Tuesday, August 4, 2009

Gittin' Yer Health Care On

We've got two bits on the op-ed page today related to health care, and that makes a nice jumping-off place for a little rant.

First, Tina Blake, billed as a "Yavapai County Community Member" (I think a hack of Yavapai County Community Health Services Member), urges readers to take a class and take control of their own health. In Prescott this is on offer Fridays at the YMCA.

Then there's the Talk of the Town column by Tom Bromley, credited as a retired NY state health care administrator, who sees the need for public health care, but can't quite see how we'll pay for it.

It's a fortuitous coincidence that these appear on the same page.

Bromley's thesis seems to depend largely on the idea that including 45 million uninsured Americans will incur enormous new costs, as if they're paying for it all out of pocket now and they'll pay nothing for it later. I think five seconds of thought about that pretty well dissolves it.

This is not to say that a "robust" public health-care system will cost nothing, of course. What so many of these commenters seem to miss or gloss over is that as a nation we're already paying for all of our health care, that cost grossly inflated by waste, excess bureaucracy, a strong bias for acute care over preventative care, and massive profit-taking. Reducing those costs is what makes these systems economically sensible, and it's also what scares an industry grown fat on the status quo.

What's a lot fuzzier is the huge potential for reducing costs simply by working to prevent health problems. This is practically impossible under our profit-motivated system, and that factor deserves a lot more scrutiny and thought from voters. The YCCHS program is a perfect example of what government is compelled to do that private industry simply won't. Imagine what's possible when reducing costs by making people healthier becomes a primary goal of the entire system.

Here's a smart, easy read today from the LA Times by a Canadian doctor comparing the US and Canadian systems and the lessons we could learn from Canada if we'd deign to take a look.

Lesley contributes an interesting list:

Countries with universal health coverage

Afghanistan*, Argentina, Austria, Australia, Belgium, Brazil, Canada, Chile, China, Cuba, Costa Rica, Cyprus, Denmark, Finland, France, Germany, Greece, Iraq*, Iceland, Ireland, Israel, Italy, Japan, Luxembourg, the Netherlands, New Zealand, Oman, Portugal, Russia, Saudi Arabia, Spain, Sweden, South Korea, Sri Lanka, Ukraine and the United Kingdom

*Universal health coverage provided by United States war funding

PS: Props to Grundlecat in the comments for pointing out the headline malfunction on the LTE.


Chris Bergman said...

Okay, Steven, help me out here. Why can't I just be left alone when it comes to my own, personal healthcare decisions? I want to make my own decisions about what kind of care I get and I want to pay for it myself. I don't want you to help me and I don't want to be "compelled" to help anyone else (I might choose to help, but it's my choice. It's the compulsion I have a problem with). Many of those "millions" of uninsured, want to be. They have chosen not to be. Can't we just leave them alone? Yes, the problem of healthcare costs needs to be addressed, but must the answer be a government mandated, government designed, government regulated and government apportioned system? And when we say "government" remember who we're talking about. These aren't the nation's best and brightest but some of the dimmest bulbs in the closet. Why can't you and others leave me alone to make my own decisions about my life?

Steven Ayres said...

Quite simply, Chris, because the laissez-faire system has consistently proven itself to be not viable economically, worldwide. The problem is that when you screw up and wind up needing help, I and everyone else have to pay to clean up your laissez-faire mess.

Sure, we could choose to ignore your plight and leave you to bleed in the street. But that's not the sort of world we want to live in, so we deal with the reality of that choice. If you want to live a different way, perhaps you should go looking for that sort of society. It isn't America.

Just as we require you to wear your seat belt and get a license before you can buy explosives, we work through law to reduce the risk to society that freedom inevitably entails. Right now your 'free-market' model is bankrupting the country and a whole lot of our people. Voters seem to be getting the picture that we shouldn't have to put up with it anymore.

None of us is an island, and very little of what we do individually has no effect on someone else. We all share the responsibility, and if we acknowledge that and work with it, we can all share great benefits.

