Two tragedies

So the health beat reporter at the paper does a nice piece on Westside Health Center and the other clinics that serve Delaware's un- and underinsured, and it prompts a letter to the editor:

As I read about Westside health clinics, the word "underserved" was used quite a few times. I have yet to find a community health center outside the city limits. I don't know of any in the suburbs of New Castle County. I would say the underserved would be the people who make incomes just beyond the qualifying amount to receive Medicaid or any health services provided by the state.

The underserved would be the Delawareans who work every day and pray no one in their families gets sick. They have to decide whether to go to the doctors, buy food, pay the electric bill or fill the car with gas.

The News Journal is there for prisoners, criminals and ex-crackheads. I feel better already.

That letter summarizes two great American tragedies.

First, as the writer says, there are millions of Americans who "make incomes just beyond the qualifying amount to receive Medicaid or any health services provided by the state," and who "work every day and pray no one in their families gets sick" and "have to decide whether to go to the doctors, buy food, pay the electric bill or fill the car with gas."

In the developed world, this is a uniquely American phenomenon. It's what you get when you pretend that there exists a "free market" for health care that functions just the same as the free market for soda pop or lawn furniture. It's a bad system -- far more costly and inefficient than any of its various alternatives. Defenders of this system claim it is superior because it allows for competition -- although in terms of cost, access and health, it's not very, um, competitive.

I doubt the letter writer will take much comfort from President Bush's proposed "Health Savings Accounts." HSAs will mean that instead of choosing between buying food and spending money at the doctor's office, he will have the exciting new option of choosing between buying food and setting aside money to be spent at the doctor's office later.

On the other hand, inefficiency does create jobs. America spends billions of dollars every year shuffling tons of paperwork that doesn't exist in the health care systems of any other developed country. Get rid of all that paperwork and tens of thousands of people would be out of a job. (And think of the gleam in a young child's eye when she says, "When I grow up I want to be an assistant billing clerk in a doctor's office and spend all day filling out forms in quadruplicate!" No Canadian child can dream such dreams.)

Millions of working Americans experience the food-or-health-care bind described above. It doesn't have to be that way. It ought not to be that way. Yet it is that way, every day, and the letter writer's anger on that score is understandable, appropriate and just.

But then there's the other tragedy illustrated by the letter above, which also involves a misunderstanding and misapplication of the idea of "competition."

The letter writer assumes that the working poor of the suburbs are pitted against the working poor of the city in a zero-sum struggle. He assumes that adequate medical care for the urban poor, or for prisoners and addicts, can only come at the cost of inadequate care for his family and other suburban families like them.

It is possible to imagine, or even to create, a society like the one the letter writer describes. It is possible to interpet the world this way, and thereby to ensure it is a world of zero-sum scarcity in which enough for one family can only mean not-enough for another family. Hobbes called this the "war of all against all," but he at least thought he was being pessimistic and not providing a blueprint for the ideal society.

It is also possible to imagine, and even to create, a society in which this is not the case -- a society in which "enough" is available to everyone at the same time. This is precisely what Christian theologians imagine when they speak of the virtue and obligation of "solidarity." And it's what America's Founders imagined they had created when they wrote of "We the people," as in:

We the people of the United States, in order to form a more perfect union, establish justice, insure domestic tranquility, provide for the common defense, promote the general welfare, and secure the blessings of liberty to ourselves and our posterity, do ordain and establish this Constitution for the United States of America.

That still leaves more than enough to compete over because it leaves more-than-enough to compete over. People who have enough are free to compete for more-than-enough. People who have less than enough are free to decide between buying food and going to the doctor.

(Inoculatory footnote: Those who wish to characterize the above as "socialist" will need to demonstrate that the statement "Biological necessity results in inelastic demand" somehow leads inexorably to a centrally planned economy. Points will be subtracted for any use of the term "redistributionist" that does not clearly demonstrate why that term/epithet is not equally applicable to, say, private health insurance. Show your work.)

Comments

[Bugmaster]

Sorry Fred, but government-sponsored universal health care is a form of socialism, because the means of production (in this case, of health care) are in the hands of the government, not private enterprise. However, just because it's socialism, doesn't automatically mean it's eeeeeevil. It's entirely possible that socialism is an acceptable policy as far as health care is concerned; in fact, Europe seems to have made this decision, and it works fine for them.

