Tuesday, October 27, 2009

Do No Harm

This is a great conversation that has spilled over from the comments in my last post. I'd like to try to address as many of the points raised there as I can, but I'll say from the outset that I don't claim to know what the best answer is and I don't claim to even know for sure what I think we as a country should do. So... With my lack of qualifications firmly established, let me begin to make policy.

CC said that it would be preferable for everyone to be in the system (a public option) because that way, healthy and sick, young and old, each would balance out the other thereby making the cost of the insurance more affordable to all. "[That's] what makes an insurance pool work." Exactly right, you need the one to off-set the other. However, the coersive nature of government (id est, government's power to force compliance) makes it dubious insurer. If I can force you to pay for my services, I've nullified the very foundation of a free-market. Where is my incentive to keep my prices low? How long before the public option becomes onerous and used only by those who are sick or cannot afford other options?

I think it's useful to understand the purpose and definition of insurance. I spent some time in the financial sector (I was licensed to sell both securities such as stocks, bonds, mutual funds, and yes, health insurance.) In the definition of "insurance" is the phrase "the transfer of risk." In other words, you the Insured tranfer the risk of your death, auto accident, or medical problem to the Insurer. We can debate the purpose and function of government all day, but I do not think any of us would be particularly comfortable with the notion of tranferring the risk of an entire population's health onto the federal government. That's not a function of government. That's why we have Insurance Companies.

CC zeroes in on a major priority of any health insurance overhaul: cutting costs. I concur, advertising of pharmaceuticals is a problem. It artificially drives up costs. I will add to this with another commonly mentioned cost -- malpractice insurance. This must, must, must be reduced and drastically. There needs to be limits on the awards that plaintiffs receive in court in situations where criminal negligence is not involved. If a doctor misdiagnoses your condition, and has done due diligence, it's unfortunate, but it's reality. Americans need to accept that medicine is not a simple and exact science. The human body is far more complex than a PC, yet no one expects the Geek Squad to buy you a new house if they fail to retrieve your data from a crashed hard disk.

Another point I think needs to be made here in regards to this sense of "entitlement" that I see in Americans. There is a disdain for the fact that rich people can afford better care than can poor people. Americans look at this and immediately say, "That's not fair. Everyone has a right to equal healthcare.

They do? Says who? Where is this written? Under which philosophy of ethics is this implied? As an American, you and I have equal opportunity to be as rich or as healthy as our own individual talents and abilities allow. If you have more money than me, why shouldn't you be allowed to use your lawfully obtained resources to benefit the lives of you and your family? If I do not have the same resources, how is it justified that others be forced to pay for my care? I do not understand this thinking. It's un-American and it's unrealistic. It is that sense of entitlement that has driven our government and our society toward economic unsustainability.

AsterixChaos suggests that costs can be cut by simply cutting off care to those who are beyond helping. Well, I can see the reasoning behind this point, but I do not see it as a major change in our current system. I do not believe that there are masses of doomed people who are artificially being kept alive against their will. In this country, when you say, "That's enough," then that's when your care ends. The only time the state can intercede is when its determined that you're unable to make that choice yourself. And, despite what we may see anecdotally in the news, those cases do not make up much of the overall costs of healthcare.

CC makes a great counter argument, one I agree with, that if we allow our society to become sickly, then we put our country at risk and we become a burden upon ourselves. Well said, CC. In this sense, yes, I see the Federal Government as having a stake in this argument and an interest in promoting "the general welfare." (This, however, is not the case right now, but if it were, certainly the government should act.) Moreover, I believe strongly that the morals and ethics of our country do not allow this policy to be employed. What benefit is there to being a member of a society that denies care to those in need if they have the resources to obtain the care? Beyond this, I believe there should be some nominal "safety net" to care for those who lack these resources.

OK, so let me get to the heart of the matter: What should we do?

Again, the caveat holds true that I mentioned before. I don't claim to know for sure what to do. However, I think each of these points need to be a part of the solution to this pressing problem.

First, costs must come down. Malpractice insurance, advertising of pharmaceuticals, jury awards, outrageous and inequitable hospital charges against different types of patients (depending upon the insurance they carry) and other costs must be examined and addressed. And lowered.

Second, (for those who like Federal Government intervention) Americans need to be taught and "socially engineered" to understand that healthcare starts and ends with prevention. No, you don't get to have a heart transplant if you've spent your life at McDonalds and you weigh 400 pounds. No, you don't get a new liver, Mr. Mantle, if you've spent your life drinking like a fish. If the government wants to intercede in this situation, let's spend money on physical education and getting people healthy. THAT would be a legitimate govnerment interest. Paying for people's problems after the fact is a poor social program that has no end to it. Let's start with this and see how we do before we start re-defining our Constitution and throwing HUGE gobs of money at the problem. Also, let's stop perpetuating the myth that the government will bail you out when you've soiled yourself. God help this generation of Americans.

