, and routine non-emergency medical treatment, which millions of people don't currently have access to. Sure, if you get really ill you can get treatment at a hospital, but this is neither a desirable nor workable system. A kid should be able to see a doctor about a cough without having to wait for it to turn into pneumonia first.
Health care in America is actually pretty good for pretty much everybody. You get sick, you go to the hospital, they treat you
Health care goes a lot further than getting sick. A big part of health care is (or should be) preventing that from happening, through things like vaccinations, checkups, and routine non-emergency medical treatment, which millions of people don't currently have access to. Sure, if you get really ill you can get treatment at a hospital, but this is neither a desirable nor workable system. A kid should be able to see a doctor about a cough without having to wait for it to turn into pneumonia first.
Ahh...the danger of posting the day after the actual blog, but I can't resist.
AWF:
Fair points on my choice of language. I could pick at it, but I take your point certainly.
RRL:
#2: I did, in fact, reference the endless ethical-legal scandals of government when I suggested that I work primarily on issues in the developing world. Worried about a senator abusing his power and sleeping with his intern? How about a totalitarian regime that kills its citizens, or ignores toxic chemical disasters perpetrated by foreign corporations upon its poorest citizens, or... I'm fully aware of this, and wouldn't propose the same system in a less stable state than the US, but given that we're mostly a healthy, functioning democracy (despite a sham election in 2000 -- heheh), I think the system works here.
Re. #1: there is no competition for the majority of citizens, who cannot either afford an alternative option, or (like me) can only participate in the group health plan of their employer because they'd be denied for preexisting, or... Once again, it comes back to ethics, and equity -- what you say it absolutely true, but it's also unfair, and I believe that in a society we give certain things up to work towards some modicum of fairness.
And I'm not from that law school...or any law school. So my Marxist tendencies (chastened by a belief in regulated capitalism) arise from other disciplines and, oh yeah, life experience.
SGirl: I'm totally with you. The problems that those of us with preexistings that we were born into (or, for some, have developed) face overlap with those losing their job and not being able to afford insurance. But your point, I'm sure, refers to a much larger segment of the population. We also could mention the working poor -- those at Walmart and gas stations, etc., who have three part-time jobs, none of which supply health insurance, and who cannot afford insurance. Hope they don't get really sick, because they're not getting Justin T.'s preventative care (which would, indeed, be nice).
OK. I need to stop now. No one's going to read yesterday's post anyway. Make nice haikus.
AWF:
Fair points on my choice of language. I could pick at it, but I take your point certainly.
RRL:
#2: I did, in fact, reference the endless ethical-legal scandals of government when I suggested that I work primarily on issues in the developing world. Worried about a senator abusing his power and sleeping with his intern? How about a totalitarian regime that kills its citizens, or ignores toxic chemical disasters perpetrated by foreign corporations upon its poorest citizens, or... I'm fully aware of this, and wouldn't propose the same system in a less stable state than the US, but given that we're mostly a healthy, functioning democracy (despite a sham election in 2000 -- heheh), I think the system works here.
Re. #1: there is no competition for the majority of citizens, who cannot either afford an alternative option, or (like me) can only participate in the group health plan of their employer because they'd be denied for preexisting, or... Once again, it comes back to ethics, and equity -- what you say it absolutely true, but it's also unfair, and I believe that in a society we give certain things up to work towards some modicum of fairness.
And I'm not from that law school...or any law school. So my Marxist tendencies (chastened by a belief in regulated capitalism) arise from other disciplines and, oh yeah, life experience.
SGirl: I'm totally with you. The problems that those of us with preexistings that we were born into (or, for some, have developed) face overlap with those losing their job and not being able to afford insurance. But your point, I'm sure, refers to a much larger segment of the population. We also could mention the working poor -- those at Walmart and gas stations, etc., who have three part-time jobs, none of which supply health insurance, and who cannot afford insurance. Hope they don't get really sick, because they're not getting Justin T.'s preventative care (which would, indeed, be nice).