[RoCo]

I live in Dublin, about the least socialist of the European health care systems (we all have to buy private hospital cover, which is very cheap (€5/week) because it can't choose who or what it covers or how much it charges who). Our system has problems -- copayments of €30 or €40 to see a doctor are a bit hard on the elderly, and the hospitals have a chronic shortage of beds - but it's nothing like the States. When I visited Copenhagen recently, my girlfriend got an eye injury, and we went to the hospital. They fixed her up, and then we thought we should look around for the billing desk to fill out the always-necessary forms and present the insurance cards. There wasn't one. Anywhere. We asked, and they laughed at us -- 'This is a hospital, not an office!' Bet that makes their health care cheaper, too.

[Quinn]

Although I am a bit socialist of sorts, I've always found it hard to combine that with healthcare. The term "socialized medicine," with its implications of there being a means of health care "production" that Bugmaster mentioned, seems baffling. It seems to contain within it the same assumption that is afflicting our healthcare system now - that healthcare is a commodity, like Fred's lawn furniture or soda pop. And it's not. Our Constitution, which Fred quoted from the preamble, is a good place to start with arguing that health care should be universally available (promoting the general welfare), but since the Constitution is simply a framework for how the government will operate and how it will adapt, it's not a final place we need to look in order to make the argument for universal health care. We need to look at the Declaration of Independence, the document that defines the ideals the Constitution and the government were instituted to embody. Our society claims that the first inalienable right we have is that of Life (for sake of limitation, let's not include the abortion debate eventhough the language might suggest it, let's stick to those already born and their right to live and worry about the unborn once we can ensure they'll be adequately provided for once they become born). For America, if we allow someone to die from a treatable disease, we have failed to protect one of the supposedly most important rights we have chosen to protect. We cast aside that guiding principle of our democracy "that all men are created equal and endowed by their creator with certain inalienable rights" the first of which is their right to live. What's that old saying about those who silently allow a murder to happen are as guilty as the murderer?

[Scott]

Inoculatory footnote: Those who wish to characterize the above as "socialist" will need to demonstrate that the statement "Biological necessity results in inelastic demand" somehow leads inexorably to a centrally planned economy.

No, if you want to centrally plan a large chunk of the economy, you're a socialist. I don't need to jump thru your arbitrary hoop to prove that.

This is precisely what Christian theologians imagine when they speak of the virtue and obligation of "solidarity."

You have no more right to legislate your interpretation of Christianity as the religious right does. You can believe in 'solidarity' all you want; you still have no right to force everyone into any 'unified' plan to make us all 'one'. Fred, I don't want to be 'one' with you any more than Halle Berry wants to be 'one' with one of her many stalkers - nothing personal.

And it's what America's Founders imagined they had created when they wrote of "We the people," as in

It's always amazing how only the preambles of bits of the Constitution matter to the left ("we the people", the 'militia', etc). Vague expression of ultimate goals are all that's necessary to empower govt; the actual limited powers (and explicit limits on those powers) in the mere body of the Constitution or it's amendments just fall away. It makes you wonder why the Founders even bothered to flesh out the Constitution past the preamble if that's the only part that matters.

[the other michael]

uh, Halle Berry?! ya lost me a bit there Scott.

Actually, the Sermon on the Mount agrees more with Fred than with you & Halle.

m

[manalive]

In the latest Atlantic Monthly there's an interesting article on Walmart's health care policies and Walmart Watch. Apparently Walmart Watch's main aim is to hound Walmart about healthcare so much that Walmart starts pushing for gov't sponsored care programs. I recommend the article.

[Chuck]

When I read it, I thought this was going to be the best line in the post:

"That still leaves more than enough to compete over because it leaves more-than-enough to compete over."

But then I read this:

"Inoculatory footnote: Those who wish to characterize the above as "socialist" will need to demonstrate that the statement "Biological necessity results in inelastic demand" somehow leads inexorably to a centrally planned economy."

You never stop blowing my mind.

[Bugmaster]

Quinn and Fred: it's nice to imagine health care as being this abstract humanitarian entity that every human being deserves, but, unfortunately, health care doesn't just condense out of the aether. Health care is a service performed by workers (doctors, nurses, etc.) through labor (sometimes, back-breaking, soul-crushing labor). Health care also has some pretty definite material expenses: drugs, hospital beds, electric power, etc.

So, realistically, health care is a labor-intensive, expensive service. The only question is, who will soak up the expenses ? Should it be private enterprise, the government, or a combination of both ? Who can deliver the best service at the cheapest net price ?

This is why I think that framing the issue as a matter of "inaliable rights" is misleading. Inaliable or not, health care involves a lot of work that someone has to pay for, in the end.

[Chuck]

Scott,

When you say "if you want to centrally plan a large chunk of the economy, you're a socialist" you're not addressing Fred's points, you are addressing your own points.

