Tuesday, June 9, 2009

Perspectives on Health Care and Politics

The Denver Post devoted the cover of its Sunday's opinion section to the controversy over plans for a public option on health insurance. Featured were a Canadian clinical psychologist named Rhonda Hackett who focused on "Debunking Canadian Health Care Myths" and a local citizen who asked "What Do We Pay for, Anyway?" Both of these pieces offered important insight and perspective, and simply reinforced the idea that reform is necessary and change is coming. What that is remains to be seen. Of course, there is plenty of evidence that many people who are still clueless about the current system and alternatives. I recently spoke with a man who lambasted national health care and said we should pay for ourselves, ignoring the fact that he has, has always had, and is very satisfied with his veterans benefits.

For some perspective on the public option, there is much debate and commentary going on in the papers and on the blogs, though sifting through it all could take hours, if not days. One notable piece recently featured on the Huffington Post argued "Fixing Health Care Does not Require a bi-partisan Bill - It Does Require a Public Health Insurance Option. Creamer offers some insight into the politics involved when he says, "it won't matter one whit to average Americans whether the bill passed by Congress is "bi-partisan." That's true. He goes on to explain that while the bill may not be bi-partisan, the feelings of country are. For example:

A poll conducted earlier this year by the highly respected Lake Research Partners found that voters overwhelmingly want everyone to have a choice of private health insurance or a public health insurance plan (73%), while just 15% prefer everyone having private health insurance.

And the preference for a choice between public and private health insurance plans extends across all demographic and partisan groups, including Democrats (77%), Independents (79%) and Republicans (63%). So in fact, President Obama's proposal that creates a choice of a public health insurance option is a bi-partisan plan - whether is has "bi-partisan" support in Congress or not.

I'd say Creamer is right especially when he notes:

If private insurers can't compete with an efficient public health insurance plan, they have no business being in the market place. After all, they would be the first to argue that the "private sector" is always more "efficient" than government.

What they're really worried about is that in order to compete they would have to cut massive CEO salaries like the $26 million Cigna paid last year to its CEO - a figure that is 65 times higher than the salary paid to the CEO of the Federal Government - President Obama. Insurance companies are worried that they would have to become more efficient and cut their profit margins in order to compete. Of course from the point of view of the taxpayer, that is one of the major goals of health care reform: to control skyrocketing costs and incentiv-ize efficiency instead of waste.


Anonymous said...

Michael, do you even believe that it is possible to have an efficient public health insurance plan? I don't. The worst thing about a public health insurance plan, or perhaps this is the best thing, is that the government will decide which medical services will be provided and how much medical providers will be compensated for their services. Either Obama is in denial about this or he is being dumb like a fox. I think the latter is true.

mazenko said...

Well, Anonymous, the proposals call for an "option" of a public plan to compete with the private industry. And if the private industry can't compete with a system that you believe will provide substandard care, then that's a pretty telling criticism of the private industry. If American's want the choice, and they do, then why do you seek to restrict that option.

And, as far as believing we can have a viable public plan, I do. It's called Veterans benefits - or Switzerland or Taiwan or Germany. Ultimately, though, I've advocated the HAA or FEHBP, which are not public plans, but simply blend the public private sector into a risk-reducing pool of 300 million payers to whom private providers bid to offer services.

If the worst thing is having the government decide which medical services will be provided - which incidentally isn't true in HAA or FEHBP - then how is that different than HMO/insurance executives deciding it? Currently, people with a profit motive make the decisions, and ultimately insurance companies make the most money by "collecting premiums and denying claims."

Obama is in no more denial than you are about the current system. All HMOs and insurers ration care. If you haven't had that experience, try talking to people who have Kaiser Permanente - I waited seven weeks for a simply specialists visit to a urologist. So much for the criticism of avoiding the long waits for specialist care in Canada.

Incidentally, all medical decisions in Canada are made between doctor and patient. Though I'm not advocating that system. The purpose of the two links was to spotlight Americans' misunderstanding and lack of experience with other health care systems. Unlike most Americans, I have lived under a national plan - in Taiwan - and it was every bit as efficient as the current system I'm stuck in - and cheaper, too.

Anonymous said...

Michael, you say that "if American's want the choice, and they do, then why do you seek to restrict that option." What this really means is that Americans want the choice to use the government to force OTHER PEOPLE to pay for their health care, instead of paying for it themselves. Got it?

mazenko said...

