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Lakeshore
An author of no particular popularity

Jay Lake
Date: 2009-08-28 04:53
Subject: [politics] Various comments on healthcare reform
Security: Public
Tags:healthcare, politics
A few responses from me to some interesting comments in yesterday's healthcare post. (Worth reading the comments in their entirety, though I've trimmed them here for clarity as I respond.)

Shawn Scarber:

1) Can we do this without putting thousands of people who are presently employed by the insurance companies out of work?

I appreciate this problem, but speaking as someone who's been laid off five times over the years due to working in unprotected industries (advertising and consulting), my experience is that job protection is rarely a priority in our economic decision making. Why do you think this particular workforce should be protected?

2) Are enough people who actually work in the medical field like doctors, specialists, nurses, and administrators going to have a controlling interest in how this is run?

Ghu, I hope so. That's part of my point. The current dynamic runs like this:

Democrats: "Healthcare idea."
Republicans: "SOCIALIZED MEDICINE!!!! DEATH PANELS!!!!"

What it should be is:

Democrats: "Healthcare idea."
Republicans: "Different healthcare idea."

Which would include, certainly, involving the medical field. See this excellent post on the same topic, taking a doctor's point of view.

(And note that "different healthcare idea" can include, "keep the system as it is". Not that I agree with that, but it's a position that could be taken.)

3) Can we actually cover everyone? I dont want to overhaul the system to find that the people we wanted to cover are still left out of the system. Every American gets coverage.

To me, that's entirely the point of this process. See above, it needs to be discussed rationally and carefully.

4) Is it possible for this system to work like the Postal Service so that it works competently and allows competition with companies like FedEx and UPS.

Unless we go to single-provider, which has never been on the table (despite Republican accusations to the contrary), I don't see why it would be anything else but openly competitive. For that matter, people in Canada and the UK are free to buy private insurance, and some do, for various reasons. So do people on Medicare in this country. So, erm, yes, I don't think this is an issue in the high level sense. As always, the devil is in the details, but until we get past the noisy, opportunistic "death panel" rhetoric, we're not going to get much in the way of detail.

Additionally, I hate that this has become a political issue

Yep. All you have to is look at the public statements of people like Inhofe, Boren and Armey to see why it has become a political issue. They're quite open about it. The GOP didn't even slow down to consider this as a policy issue before they seized on it as a way to tar Obama and the Democrats going into the 2010 midterm elections and the 2012 presidential elections. They're not bothering to pretend to principled objections to the proposed reforms, or even rationally discussing the need for a reform. Conservatives politicized this issue to make it DOA and to have a stick to beat Obama with.

Brad R. Torgersen:

I think a big part of the problem is that many Americans think 'Healthcare Reform' is code for 'Socialized Medicine,' wherein all docs, nurses, hospitals, clinics, etc, become state-run and state-controlled entities. I'm not sure the U.S. healthcare industry or patients will ever want to go down that road.

Absolutely. And what frustrates the hell out of me is that conservative political leaders and media figures only contribute to that perception, even though they certainly know better. Medicare is socialized medicine, so far as that goes, so is the VA system. So the Americans who fear "socialized medicine" have their fears and biases confirmed for opportunistic electoral gain, instead of participating in a rational debate about one of our society's biggest problems.

It may be that just as only Nixon could go to China, only a conservative leadership could deliver meaningful healthcare reform. But I hate that this thing is quite likely to go down, not on the merits, but out of carefully cultivated ignorance and pumped up hysteria.

Many Americans believe that getting and keeping coverage is an individual responsibility. Which is generally where we can differentiate a lot of things, between conservatives and liberals: individualism versus collectivism.

Which would be fine, if coverage were affordable and available to individuals. I have an income in the upper quartile of American wage earners, but due to my cancer, I cannot afford coverage outside of nonqualifying employer sponsored group plans. Even if I could find someone to underwrite me, it would take at least 20-40% of my income, and not cover my core needs due to pre-existing condition exclusions. (Not the mention the catastrophic financial impact that lifetime maximum coverage limits will have on me in a few years, no matter how good my insurance.) The current system doesn't allow many, or even most, individuals to get and keep coverage, and that's a big part of what is profoundly broken.

