Wednesday, October 14, 2009

Balancing the Common Good with Freedom - Health Care

One of my more daring/foolish exploits in the blogosphere is actively engaging with liberals.  Sometimes, I learn something.  Sometimes, we merely butt heads.  And sometimes, I suspect that said liberals begin to understand.  At least that's the reason I keep going.  The rest of this post is dedicated, and to a degree, a response to a discussion I had on The Swash Zone yesterday.  It was about 6 liberals vs me, and I had to fit work into that, then go get kids.  Not that I ran out of steam, just time.  This is my general response....

Most on the left cite an overwhelming public interest in the passage of the current form of health care/health insurance reform.  In the ensuing discussion, many on the right face non-starter responses and occasionally irrational arguments.  Let me try to address them:

The Rationing discussion - Anything in finite supply is rationed.  Health care is currently rationed, in a hybrid system of classic supply and demand, a messy 3rd party system with numerous flaws, and some government insanity.   Obviously, the current system is a mess.  But the question is in which direction do we go:  A system where the government becomes increasingly in control of the minutiae of payment and treatment (the current plan) or a system where it comes back to free individuals (with a government safety net the likely result)?

Until we can agree that both sides want the same end (coverage for as many Americans as possible (all can never happen)), we're going to continue to spin some wheels.


The Rest of the Civilized world - Now one argument that seems to be flung out is that the rest of the civilized world has government-controlled health care.  I've looked at the situations in many of those countries.  I've noted a few things.  First, the countries with the most centralized health care (The British and Canadians) appear to be quickly reaching the point where their system can no longer sustain itself.  In fact, Canada is slowly in the process of rolling back some of the government monopoly to allow people the freedom to pay for their own health care (this being the fear of what we're headed toward).  Compare that with France, which has more of a hybrid system.  They seem to still be sustainable.  Yet, their cradle-to-grave quasi-socialist system is producing increased unemployment, decreased productivity, and is creating more strain on the system.

And none of those countries are as big or have as much effect on the world as the United States.  As i have tried to clarify, our biggest problem, and the one that has led our health care to the mess that it is, is that we stopped taking personal responsibility for our health care.  And in the current system, most people can no longer do so.  Again, it comes down to moving the responsibility and control toward a government model, or decentralizing it back into an individual system.

While we should certainly look at things in other countries that work, we must also remember who we are, and how we differ culturally from these other countries.

Government already "provides" so much - I know.  That's the central issue we have wrangled with as a country since our inception:  What is the appropriate level of control for the federal, state, and local government over our lives.  In the beginning, we strove to be as decentralized as possible.  Starting with the Constitution, we have moved slowly to a more centralized form of government, with no significant moves to distributing the power back to the people who are most trustworthy:.  The individual as a whole, with the only constraint being the equality of all under the law.

We live in an age where EVERYTHING has a federal program or office doing something to regulate or control it.  That's not necessarily a good thing in many cases.  It's certainly at the heart of our current financial, military, and social messes.  It's why any health care reform from anyone sane accepts the fact that the government will be there in some form.  But we've seen both parties pile on the programs.  And one thing I've seen in common from both the left and right is that we're pissed about our politicians, and the government in general, trying to control facets of our lives!

If we can agree that more government control is not a good thing, then we can continue finding a solution to the mess.

You don't care about sick people, you want to protect BIIIIIG BUSINESS (hiss, hiss) - I've heard this from a few quarters, most prominently, President Obama, most vehemently, the idiot Rep Alan Grayson.  To those who honestly believe this, and more specifically, those who say something along these lines out of a desire to win an argument, I have crafted an appropriate response:

Go fuck yourself with a scalpel, you manipulative shits:  You self-righteous bastards think you are the only fucking saints who give a shit about people?  I gauran-damn-tee you are about as wrong as a public Obama/Ron Paul double Dutch rudder session would be (I had to take the anger out of this statement a little).