OK. I need to stop now. No one's going to read yesterday's post anyway. Make nice haikus.
# posted by : 8:36 AM
: 8:36 AM
Yes, Septimus, you're right: I certainly intended to refer to everybody, not just to myself, with my point. I didn't intend any selfishness with that point.
# posted by : 11:10 AM
: 11:10 AM
Wow!
This is making the rounds:
http://www.youtube.com/watch?v=fRdLpem-AAs
If you want some historical perspective, this Reagan speech from the 1960s is a jewel.
This is making the rounds:
http://www.youtube.com/watch?v=fRdLpem-AAs
If you want some historical perspective, this Reagan speech from the 1960s is a jewel.
I am opting out of this debate but I am curious.. Several of you mentioned pre-existing conditions. Does the recent legislation passed by Congress earlier this year help you in any way? I think the intent was to amke sure that private insurers can't hold it against you when applying for a policy.
I also agree with Justin T (2:08 post) regarding defining what this coverage should entail? Is it for preventive care (check-ups, etc..) or will it help me not go bankrupt when I am in a car crash and spend a month in the hospital. Defining what it means is important.
I also agree with Justin T (2:08 post) regarding defining what this coverage should entail? Is it for preventive care (check-ups, etc..) or will it help me not go bankrupt when I am in a car crash and spend a month in the hospital. Defining what it means is important.
I have two points to add:
1) The biggest problem with rising health care costs is the 3rd party payment system of health insurance. For market efficiencies to work, the consumer has to know what they're paying for goods and services and have the ability to shop around for better service and prices in order to make an efficient market place. Now, insured people just pay their copay at their doctor, or whatever in-network clinic, and get their prescriptions filled at Walgreens instead of shopping around for the best prices.
2) Since when does being uninsured mean you don't have access to healthcare? Want a checkup? Bring your checkbook. Doctors take cash. Hell, they often offer cash discounts. Health insurance was never meant to cover EVERY health-related service. It was meant to defray the RISK of catastrophic healthcare costs. An increasingly popular option is to have a health savings account that you can spend on things like checkups and then catastrophic medical coverage, which would cover your costs if you got really sick, injured, or needed surgery.
The point is, we call get to pick the kind and amount of coverage we want, if any, because we get to determine how to allocate our own economic resources. You can get insurance on your own independant from your job if you wish. It might be expensive, but it's sure available...
1) The biggest problem with rising health care costs is the 3rd party payment system of health insurance. For market efficiencies to work, the consumer has to know what they're paying for goods and services and have the ability to shop around for better service and prices in order to make an efficient market place. Now, insured people just pay their copay at their doctor, or whatever in-network clinic, and get their prescriptions filled at Walgreens instead of shopping around for the best prices.
2) Since when does being uninsured mean you don't have access to healthcare? Want a checkup? Bring your checkbook. Doctors take cash. Hell, they often offer cash discounts. Health insurance was never meant to cover EVERY health-related service. It was meant to defray the RISK of catastrophic healthcare costs. An increasingly popular option is to have a health savings account that you can spend on things like checkups and then catastrophic medical coverage, which would cover your costs if you got really sick, injured, or needed surgery.
The point is, we call get to pick the kind and amount of coverage we want, if any, because we get to determine how to allocate our own economic resources. You can get insurance on your own independant from your job if you wish. It might be expensive, but it's sure available...
I got sick in England one time and had to go to the hospital. It stikk cost less than going to my Dr. here.
The leading cause of bankruptcies in America? Health care expenses.
The leading cause of bankruptcies in America? Health care expenses.
# posted by : 5:43 PM
: 5:43 PM
Ture story...
I fell down the stairs while working in Sydney Australia in 2000. The office sent me to a workman's comp doctor who cleaned the deep cut (would have been stitched in the US) and sent me on my way. I still have scars - fortunately they don't really bother me. In retrospect, at the very least I had a severly sprained my ankle and or had a hairline fracture to my tibia (trust me on this one).
