Life is right

I see a tweet from No. 10 that leads me to this statement by PM Gordon Brown:

… healthcare is not a privilege to be purchased but a moral right secured for all.

A moral right for all. That is where the debate should begin here.

  • http://www.cincomsmalltalk.com/blog/blogView James Robertson

    Umm, really? Where do you draw the line then? Food is way, way more important than health care, so is that a moral right as well? Do we need to create a federal program to ensure that everyone (not just the truly needy) get exactly what they need?

    Saying that health care is a “moral right” is a deeply dishonest position to take. The intent isn’t to create a space for debate; it’s to rule out of consideration any and all objections to your preferred plans as immoral and unworthy.

  • Anon

    It is also important to acknowledge the issue of “What level of healthcare?”. Should everyone have the right to the same level of services regardless of whether they are paying for it themselves (i.e. with private insurance or their own funds) or through a government funded program? The only way for all to be on equal terms would be for everyone to get everything – a sure plan for financial ruin – or limit what those who can afford it are allowed to buy – morally questionable and politically unacceptable.

    Which leads us to back to some unequality will always exist for healthcare. Though we can, and probably should, reduce the inequlaity by biringing the bottom up.

    Perhaps, best to define as “Basic healthcare is not a privilege to be purchased but a privilege the government will provide because we feel it is morally right to do so.”

  • http://friendfeed.com/jlj JJ

    Well said, Anon. I suspect it’s what Brown meant. At face value, his statement is completely unrealistic, as you said, even if he prefaces it with ‘British’, which would be entirely arbitrary in a discussion on morality.

  • http://robertdfeinman.com/society robertdfeinman

    Well one attempt at getting a dialog going can be found at http://www.healthbeatblog.org/

    Why do the hard-hearted libertarians always surface when social programs that depend upon communal responsibility are discussed? The details of how universal health care would be managed have been dealt with in the many countries which already have successful systems: France, UK, Japan, German and all of Scandinavia, for a start. Not only have they all come up with workable solutions, they have all come up with different ones.

    Surely there must be something in all of these that can be adapted to the US. Of course they don’t have to face the barrage of libertarian selfishness funded by the super wealthy in the US who fund the think tanks that generate the misleading objections. In fact they don’t even have much of a super wealthy class (UK excepted) at all.

    Egalitarian societies have no problem adopting egalitarian solutions. Strange isn’t it?

  • http://www.cincomsmalltalk.com/blog/blogView James Robertson

    robert,

    Those countries – like us – have imperfect systems. The Canadians are adding private coverage back in, as are the Brits. What we can learn from them is that a purely socialized system has as many problems as some theoretical purely free market system (which we don’t have here).

    What I dislike is Jeff’s attempt to rule out of discussion any dissent by claiming that health care is a “moral right”.

  • http://www.buzzmachine.com Jeff Jarvis

    Chill, Robert. This precisely starts the discussion. What is a moral right in society? Clean air? Water? Education? Safety? Health? Speech? Society makes these decisions not as economic decision but as moral decisions: we have a right to speech in America. The First Amendment says it is unAmerican to cut that off (unless you’re the fucking FCC).

  • Marco Lugon

    Robert,

    The problem with systems “that depend upon communal responsibility” is that communal systems in an evolutionary sense evolved with negative feedback loops to punish free loaders; people that point out the importance and even genetic predisposition to work together, conveniently leave out the genetic predisposition to punish people who don’t contribute their fair share.

    Having spent many years living in Germany, I can tell you from first hand experience that health care goes into a downward spiral when it’s ‘free’. People feel like they’re paying a bunch (in the form of taxes) to fund the system, so they go all the time (most Europeans view Germans as hypochondriacs). So they raise taxes, and people go more again.

    In an evolutionary sense, if someone was freeloading or taking more than they deserved from the tribe, they were castigated or punished by the tribe. In Germany, this doesn’t happen, health care just gets more expensive and they just ration it more. The cycle continues until you have very long waiting lines and mediocre health care for everyone.

    I think we need a sane solution. Without arguing a very arguable number, 47M people are without heath care in the US; this amounts to about 15% of the population. In other words, should we really completely change a system and diminish the quality of service for 85%, to fix it for the 15%?

    Now lets looks at that 47M number, it includes:
    – 8-10M, illegals; who wouldn’t be officially covered under any plan
    – 9-12M, people who went without insurance while changing jobs
    – 10-12M young healthy people who chose not to purchase insurance.
    – 5-8M People who qualify for State or Federal programs but don’t sign-up

    What you’re left with is about 10M who need insurance but can’t get it; these are the people we need to insure.

    You’d don’t give a patient chemotherapy if they have a cold, and you certainly don’t need to socialize medicine to provide health care to 2-4% of the population that can’t get it today.

  • José Luis Campanello

    While i don’t live in the US, we have many health care problems (inequalities, should i say) where i live (Argentina). For starters, our public health system is pretty much collapsed (despite enormous efforts by the industry professionals).

    It strikes me that it would make more sense a talk framed into “ethics” rather than “moral”. I tend to believe that moral is more dependent on a lot of personal choices (religious, political, economic, ethnics biases, etc).

    Ethics sounds like a more rational ground.

    Of course, emotion (empathy) has an important role on this and other subjects (public education, food, work).

  • http://www.beatcanvas.com Brett Rogers

    At what point are adults expected to be responsible for themselves? I get covering children. Adults? I have a much harder time with that. If there is to be any coverage for adults, it should be temporary, like welfare.

    As for a moral right, what the hell is that? Moral right = it’s just the decent thing to do, so we do it?

    I think the debate should begin with my first question: At what point are adults expected to be responsible for themselves?

  • Tim

    Why not introduce a Guaranteed Annual Income? How can you get exercised about the lack of health care coverage and not get equally upset about the many people living in abject, third-world squalor in the USA?