BearWhizBeer said...

health care is the reason i've been harping on the common assets theme. the question is whether the health of all americans should be considered a common asset which should be managed in common. phrased another way: is our collective health valuable to us as individuals?

judging from this post, chris would say no. steven would probably say yes. i would as well, operating on the theory that if everyone is healthier i will have a wealthier, more tolerant, and more just society to live in.

i'm beginning to get some sense of the history of our current health care system, so it's beginning to be comprehensible how it came to be, but i can't help thinking that a for-profit health care system is inherently flawed, and an insurance-based system outright insane. the motives all work the wrong way: insurance companies have no incentive to deliver better health care or indeed any health care at all. doctors have no incentive to seriously engage in preventative care, which is what will most effectively bring costs down for all of us, lawyers and patients are motivated to sue the doctors, who then need more insurance to protect themselves. just looking at it from a systems point of view, it's clear that it can't work properly.

i am a zealous believer in the power of the free market and competitive capitalism. i worked in high tech for 17 years and i have seen that system do great things first-hand. i am not a socialist, and i do not believe that government control of most aspects of our lives is going to improve anything. instead i believe that the market and government are tools which have their proper uses and their limitations. government is the tool best suited to managing common assets and regulating the market when necessary. the market is best for just about everything else.

having concluded that our collective health is a common asset because it benefits everyone, i think we need to get government involved here. i guess i would favor a system that provides a base level of care focusing on preventative medicine for a reasonable price and allows anyone with more means to get the extras at whatever price they can negotiate.

the attitude that everyone should be, must be solely responsible for their own health
is disturbing because of the utter lack of social cohesion it reveals. if we do not look out for each other, how can we be anything but hostile and suspicious towards each other?
if the idealism of that statement is disturbing, try this one: if we are all healthier, we will all pay less for health care.

Chris Bergman said...

BearWhizBeer: You have hit the nail (though a glancing blow, I think). I really, really want to follow up on what you've said and maybe by doing so, answer Steven as well. You say you think an individual's health is a common asset. If that is the case then YOU are a common asset too, because your health is an integral part of who you are and what you are able to produce for the good of the community. You are not a person, you are property. Essentially, you are not human, you are cattle; reared, fed, cared for and eventually, butchered for the benefit of those in authority over you. That seems a little extreme, I know, but following your assertion of “common heath assets” there is nothing to stop this scenario except the “good will” of those in authority. Are you sure you can count on that? Do you want to trust you children's and grandchildren's futures on that? Regardless of what you're willing to do, I am not.

Then there's the motive for your position, which you and Steven share. You are demanding that others yield control of their personal sovereignty for the majestic goal of providing YOU a happier, wealthier life. Steven was a little more convoluted but said essentially the same thing. Because you have made certain choices or want to make certain choices other must give up their freedom to choose. You will no doubt say that everyone will benefit but that's not true. Those compelled to act against their free consciences will not benefit. Those forced (under threat of violence, I might add) to diminish their lifestyle solely for the purpose of benefiting others will not be happier. The system both you and Steven advocate REQUIRES that most pay for more than they get so that some can get more than they pay for. It is inherently unjust, dishonest and dehumanizing.

You say you're against a profit driven system. Tell me, do you work? Do you get paid? Do you realize that if you do work and get paid, the money you're paid with comes from your employers profits? Do you wish to deny doctors and nurses the freedom to profit from their sacrifices and efforts? If so, who would willingly enter into such a profession without coercion? Of those coerced, who would you trust your healthcare to?

To finish up; Steven, you say participation should be compelled because “No man is an island” and “We are a nation of laws.” You are right, an island is fixed, it is an object, it is merely a thing. A man is a being, endowed with free will. To deny man the free exercise of his will is to make him less than a man. It is to make of him an island; a thing, an object to be used at some other's discretion.

We are indeed a nation of laws but it is not enough to simply pass laws. Laws, to be lawful, must be just. To be just, laws must recognize the inherent dignity of man. They must acknowledge what is RIGHT or they are merely rules, founded not in conscience but in force. The rule of force goes to he who is most violent, most cruel, most barbarous in his opinions of his fellow man. Should I exercise such an opinion over you? Over my fellow man? What if I chose to rule by force? If “right” is determined by the will of the people, but the will of the people is constrained by one who exercises force over them; how, then, will you determine “right?”

giftedhands said...