In the end it healed. My bill was $10 Aussie (graciously reimbursed by my contractor). I did not understand the extent of my injury until the following day when the shock of falling down a flight of stairs had worn off and my ankle was the size of a 4
"x4". In fact my initial treatment by building security - the guard was squeemish and I had to cut the pantyhose off my own leg so he could clean the wound with peroxide and put a bandaid on it! I was in shock.
Now knowing that I slid down a flight of concrete stairs on my shin probably would have prompted a different response in most countries of the world and especially if this had happened at an office in the US.
That is why defining what is covered is so important.
I fell down the stairs while working in Sydney Australia in 2000. The office sent me to a workman's comp doctor who cleaned the deep cut (would have been stitched in the US) and sent me on my way. I still have scars - fortunately they don't really bother me. In retrospect, at the very least I had a severly sprained my ankle and or had a hairline fracture to my tibia (trust me on this one).
In the end it healed. My bill was $10 Aussie (graciously reimbursed by my contractor). I did not understand the extent of my injury until the following day when the shock of falling down a flight of stairs had worn off and my ankle was the size of a 4
"x4". In fact my initial treatment by building security - the guard was squeemish and I had to cut the pantyhose off my own leg so he could clean the wound with peroxide and put a bandaid on it! I was in shock.
Now knowing that I slid down a flight of concrete stairs on my shin probably would have prompted a different response in most countries of the world and especially if this had happened at an office in the US.
That is why defining what is covered is so important.
No system is perfect. People with relatively more resources than others possess will always be in a position to buy more care here in the USA or somewhere else.
Wealthy Americans already travel to India to receive state of the art care (at a fraction of the cost that they would pay here) in Western style hospitals.
No one can afford health insurance. Private insurers make money by denying access to people with pre-exisiting conditions.
If we respect life, as conservatives frequently claim to do, then every person should be covered regardless of his/her employment or family relationship.
As a society, we need to ensure that every person has access to a certain basic standard of care.
No one should have to decided between buying groceries or going to the doctor.
No one should be going bankrupt because they had a trip to the emergency room.
As for those who claim that government run care leads to rationing, I have three letters:
HMO.
Thank you President Nixon.
We can achieve universal access through single payer or through some sort of national exchange combined with individual mandates and tax credits to individuals and families.
Wealthy Americans already travel to India to receive state of the art care (at a fraction of the cost that they would pay here) in Western style hospitals.
No one can afford health insurance. Private insurers make money by denying access to people with pre-exisiting conditions.
If we respect life, as conservatives frequently claim to do, then every person should be covered regardless of his/her employment or family relationship.
As a society, we need to ensure that every person has access to a certain basic standard of care.
No one should have to decided between buying groceries or going to the doctor.
No one should be going bankrupt because they had a trip to the emergency room.
As for those who claim that government run care leads to rationing, I have three letters:
HMO.
Thank you President Nixon.
We can achieve universal access through single payer or through some sort of national exchange combined with individual mandates and tax credits to individuals and families.
# posted by : 8:44 PM
: 8:44 PM
Yes, I had some of that wildly cheap health care in India. The health care does vary, to be honest, but at its best it's similar to the US and very cheap: when I was living there I paid $16 for a mammogram and $20 for a pelvic ultrasound, which would have cost $400 - $500 in the US.
Now, I'd say the Indian health-care system is only cheap compared to the US because of the currency exchange; $20 for a medical test is not cheap for the average Indian. For some, $20 is a month's wages.
But the upper-middle-class Indian could afford it, once in awhile. Pretty much the same as here--which is the same problem.
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Now, I'd say the Indian health-care system is only cheap compared to the US because of the currency exchange; $20 for a medical test is not cheap for the average Indian. For some, $20 is a month's wages.
But the upper-middle-class Indian could afford it, once in awhile. Pretty much the same as here--which is the same problem.
# posted by : 10:23 PM
: 10:23 PM << Home