    The problem is, a lot of working- and middle-class people are still not covered adequately. When they are, the public conversation about all of this will end and the poor will continue to rot.

  • Marco Lugon

    I think we’re mixing ‘rights’ (free speech, life, liberty, pursuit of happiness, right to vote) with laws we pass to ensure we have things we like or things we feel a society should provide (education, clean air, clean water). Clean air or clean water aren’t rights, they aren’t protected by the US Constitution. I don’t remember it reading, life, liberty, the pursuit of happiness, clean air, clean water, health care, social security.

    I certainly think a rich society should be able to provide health care for its neediest citizens, just like we should provide social security as a safety net for elderly not to slip into poverty (no, social security should not be a ‘retirement plan’).

    Strictly speaking, I think a right is something you can guarantee to someone but it shouldn’t oblige someone else to work to provide it for you. I don’t have to work for 5 hours a day to give you the right to free speech, or the right to practice your religion, or the right to vote.

    I think it’s dangerous to claim that you have a right to someone else’s productivity. In England, they lived with a monarchy, this isn’t surprising for the PM to claim this (the monarchs had a right to your output); in the US, we generally don’t give someone the RIGHT to your productivity, we pretty much got rid of that when we ended slavery.

    We chose to live in the US, and understand that to live here we have to pay taxes to provide certain things a country like the US feels it should provide its citizens; but those things (health care, clean air, clean water) aren’t codified rights in the US constitution, nor in my opinion should they be.

  • http://roborant.info Rob

    There doesn’t seem to be a very good correlation between life expectancy and the degree to which medicine is socialized in a country. To me, this means that “free health care for everyone” doesn’t correlate to “better life outcome for everyone”, which is what any underlying morality would be about.

    For example, lifestyle choices probably have a lot more negative impact on people’s lives in the US than lack of healthcare access. If I gain a lot of weight and become diabetic, my quality of life has just degraded a good deal, even if I have access to good healthcare. If I smoke … well, you get the idea.

    So, it might be that education and preventative care and counseling would provide more bang for the buck than actual healthcare.

    All of this is a long winded way of saying that we should be careful to frame the debate in terms of the most beneficial life impact rather than simple “access to healthcare”.

  • http://www.shootingbynumbers.com peter

    the whole libertarian stance is complete bollocks. No-one believes in it except Robert Mugabe and a few paedeophiles.

    embrace socialism – it is the future….if there is a future

  • http://www.buzzmachine.com Jeff Jarvis

    It would even help if insurance were portable and we were guaranteed not to be rejected. I believe that if we analyzed it, we would find a considerable economic cost to so many workers being trapped in their jobs because of insurance.If we were free to move, I’d wager that we’d see more people going out on their own, starting companies, creating value. But now we’re insurance slaves.

  • Anon

    Technically, insurance is portable or, at least puchasable. The issue is the cost. The reason it is cheap when working for a large company is that the company is picking up half (or more) of the cost.

    To control cost, you largely have to control the level of service you are providing. Right now, we basically have one level of service for healthcare – whatever it takes to treat me, whatever the cost. Naturally, this is quite expensive. So, for many it ends up as a binary choice – either I have insurance or I don’t.

    If there were a way to tier treatment levels based on the level of insurance you were willing to buy, there would be more affordable options. Maybe I’m only treated by less experienced doctors or am assigned a hospital based on availability rather than convenience.

    The problem is that health care, when argued as a moral right, doesn’t allow these gradations of treatment because it presumes equality of treatment, as moral rights should. If we move away from the moral argument and view it as privilege, we have more flexibility in options.

    As to the discussion of Germany above, there is a relevant economic maxim that says, “Something which has positive value and zero cost will have unlimited demand”.

  • Marco Lugon

    I’d love to see it be portable as well, but as Anon says, it’s paid for by companies, and they receive a tax deduction for it. If I buy insurance, I have to pay with it from after tax dollars. There was a proposal to allow privately paid insurance to be tax deductible, but it never went anywhere.

    Companies could just as easily give you the $5K a year it costs to buy insurance, but you’d pay $1-2K in taxes on it.

    As for only having one level of care, a lot of states put minimum requirements in place on health care companies; for example, in some states, you can’t offer a plan that doesn’t include a mental health (therapy) coverage … all under the guise of ‘looking out for health care recipients’ (I’m sure there isn’t any lobbying from groups like APA to get this included!)

    Of course, these mental health care benefits drive up the cost on even basic plans, so now, there is no basic coverage ‘medical’ health plan; you can’t even chose one without mental health. Don’t get me wrong mental health is important, but fixing broken limbs, stitching open wounds, and getting cancer treatment are little higher on my list.

    If the government actually let companies put different level plans in place, then you might have some cheaper options; even thought they might not include things like chiropractic care.

    Perhaps you do a Quid pro quo with insurance companies; you let them offer the plans they see fit; and in turn you pass a law that prevents any insurance company from discriminating against preexisting conditions (to address Jeff’s point about being guaranteed not to be rejected).

  • harris6

    “A moral right for all. That is where the debate should begin here.” {–Jeff Jarvis}

    `

    No. Assertion of health-care as a “moral right” is really intended to shut down all debate on the ethics, economics and efficiency of socialized health-care. Then the only remaining agenda item for ‘debate’ from this ‘starting point’ … is how to quickly implement this alleged “moral” imperative.

    If health-care is a “moral right” — where is the proof of that opinion from Mr Brown and others ?

    A genuine moral principle must be true for all people, all the time… not just current Anglo-American societies.

    Do health-care service providers ‘owe’ health-care to the needy sick & injured everywhere on the planet.
    Do all healthy people morally ‘owe’ their income & assets to the billions of needy poor in the world ?