Well, that's a somewhat limited view of the issue - currently, the system leads me to pay for the emergency room visits of the uninsured. Thus, if I'm going to pay, wouldn't I want it to be cheaper.

Perhaps, the notion of being a citizen and a community member isn't favorable to you, but I pay for foreign policy initiatives I don't support, I help build roads in other states and other countries, I support the educating of children that aren't mine, I pay for the protection of people from crime and fire even though I don't know them, etc.

It's called representative democracy.

mazenko said...

And, to follow up:

I do believe that people should "pay for their health care." That is why I don't prefer, or promote, single-payer systems, but instead the HAA or FEHBP. People should be more responsible for their regular health care, and should be insured against the catastrophic - cancer, serious accidents, strokes. Of course, it was the current private/employer-based HMO system, with its cheap co-pays for office visits and prescriptions which led to the over-consumption of health care and rising costs.

The question would be why I want would refuse even the "option" of a public system to stick with a system that is bankrupting some, marginalizing others, and profiting on our "fear of catastrophe." Why would I prefer my "only option" to be restricting myself to the employer-based care - a system in which both Cigna and Kaiser charged me three times the premiums that they charge employees of other businesses for the same plan. They charge me those rates even though I consumer almost no health care. Thus, am I not "paying" in the current private system for the health care of others who "should be paying for it themselves"?

Anonymous said...

The problem I see with your notion of being a citizen and community member is that it involves a massive amount of state coercion to maintain. You say that it's called representative democracy, but representative democracy is not compatible with an individual's unalienable right to liberty. Representative democracy might be better than a dictatorship, but it's still the notion that some have the right to rule others.

I oppose aggression, which is the initiation of force against innocent people, and I believe that aggression can never be justified. The programs you prefer require aggression in the form of taxation and state regulation. The fact that some people have needs that are not being met can never be a justification for the state or anyone else to employ aggression against other people.

mazenko said...

Well, then we're into a whole other discussion in which you want all taxes and, subsequently, all government functions from the military down to education to fire protection to be voluntary for all citizens so their "liberty" is not infringed.

Fascinating theoretical and ideological argument, but not remotely practical for a society. I've never heard a logical response to that, though I've heard your position stated many times.

That said, any thoughts on FAA or FEHBP? Any reason why I would choose the non-competitive contracts of Cigna and Kaiser?

Anonymous said...

Liberty enclosed in quotation marks, Michael. What's that all about?

Anonymous said...

Michael, you assert that my idea for a just society is not remotely practical (whatever that means). But my argument is not based on practicality, it's based on ethics. I argue that aggression can never be justified, and that the state necessairly employs agression, so, therefore, the state is unjustified. It's a very simple argument, which can't be invalidated by appeals to practicality. The only way to invalidate the argument against aggression is to show that aggression (the initiation of force against innocent people) is justified. Good luck with that one.

mazenko said...

"Liberty" was quoted because the generalization of the term is deceptive. Obviously, in a civilized society, no has the liberty to violate the rights of another. Another point is that no one has the liberty to be "free" from any responsibility. You could, of course, argue that an individual is only responsible for himself - yet that brings into question the idea of a civilized society.

Your idea is, in your words, based on ethics - and in my view it is based on theoretical ideology. However, the United States was not founded on that idea of libertarianism. The foundation of the United States is based on the society's need and desire to organize and develop basic organizational concepts from defense to public safety.

That's the point of practicality. The US is not going to leave the funding of basic public ideas like safety, defense, infrastructure, law enforcement to a voluntary status.

Any thoughts on HAA or Cigna's control of my health care?

Anonymous said...

Michael, I agree that in a civilized and just society no one has the liberty to violate the rights of another. But the other side of that coin means that we all have a responsiblity to not violate the rights of others. And if those views are held consistently, we must conclude that not violating the rights of other people is where our responsibility ends. Otherwise, we are saying that some people have a right to use other people for their own ends, without the other people's consent. Which means that some are masters and others are slaves.

The United States was founded on the idea that we are all created equal, that we all have certain unalienable rights, among these are life, liberty and the pursuit of happiness, that governments are instituted by men to protect these primary, unalienable rights, and that government derives its just powers from the consent of the governed. So, yes, the United States was founded on my libertarian ideal.

Unfortunately, the government of the United States has never lived up to that ideal.

Anonymous said...

