tag:blogger.com,1999:blog-7907752.post4930599889068952739..comments2024-03-27T07:18:39.229-05:00Comments on In Medias Res: Justice and Fairness in Health Care #2: A Follow-UpUnknownnoreply@blogger.comBlogger9125tag:blogger.com,1999:blog-7907752.post-85065041057434825602009-08-06T16:36:15.174-05:002009-08-06T16:36:15.174-05:00Baden,
Thanks very much for commenting. Your comm...Baden,<br /><br />Thanks very much for commenting. Your comment helped inspire my <a href="http://inmedias.blogspot.com/2009/08/can-health-care-be-local-justice-and.html" rel="nofollow">most recent</a> post on this topic, if you're interested in checking it out.<br /><br /><i>In my view, a strong public option for the poor--and only for the poor--and tort reform would be good things.</i><br /><br />You might run into a little bit of trouble with your "only for the poor" restriction on the public option, because you have to ask yourself: who's poor? and when? and under what circumstances? It's not just the indigent who use emergency rooms, it's people between jobs, whose insurance isn't portable, or use COBRA has run out, etc. Still, overall, I agree with you--universal coverage (aimed primarily for the poor, made possible by a public option insurance plan) joined with tort reform would make an excellent health care reform package--not my ideal, but much better than what we have now. (Tom Daschle agrees with us, for whatever that's worth.)<br /><br /><i>[W]hy haven’t the states done this?...I have to assume it is because it is such a difficult and expensive thing to accomplish. This is what I don’t get, if the states haven’t done it because of one reason or another, why should the federal government being do it? Is the federal government financially in a better position? No. Is the federal government going to run a more efficient program than a state government? No. Therefore, I believe it is on the state level where the reform has to take place.</i><br /><br />For one thing, Baden, who might want to take into consideration the lurking problems of justice: some states are much poorer than others, and have differing political cultures, and so will come up with differing regulations. So what happens when families relocate, following jobs from one community to the next, crossing state lines? They may have made plans to address their childrens' health needs that might be thrown into the crapper by a job transfer. Not very fair, that.<br /><br />More broadly, why do you assume that state governments are always more efficient than the federal government? Surely they are in some ways, but will they be in regards to this issue? (When it comes to dealing with nation-wide crime operations, the advantages of having an FBI as opposed to 50 state police coordinators have been pretty persuasive.) And as for the financial issue, looking around at state budgets these days. Some states are on much more solid ground, in terms of deficits and making their budgets, than the federal government is. But on the whole, the federal government is much richer than all of them, and much more solvent than most.Russell Arben Foxhttps://www.blogger.com/profile/03366800726360134194noreply@blogger.comtag:blogger.com,1999:blog-7907752.post-50782560449613384582009-08-04T23:42:53.987-05:002009-08-04T23:42:53.987-05:00I disagree with the federal government getting inv...I disagree with the federal government getting involved in healthcare. Two points from the discussion that I can understand are: the idea that we are already paying for those without health insurance through emergency rooms so why not give them proper health care and the other being the need for tort reform. In my view, a strong public option for the poor -and only for the poor- and tort reform would be good things. My question is this: why haven’t the states done this? According to my understanding all states have varying degrees of public health programs, some more than others such as I believe Massachusetts and California. I have to assume it is because it is such a difficult and expensive thing to accomplish. This is what I don’t get, if the states haven’t done it because of one reason or another, why should the federal government being do it? Is the federal government financially in a better position? No. Is the federal government going to run a more efficient program than a state government? No. Therefore, I believe it is on the state level where the reform has to take place.Badenhttps://www.blogger.com/profile/00478031918981826638noreply@blogger.comtag:blogger.com,1999:blog-7907752.post-19311147259751712702009-07-30T10:49:40.431-05:002009-07-30T10:49:40.431-05:00Thanks to everyone for being part of the argument-...Thanks to everyone for being part of the argument--even if I disagree with you, I appreciate being forced to think more about things.<br /><br />Sister Blah--excellent comments and questions about "defensive medicine" and rationing. I think it's unfair to label the "every man for himself" mentality a GOP creation; it's roots are much larger than that, tracking back, in my mind, mostly to the generally defensive and therapeutic individualism which is a hallmark of modern America. But I think your reasoning about how the insecurity of our insurance system generates lawsuits is dead-on.