It's easy to look at one side of an argument and say: Hey, they have more than I do.  I want to have the government we both have use their gun to take from them and give to me.   But where do you draw that line?  At what point does it go from a necessity to an attempt to reengineer society into the failed socialist model?  It comes down to morality.  Government is the only entity that can legally take money from people.  And while some targets are easy to attack (tobacco companies, for example), to condemn them as the greatest evil in the world, punish them with continued settlements, force them to not advertise their product, put labels on it telling people that it'll kill them, then tax the shit out of the people that use it is hypocrisy.  One thing to note:  I'm not a fan of habitual cigarette use, and it is bad as shit for you, but I'm forced to defend the companies simply because if it's acceptable to hound an industry out of business (rather than just ban the product, 18th Amendment style), then it's acceptable to do that to any industry.  It's the same with any right.  Larry Flynt, for example.  He won in the Supreme court when they upheld his right to produce obscene shit.  Good.  While I'm certain many people find his stuff objectionable (I'm a perv, so....), protecting the rights of one individual from the mob rule (democracy) is the cornerstone of our government.  A corporation is an individual entity in this sense, and more importantly, it's made up of many people.  Why should they be held up at gunpoint because another person needs something?  There are ways to allow them to continue doing what they do, and still take care of the needs of those who can't take care of their own.  The answer lies there.

Now look, we can't fix the problem if we don't agree that the problem needs fixed.  Those that don't come to the table wanting to find a solution, well, we ignore them.  However, finding a way to agree on how we solve the many problems is the real challenge.  If you can respect the fact that we want as little of the government involved as possible, then we'll be glad to give in other areas, especially where deception and dishonesty are tolerated now in the insurance industry.

This debate, as always, comes down to a fight over government power versus individual freedom.  And my default position will always take me toward the latter.  And if we can have a civilized debate and respect that both sides want the same end, that going to any extreme or betting on a one-size-fits-none solution is a bad idea, and that the people that are crafting these changes can't be trusted to get it right without us giving them unprecedented amounts of shit, then we can begin to correct our mistakes of ages past, and solve the health care mess once and for all.

15 comments:

rockync said...

Actually, I think what all this boils down to is being able to obtain affordable healthcare without fear of having someone arbitrarily pull the rug out from under you when you are sick.
I can't get insurance without a boatload of ridiculous exclusionary riders that would make having insurance meaningless. And the cost of said insurance would be astronomical. I believe we should have a public option for people who can't afford health insurance - I won't qualify for that, but there are other things that need to be provided. You cannot honestly tell me that the current bill on the floor,with its provision forcing people to have insurance has anything to do with freedom or that is does not pander to the gigantic health insurance industry -
Without a public option there should be no demand for forced insurance. Also, there must be government regulation of an industry that has proved it cannot police itself. The government regulates what my utilities can charge me and so it should be with health insurance. Definitely need to outlaw pre-existing clauses and the ability to drop policy holders when they get too sick.
A free for all market just doesn't work well when dealing with essential services. What we have now is more of a feudal system where the king sends out his thugs to collect payola and the people have to just shut up and take it.
BTW - Patrick said "It was about 6 liberals vs me" Your foray into the "liberal" land of The Swash Zone was not exactly a gang bang. As you (and the rest of us) are well aware, when any of us go to a blog with an opposing view, you can always expect several players in a debate. You really need to drop that martyr mantel. Geez! What drama!

Satyavati devi dasi said...

Well, I was going to post on this but Rocky's read my mind, down to the part about essential services being in a different league than general services.

Which proves that great minds do truly think alike.

And as far as the martyr thing goes, I heard a great line the other day:

"Get off the cross. We need the wood."

Jennifer said...

"Go fuck yourself with a scalpel, you manipulative shits: You self-righteous bastards think you are the only fucking saints who give a shit about people? I gauran-damn-tee you are about as wrong as a public Obama/Ron Paul double Dutch rudder session would be (I had to take the anger out of this statement a little)."

AMEN! This pisses me off more than I can say. Apparently liberals are the only ones that give a shit! Just because I don't want government in control of my health care doesn't mean I don't care. Do I need to repeat that? I can if I need to!!

I don't have insurance myself and am struggling paying for tests, treatments, and Dr. visits. I need help and yet I can look past the "give me" attitude that so many are preaching. Yes, I would love for health care reform to come about as soon as possible. Who wouldn't?

As far as Swash Zone, good luck!! I will not go there because I have no interest in being lectured and put down. (I've seen it happen to too many good people) I can find good discussion at blogs like liberals blogs like Shaw, Truth and TAO's without being attacked. I have no interest in a blog that have so many authors that think the same that they yes each other to death.

Why can't the left see anything but black and white? I have listed on many different occasions things I think would do to improve health care and it doesn't involve government take over.

If something is broken, by all means fix it. There is no reason to take it over!!

rockync said...

Talk about the pot calling the kettle black! Jennifer, this is now one of several times you have made disparaging remarks about the Swash Zone on other blogs.
To my knowledge, no one has spoken badly of you on other blogs or have been over to bother you at your blog.
You're free to bitch and moan as much as you want, but it's very rude and childish.