Michael, regarding Cigna's "control" of your health care, in a free market Cigna has no obligation to provide you with anything beyond what you and they mutually agreed to. If you are not happy with the services Cigna provides then you are free to seek other arrangements. That's what free markets and competition is all about. The difficulty in doing so (changing employers) might not make it worth the effort, but you would still be free to do so.

As far as the state being involved in health care, you can probably guess my answer based on my prior comments. The state doesn't legitimately compete with private industry, because the state has a captive revenue stream via compulsory taxation, while private industry must offer something of value in exchange for their revenue.

mazenko said...

In terms of responsibility, and your designation of masters and slaves, I'm still unsure what your specific argument is about aggression and "force against innocent people," especially if you are talking simply about taxes and public services such as defense and law enforcement. Thus, if you are equating "taxes" with "slavery" then I would again say we are no longer having a rational discussion.

Certainly, the Declaration of Independence was written in generalizations about government being instituted among men to protect the rights of life, liberty, and happiness. However, the Declaration was the establishment of government, it was the dissolution of a monarchical/colonial relationship. The founding of the United States - delineated in the Constitution (after, of course, the breakdown of the Articles of Confederation which proved to be unfeasible) - clearly identifies "powers" given to the government. One of those is to levy taxes and raise revenue. It also allows the people to amend the Constitution - though not frivolously or easily - if the will of the people through representative democracy choose to do so - thus, the income tax. It also allows similar moves to be made at the state and local community level.

Thus, the United States was not founded upon your libertarian - ie, I guess you mean voluntary payment of taxes and following of laws - beliefs. Separation was declared on that idea, and government was founded upon much more republican ideals.

In terms of Cigna - you have a clear misunderstanding of "the free market." For my tax deductible benefits, I am bound by employment contract to only one provider. Companies like Cigna and Kaiser lobby for the rules that limit me to that contract, allow them to arbitrarily discriminate on how they charge for their fees, and prevent me from buying health coverage out of state. The companies don't seek free market competition - they pay for legislation that shields them from such.

Anonymous said...

"Separation was declared on that idea, and government was founded on upon much more republican ideals."

I'm glad that you recognize that, Michael. In other words, the Constitution was a betrayal of the ideas contained in the Declaration of Independence. Our government does not, in fact, recognize that we are all equal and does not secure our individual rights to life, liberty and the pursuit of happiness. And our government does not, in fact, derive its just powers from the consent of the governed. Those ideas were tossed aside when the Constitution was formed. Which is unfortunate, because those are really good ideas. They were the ideas that inspired us to break away from the tyranny of British rule. Perhaps if blacks, women and other disenfranchised people had been given a voice when the Constitution was written, the ideas of the Declaration of Independence would have been retained. We'll never know.

When I say that aggression is the initiation of force against innocent people I mean innocent people to be those whose actions are not harming anyone else. For example, if you're sitting in your living room smoking pot you're not harming anyone else and should be left alone. If you refuse to pay for government programs that you don't want to use or that you believe to be immoral you are not harming anyone else and you should be left alone. To threaten or commit force against someone who is not harming anyone else is to commit aggression against that (innocent) person. Force should only be used for defensive or retaliatory purposes.

An institution that can impose taxation on individuals to force them to pay for things that they do not want and/or consider to be immoral has made these individuals into their slaves. And that is a grave injustice, regardless of how you feel about it.

mazenko said...

"The Constitution betrayed the Declaration of Independence ..."

Wow, that's ..... interesting? I'd love to get Jefferson and the Gang's take on that. I'll have to begin checking the writings.

Of course, we'd get to the pot smoking in the living room. That's an oldie but a goodie. And then, again, with the voluntary and arbitrary paying of taxes. Thoreau - my favorite civil libertarian - tried that approach. Of course, he only held out for a day until Emerson paid his taxes for him.

A great academic and ideological debate - but not one I hope to see happening on the legislative floor. Mainly because I'd like society to continue to exist with some coherence and continuity.

Taxpayers as the victims of "a grave injustice." Hmmm. Not much to say in response to that.

Anonymous said...

Michael, read "A Foundation For Panarchy" by Michael Rozeff. You can find it at www.lewrockwell.com/rozeff/rozeff210.html. Or you could google it.

Anonymous said...

Michael, what does your comment about Emerson paying Thoreau's taxes have to do with the justification of forcing people to pay for things they either don't want or they consider to be immoral, besides nothing?