Third, rather than pumping this mess up to the Federal Government, let's push it down to the communities where we can have some control and some accountability over it. Lets fund and staff local clinics in our towns to intercept the small problems rather than overwhelm our hospital emergency rooms with people who need naught more than an aspirin and a Kleenex. When I smashed my pinky finger with a 4lb hammer as a 17 year old, I went to the local town clinic. A doctor gave me a prescription for a pain killer and stitched up the wounds. I didn't need an ambulance ride and an emergency room visit at the hospital that would have cost ten times as much and would have taken ten times longer to see a doctor. Our baby Benjamin had trouble breathing recently in the middle of the night and we took him to the hospital at 2am. SIX HOURS LATER they finally had a doctor see him. What the hell is that?! If I have to pay another tax, I'd rather it stayed in my town and bought me a local clinic that can care for the needy and provide routine medical procedures (flu shots, bandaging, burns, cuts, etc.) Having trouble paying for it? How about a "Peace Corps" like program that enlists new doctors to serve in such clinics in return for some loan forgiveness?

Fourth, let's listen to our Insurance Companies. Let's see what they can tell us about why costs are so high. They're the ones paying the bills, perhaps they might have something to add to this conversation? (Ya think?) Before I'm going to listen to Sen. Frank Lee Blowhard, the junior senator from Idaho, I'd like to hear what the professionals have to say.

In short, there are a lot more and better ways to fix this mess than for the Federal Government to usurp and entire industry with socialism. Why don't we try a few before we start re-defining the U.S. Constitution?

Your thoughts?


Recessionista Genie said...

My thoughts (because you knew this was coming!):

1. I think you misunderstand what "public option" means. A public OPTION would compete with private insurance, not replace it. Even if there was a mandate for all Americans to buy insurance, we would get to pick whatever insurance plan we want. If you like Blue Cross Blue Shield better than the public OPTION, you can buy that. The Public Option is to increase competition, not "take over" or create a monopoly. The Public Option INCREASES your ability to choose a plan that works for you.

2. You say, "As an American, you and I have equal opportunity to be as rich or as healthy as our own individual talents and abilities allow." Does this apply to newborn babies? Because newborns are the beginning of the problem. American prenatal and infant care is terrible. Are you blaming babies for being poor? You don't get any control over your income until you're legally able to work, by which time you may have malnutrition, brain damage, debilitating disease, tooth decay, or even death from lack of health care preventing that American Dream success. Also, the number one cause of American bankruptcy IS health care. Even an upstanding, hardworking citizen with a good job (like my husband's father) can be financially destroyed by a health crisis that was not their fault (like getting hit by a car, like my husband's father) causing a permanent brain injury that Blue Cross Blue Shield doesn't want to cover. Does he now, in reverse, no longer deserve his health care because his health crisis made him poor and brain damaged, so now he can't work? Is that really how you feel? C'mon now.

3. I very much agree with what you say about saving costs by tackling preventive care, pharmaceutical advertising, malpractice insurance, etc. I also agree when you say, "Lets fund and staff local clinics in our towns to intercept the small problems rather than overwhelm our hospital emergency rooms with people who need naught more than an aspirin and a Kleenex."

Of course!

But I don't think you understand that that is one of the things a private option would help DO. It's government health INSURANCE being proposed, not government-controlled CARE. The government would foot the bill for whatever your doctor decides, and for care YOU choose to receive at one of those nice, local, small clinics, not make health decisions for you or force you to go to a big hospital and get things you don't need.

The proposed legislation would give YOU, the consumer, the option to purchase an efficient, government-run plan like Medicare--or not--and decide what treatments YOU need with the doctor YOU choose. It would then force insurance companies to compete and work harder for you, the consumer, rather than spending their money defending regional monopolies in court so they can make more money off you and provide less health services to you each year.

What's wrong with a public option? It would help meet all those goals and wishes you just laid out.

Anonymous said...

Right off the bat. My argument with Ryther was that public option would basically put out most insurance. My basis was that we have seen what private pensions have become in tough economic times. Once a perk, they are now dominated by 401K plans, which many companies are no longer putting any $ into, and Social Security. The same thing will happen eventually to private health care offered by companies.

That's my 2 cents for the moment. I have a movie to watch. More later perhaps.

Glenn said...