When Fred said, "demonstrate that the statement "Biological necessity results in inelastic demand" somehow leads inexorably to a centrally planned economy." he was anticipating your leap of logic from universal health care to (shudder) socialized medicine.

Not to put words in his mouth, but I would guess that Fred's point is that the term "universal health care" doesn't require government ownership and administration of doctors and hospitals. It could be accomplished by simply buying health insurance for people who can't afford it from a private provider.

Finally, it seems to me that this blog is basically about where politics and religeon intersect. Fred observed that a political position, universal health care, is compatible with our constitution, and then observed that this political position is butressed by the religeon of many of the opponents of universal health care. That doesn't mean he'd like to legislate his interpretation of Christianity. It just means that he's here to talk about religion and religion+politics.

There are lots of non-religeous people who support universal health care.

[Chuck]

Bugmaster,

If you think money is the most sacred thing on earth, then yes, universal heath care is something that should not be done.

If you think that people are the most sacred thing on earth, then you'll concede that providing some reasonable level of universal heath care is something we should do.

And rather than just throw around platitudes, let me get more specific about reasonable. Reasonable is that everyone has coverage for broken arms. (No one is going to go out and break an arm because, "hey it's free, the laws of supply and demand say I'm a fool if I don't soak up as much as I can!") Reasonable is providing humanitarian care, care that is cheap, and care that is cheaper-in-the-long-run. Cheap is providing children with antibiotics for their ear infections. Cheaper in the long run is managing diabetes rather than letting it run its course to gangrene and amputation, or providing anti-psychotic drugs instead of lifetime incarceration for crimes committed by untreated psychotics. Unreasonable is everyone has coverage for heart transplants or plastic surgery. There is a big middle ground here.

Now, the fact that my reasonable universal coverage doesn't cover everything isn't the same as rationing. It would be perfectly reasonable to buy private supplemental insurance that would cover procedures like heart transplants or plastic surgery.

Don't forget, universal coverage is not the same as socialized medicine - you can provide universal coverage through private insurance and hospitals.

Finally, we already cover all the elderly though medicare. That is the very most expensive part of the population. Adding in the cost of the 40 million or so other young people in the country is likely *relatively* cheap, especially if you value people more than you value money.

[Chuck]

I want to apologise for saying "if you value money more than people..." That wasn't fair.

I would like to have said that this isn't an all or nothing game, if you value both people and money, or something along those lines. No time to wordsmith, time for bed.

[malpollyon]

The trouble with the ideal of "user-pays" healthcare is that it doesn't make things cheaper. In healthcare there are a lot of situations where going to the doctor when you don't need to can save orders of magnitude of money. Eg my Grandma refused to go to the Doctor for a sore toe, ended up in Hospital with blood poisoning. When a lack of diagnosis can inflate long term costs exponentially, such as in cancer, it seems obvious that just letting people visit the doctor when they want and sharing the cost is cheaper for *everyone*.
The statistics show that insured Americans are paying more than taxpaying "socialists". Universal Healthcare - Because I don't want to pay for your cancer medicine when you could have got a masectomy.

[Duane]

How much did Jesus charge for healthcare?

[Diggadee]

Note to the dense: The questions that follow are rhetorical.

Is there any good reason why health care in the U.S. is part of the "free market" sector, along with commodities like soda pop and lawn furniture?

Wouldn't we all be better off if health care were just another way that the dreaded socialist state provides public good for its members, like, um, libraries, police and fire departments, corporate subsidies, highway construction, public schools, the Pentagon?

[Peatey]

Duane, a tongue-in-cheek answer for you, the cost of healthcare in one instance:

4 friends
1 gurney
1 ladder
4 pieces of rope

[Steve]

malpollyon: This article gets at what you are talking about. In Denver they did a study, and one homeless person living on the street could cost the city over $1,000,000 a year due to emergency room visits, police interaction, etc. They found it was (a lot) cheaper to pay for this person to have an apartment and supportive services. Raised a lot of interesting questions, but for those concerned about cost...there certainly is costs savings to be had in increasing access to regular, preventative healthcare.

[Dave]

"When I grow up I want to be an assistant billing clerk in a doctor's office and spend all day filling out forms in quadruplicate!" No Canadian child can dream such dreams.

Setting aside whether or not socialized medicine is a good idea, the idea of reducing paperwork by making healthcare a government function blows my mind. Perhaps the Canadians have pulled this off. IMO that accomplishment would rank with a moon shot in terms of technical acheivement.