    Isn’t the moral theory of a health-care ‘right’ obviously silly, irrational, subjective and unworkable?

    Of course, modern advocates of universal-health-care conveniently brush aside their claims of universal “moral right” when it comes to actually implementing their system. They merely want a compulsory, national, tax-based system that redistributes income & assets among the citizenry for subjective “health-care” … at the discretion of wise and selfless politicians.

    [The Seductive Lure of Socialism]

    “Here I encounter the most popular fallacy of our times. It is not considered sufficient that the law should be just; it must be philanthropic. Nor is it sufficient that the law should guarantee to every citizen the free and inoffensive use of his faculties for physical, intellectual, and moral self-improvement. Instead, it is demanded that the law should directly extend welfare, education, and morality throughout the nation.”

    (– Frederic Bastiat)

  • http://deleted Tansley – addendum

    The assignation of moral rights is as purely arbitrary as the assignation of essential freedoms. There is no firm ground here, save for what can be arrived at by majority concensus.

    Having said that, I would idealistically hope that all would agree that health care is something that we should not be monetarily GOUGED for, as we have been, along with pharmaceuticals, gas for transportation, food, etc.

    Capitalism works to a point…but when the ‘haves’ suppress technological and social advancement in the name of greed, the system breaks down. I don’t know where the solution lies, but clearly capitalism devoid of moral conscience is not doing a very good job of it…

  • R T Cregan

    It is interesting how the political candidates have successfully blurred the meanings of terms to avoid confronting the prices paid for their proposals. Universal Health Insurance coverage is now being called “healthcare”, even though as we see in the UK and Canada, you can have one on the books and not receive the other in the ward.
    Making a national health care system actually serve the ideal of health care for all may be impossible. Here in the US, we have never had a “system” except in the eyes of reformers. What has grown up over the years has been a plethora of systems(union plans,private insurance,employer sponsored,government run,etc.), each with its own gaps.
    Viewed from the Olympian heights of the national health insurance proponents, this has to be ended, as in the Hillarycare proposal which may have been neater than the current chaos, but no one involved could explain how it could pay for itself.
    Effectiveness should mean more than neatness where lives are involved and neatness on paper does not create neatness in practice when creating a bureaucracy to run a massive, national program.
    The US system of government has been based upon the concept of compromise. Our current health care “system” may be the best available because it comes out of so many compromises.

  • http://robertdfeinman.com/society robertdfeinman

    1. Government-administered health care is not “socialized” medicine. Medicare/Medicaid is government-administered. Participants get to go to almost any doctor/hospital/lab. What the choice of treatment should be is determined by the doctor and patient.

    What the government does is set a schedule for how much the program will pay for each service. This is exactly the same thing that private insurance plans do, and in addition the private plans put bigger restrictions on who can provide service. “Socialized” medicine is generally taken to mean that the government employees the service providers. This is the VA model (which also works well – or at least it did until the wars and lack of funding by Bush caused it become swamped).

    2. What is needed is universal health care. Insurance is one way to pay for the care, but it is not the only way. Private insurance adds a for-profit layer to a service and can be eliminated if society wishes. One can have non-profit insurance companies as in Germany, or no insurance companies as in Cuba. One can have no insurance companies as with Medicare in the US and also have add on private insurance for additional protection, as with medigap policies. How services are paid for is a separate issue than providing them to everyone.

    3. Libertarians (still!) don’t understand the idea of spreading risk through communal action. They also don’t understand that in a democracy, some people have to pay for services that they may not wish to. It’s called taxes. I’d prefer not to pay for the next useless aircraft carrier being constructed. However, when the majority decides that society is going to pay for something then you perform you civic duty. If you think the policy should be changed then vote for the candidate who believes as you do, or run for office yourself.

    4. Libertarians also seem to think that misfortune is due to human weakness or some sort of moral failing, and they, being superior beings, will never be hit by a truck, or get cancer, or even grow old and have to depend upon communal social services. What is continually amazing is how limited this libertarian mindset is. It exists nowhere else in the world, with a small exception in the UK. One would think that if this philosophy was so compelling it would be common elsewhere, but it’s not. I won’t go into the reasons for this, there are plenty of essays on my web site dissecting this movement. Suffice it to say – follow the money (Koch, Scaife, Olin, Mars, Walton, etc.)

    5. The fact that there are many other societies which have developed functional health service systems, and have better outcomes, at lower cost, than the US should be proof enough that the reasons that the US situation isn’t revised is not due to a lack of technical solutions, but to the political decisions which benefit those who support the status quo. Like many other persistent, unsolved, problems in the US the cause can be traced back to our corrupt electoral system. Our elected officials’s need for vast quantities of money to run for office has made the captives of the industries which pay for their election expenses. Any major changes in policies won’t happen until this link is broken.

    6. Judging by the number of knee-jerk, clichéd, remark, above there is a widespread lack of understanding of the issues. I’ll repeat my suggestion to read up on the topic at this well-run site:
    http://www.healthbeatblog.org/

    Of course, true ideologues don’t need to be confused by the facts.

  • Michael Katcher

    @rfd

    Your #6 is interesting since you use #3 and #4 to attack strawmen libertarians that don’t exist, and then admonish others for knee-jerk, cliched remarks. Cognative dissonance at work, although I prefer Orwell’s term, doublethink. I call myself a libertarian and I don’t recognize a single belief you attribute to me. I would also note that the most successful country in the world is also the one whose laws come closest to the libertarian model.

    Your last sentence is also another example of doublethink. Your #5 is a claim without evidence (and in fact first person evidence has been provided above contradicting your claim) and yet you accuse others of ignoring facts. Where are these “many other societies” with “better outcomes at lower cost”? In terms of the quality of healthcare, elites around the world come to American hospitals for their treatment. But I suppose that’s just one of those pesky ‘facts’ that we can safely file in the doesn’t-fit-my-argument trashbin.