Mr. Bergman,
First of all no one is denying you the right to the health care of your choice. Secondly I hope you get all the health care you can afford and deserve.
But your assertion that all Americans without health care are that way because they chose to be is ignorant and infuriating.
it is precisely this attitude of "I got mine" that has driven this country to the brink of disaster. If you would simply google "uninsured americans"
you would find a plethora of information on the subject.
I quote a National Survey to support this, I encourage you to pay particular attention to the capitalized portion.
I personally have had private health insurance for over 20 years and
have continued to pay my premiums thru 2 recessions. I believe in
accepting my responsibility as an american not to be a burden.
However the current economic climate has brought to the forefront a
problem way past it's sell by date. Millions of Americans deserve the same health care the very least afforded our Senate. Our government
in a selective mood of socialism even provides universal health care for
the citizens of Afghanistan and Iraq. Are we not equally deserving?
Where is your humanity? much less common sense?
I suggest you leave your cocoon and open your eyes, there's a world out there!



Chris Bergman said...

Okay Lesley, let's walk this one through together, hand in hand, shall we? I have never, ever; and by that I mean EVER, even by accident, said that everyone who doesn't have healthcare chooses not to, alright? I have said that just because you can't afford the healthcare you want does not justify your sticking a gun in my face and demanding I help you pay for it; and that is exactly what is being proposed. No, you say? What do you think is going to happen when (after it's passed) I refuse to help you pay for your little program? That's right, the threat of force looms over anyone who doesn't want to play by your rules. But be careful, force has a nasty habit of turning on those who use it aggressively.

If you're paying for non-emergency, non-catastrophic care health insurance, I believe you're part of the problem. Insurance DOES NOT reduce the COST of care, it merely shift the burden of who pays for it by raising the cost to those who use less. It is not a bucket that you pay into now and take out of later. It allows prices to increase without market resistance and it promotes demand without increasing supply.

I love this one... “Millions of Americans deserve the same health care the very least afforded our Senate.” If you're referring to our service men and women; those who have EARNED it, then yes, I'm in full agreement. If you're referring to Joe Sixpack next door, that's utterly ridiculous. How in the world does anyone get to DESERVE the active assistance of another (morally free agent) without earning it first? This notion of “deserve” is obscene. As a consequence of being human you “deserve” life; that means no one may take action against the life you were born with (that's called murder). You “deserve” liberty; that means no one may take action to force you to act against your conscience (that's called slavery). You “deserve” exclusive ownership to the fruits of your labor; that means no one may deprive you of your property or the product of your labor (that's called theft). To “deserve” anything else, or to “deserve” what belongs to another you must first PAY for it somehow. To demand that others pay for it because you want it (or need it) but can't afford it, is morally reprehensible. Where's YOUR humanity?

And my humanity? It resides firmly in defense of that very human you wish to turn into cattle. Perhaps you've heard of him; he's called the forgotten man. http://www.blupete.com/Literature/Essays/Best/SumnerForgotten.htm

Read it, it will do you good.

Steven Ayres said...

You dodged my point, Chris: the problem is not getting someone else to pay for my health care, rather it's reducing the cost to me of your health care, and the cost to you of mine.

Your exposition on the grand ideal of individualism and your fears of becoming property are entertaining and perhaps informative about your psychological profile, but I have to tell you they're more than a little over the top in context. I guarantee that the frenzied libertarians for whom you're chewing the scenery are not reading this blog.

And please don't use quotes when you're paraphrasing or, as in this case, projecting your own ideas, that's a pretty basic journalistic rule your incompetent editors ought to have taught you long since.

giftedhands said...