One major problem I have with Recessionista Genie's comment is when she says, "The government would foot the bill for whatever your doctor decides." The government is telling me that I need to have health insurance (which by definition is meant to have healthy people help may for sick people) and is then saying that if you cannot afford health insurance then we (the people since the government only gets its money from us) will pay for you as well. So we're being hit from both sides on this.

Where is my tax break for being able to pay for my own health insurance since I am also going to be paying for those who cannot afford it? Where is the incentive for those who cannot afford insurance to get into a position to pay for it since there is a point at which making more money makes you less well off?

Gleno said...


Though some of what you said seemed unduly effusive, and almost personal, I recognize that this is an emotional issue for many people. In point of fact, it is for me, though from the perspective of other side of the aisle. Allow me to respond to each of your points:

1. Public Option is currently being couched as an "OPTION", yes, I do in fact understand that. However, I think you're ignoring the fact that Obama has made it clear in numerous statements that his intent is to END private insurance. This isn't any secret to anyone. To the contrary, it's perfidy to pretend that any private insurance company can compete with a competitor that has unlimited power to tax its "customers". Would your company fair well against mine if all I needed to do to overcome problems would be to print myself more money? It's fallacious to think that the government's so-called "option" isn't just a toe in the door to a much more far reaching government take over.

Watch this video of Obama own words affirming his dedication to ELIMINATING private insurance:

So yes, I clearly "understand" what public option" means. You might want to look further at it's implications and ramifications.

2. Yes, you got me here. I didn't realize I had shown my hand so early, but I am indeed blaming babies for being poor. I had, in fact planned to post a blog latertoday condemning babies and outlining how we might entirely eliminate them from this country.

(The problem with using a straw man argument is that it looks silly once it's been pointed out.)

Personally, I'm inclined to think that babies should have some sort of representative when they are brought into the world. Perhaps an adult (or even two) could be assigned to them to tend to their needs, to raise them, and provide them the resources they need to survive. If this were the case, then we could place the responsibility for providing health insurance for the baby upon these representatives. (We could call these representatives, oh, how about "parents" for lack of a better word?)

You mentioned two anecdotes regarding health insurance failures. Your father-in-law had catastrophic health care bils that his insurance company failed to cover.

Honestly, I was not aware that I felt he did not deserve care and insurance until you informed me that that was how I felt. Prior to being told this, I probably would have said that his health insurance company should have been forced to pay for his medical bills, and that he subsequently should have been covered by disability insurance.

Thus, the solution to the problem isn't to create another ginormous government entitlement program, rather it would be simply to force the insurance company in question to pony up what it had been already paid to cover.

Please pardon the abundance of sarcasm.


Recessionista Genie said...


Sarcasm not only pardoned but perversely appreciated. The snarkier we get with each other, the more I think we’re getting to the core of this debate. I can’t genuinely say “I’m sorry” at this point (see end of comment), but I must concede a couple of things. To respond to your latter comment (honestly, sans sarcasm):

1. Yeah, I do see your point there. I don’t think Obama has been forthright either. In fact, I think the Obama administration’s attempt to be “transparent” has been, at best, half-assed. I do recognize that he would rather do away with private insurance and truly favors a “single payer” system as the ideal.

Where we differ is that I think that’s a good thing. (Putting private insurance out of business, not the president’s dishonesty.) I think that some private insurance companies certainly will go under, because they won’t be able to compete. Because they suck donkey butt. They treat people terribly and deny claims at every opportunity. I won’t miss them. Also, I don’t believe the result of a public option will be a government monopoly of health care insurance. That’s not what happened in Germany, and I don’t see how our situation is different in any relevant way. I think that private insurers will be forced to get better or fail, and some will go either way. But this comes down to gut feelings and who we trust. I can’t see the future, and neither can you. We can only guess. I work with many doctors who are in favor of single payer health insurance, or at least the public option, and I trust their professional opinions. Heck even my husband’s union, the Teamsters, support a public option. I don’t fear catastrophe, because I’m listening to medical experts and looking at what has happened in every other developed nation. I don’t think our system of government is less civilized or capable than other nations.’ I’m also looking at our own government’s Medicare system, which is good, and other programs like our Postal Service, which is the best in the world. I don’t fear that the government will use a health care “takeover” to impose higher taxes or print money for itself or whatever. I look at my evidence and feel confidently hopeful about reform. I look at the status quo and see disaster.

Recessionista Genie said...

2. Touche. I don’t really think you hate babies and disabled people. Admittedly, I was prodding you to rethink and explain your position to my satisfaction. I don’t believe you don’t care about babies and disabled people, but I stand by my implied accusation that your position, in effect, does them injustice. You say that parents should take care of their babies and health insurance companies should take care of their clients, as they are paid to do. Agreed.