  • http://roborant.info Rob

    >What is needed is universal health care

    An assertion is not a proof. Jeff started this thread to debate what you have just stated is a fact. The rest of your post is irrelevant until you prove its underlying assertion.

  • Marco Lugon

    To: robertdfeinman;
    1) Statement: “What the government does is set a schedule for how much the program will pay for each service”

    Counter: If this works better than the market, we should be able to apply it everywhere. Why not have the government set prices for everything, gas, software, super-bowl commercials.

    2) Statement: “Private insurance adds a for-profit layer to a service and can be eliminated if society wishes”

    Counter: If society wishes, we could just eliminate all profit; why should we pay profit to companies like The New York Times, Microsoft or Budweiser

    3) Statement: “Libertarians (still!) don’t understand the idea of spreading risk through communal action.”

    Counter: Name one libertarian who doesn’t believe in funding ‘communal action’ in the form of police or fire departments; even Ayn Rand supported these.

    4) Your early part of #4 is just restating #3; but later …

    Statement: “What is continually amazing is how limited this libertarian mindset is. It exists nowhere else in the world, with a small exception in the UK”

    Counter 1: Hong Kong was lauded by many as the truest libertarian ‘country’ in the world until it was re-united with China; compare the quality of life in 1997 with those living in Hong Kong to those living in mainland China. You have no clearer example of the results of a total free market system (Hong Kong) and the planned socialist economy of the People’s Republic of China. In 1997, where would you have preferred to live?

    Counter 2: Name one company that has excelled by copying everything another company did? The US has more prosperity than every other country in the world for a reason; and it’s not because we do what everyone else does.

    5) Statement: “The fact that there are many other societies which have developed functional health service systems, and have better outcomes, at lower cost, than the US should be proof enough …”

    Counter: It would be proof, if it were true. I’m going to have to get into math here, so concentrate real hard. The outcomes comparisons that people make when they compare the US to other select countries that show those other countries with better outcomes have 2 major flaws:

    a) They are comparing the outcomes of their population as a whole (who are all essentially insured), to the US population as a whole (where only some are insured)… apples to oranges; when you compare their insured (all of their population) to our insured (apples to apples), the outcomes in the US far exceeds those in other countries.

    b) You’re assuming the same baseline, it’s a FACT, that US citizens are less healthy (due to lifestyle choices such as eating and drinking too much) as such, you would expect worse outcomes. The fact that the US has better outcomes for the insured only means that the US system must be far superior to other systems.

    Based on these facts, it would seem that the most desirable outcome would be to make everyone in the US insured, so everyone in the US could have these outcomes; not to change the system to the European model where they have worse outcomes.

    6) I can’t really counter name calling; hopefully my ‘knee jerk’, clichéd remarks speak for themselves. I’d be happy to give you some ideas on books to read, but I doubt you’d spend much time reading them. I do regularly read both http://www.healthbeatblog.org/ and http://www.thehealthcareblog.com/; but at the end of the day, I like to take these as inputs to everything else I read and form my own opinions.

  • http://www.comicspundit.com Shawn Levasseur

    Stepping away from the details of free markets, regulated markets, and government control, to get to the core debate I think Jeff is angling for:

    The declaration of a ‘right’ where it is a right is good when it is something that could be said that you inherently have as an individual apart from other’s influence: The ability to speak, to think, to make your own choices.

    It is good, but a little more complex, when it is a right to a more abstract concept like ownership. The right to keep the property and wealth. It requires some common definition of what the right actually means. It is in that act of definition that one can begin to find wiggle room to undermine or loosen the definition of ownership to suit a cause or agenda. But that wiggle room is limited, depending on the culture it occurs in.

    The ‘right’ to something completely outside the self, to goods or services provided by third parties (such as the given example of health care) is where the whole concept of a ‘right’ threatens to go off the rails.

    One problem is the lack of a definition to what such ‘rights’ mean. It doesn’t help that in this case to even question what the definition is, is in itself a taboo. A “when did you stop beating your wife?” situation. How can you be against the ‘right to health care’, when it casts you as for people being sick and without health care?

    Does a right to health care mean treatment cannot be refused. But what if such treatment falls outside a medical provider’s ethics? Can a doctor be required to prescribe a drug or a perform a procedure that they feel is wrong or one that won’t help the patient? And who gets to make that decision?

    Does having to pay for something constitute interfering with a ‘right’? Then the ‘right’ to health care is in reality not a health care issue but one of money, economics, property rights and the right to profit from you own labor and skills.

    Okay, enough framing, what’s my opinion?

    I think that so much of what is called the ‘right’ to health care in the current context here in the U.S. is relying heavily on the “When did you stop beating your wife?” argument. Presently, health care is available to everyone who needs it. The main problems are of cost, and control.

    Worse, there’s a shell game going on confusing the two issues of cost and control. Being a Libertarian, I’m against government funded health care, but I would be less worried if it was only a question of who pays the bills. The bigger problem is that the economic problems of health care are being addressed through (and worsened by) the attempts to manage the “system” by government regulation of how medical services are provided and managed, and even how private funding mechanisms (aka insurance) are run.

    The right to run a business based on it’s operators may not be an absolute, but in the name of the ‘right to health care’ doctors, hospitals, insurers, and other medical professionals have their judgment trumped by government regulation and bureaucracy far beyond any other.

    Contrast that with another essential product for life, food. Where government does provide funding for the poor to buy food, it does not trump rights of food distributors and retailers to organize and price their products. Competition is not restricted in the name of preventing ‘duplication of services’ (a false premise is that removes competitive pressures, and the benefits of greater choices).