I think Shawn brings up a huge and often-overlooked problem: malpractice insurance

And the rest of the First World seems to be able to deliver quality healthcare without that problem. Note that according to martianmooncrab, entering the VA system involves waiving your right to sue for redress. It seems to function pretty well regardless. Meaningful malpractice reform would help a hell of a lot. See the link above to a doctor's perspective for a bit more on this.

Which, again, brings up the fear many Americans have of seeing their tax dollars used to give away billions in healthcare dollars to people who dont put back into the system.

And that may be a conservative-liberal divide. To me, as a liberal-progressive, one of the primary purposes of government (and therefore, by definition, tax expense), is to put money into places that can't self-fund. Fire departments don't pay for themselves. Neither do libraries. Or most roads and bridges. As a citizen, and as a moral actor, I have a strong interest in seeing my fellow citizens remain healthy and well-cared for, regardless of whether they can self-fund.

The first order implication of the widely-held viewpoint you cite is that people who don't have money don't deserve healthcare. To my mind, that's immoral, unethical and frankly chilling.

On a more practical note, we already pay billions for those people who don't put back into the system. They come to emergency rooms when they get sick because they couldn't afford an $80 doctor visit. This is very well documented. We're paying for it now, out the back door, and very inefficiently. We may as well make it work through the front door, where we can fairly manage and allocate tax dollars and medical resources. The alternative is closing emergency rooms and clinics to everyone who can't already pay.

The other flaw in that viewpoint is that it ignores the fact that anyone who loses their job joins that pool of people who don't put back into the system. Except for high net worth individuals, or the very healthy (and young), we're all one layoff notice away from being in that very same position. Sheer self-interest ought to drive the most die-hard conservative toward a public safety net.

Originally published at jlake.com.

Post A Comment | 16 Comments | | Link






International Bon Vivant and Raconteur
User: nick_kaufmann
Date: 2009-08-28 13:31 (UTC)
Subject: (no subject)
I see no reason why a government-run healthcare insurance plan would put private plans out of business. Public libraries didn't kill the bookstore business. State colleges didn't put an end to private ones. Free public elementary and high schools didn't run expensive private schools out of business. People like choices, and as long as people want choices, there will be choices. That's the nature of capitalism, to identify a need and provide the service or product that fills it.
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User: lonfiction
Date: 2009-08-28 17:09 (UTC)
Subject: You forgot one!
And PBS certainly didn't run the networks out of business!! Though its later fate does make it a not so great example, I guess.
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International Bon Vivant and Raconteur
User: nick_kaufmann
Date: 2009-08-28 17:23 (UTC)
Subject: Re: You forgot one!
Good point, Lon.
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User: etumukutenyak
Date: 2009-08-28 17:20 (UTC)
Subject: (no subject)
Keyword:Gromit puzzled
May I copy this (with attribution) to my LJ? I want to post on this topic, and you have said very succinctly what I've been thinking.
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International Bon Vivant and Raconteur
User: nick_kaufmann
Date: 2009-08-28 17:22 (UTC)
Subject: (no subject)
Sure!
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User: etumukutenyak
Date: 2009-08-28 17:54 (UTC)
Subject: (no subject)
Keyword:Nuclear night test
Thanks!
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mcjulie
User: mcjulie
Date: 2009-08-28 14:39 (UTC)
Subject: (no subject)
Many Americans believe that getting and keeping coverage is an individual responsibility. Which is generally where we can differentiate a lot of things, between conservatives and liberals: individualism versus collectivism.

I wanted to respond to this one, because I think it's a common viewpoint -- it's what conservatives *tell* themselves the conflict is, but it's not really what the conflict is.

Insurance itself is *already* collectivism, that's the whole point -- shared risk pools and all that.