I am sorry but you did in fact say -' Many of those "millions" of uninsured, want to be. They have chosen not to be. ' If you meant something else say that. If you are going to paraphrase please do it correctly.
In reference to Senate, I need to correct myself I meant Congress specifically. Not armed services or only one else. I have added information on that at the end of this comment.
Additionally, I have only major medical insurance for
catastrophic events. No emergency care, no fluff. Which continues to go up resulting in my having to increase my deductible. I have never used my coverage and pay preventative care out of pocket. My point is that if the cost is shared equally over all citizens, all our costs go down. This is assuming a single payer plan is passed, which I highly doubt. What will probably happen is more in keeping with the plan the state of Mass. now employs. If you want it you apply and it is based in your income. If you prefer private health care nothing changes.
This of course is flawed and going broke, however Mass. physicians agree that more people are getting treated and no one is turned away.
I am curious that you do not have a problem with Access
and other programs you are forced to support with your
tax dollars? You prefer private Hospitals and Pharmaceutical Companies that have become nothing more than big business, charging us astronomical fees for services and medications that they sell to other nations at a fraction of the cost. These high costs do not bother you?
Your defense of those you refer to as cattle is interesting considering it is precisely what your right wing government would like you to become. Easier to control.
I admit my ideas may be naive and altruistic. But I believe everyone in this country should be given the opportunity to prosper, be healthy, learn, and yes demand more from their government. I do not support taking away all my hard earned dollars but I think I can afford a percentage of it. I think I can share.

Lesley Aine Mckeown

From: http://public-healthcare-issues.suite101.com/article.cfm/health_care_for_the_us_congress
As soon as members of Congress are sworn in, they may participate in the Federal Employees Health Benefits Program (FEHBP). The program offers an assortment of health plans from which to choose, including fee-for-service, point-of-service, and health maintenance organizations (HMOs). In addition, Congress members can also insure their spouses and their dependents.

Not only does Congress get to choose from a wide range of plans, but there’s no waiting period. Unlike many Americans who must struggle against precondition clauses or are even denied coverage because of those preconditions, Senators and Representatives are covered no matter what - effective immediately.

And here’s the best part. The government pays up to 75 percent of the premium. That government, of course, is funded by taxpayers, the same taxpayers who often cannot afford health care themselves.

Read more: http://public-healthcare-issues.suite101.com/article.cfm/health_care_for_the_us_congress#ixzz0NQe6QSQP

BearWhizBeer said...


it seems i have given you the wrong impression. i never wrote (or meant) that anyone's individual health should be considered a common asset. what i actually wrote is that i think our collective health should be considered a common asset. not the same thing at all.

Chris Bergman said...

Okay, guys, one at a time. Steven, I'll keep my responses to the other guys brief and concentrate on yours last.

Lesley, forgive me for what will surely sound condescending, but you've driven me to it.“Many” is not “every”, “every” is not “many” got it? Of the 40 to 50 million cited as not having insurance about 25% (conservatively) do so by choice. That is, in my book, many. It is not every, to be sure, but it is many. Second, the “government” pays for nothing. The government simply redirects your wealth to pay someone else's bill while keeping a sizable chunk for themselves. PLEASE, read the article I linked to.

BearWhizBeer, (btw, what are you drinking? Fosters? Pabst? Colt44?) When you say “our collective health” what are you collecting? Why, individual health, of course. You can wiggle all you want, but you put yourself on the hook my friend. Even so, when you seek to manage “collective health” you can only do so by suppressing individual liberty. So no mater where you start from, you end up in the same place. This is a necessary consequence of “collectivism.” Some may say it's worth it; I disagree.

Okay, Steven, I guess I own you an apology. I didn't really dodge your point, my answer was just buried amidst a bunch of other stuff. Let me be more direct. You say you're trying to reduce YOUR cost of MY healthcare. Fair enough, I'm trying to do the same. I'm trying to protect myself from having to pay for others healthcare too; especially those over whose lifestyle I have no control. The difference is in how we go about it. In the final analysis, the only person whose behavior you can control is your own. We all have free will, but only freedom of our own will. I choose to exercise my will over myself and I explicitly do not seek to force anyone else to act in any particular way. I leave that to the free exercise of THEIR will. My decisions may have repercussions, but not compulsions, and that's a huge difference. You, on the other hand, have declared your decision (freely made) to act in a certain way, but you want to hold me responsible for your decision. In essence, you seek legislation to protect you from your own better nature; legislation... to save you... from doing the self admitted good... your nature drives you to do. It makes me wonder if you've been hanging out with those “darksiders” you talk about. Anyway, of our two methodologies, mine is consistent with humanity. Mine is consistent with justice and fairness. Mine is consistent with considering all men equal to myself. Yours, IN MY OPINION, is not.

Finally, Lesley, BWB, this is Steven's blog, let's let him run the show, okay?