But this is not happening, so what is to be done about it? Many babies do not actually have parents who are alive, non-disabled, and willing to care for them. Do you believe the children should pay for the sins (or absence through death) of the parents? I doubt that this is how you would characterize your feeling, but without throwing out that “straw man,” I can’t highlight the actual implications of your statements. Can you elaborate? Blaming bad parents and bad insurance CEOs is not helpful to the victims. HOW will we make caretakers take responsibility? How do we make insurance companies stop denying claims unfairly? How do we ensure children have an opportunity to live and develop normally before we start blaming them for their failures?

Something must change, for the sake of our nation. We Americans are so sickly and poor at this point that we can’t even compete in the global marketplace. Covering all Americans under a public health insurance plan is one solution. I recognize that it is not the only possible solution, but none other has been seriously proposed. Do you have any ideas for how health care justice can be enacted, besides the public option?

Yes, my comments on your health care posts have been heated. I promise that when you post on a topic that doesn’t directly affect the lives of my brother, father-in-law, children of disabled cousins, friends, and other loved ones, I will find it much easier to be polite. This is no distant, theoretical philosophical or political discussion we’re having. Without exaggerating for dramatic effect, I can say that this is a matter of life or death for people that I know. There’s no way around that.

Recessionista Genie said...

GlenN- I guess it’s a matter of how you prioritize your values.

Is it fair that some citizens be taxed more than others and receive different amounts of services? No.

Is it fair that some people get access to health care and some don’t? No way.

Let’s see, taxes versus untimely death… What’s worse? Hmmm. I can’t keep the sarcasm out of this one. I’ve worked with children in the foster care system, abused children and those suffering from agonizing disabilities. Should you have to pay for those children’s care? Is it your fault? No. Do I think it’s better that those children die in the streets than you have to pay taxes? Nope. Forgive me if I can’t muster up a tear or a tiny violin accompaniment for your tiny tax hike. Besides, you could become sick or disabled at any time, no matter how healthy you are now or how responsible your lifestyle. Tragic accidents can happen to anyone, like my father-in-law. If something terrible happened to you, you would be covered by an efficient insurance program too. And if nothing terrible happens to you, you’ll get elderly someday and need health care services one way or the other. And you’ll be covered, no worries, if our nation has a functional insurance system for all Americans.

Recessionista Genie said...

And with that, I'll say goodbye for awhile. Tonight I'm going to a kickoff party for my month-long NaNoWriMo adventure. Until at least December, I won't be reading blogs or doing much posting on the blogosphere except what relates to the NaNo. Have fun until then, and I'll catch up on the blogging action later. Who knows, maybe there will be new legislation by the time I come back that will please one of us, both, or neither. Or maybe our government will still be bickering like blogging friends and have done nothing. We shall see. I do hope the world as we know it doesn't end in the meantime. Catch you later!

AsterixChaos said...

This "public option" that keeps getting tossed about is actually a typo. We're facing a "Pubic Option," as we're getting buggered any way we look at this. Long and long, liberals have used language as a finely-honed weapon, not unlike the Inner Party of Orwell's Opus, and our very own Ministry of Plenty is seeing just how far we can go without, as a whole. "Public Option?" The WORDS summon up warm and fuzzy feelings of freedom and the ability to choose... When in reality, at its very, very basic core, it's taking AWAY my choice.

Money, we are told, is intended to represent the energy, effort, or work that we perform, allowing for a fluid transaction between the work that I do for Willy's Widgets, to allow me to trade at Gary's Grocery, without having to figure out how to trade widgets for corn. Willy says, "You did $10 of work," and I can go to Gary and buy $10 of corn. This is good. This is freedom, as I get to CHOOSE how I spend my money, or more to my point, how I'm NOT going to spend my money.

This pubic option is bending me over and saying, "I don't care who you are, what your circumstance is, how, why, or what... But you're going to get insurance, whether your need it or not."

I'm a US Air Force veteran. I get free medical care through the VA. I don't have insurance--I have the broken parts of my body and soul that I gave to protecting my country. Our wonderful government is going to punish me for that, as I will be forced--forced--to pay someone, somewhere for insurance.

Option? Option, my ass. It's yet one more little sliver of freedom being stripped away. Everything else is peanuts. Who or how we create "better healthcare" is complete bunk. The fact that we are taking away the freedom of We the People to be as safe or as dangerous, as wise or as foolhardy, as wealthy or as poor as we WANT to be.

To hell with this pubic option. I much prefer having a choice.