[Alexis]

If I understand my British sources correctly, the NHS used to be a little-or-no-paperwork system, but Thatcher's policies in the 80s added tons of admin to it and crippled it badly. The amount of paperwork and the universality or provider of the coverage aren't necessarily correlated, so the leap to saying that no Canadians need to grow up to be assistant billing clerks because it's government healthcare isn't justified by logic; it needs to be backed up by information about the Canadian system.

[Bugmaster]

Chuck: I think your rage blinds you. Calm down.

I never said, "OMG universal health care is t3h suxx0r". I merely said that talking about universal health care in terms of inaliable rights is a mistake, for the reasons I've stated (namely, because health care takes a lot of resources that someone has to end up spending). This doesn't mean that universal health care is somehow useless or evil. We don't often talk about road maintenance in terms of rights, and yet I think we all agree that road maintenance is a good thing. Road maintenance doesn't magically coalesce out of the aether because someone decides it must be done, and neither does health care.

That said, I'd like to address your point about valuing money more than people. I happen to believe that money is a very good yardstick that we can use to decide policy. If you really believe that no one can put a price on human life, then you can't possibly make an informed decision about the budget. How much funding do you allocate to FEMA, or the FDA, or your new universal health care program ? Well, if you believe that human life is priceless, your answer is either "infinity" or "zero", depending on how you interpret the word "priceless". That's not a good way to run a nation.

Money is a common unit of measure that lets us measure the value of labor, material goods (such as medicine or bicycles), services (yearly health checkups, car tune-ups), and yes, even people's lives (insurance companies do it all the time). Trying to run a government without assigning monetary values to policies is like trying to do physics without using meters (or feet, if you're American) to measure length. You can probably try doing it, but you'll suck at your job.

Money is not more important than people. Money is how you measure just how important people are to you.

[bulbul]

How much funding do you allocate to FEMA, or the FDA, or your new universal health care program ? Well, if you believe that human life is priceless, your answer is either "infinity" or "zero"
I sincerely hope you are not planning to run for an office any time soon. It's exactly that kind of thinking filled with false dichotomies that got the US to the mess you're in.
My answer to your question is "as much as I can". A politician's answer would probably be "as much/as little as I can get away with", depending on where he/she registers on the left-right scale.

Money is how you measure just how important people are to you.
"Babe, you know you're worth at least $100.000 to me"
Yeah, right.

[Francis]

Setting aside whether or not socialized medicine is a good idea, the idea of reducing paperwork by making healthcare a government function blows my mind. Perhaps the Canadians have pulled this off. IMO that accomplishment would rank with a moon shot in terms of technical acheivement.

In which case, I guess that every single Western European government, in addition to the Antipodes and Canada have pulled off something equivalent to a moon shot. It's not that centralised healthcare is particularly good, it's that the American healthcare system is particularly bad.

If I understand my British sources correctly, the NHS used to be a little-or-no-paperwork system, but Thatcher's policies in the 80s added tons of admin to it and crippled it badly.

Indeed. Thatcher was trying to cripple it to make way for privatised healthcare - under the 1970s system, no one would have been stupid enough to want a privatised system. (I hate "Starve The Beast" politics/economics). Unfortunately, New Labor has only added to the paperwork due to massive numbers of performance measurements and the like. And the paperwork burden is still significantly lighter than the US...

Money is how you measure just how important people are to you.

??!!?

[A Texan in Germany]

Here in Germany, they take down your health insurance information when you're in a decent condition to give it, then worry about any bill later. At a typical private-practice doctor's office, the same woman who booked your appointment draws your blood (and they tend to leave you looking like less of a heroin addict than some doctors do!) and takes your billing information as you're leaving.

The German system is a mix; if you gross less than about 3900 Euro ($5000 right now) a month, you have to go with the state-mandated system where pricing is a certain percentage of your income, usually about 6-7%, but you can pick from myriad Krankenkasse (sickness funds) to service your policy. Any dependents are covered under this, with no change in cost. If you make more, you can go with a private insurer, which can be much cheaper (if you only want to really insure against catastophic expenses and are young, healthy and have no dependents) or more expensive (if you want your own hospital room and to be seen by the chief doctor). The unemployed are covered under the state-mandated system.

It all comes together to make sure that every citizen and registered resident who NEEDS health insurance has it - the only people who really don't are either here illegally or fantastically wealthy.