    Even if you accept that the ‘right to health-care’ requires such levels of command and control by government, you have to face the question of at what point does it affect people’s willingness to work within the health care industry? At what point are medical professionals going to walk away, or people avoid choosing it as a profession? You run up against the right of the health care providers to make their own decisions.

    Maybe the ‘right to health care’ should be re-defined as the right having freer health care market, and not a heavily bureaucratically regulated one.

  • http://robertdfeinman.com/society robertdfeinman

    Life expectancy is greater than the US in several countries including Canada and Australia. Look at Wikipedia for details. US – 78.06 (ranks 38), Canada 80.7 (ranks 11).

    Infant mortality rates are lower is a number of countries as well, including many in western Europe. The US ranks 180 out of 222 which means 42 countries have lower death rates.

    US health costs per capita (2003) $5711. Canada: $2998.

    Does anyone really want to claim that life is worse in Canada because of this lower spending? The lifestyles (Twinkies and couch potatoes) are pretty similar, the health care systems aren’t.

    People may be entitled to their own opinions, but not their own facts.

  • http://www.comicspundit.com Shawn Levasseur

    “the whole libertarian stance is complete bollocks. No-one believes in it except Robert Mugabe and a few paedeophiles.”

    Has the art of trolling really fallen so far, to be so blatantly obvious? Sad.

  • JT Carpenter

    What would be wrong with a proposal such as this?

    The Federal Government acts as a giant pool representing every citizen of the United States. They then offer the right to insure the pool of U.S. citizens up for competitive bid to the health insurance industry that will administer and pay all claims. The program would be paid for by adding a surcharge on to the payroll and/or self employment tax but which would also apply to all income earners who earn more than $97,500 in AGR. What that surcharge or percentage should be would have to be determined and it would be the task of the Federal Government to oversee the insurer’s administration of the program and make sure that it was fairly, adequately and cost effectively handled. I know that may seem like a long shot for some of you, but its better than having the Feds actually running the program which is still left up to the private sector.

    This would provide at least a minimum amount of coverage to every U.S. citizen and insure all against any terrible medical catastrophe. And individual citizens would still be free to purchase additional more elaborate or comprehensive coverage on their own.

    For people who were not U.S. citizens that were unable to pay for whatever reason, their coverage and bills would have to be covered by charitable organizations. But by providing a basic minimum coverage for every U.S. citizen it seems likely that a great many charitable dollars would be freed up to cover just such a situation like this.

    Everyone would at last be covered, the private sector would still run the program, costs would be spread out over the entire population, and charitable monies would be freed up to cover the illegal alien problem. Does this not address the objections of every philosophical group debating here and give them all a suitable compromise?

    Instead of cursing the darkness over whether or not health care is a “moral right” perhaps it is better to light a candle by debating possible solutions. Personally, I do not believe health care for all is a “moral right” but I do believe it is a “moral obligation” of any truly civilized society.

  • http://robertdfeinman.com/society robertdfeinman

    JT:
    There is a proposal similar to what you suggest circulating at the moment. It would be funded by a value added tax.

    Here’s a good description of it (along with some criticisms):
    http://www.healthbeatblog.org/2008/06/should-progress.html

  • Anon

    Lies, damn lies, and statistics…The numbers can be interpreted in many ways to make a specific point. However, I believe (hope?) that we all can agree that:
    1) If you do not have insurance, you are probably better off in Canada or the UK or (insert socialized medicine country here)
    2) If you do have insurance, you will probably receive better medical care in the U.S. than any other country.

    So the key issue becomes how do you fix #1 without fucking up #2? I believe JT is on the right track and I said something similar above. Tax me more (I accept my moral obligation) to provide a base level of coverage and let me purchase additional insurance so I can get the absolute best service when I need it. What’s not to like?

  • JT Carpenter

    Robert,

    Thank you for the link. Now THAT was a very interesting debate and the Emmanuel proposal, in principal, is one that I think, if explained properly, the large majority of U.S. citizens could get behind. I think we can all agree that the first step is to get costs under control and insure everyone is covered and the essential first step to doing that is to spread the risk more effectively.

    I do have a problem with using a VAT to pay for it because that strikes me as unnecessarily regressive. A system like this that benefits all will benefit the wealthiest of U.S. citizens immensely in the long run and they would have the easiest time avoiding having to pay any VAT tax. Better, in my opinion, to place a surcharge on the taxes people already pay. In other words, if I make a million dollars a year and pay say $250K in taxes after all deductions, then another $25,000, as an example, seems worthwhile given all of the other societal benefits that are to be gained. But perhaps there is a better and more equitable way of paying for it. That would be a question for people far more expert in this area than I.

    But these are details that reasonable people SHOULD be able to come to a suitable compromise on. If we are in majority agreement that universal health care is at least a moral obligation of a civilized society then we should also be in majority agreement that in order to get costs under control the risks need to be spread out more effectively. This would benefit not only health care consumers and our society in general but, in the long run, the insurance industry as well.

  • http://robertdfeinman.com/society robertdfeinman

    So we should take time to debate “anon”. OK, I’ll bite.

    #1. The “uninsured” are a distraction when it comes to the overall quality of health care. Of course they get poorer care than those with insurance, that’s why people are pushing for universal care. However, there are many, many more in the US who are under insured. The have policies with high deductibles, or with lots of exemptions. They also get poorer care than in the countries with comprehensive coverage.

    #2. When faced with actual data “anon” says:

    Lies, damn lies, and statistics…The numbers can be interpreted in many ways to make a specific point.

    .

    No, when faced with actual statistics they can’t be interpreted in “many ways”, they are facts. On the other hand we are supposed to take you unsubstantiated assertion that

    you will probably receive better medical care in the U.S. than any other country.