*Individualism* is me going on my own to a doctor or medical service willing to take uninsured patients, and then paying for it out of my own pocket. Which is what I have done for the past eight years.

The conflict isn't between collectivism and individualism. The conflict is between for-profit collectivism, and between not-for-profit collectivism.
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Kari Sperring
User: la_marquise_de_
Date: 2009-08-28 15:46 (UTC)
Subject: (no subject)
One of the things that really baffles me, as a Briton, is the fear some citizens of the US have of 'subsidising' others. And yet the same people are welcoming and supportive to new neighbours, say -- but both taking round a pie and paying tax which goes to aid others are subsidies in their way (yes, one is cheaper fiscally, but interacting with a community can be very expensive of time and energy). A society works through mutual support and mutual aid: my tax pounds educate other people's children; other people's tax pounds helped educate me and so on. Given the USA's history as a place for the dispossessed, the poor and so forth, I find it odd that this very (to my eyes) puritanical and punitive idea that those who don't have must have deserved their condition is still so persistent. To me, universal healthcare is a no-brainer. It benefits everyone at all levels. It helps those who are poor. It helps those who are rich. It helps to prevent the spread of conditions such as drug-resistant TB (which is a threat to everyone). But clearly there's a cultural weighting in operation that is opaque to me.
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Jay Lake
User: jaylake
Date: 2009-08-28 16:06 (UTC)
Subject: (no subject)
It's damned opaque to me, too, and I live here and (more or less) understand it. Your use of the term "puritan" is literally true in this case.

What I find especially bizarre is the overlap between self-identified Christians in conservative circles with that selfsame belief about how the less fortunate do not deserve support from our society. They're obviously working from a different Bible than the one I grew up reading.
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User: lonfiction
Date: 2009-08-28 17:10 (UTC)
Subject: (no subject)
Amen.
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Kari Sperring
User: la_marquise_de_
Date: 2009-08-28 22:52 (UTC)
Subject: (no subject)
It's the same dilemma that Weber analysed in The Protestant Ethic and the Spirit of Capitalism a hundred years ago. There is something deeply perverse about that link between very punitive forms of religion and the abandonment of the poor.
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madrobins
User: madrobins
Date: 2009-08-28 16:40 (UTC)
Subject: (no subject)
I hear people complaining about having to pay taxes that support the education of other people's kids, too. My response is always that, at a bare minimum, society--including the speakers--have an interest in being surrounded by educated people. Wouldn't you want the kids who are in school now to be well educated and appreciative, since they're the ones who are going to be changing IVs, administering living wills, etc. when you are elderly. In the same way, society has an interest in a healthy, productive, non-diseased populace. The people who cannot see beyond their own living room depress and confound me.
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Jay Lake
User: jaylake
Date: 2009-08-28 16:49 (UTC)
Subject: (no subject)
The people who cannot see beyond their own living room depress and confound me.

In a nutshell, that's American conservatism &mdash the Tragedy of the Commons gone berserk.
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User: lonfiction
Date: 2009-08-28 17:11 (UTC)
Subject: (no subject)
Or perhaps Victor Hugo's evil poor, as applied to the philosophically impoverished...
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Kari Sperring
User: la_marquise_de_
Date: 2009-08-28 22:57 (UTC)
Subject: (no subject)
We have that one here, too -- and it makes no sense. In the UK, we have all in some way or another benefited from education paid for by other people's taxes. Selfishness goes horribly deep.
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User: mrtact
Date: 2009-08-30 04:03 (UTC)
Subject: (no subject)
Unless we go to single-provider, which has never been on the table (despite Republican accusations to the contrary), I don't see why it would be anything else but openly competitive.

Indeed, the much-maligned public option would create "insurance gateways" that aggregate hundreds of thousands of individuals and small businesses, and any insurance company willing to meet certain standards could offer policies through this gateway. Which means insurance companies could potentially earn revenue from people currently considered uninsurable because they're not in a big enough pool to spread the risk around.
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