[Mike Timonin]

One of the big debates re: the Canadian health care system within Canada is the idea of a "two tiered" system. IE, someone with no money is covered by goverment insurance. Someone with lots of money also has private insurance. In the much debated "two tiered" system, the person with no money waits for public medical services while the person with lots of money gets the care he needs immediately at a private clinic. The solutions seem to be either to make all health care the same as that available in the private clinic (very expensive for the government), or to prevent access to the private clinic entirely (unpopular with people who have money). Of course, this creates a false picture of poor people dying for lack of basic care while rich people run around with redudant organs sticking out like that Invader Zim episode, and it's not true. One of the things that seems to have prompted this false image is the picture of the American system across the border, where, presumably, if you have money when you arrive at the emergency room, they bump you to the front. "Nurse, I have a bad hang nail, and $20 Million! Take me before that impovrished person with both his legs cut off!" Which is also not true.

On another point, I know that paperwork still happens in Canadian doctors offices, because Canadian doctors still get paid for their services. Thus, billing must occur. I gather that they use the ICD 10 coding system, while the US is stuck in the dark ages with the ICD 9 system.

[Quinn]

I don't make the argument of "inalienable rights" flippantly, nor based on an actual belief in the concept; however, that's the wording in the D of I. I tend to fall in line with Robert Heinlein in "Starship Troopers" who argues that there is no such thing as an inalienable right - to paraphrase: if you were drowning, the sea would not pay any attention to your "inalienable" right to live. The finer point behind that argument is that we all, I hope, can agree that it is pathetic for a someone in the richest country in the world to have to choose between food and healthcare, it's pathetic that someone with two jobs and no health insurance might die of an easily preventable disease. There will always be people who refuse care, but of the estimated 36,000 that the CDC says die of the flu every year, how many wanted a flu shot but couldn't afford one or didn't have access? The D of I and the Constitution are the ideological contracts between the the People and the Governemnt. The idea of "inalienable" rights is logically flawed, you're right Bugmaster. It was, perhaps a bit of overblown rhetoric, but there's no one here who wouldn't scream about their "right to live" if they were told they were going to die of cancer unless they got treatment, and then told they were going to be denied treatment because they couldn't afford it. Whether the argument is flawed or not, this country, by claiming it as one of our defining ideals in both our secular and religious halves, has chosen to stand on it, and we're failing.

[quinn]

As far as paying for universal healthcare, why not stop subsidizing big oil and other megaprofitable pollution generating industries, force polluting companies to pay for cleaning up their own messes and funnel that money into universal coverage, quit funding research into the next nuclear weapon, quit blowing billions of dollars trying to be the world's police force, and don't let big corporations get away with not paying their taxes.

[John]

So, realistically, health care is a labor-intensive, expensive service. The only question is, who will soak up the expenses ? Should it be private enterprise, the government, or a combination of both ? Who can deliver the best service at the cheapest net price ?

As history has shown, over and over again, every single time it's been tried, the best way to pay for essential services that all people will potentially need is for the government to do it, defraying the cost through taxation of everyone.

Health care, police, fire departments, military, a social safety net, roads... all of these are things where "the free market" leads to massively increased costs and decreased effectiveness, every time. This is because they are not services that can be done without if the price is wrong, and where the cost to the individual is impossible to bear without deferring it across many, many people. Oh, and that whole bit about how being able to go to the doctor for a $40 problem without starving means that you're not stuck with a $4000 problem in a month - you no longer have to gamble your entire life on whether or not that infection will get better on its own.

[Scott]

When Fred said, "demonstrate that the statement "Biological necessity results in inelastic demand" somehow leads inexorably to a centrally planned economy." he was anticipating your leap of logic from universal health care to (shudder) socialized medicine.

You mean Fred would just give millions of dollars to *shudder* private health insurance companies and leave the defensless poor to their tender mercies?

No way the left would accept that, any more than they'd let the middle class leave Social Security and spend their SS taxes on private investments and keep SS for the poor only. The left has to force everyone into their programs to force everyone to support them ("programs for the poor are poor programs"), and use govt power to forcibly change political opinions into support for govt.

This is just typical leftist bait-and-switch. He'd buy private insurance, that govt program would fail (or cost way more than he projected). Then, "of course", the govt would have to regulate costs, benefits provided, etc. That would fail, so of course we'd just have the govt step in and run it. That would fail, so we would have to force everyone else into the program to get the costs down and "pool risk" (can't have the rich not pooling their risks w/ the poor).

There are lots of non-religeous people who support universal health care.

You don't have to be a Southern Baptist to be pro-life, but they are still "legislating their morality"; when Fred goes on about 'solidarity', like the weirdo calling the woman he's holding hostage in his basement his 'bride', he's legislating his religious views.