    That’s just what the data shows in not borne out by the evidence. If you want to make such claims you will have to do better than this. In fact you might even have to use some of that ugly stuff – the facts.

    What people get in the US is more treatment than elsewhere. That this doesn’t produce better outcomes is part of the discussion. Trying reading the studies instead of making up things.

    By the way, if you want to be taken seriously in the future, you’ll have to do better than “anon”. Why should anyone listen to your unfounded ideas when you aren’t even willing to stand behind them by name?

  • Andy Freeman

    The folks who rail about the evils of private healthcare in the US “forget” that about half of the folks who have prepaid healthcare get it through govt programs, such as the VA, Medicare, other federal programs, and state and local programs.

    Curiously enough, the spending by those programs is about equal to the spending through the private system. In other words, US govt healthcare is NOT more cost efficient than US private healthcare. (It doesn’t much matter whether Canadian govt healthcare works – we’re going to get US govt healthcare.)

    The US currently spends about 15% of GDP on healthcare. Rounding down, half is 7%. Folks who say that the US could get by with 10% under US govt healthcare are telling us that the govt system could cover twice as many people as it does now for less than 50% more money. Right.

    If you’re going to argue that the US govt can do a better job of healthcare than the private system, shouldn’t you first demonstrate that the US govt can do a better job than the private system? Then open it up to folks to come in at cost. If it really is better&cheaper, they’ll abandon the private system.

    However, as long as US govt healthcare is no better than private healthcare….

  • Anon

    Robert, sorry to take up your time by engaging in a discussion. If you want to classify it as “debate”, I guess that’s fine.

    As to my use of “Anon”, I also apologize for not posting my name. The issue is that I post to this site using my name as a representative of my company. This particular discussion. er debate, has no relevance to my company and I am posting my personal opinions. To avoid my personal views from being confused with my professional opinions, I am using “Anon”.

    To substantiate my point on the quality of US healthcare (the “ugly facts”, I think you were looking for), here is a study from the Commonwealth Fund on care in the US vs other countries. The U.S. ranks very highly/highest on effectiveness and timeliness of care. And this is a mix of both insured and uninsured patients – I would presume that the US would score even higher if only insured patients were surveyed. Highest on everything? Definitely not. Effectiveness? Yes.
    http://www.commonwealthfund.org/publications/publications_show.htm?doc_id=364436

    By the way, if you want to be taken seriously in the future, you’ll have to do better than being an asshole.

  • Warren Harrison

    Fascinating exchanges, because i’m a UK citizen where we benefit from the ‘moral right’ for a nation to care for the health of its citizens – those of you confounded by the NHs might find this useful or extremely irritating. If Nye Bevan had never have seen the need in our post war years for the NHS many of you would not be so upset.

    http://www.nhshistory.net/intro1.htm#The_inheritance_of_the_NHS

    The ‘moral right’ that the PM refers to is based, wait for it, on a commitment ‘from cradle to grave’. I think a crucial quesiton for the US might be why does this issue create so much debate in your society? In the land of the brave and home fo the free is it only the strongest/richest who survive? It may well be easier and cheaper for many in the US to fly to the UK and walk in to a hospital.

  • http://robertdfeinman.com/society robertdfeinman

    Anon:
    Thanks for proving my point. Hide your identity, make personal insults and then don’t even read the study you cite:

    Overall, the findings indicate that the U.S. health care system often performs relatively poorly from the patient perspective. The U.S. system ranked first on effectiveness but ranked last on other dimensions of quality (Figure ES-1). It performed particularly poorly in terms of providing care equitably, safely, efficiently, or in a patient-centered manner. On measures of timeliness, the U.S. system did not score as well as some of the other countries and rarely received top scores.

    Exactly what do the words “poorly”, “last” and “particularly poorly” indicate? You cherry pick one measure “effectiveness”, but ignore the overall negative assessment that the report comes up with. This isn’t even a very good report to cite since it is based upon patient evaluations. How reliable can these be when a patient has never been treated in another setting? What’s their basis for comparison?

    These rankings summarize evidence on measures of quality as perceived or experienced by patients. They do not capture important dimensions of effectiveness or efficiency that might be obtained from medical records or administrative data.

    Not only are you a coward, but you are an ill-mannered and uninformed one as well. I’m through.

  • Anon

    Robert, get over yourself. You started with the rudeness. If you can’t take it when it comes back, Web 2.0 is not for you.

    Read my original comment “If you do have insurance, you will probably receive better medical care in the U.S. than any other country.”

    I never said the US had the most equitable system (it doesn’t) or efficient (it doesn’t), simply the most effective care (I did read the study and it confirms this point). Safety, as noted in the study, is an issue. But, in my view isn’t as important as the measure of overall effectiveness of treatment.

  • http://faler.wordpress.com Wille

    The comment should be seen in the light of the recent debate where the UK National Health Service (“NHS”) refuses to give certain treatments and medicines that dramatically increase a patients chances of survival because the treatments are “too expensive”.
    When patients with potential terminal illnesses have gone private to get the better treatments, they have been cut off from ALL tax funded healthcare and had to stump up ALL of their healthcare costs by themselves.

    If healthcare is a “moral right”, effectively signing peoples death sentences by pulling healthcare funding is a very strange way of showing said moral right.

  • http://www.healthbeatblog.org Maggie Mahar

    All Americans should have the right to comprehensive, effective health care and the $2.2 trillion that we now spend, as a nation, is more than enough to provide that
    care for everyone.

    We now have more than two decades of research, which is well accepted by the medical cognoscenti, showing that rougly one out of three of our health care dollars–or about $700 billion–is spent on unncessary procedures, redundant tests, and over-priced drugs and devices that are no better than the less expensive products that they have replaced. If we excised the waste (by looking at medical evidence ) we could easily cover everyone.