TAO said...

Your first false assumption is where you say, "Until we can agree that both sides want the same end (coverage for as many Americans as possible (all can never happen)), we're going to continue to spin some wheels."

We are obviously going to continue to spin our wheels because the reality is no one agrees to the concept of 'coverage for as many Americans as possible."

Even insurance companies DO NOT WANT this concept. They do not want to cover sick people, or those people who have a legitimate need for health insurance.

If they thought that they had a product that was so wonderful and that accomplished everything that a majority of Americans thought was ideal then we would not be having this discussion at all would we?

Their goal is to make money not provide insurance to everyone that needs it.

Now, hospitals are getting screwed because they cannot turn away anyone from an emergency room; now explain to me Patrick why it is okay for health insurers to turn people away, or price them totally out of the market but it is not okay for hospitals to do the same?

Another false assumption is this, "Government is the only entity that can legally take money from people." Actually with a court order anyone can take money from people; collection agencies are all over the place.

Government is also the only way people can act, in unison, to express a dissatisfaction with certain aspects of our society that YOU as a freedom loving individual would be powerless against.

Beth said...

Another false assumption is this, "Government is the only entity that can legally take money from people." Actually with a court order anyone can take money from people; collection agencies are all over the place.

Court orders to get money is a legal matter for people who break a contract and do not pay money they OWE. The government takes money at will through taxes, there is no contract.

TAO said...

Beth,

There is a contract, its called the social contract...

As far as court orders go, I can go to any court and submit a bunch of invoices and say that you refused to pay them and BOOM I got a right to collection...

You do not have to be informed and you won't know....till I garnish your pay...

It happens all the time...

Satyavati devi dasi said...

If you don't want to pay taxes, then give up everything those taxes (and the government) fund.

Period.

Jennifer said...
This comment has been removed by the author.
Patrick M said...

Rocky: First of all, not complaining. I'm just proving it takes 6 liberals to argue against me. it's called "evenly matched."

The problem with the debate is simplifying it into a single thing. There are at least 5-6 different interrelated items that make up the situation (actual costs, regulatory costs, structure of the "market"/ lack of a free market, the uninsurable, the poor, and the underlying psychology which is a hell of a lot bigger than this debate (next post)) that make it impossible to pull off the solution with a single partisan bill.

As for the government option ("public being an intentional misnomer), you and I and every congressman know that the goal of it is to create a government-payer system. And that is a measure that will do more harm than good for the majority of America.

I think I almost need a post to explain how insurance works (and where a role for the government could be found).

Jenn: You're getting tired of being portrayed as an uncaring fuck too?

As for Swash, they do write well, and passionately, even if they're as wrong as soy Soylent Green. So come and join the fun. With two of us, they'll be outnumbered.

Tao: They [insurance companies] do not want to cover sick people, or those people who have a legitimate need for health insurance.

No shit. Their reason for existence is to make a profit by collecting more in revenue they they pay out.

However, that's why addressing their deceptive practices is the reasonable course, as well as actually trying to get the marketplace moving rather than keeping it an oligopoly by law is the answer there. The uninsured and uninsurable need to be addressed in another way than killing what's left of the companies, because then we've reached the point of government health care.

As for hospitals not being able to turn people away, that's another issue that needs to be addressed, with some common sense (and a good triage nurse), as well as a way to cover those costs that can't be collected. But forcing the insurance industry into the money losing model will cost people more in the long run.

Another false assumption is this, "Government is the only entity that can legally take money from people." Actually with a court order anyone can take money from people; collection agencies are all over the place.

Look at that statement and tell me what's ass-backwards: "Actually with a court order....

That's the government acting to enforce (with police power) the rights of one individual. No one can legally force me to pay them unless they have the force of government against them. A collection agency by itself can't legally send goons over to take your cash (or beat it out of your ass).

Government is also the only way people can act, in unison, to express a dissatisfaction with certain aspects of our society that YOU as a freedom loving individual would be powerless against.

But it also exists to protect the individual from the overwhelming demands of a popular sentiment. Our government has forgotten this.



Saty: If you don't want to pay taxes, then give up everything those taxes (and the government) fund.

Part of paying taxes is the ability, through representation, to ensure that the taxes are only as much as is necessary to fund the government. We've been far beyond that for a long damn time.

We are to the point that taxes are mostly theft for redistribution.

Jennifer said...

Rocky, I had this whole comment written out but it was just not worth it. Think what you want, I have different priorities right now, and they don't include going back and forth about about a blog you belong to.