How much did Jesus charge for healthcare?

Jesus worked in the private sector. He did what he did voluntarily and wasn't being paid to do so by the Roman govt.

Some stats from Cato.

[Orion]

On universal healthcare; I support it, but I willl admit that it has aftereffects that lean to the socialist side.

Sure, the government can pay for healthcare from privately owned hospitals. however, with the government becoming such a large buyer, you run the risk of a monopsony situation in which the free market fails to operate because the government has too much bargaining power.

That's private hospitals. Private insurance is a different matter. I don't see the need. If the government is going to pay for people's healthcare, let the government provide the insurance. It already runs social security, so adding another form of insurance is certainly within its powers.

Private insurance is a bizarre market anyway, and, oddly, it gets worse the more information is present. the problems in adverse selection and moral hazard alike are huge; a mandatory government insurance prgram gets rid of the adverse selection, at least.

Private insurers want to avoid giving insurance to the people who need it, so the more you can expect to need your insurance, the mroe it costs you. if you could predict exactly how much healthcare you would need, the private insuerer would charge you that much for your healthcare, rendering it moot.

universal government health insurance would also end the tying of insurance to jobs, which is one of the more stupid and dstructive policies I can think of.

[Scott]

As history has shown, over and over again, every single time it's been tried, the best way to pay for essential services that all people will potentially need is for the government to do it, defraying the cost through taxation of everyone.

Welcome to Earth. Your home planet sounds like an interesting place.

How much did Jesus charge for healthcare?

Doctors will still charge under any govt program unless you plan to force them to work for free. That's right, the Holy and Sacred Government will touch, and therefore bless and sanctify, the payment as it goes from the patient to the doctor thru that Holiest of Holys, the IRS (blessed be it's name).

The letter writer assumes that the working poor of the suburbs are pitted against the working poor of the city in a zero-sum struggle. He assumes that adequate medical care for the urban poor, or for prisoners and addicts, can only come at the cost of inadequate care for his family and other suburban families like them.

I think that part of the problem is that most of us (myself included sometimes) think of "the economy" as something comparable to their own household budget, not the hugely complicated system of subsidies and controls that it is. Hence, if I spend all the money I made this month on X, there will be no money for Y. If the crackheads take all the healthcare money to fix their crackbrains, there won't be any healthcare left over for my kid's strep throat. The paperwork and time and trouble and existing inequalities and unfairness in how coverage is provided further supports the perception that everything is a quickly-depleted resource. And the "We are at war with Eurasia, we have always been at war with Eurasia" attitude of the Administration on the state of healthcare is such a disconnect with people's actual experiences that it's no wonder they lash out against any easier target.

[bulbul]

Jesus worked in the private sector.
... and as everyone knows, he was pro-private property, pro-finances and very big on competition.

[PK]

I'm Canadian, and I think our system is pretty good, if not perfect.

However, a recent Supreme Court ruling just paved the way for a partially private system.

Click for lots of info.

[PK]

bulbul: ...very big on competition.

I think you meant this? :)

[Chuck]

Bugmaster,

I hope you eventually saw the apology I posted for what was a cheap shot about valuing money over lives.

I was at one time a Rand-ian Libertarian type, and valued money as symbol of a claim on peoples time. I still do, to a large extent.

I'm not full of rage, I'm just wound a bit tight and care about this issue. One of the good things about this blog is the civil and thoughtful tone, which hopefully I will do better at emulating.

Unfortunately, your reponse makes me believe that you missed my point. My point is that there is a middle ground between what we have now and universal and full-coverage government run health care, and I went into some detail about what I meant by reasonable.

Both ideas and details matter. To me, it is easy to agree with the idea that we should do what we can to get some reasonable level of health care to everyone in the United States. (And yes, part of what I defined as "reasonable" was "affordable". So I don't view each and every life as having an enforcable claim on all the resources of the world.)

But even if we agree on the idea, we still need to get the details right so that the program works. It should include universal health coverage. It should be set up so politicians can't monkey with the inner workings but can control costs. As an example, Congress sets the level of funding paid to a group of government-chartered private corporations (in some ways similar to Freddie Mac/Fannie Mae) who define and administer the plans as a group and then compete to provide covereage. Or perhaps another way.

You seemed to support the idea of universal coverage, but then seemed to claim, based on ideological grounds, that there is no convievable way to implement.

Will there be corruption, fraud and abuse? Sure there will be. There is now all over the place in the private sector, too. Ask Enron stock holders. Ask my friend who bought concert tickets online from a broker and never recieved them.