    Why is healthcare a right? Because unless you are healthy, you are not able to pursue any of the other opportunities that a democratic society offers.

    And in a society where all men and women are deemed equal, all of us have the right to the same full comprehensive package of health benefits that you and I would want for ourselves, our children, or our parents.

    Warren rasises a good question: “why does this issue create so much debate in your society? In the land of the brave and home fo the free is it only the strongest/richest who survive?”

    I’m afraid the answer is a lack of social solidarity in the U.S. The French have a much better health care system than we do because the French feel that nothing is too good for another Frenchman. I’m afraid we don’t feel that way about each other. I’ve written about this here: http://www.healthbeatblog.org/2008/03/obstacles-to–2.html

    What do I mean by effective care? Care which is based on medical evidence, and which has been proven to reduce suffering and disabilities while promoting not just longer life, but a healthy old age.

    As to whether universal coverage leads to better health–the answer is yes. By most measures healh and outcomes are better in most Western European countries than in the U.S. This is, in part, because we tolerate so much poverty.Thanks to higher taxes and social programs that create a saftey net, these European countires are largely middle-class–they don’t accept the extremes of poverty that we do.

    Some people argue that the “diversity” of our society (code for minoritites) explains why overall health is poorer in the U.S. But a couple of years ago a large studying comparing white males in the U.S. to white males in the U.K. debunked that theory. It turned out that income does matter: in both countires wealthier white males enjoyed better health than poorer white males. But the wealthy white males in the U.S. were only as healthy as the poorest white males in the U.K.

    What explains the difference? The medical reserachers looked at cultural factors. We’re fatter. But the British drink more. Smoking was about equal. They really couldn’t find an explanation. The only major difference, of course, is that the U.K. has universal coverage, and much better preventive care.

    It’s poverty, not “lifestyle choices” that have the greatest effect on our health. Obesity is much more prevalent among the poor because the least expensive, most filling foods tend to be high in starch and fat. Fresh fish is exepenisve. And if you grocery shop in the ghetto you will find that fresh fruit and vegetables are either unavailable or extremely expensive.

    If you are poor, you don’t belong to a gym. Exercising outdoors in your neighborhood may be dangerous. And if your children go to a public city in an inner city neighborhood, they probably don’t have a gym or even a playground. There is no phys ed.

    Mental illness is also widespread among the poor (being poor is stressful–you worry about finding a job, losing a job, you worry about your children being hurt in the street , you worry about keeping the heat on. If you’re stressed you are likely to self-medicate–abusing alcohol, and other drugs. As for smoking–half of the adults in this country who smoke are mentally ill. Many are addicted to another substance in addition to tobacco.

    There is some misinformation on this thread . For instance, anon says: ” If you do have insurance, you will probably receive better medical care in the U.S. than any other country.” If you read medical journals– or even newspapers–you know that the number of life-threatening medical errors is significantly higher in U.S. hospitals than in hospitals in other countires. Outcomes are better for many diseases in other countries. Just Google “errors, hospitals, U.S. and Europe–or pick a country.

    Finally, someone asks, if you don’t like for-profit healthcare, why not elminate profit from all sectors? Because healthcare is a necessity, like heat and light. (This is why we regulate utilities; we don’t let them gouge customers. Secondlyin the U.S., by law, a corporation’s first responsibility is to its shareholders–to make as much money as possible. Shareholders expect it to charge as much as the market will bear for its products.
    But customers can push back by deciding “flat-screen TVS are too expensive–I’ll wait till prices come donw.” When it comes to the big-ticket items in healthcare (which accounts for the vast majority of healthcare spending), if you need a cancer drug that costs $100,000, you can’t say, “I’ll wait until competitors enter the market with a cheaper product.”
    First, you can’t wait. Secondly, the next product will be even more expensive. In contrast to other technologies, the price of medical technologies (drugs, devices, equpment new procedures and tests) almost always go up–not down–because customers have no power to push back.
    Finally, medicine is a profession –which means that the health care providier (doctor) is supposed to put his patients’ interests ahead of his own interests (financial and otherwise.) But when medicine becomes corporate, and is run by for-profit corporations, there is an inevitable conflict of interest between the corporations’ first allegiance–to its
    shareholders–and to its duty to the patient.

  • http://www.healthbeatblog.org Maggie Mahar

    All Americans should have the right to comprehensive, effective health care and the $2.2 trillion that we now spend, as a nation, is more than enough to provide that
    care for everyone.

    Why do I say $2.2 trillion is “enough”? Because we now have more than two decades of research, which is well accepted by the medical cognoscenti, showing that rougly one out of three of our health care dollars–or about $700 billion–is spent on unncessary procedures, redundant tests, and over-priced drugs and devices that are no better than the less expensive products that they have replaced. If we excised the waste (by looking at medical evidence ) we could easily cover everyone.

    Why is healthcare a right? Because unless you are healthy, you are not able to pursue any of the other opportunities that a democratic society offers.

    And in a society where all men and women are deemed equal, all of us have the right to the same full comprehensive package of health benefits that you and I would want for ourselves, our children, or our parents.

    Warren rasises a good question: “why does this issue create so much debate in your society? In the land of the brave and home fo the free is it only the strongest/richest who survive?”

    I’m afraid the answer is a lack of social solidarity in the U.S. The French have a much better health care system than we do because the French feel that nothing is too good for another Frenchman. I’m afraid we don’t feel that way about each other. I’ve written about this here: http://www.healthbeatblog.org/2008/03/obstacles-to–2.html

    What do I mean by effective care? Care which is based on medical evidence, and which has been proven to reduce suffering and disabilities while promoting not just longer life, but a healthy old age. (Other countries do “comparative effectiveness research” comparing new products and procedures to existing ones before letting them into the marketplace or agreeing to cover them. Our FDA only requires that the sponsor of the new product compare it to a placebo–proving it is “better than nothing.” Often new products and procedures are no better–and often riskier –than the less expesnive products and procedures we already have. But in our for-profit healthcare system, so many people are selling something–and selling hard. This accounts for a huge amount of waste.