<br /><br />Anonymous--Paul Krugman may not be to your liking, but you can't deny that a pretty significant chunk of profession economists agree with him. As for some of your other points, you don't seem to want to make the obvious connection between controlling "real costs" and setting up disincentives to certain individual behaviors. Doing tort reform first of course could have been an option, and maybe you're right that the Democratic party's choice of what to pursue first was driven by politics...but that's neither here nor there at the present time, which is all about the politics of the possible. Which goes to your final comments: are you genuinely of the mind that health care reform will collapse, and suck down any possibility of making improvements to Medicaid and SCHIP (two federal policies that will be <i>easier</i> to make more progressive once/if general healthc care reform happens!) along with it? If so, then what we have here is a disagreement over the president's pragmatic political calculations, not his principles, right?<br /><br />Bob and Christopher--thanks for your kind words.<br /><br />Paul--your comment poses both a strategic question (what's the most direct way for a socialist organization to help the local community it is most centrally a part of?) and a moral/theoretical one (to what degree can the vision of a just and fair health care system--which will invariably involve some redistribution, subsidies, and rationing--be reconciled with the local provision of such, where people are given free choice to follow their principles and do what's best for their families?). Simple answer to the first question is that my local organization doesn't has anything nearly like a sufficient budget, even if all of us acted collectively to a seriously deprivationary degree, to support genuine local alternatives. As to the second question--which is a very good one--I don't have an answer. I'm still thinking about it. Perhaps in a later post.Russell Arben Foxhttps://www.blogger.com/profile/03366800726360134194noreply@blogger.comtag:blogger.com,1999:blog-7907752.post-55773473446588609892009-07-30T10:12:22.026-05:002009-07-30T10:12:22.026-05:00It appears you are leaning to your populist and so...It appears you are leaning to your populist and socialist views. Could I suggest that you follow more your communitarian and localist beliefs? Wouldn’t they support their local hospitals by their own means? In other words, being you have joined your local socialist organization, why doesn’t your local group reach deep into their pockets and subsidizes these hospital E.R.s.—show the nation how it can work. OK, OK, this probably sounds silly to you, so let me put it another way. When these social programs are created, folks tend to opt out of their existing plans. A case in point, my employer offers Healthcare partner’s HMO plan for families at a premium of $1054 per month. Healthy Families of CA offers a better plan of healthcare through the same Healthcare Partner HMO, but they also get dental and vision and pay I believe only about $20 per child per month—some less. I have values, so I pay the $1054 per month out of my pocket and live below my means and pay rent. Where I work of 500 employees, I am the only person with family insurance. Nearly everyone else is on Healthy Families and drives $30,000 to $40,000 cars and are trying to pay for homes they cannot afford. This is the bigger reason why premiums are so high, not the E.R.s. Healthy Families enrollment has now switched to a waiting list; we are waiting for the rest of the nation to bail us out--forcing the program to work. Why don’t socialist put their money where their values are? No one is stopping them.Paulnoreply@blogger.comtag:blogger.com,1999:blog-7907752.post-50458338432583421572009-07-30T00:50:46.739-05:002009-07-30T00:50:46.739-05:00Anonymous, you talk a lot about rationing. Can you...Anonymous, you talk a lot about rationing. Can you explain what your definition of rationing is? <br /><br />A lot of people aren't able to get care because their insurance won't cover it and insurance co's very frequently have limits on various things (ex: "no more than x times a year"). <br /><br />Is that the kind of thing you mean by "rationing"? If not, what do you mean by rationing?sister blahnoreply@blogger.comtag:blogger.com,1999:blog-7907752.post-87757846176604708952009-07-29T20:37:53.158-05:002009-07-29T20:37:53.158-05:00Thanks for these two thoughtful posts, Russell. Th...Thanks for these two thoughtful posts, Russell. They have each resonated with me in analyzing what is a very complex and difficult issue. I think what I appreciate most is that you address both the economic/utilitarian aspects of the debate and also the theoretical/moral aspects. Too much discussion on this topic addresses only one or the other, but you've managed to articulate a reasonable point of view on both that makes sense to me.Christopherhttp://juvenileinstructor.orgnoreply@blogger.comtag:blogger.com,1999:blog-7907752.post-1378976086812422342009-07-29T16:51:22.165-05:002009-07-29T16:51:22.165-05:00Professor,