There is no system that works perfectly.

Scott,
"You don't have to be a Southern Baptist to be pro-life, but they are still "legislating their morality""

I don't think you're being reasonable here. Isn't this a statement of morality: "You should be free to do whatever you want to do as long as it doen't infringe on anyone else's right to do what they want to do." When you advocate for that standard in legislation, aren't you legislating your morality?

I guess at this point you'll argue that your morality is superior in some way to other peoples? ;-)

[Chuck]

Bugmaster,

I think in some ways I haven't been reading your posts carefully enough. Your first and second post seem a bit contradictory, unless one identifies your focus as inalienable rights, which I failed to do.

I guess I flew off the handle a bit. Maybe I am full of rage. I blame my mother.

[Duane]

Doctors will still charge under any govt program unless you plan to force them to work for free.

How will doctors be better off in the Libertarian Fiefdom that only provides them protection and land to farm on in return for their herbal remedies and crude surgical techniques?

(You must rememeber that your Libertarian Utopia devolves quickly without government and government cannot exist without collecting revenue from the governed.)

That's right, the Holy and Sacred Government will touch, and therefore bless and sanctify, the payment as it goes from the patient to the doctor thru that Holiest of Holys, the IRS (blessed be it's name).

Payment? I think you meant offering. Blessed be it's name.

[cjmr]

It's = It is.
Its = Belonging to it.

Please get it right!

[/rant]

[cjmr's husband]

If English is going to be our official language, what shall we make the punishment for its misuse?

[bulbul]

cjmr: And none of this would be happening had "tis" won as the official contraction of "it is". Wanna try to revive it? :o)

[David]

No one seems to be commenting on this part of the post, but I think the fallacy that life is a zero sum game is one of the most damaging in economic discussions today, since it's one that is very broadly used in rhetoric from both right and left.

An easy recent example is immigrants, where people somehow assume that every dollar an illegal immigrant makes is a dollar that didn't go to a "legal" American. The idea that an employment relationship can be beneficial for both the employee and the rest of society is never even suggested. (Of course, it isn't always beneficial. But the idea that a particular group is "stealing" our jobs and money is nonsense -- the effects are much more subtle than that.)

Zero sum is used by conservatives to oppose welfare, government health care, and similar programs, because every dollar the government spends on social programs is one dollar less in some conservative's pocket.

Zero sum is used by liberals to support welfare, etc., etc., because every dollar in some rich man's pocket must mean one dollar less for a poor working family.

They're primarily emotional arguments that have only very distant connections with the real situation. It's quite frustrating.

[Duane]

It's = it is.
Its = Belonging to it.

Please get it right!

[/rant]

I believe you may have violated Hartman's Law of Prescriptivist Retaliation.

Did I just feel a tremor?

[PK]

I'm surprised nobody's referenced Supply Side Jesus yet.

[pat greene]

David,

I don't think I've ever heard zero-sum per se used as a justification for welfare -- or more accurately, taxation to support welfare. You have more dollars in your pocket? Great. Are you doing your share in supporting public programs? -- and people point to things like welfare, but here in California, various "tax revolts" have *decimated* public schools, to the detriment of society generally. That is not "zero-sum." Provided you are carrying your fair share, it does not matter if you accrue more wealth.

This is in contrast to the other view, which is any dollar I give to you is taken from me. In the case of health care, this ignores the added value to society and the individual of things such as having kids who are less likely to wind up in jail and who are better citizens and employees because they received proper nutrition and pre-natal care; and not having to pay for emergency care when preventive care is so much cheaper.

[Skyknight]

{weary sigh} Scott...you'd do better if you toned down the passion quotient of your words. As it is, you're making it sound like "liberal" is a subset of "wicked, evil, and chimeraic" (although, from a few other elements I've read, you seem to have the same low opinion of "conservative").

For the rest of you, this quote of Scott's is rather illuminating...

"Gitmo is an example of what govt does..."

The important part is what's missing--the lack of a "the" before "govt". In other words, Scott's belief is that government is inherently cruel (at least, that's what it sounds like--any addenda, Scott?). Except...I don't see why it's inevitable. I'm not following the chain of causality. There must be SOME way to make sure neither avarice nor sloth nor wrath nor envy nor pride can latch their claws in (lust and gluttony are too lightweight to really matter here). I can understand how Scott's (form of) libertarianism can at least try to ward against avarice, envy, and pride...but I can't shake the feeling that sloth could easily hide in there. For that's what refusal to step into private economy nettles and their ilk, no matter what woes may materialize, sounds like to me--fatalism, blindness, the true meaning of acedia (i.e. what we call sloth; notice the similarity to "accede).