Patrick.....just a wee bit pissed how could you tell?

"Now, hospitals are getting screwed because they cannot turn away anyone from an emergency room; now explain to me Patrick why it is okay for health insurers to turn people away, or price them totally out of the market but it is not okay for hospitals to do the same?"

TAO......I don't think it is okay. I am all for regulations that get rid of the pre-existing conditions along with not covering someone because of a certain disease, sickness etc. This isn't going to happen on it's own though, it needs some govt regulations.

Toad734 said...

So you are saying something is wrong and it needs to be fixed??

So what's your solution if not more competition coming from the Government?

You are right in saying that America is vastly different than Canada and the UK and even France...We are also much larger but also much wealthier and pay fewer taxes which is to our advantage. The obesity rate, our aging population, our drug and gun deaths/shootings/overdoses, etc are all things these other countries don't really have to worry about to the degree we do.

That being said, we all already pay for these things. Every time my brother overdoses on heroin and spends 2 weeks in intensive care and then skips out on the bill, you pay for it. So doesn't it make sense to have a system where he has health care and can afford to treat his problem instead of waiting for him to spend 2 weeks in the emergency room? Paying for treatment will cost less than the ER. And you are on to something about personal responsibility and us not having to pay for health care on our own except we do actually pay for our own health care. We may not have to shop around for the best price but the government plan now gives us that option.

I am really no fan of what the health care reform plan is shaping up to be. I think we should just have Medicare for all and have a single payer system which would eliminate 30% of health care costs overnight by reducing all that overhead. Then we need to move towards a preventative approach to health care which means not waiting for 4 years when you weigh 400 lbs to finally see a doctor. And let’s move on from this rationing of health care crap. As you pointed out, it is already rationed. My friend’s father had to wait 3 months to see an oncologist he wanted to see and by then it was too late and he died. I had to wait 2 weeks for my last MRI which as it turns out wasn't necessary but cost me $500 and my insurance company $1500.

And by the way, most of those in congress who are against reform are in it to protect big business...that’s who got them elected. The idiot, tea baggers don't know why they are angry but partly it is because they want to protect big business as well so don't pretend that isn't an issue.

And stop pretending that government involvement automatically = disaster. Are the national parks a disaster? Is the interstate highway system a disaster? Are state governments going to do a better job negotiating with health care institutions than one central government? Is having 50 different plans, rules and regulations and overhead going to be better than having one?

Again, Im not a fan of the reform because it doesn't go far enough and it isn't really looking out for the people as much as it is looking out for the insurance industry who are really just a bunch of thieves.

Can anyone truly say they are against them ending the pre-existing condition bullshit?? I mean come on.

Patrick M said...

Toad: So what's your solution if not more competition coming from the Government?

Two points. First, the government does not compete. By its nature it does not. However, at least you're acknowledging that competition (which doesn't exist now) IS the answer.

On our differences from other countries, that's the reason the slide to government health care will kill us faster.

As for the issue with the non-pays. There are a lot of things we need to do in this area. first, we need to fix the ER problems (non-emergency and non-pay issues). I do see a limited role for government in this area. Second, we need to find a serious and comprehensive solution to things like the drug problem, especially if we have to pay for it.

Can anyone truly say they are against them ending the pre-existing condition bullshit??

I can. And I will (with explanation).

If you mean a company has to offer insurance to all people at the same price independent of the risks involved (smoker, fatass, super-veggie), and can't either exclude coverage for conditions that will kill (like terminal cancer) or exempt coverage for self-destructive behavior (heroin addict), then yes, I will. This is because insurance is about making a bet. No business that exists to make money should be required to sign someone up if they know that the lifetime cost of the person is going to exceed the premium cost.

Now if you're talking about bullshit things (like domestic violence) or something manageable and not an automatic cost (like a mental illness or a past easily-cured condition), the market can adjust the price a little for that. As well, things like certain benchmarks (routine checkups, low bmi, non-smoker) could be incentives for lower prices.

And the biggest problem is confusing health insurance with a payment plan. For most people, interaction with the insurance company should be in the form of sending in a check, like with life and car insurance. That's the fastest way yet to cut costs.

As for those who are uninsurable, we come back to finding another way (probably the government).

Beth said...

As far as court orders go, I can go to any court and submit a bunch of invoices and say that you refused to pay them and BOOM I got a right to collection...

You do not have to be informed and you won't know....till I garnish your pay...

It happens all the time...


Sounds like fruad to me.

Beth said...

Ooops, FRAUD, it's late....