You have stuck to the high road. I ad...Professor, <br /><br />You have stuck to the high road. I admire your forbearance in dealing with "anonymous," or as I have come to think of him/her, Coulreillybaugh.<br /><br />I can't think of many sites where an anonymous poster such as he/she would receive such cordial and accommodating attention.Robert Pattersonhttps://www.blogger.com/profile/16265893776303889004noreply@blogger.comtag:blogger.com,1999:blog-7907752.post-24407191260836368332009-07-29T12:59:40.500-05:002009-07-29T12:59:40.500-05:00So a Canadian health care bureaucrat doesn't d...So a Canadian health care bureaucrat doesn't deny that we'll see rationing. He thinks that rationing will make us healthier. Less care is better care, he says. (If so, the uninsured would be better off than anyone else, but why let logic stand in the way of a good social program?)<br /><br />I talked about "medical <i>costs</i> that are reflected in insurance premiums." I didn't talk about "insurance premiums." Apart from a minor reduction in costs by substituting preventative care with emergent care, how will medical <i>costs</i> be driven down? (Do you think Paul Krugman represents most economists?)<br /><br />Egalitarian aspirations are fine. But if you ask the 9.5% of the population (and counting) who are out of work whether they would rather have free well baby screenings or a job, most of them would rather have the job. This isn't the time for sweeping, costly reform.<br /><br />You <i>were</i> silent on tort reform. Even now, you think that it's something that might be looked at down the road, but not worth demanding immediately as part of an overall solution. Why not try tort reform <i>first</i>? Unlike the Democrats' plan, it wouldn't cost anything to implement. Democrats line their pockets with trial lawyer cash, so they won't do that. But what loyalty do you owe to ambulance chasers?<br /><br />No, you didn't mention french fries specifically. You said, "heaven forbid that the law ought to take into account our inalienable individual right to engage in ridiculous and destructive personal habits when they start tallying up costs." And you said it on a day when Democrats and left-leaning blogs and columnists were talking about taxing fatty and sugary foods as a way to help pay for this program. I threw out French fries as shorthand for that kind of sin tax. Sorry if that wasn't clear enough for you. But since you say that you're fine with that, then there's not much more to discuss. I don't think most Americans want Uncle Sam taxing them into eating asparagus. (The only "Decriminalize Dope" voices I'm hearing are from California Democrats who want to legalize and tax marijuana, so they can get high and pay for social programs they can no longer afford. What principles!)<br /><br />You're a hoot, if you think the Democrats are proposing a watered down half measure. You want an example of what you call "tiny reforms" that would have stood a better chance of passage? How about expanding Medicaid and SCHIP to cover over 8 million uninsured <i>children</i> in America? <br /><br />Would helping 8 million kids be too "tiny" a move towards "justice and fairness" to get the attention of someone like you? Do you think it's better to go for a long shot to insure <i>maybe</i> 27 million (out of 47 million) and end up with nothing?Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-7907752.post-24764603406540080292009-07-29T12:42:56.085-05:002009-07-29T12:42:56.085-05:00Regarding defensive medicine and lawsuits. One of ...Regarding defensive medicine and lawsuits. One of the reasons that individuals feel compelled to sue a doctor if they have a bad outcome (regardless of whether they think the doctor really did something "wrong") is precisely because of our horrible health insurance system. People know that as soon as they have an expensive condition, their insurance company will find a way to drop them, or if they ever change jobs or lose their insurance, they'll be uninsurable forevermore after that. This means that if they anticipate considerable cost going forward as a result of their bad outcome, they need to have a huge trust fund set up to take care of it, and the only way to do that is to sue and hope for a really big payout. I think most people "get it" that sometimes, despite everyone more or less doing their job, bad things do happen. But our society has turned litigious because of the GOP "every man for himself" mentality. If people had confidence that their medical bills and basic safety net will reasonably take care of them in the case of a major misfortune, they wouldn't need to sue. On the other hand, if you are parent whose child is born with some problem, and the government won't pay that child's medical bills, won't support you to stay home indefinitely to care for the child, etc, and your whole family will go into bankruptcy and be homeless trying to do this yourself. Well, yes, you're going to sue the OB.sister blahnoreply@blogger.com