I know some of you may think this impossible, yet I can't help but feel that aiming any lower than the so-called "impossible" is itself sloth. {whimper} And yet...I know that contentment is supposed to be good. But why does it sound like sloth, thus a crime, to me?!

What does it take to have perfect holiness like God, these days, without any of the vices even pretending to be nearby?

[David]

Pat, it is true that I haven't seen zero-sum used as much in mainstream advocacy for social programs as in opposition to those same programs. When it is used, it is most frequently implicit as an emotional appeal along the lines of "The only way to be rich is by taking money from the poor."

What concerns me a little more is that when people, and I think it is most frequently conservatives, implicitly use the zero-sum assumption, the other side doesn't seem to realize it or know to point out that the assumption is flawed. It is very easy to refute emotional appeals like "The Mexicans are stealing our jobs," or "Welfare is just stealing money from hard-working Americans." But I rarely see people being called on these fallacies. To some extent people respond to them, and rightly so, by appealing to human compassion over economic efficiency. But even this still supports a false duality, since the claims start out by making bad economic assumptions before even getting to the human cost.

There are situations where one person's economic gain means another person's loss. But a lot of debate seems to assume that this is always the case, and work around it, rather than questioning the applicability of the assumption in the first place. And it is easy to believe in this fallacy, since all an individual sees is their net income and expenditures, and if some of their tax expenditures go to other people, it can be hard to think of the long-term effect it might have on their net income, and easy to think "their income went up at my expense." But just because it's harder to see/measure those indirect effects doesn't mean it isn't having an effect.

Or, to descend into partisan sarcasm: If people can believe in trickle-down economics, which have not yet shown any real-world effects to any reputable economists, can't they also believe in the rather more directly visible effects of decreased poverty and better education/employment rates?

[cjmr]

Hartman's Law of Prescriptivist Retaliation

I am unfamiliar with this...

[Bugmaster]

How much funding do you allocate to FEMA, or the FDA, or your new universal health care program ?

My answer to your question is "as much as I can".

That's not an answer, that's a cop-out. Let's say that your Utopian government collects $100 billion in revenue (including national debt etc.). You have several programs to spend this money on: homeland security, police, health care, road maintenance, science grants, welfare, farm subsidies, military, social security, FDA, FEMA, FCC, ...

So, what percentage of the money do you allocate to health care ? $100 billion ? $50 billion ? How much ? More importantly, how can you make an informed decision ? If you can't put a value on human life, then you are unable to put a value on services that support human life, either, which means that you can't make an informed decision about the budget. This means that, inevitably, you'll screw up your Utopia beyound all recognition.

The statement, "human life has monetary value" soubnds horrible and evil, but the alternative is even worse. If you refuse to place a value on life, you end up under-valuing it.

Hartman's Law of Prescriptivist Retaliation:

"Any article or statement about correct grammar, punctuation, or spelling is bound to contain at least one eror."

Although I don't see what your misteak was.

[Bugmaster]

Chuck, sorry, I saw your other post right after I hit "Post".

I'm not saying that universal health care is impossible; I'm saying that discussing it in terms of rights is useless, and distracting. Like Quinn and Heinlein, I believe that the sea won't care about your right to live when you're drowning, and neither will viruses, bacteria, broken genes or broken bones.

It seems to me that Fred is advocating something like this with his health care plan:

1. Health care is a universal right
2. ?
3. Everyone has health care now

Well, you need to be a little more explicit there in step 2 (with apologies to Larson).

Personally, I think that putting health care entirely under control of the government is a bad idea (I come from the USSR, in case you're wondering). I also think that leaving it entirely to free enterprise (read: monopolies and cartels) is a bad idea. Europe and Canada seem to have found a mix of the two that works adequately, maybe we can learn from them.

I'm just very suspicious of people who exclaim, "Healthcare is a right ! Everyone should have it !", without elaborating where the money would come from, and how it would be spent. Inevitably, these kinds of people has some hidden agenda in mind -- which could be as simple as, "reelection time is coming, I'd better promise them something".

[cjmr's husband]

The "misteak" was mine, and intentional. Oops.

Not only is it possible to make policy decisions without placing a fixed value on human life, if you try to retrofit a "value" into any given set of policies, you will find that they all have different values.

And that's not even taking into account "for want of a nail, the battle was lost."

In any case, if you do find yourself in a position to place a monetary value on human life, just be careful to make sure everyone has the same value. Anyone who disagrees can take it up with T.J.