    As to whether universal coverage leads to better health–the answer is yes. By most measures healh and outcomes are better in most Western European countries than in the U.S. This is, in part, because we tolerate so much poverty.Thanks to higher taxes and social programs that create a saftey net, these European countires are largely middle-class–they don’t accept the extremes of poverty that we do.

    Some people argue that the “diversity” of our society (code for minoritites) explains why overall health is poorer in the U.S. But a couple of years ago a large studying comparing white males in the U.S. to white males in the U.K. debunked that theory. It turned out that income does matter: in both countires wealthier white males enjoyed better health than poorer white males. But the wealthy white males in the U.S. were only as healthy as the poorest white males in the U.K.

    What explains the difference? The medical reserachers looked at cultural factors. We’re fatter. But the British drink more. Smoking was about equal. They really couldn’t find an explanation. The only major difference, of course, is that the U.K. has universal coverage, and much better preventive care.

    It’s poverty, not “lifestyle choices” that have the greatest effect on our health. Obesity is much more prevalent among the poor because the least expensive, most filling foods tend to be high in starch and fat. Fresh fish is exepenisve. And if you grocery shop in the ghetto you will find that fresh fruit and vegetables are either unavailable or extremely expensive.

    If you are poor, you don’t belong to a gym. Exercising outdoors in your neighborhood may be dangerous. And if your children go to a public city in an inner city neighborhood, they probably don’t have a gym or even a playground. There is no phys ed.

    Let’s not criticize poor people for being overweight until we are willing to pay the taxes needed to provide gyms, playgrounds and phys ed in every public school –not to mention healthy school lunches, with more expensive foods replacing the starch and fat. Also, the newest reserach shows that people who are “overweight” (but not obese) actualy live longer and cost our healthcare system less than people who are thin.

    Mental illness is also widespread among the poor (being poor is stressful–you worry about finding a job, losing a job, you worry about your children being hurt in the street , you worry about keeping the heat on. If you’re stressed you are likely to self-medicate–abusing alcohol, and other drugs. As for smoking–half of the adults in this country who smoke are mentally ill. Many are addicted to another substance in addition to tobacco. (Google Dr. Steven Schroeder, UCSF, tobacco, mental illness)

    There is some misinformation on this thread . For instance, anon says: ” If you do have insurance, you will probably receive better medical care in the U.S. than any other country.” If you read medical journals– or even newspapers–you know that the number of life-threatening medical errors is significantly higher in U.S. hospitals than in hospitals in other countires. And outcomes are better for many diseases in other countries. Just Google “errors, hospitals, U.S. and Europe–or pick a country.

    Patient satisfiaction is also higher. Just one anecdote: My stepson just had a baby in Germany under their public system. Superb care from both doctors and mid-wives. The mother was given many choices. The baby had to stay a few extra days in the hospital, so they let the mother stay too–rather than discharging her after 3 days, they’re letting her stay the week. They want her and the baby to be able to bond as much as possible, realizign that this is important to the baby’s health (medical evidence shows this.) There is, of course, no charge. And my step-son is American. She is Turkish. The hosptial doesn’t care. This wouldn’t happen here.
    The Germans also explain their health care system with that one word:
    “Solidarity.” People who have more money help pay for people who have less. Germany also has a private health care system, and if you earn more than $75,000 a year, you can get your care in the private system. Less than half of the people who earn more than $75,000 chose the private sector care. “There are more amenities, and if it’s not an emergency, you may have to wait in the public-sector system,” a German pediatric onologist told me, “but the medical care is no bettter.–and sometimes it’s worse, because they’re focusing on the amentities.”
    This 40-something doctor uses the public sector insurance.

    Finally, someone asks, if you don’t like for-profit healthcare, why not elminate profit from all sectors? Because healthcare is a necessity, like heat and light. (This is why we regulate utilities; we don’t let them gouge customers. Secondlyin the U.S., by law, a corporation’s first responsibility is to its shareholders–to make as much money as possible. Shareholders expect it to charge as much as the market will bear for its products.
    But customers can push back by deciding “flat-screen TVS are too expensive–I’ll wait till prices come donw.” When it comes to the big-ticket items in healthcare (which accounts for the vast majority of healthcare spending), if you need a cancer drug that costs $100,000, you can’t say, “I’ll wait until competitors enter the market with a cheaper product.”
    First, you can’t wait. Secondly, the next product will be even more expensive. In contrast to other technologies, the price of medical technologies (drugs, devices, equpment new procedures and tests) almost always go up–not down–because customers have no power to push back.
    Finally, medicine is a profession –which means that the health care providier (doctor) is supposed to put his patients’ interests ahead of his own interests (financial and otherwise.) But when medicine becomes corporate, and is run by for-profit corporations, there is an inevitable conflict of interest between the corporations’ first allegiance–to its
    shareholders–and to its duty to the patient.

  • http://www.sarahrolph.com sarah rolph

    The issue of whether or not humans have rights is indeed a moral issue, but the term “moral right” is at best a redundancy. More likely, it’s a loaded term that is meant to imply that some rights that are more important than others, because they are moral issues. This is an incorrect use of the concept of rights.

    The only moral position on the question of human rights is the one we celebrated this weekend. Humans have the right to life, liberty, and the pursuit of happiness. That’s it. And that is enough. Every attempt to extend rights beyond that, to include things that require money or effort (such as health care, food, etc.) is essentially theft. A society build on theft cannot last.