Also, Michael, I can understand why you might disagree with me about whether using the power of the state to force people to pay taxes is justified, assuming you are a public school teacher. For if you are a public school teacher, you work for the state, therefore your livelihood is dependent on the state forcing people to pay for something they may not want to use or may consider to be immoral. You either refuse to acknowledge that the state is employing aggression against people who are innocent of harming anyone else, or you justify the state doing so because it gets you something that you want.

mazenko said...

The point of Emerson is that Thoreau took a stand, but not really, as he was more practical than that. In terms of this discussion, I simply do not see a society with no power to enforce the rules - including taxation - instituted through representative democracy. If you believe it would work, that's fine - it's just not rational to me. Additionally, I can't think of a society that functions on any large or reasonable scale that leaves all these issues up to the individual preferences of every citizen. If you can think of a place that works, enlighten me.

Of course, to assume I support taxes simply because they pay is a bit myopic as well. The society in which I live votes to maintain that system, and they vote to pay me as well. Because I enjoy my society - roads, law enforcement, parks - I can pretty safely assume I'd be willing to support it regardless of my salary. And I can draw from my time in the private sector to support that.

Of course, that's simply hypothetical

Anonymous said...

Michael, again, I'm not an anarchist because I think it will "work" (whatever that means). I'm an anarchist because I believe that the initiation of force against people whose actions are not causing harm to anybody else (aggression) is never justified, and that states necessiarly employ aggression. Therefore, the state is not justified.

My point on the Emerson/Thoreau story was that Thoreau folded not because he conceded that taxation was justified, but because of the unpleasant consequences imposed on him by the state for not paying. If a robber holds a gun to your head you will turn your money over not because the robber is entitled to your money, but because you fear the consequences of resisting.

mazenko said...

OK, just so I am clear:

You don't support the representative democracy of the United States, right?

mazenko said...

Follow-up thought:

"The very idea of the power and the right of the People to establish Government presupposes the duty of every Individual to obey the established Government."

-George Washington, Farewell Address, September 17, 1796.

Anonymous said...

Regarding the Washington quote, that's only true if you consented to the established government. And I mean individual consent, which can be withdrawn at any time.

Did you read the Rozeff article?

Anonymous said...

Michael, the rules of justice are the only things we have a duty to obey.

mazenko said...

Haven't read the article, but I will soon.

Individual consent? On every issue? From 300 million people?

That doesn't sound practical.

The rules of justice? Whose? Who decides? We're not wading into moral relativism here, are we?

Anonymous said...

Yes, individual consent. How can anyone else consent for you?

Great question, Michael (who decides?).

I have another question for you. Who is the ultimate decider on questions of morality - the state or the individual? If you say the state, then you are defending absolutism, the idea that none of us ever has a right to resist any law the state wants to impose on us, regardless of how unjust the law may be. If you say the individual, then there is some hope for you.

mazenko said...

But is there hope for the republic?

The problem is you reference the state as an individual. Of course, the morality of the society is decided by each individual coming to consensus with the community. That has developed - in this country - over four hundred years.

However, if the morality is up to the individual, and the individual can decide in the morality of the abuse of others, and the state must respect the rights of the individual, and his individual morality allows the taking of another's individuality, then we have a problem.

mazenko said...

"Panarchy is the true American revolutionary political system, in the spirit of Jefferson."

Doesn't this defy the existence of Jefferson's entire presidency, and the entire scope of his post-Declaration writings, as well as actions?

"It’s about time we realized this and put it into practice. That is the only way that America has a chance to redeem itself. That is the only way we have a chance to end Empire and get back to what America is really about."

Redeem itself and get back to what it's really about? So, the United States of America is a failure? I completely disagree - the USA has evolved into the purest example of liberty and representative government ever envisioned or enacted by man on any significant scale.

"That is the only way we have a chance once again to lift our heads in pride and not bow them in shame. That is the only way we can again become a beacon that illuminates a progressive path for the world."

Shame? Nope, sorry. Not bowing my head in shame of my country. I am quite proud of my country, though I am in no way claiming perfection.

The Constitution doesn't really, in any sense, grant powers - it's more focused on restricting powers of the state. That said, it does establish a system by which the people establish order for society through legislation arrived at through representative democracy. Certainly, people are now born into the system - they are born into a family, too, that has rules and laws that were established before they arrived. Sorry, that's nature.

Once they have arrived, they slowly mature and develop an understanding of the system. Then, as they grow, they have some choices which include the ability to contribute and bring about change to those areas which they oppose. It's about as sensible as can be constructed.

Does the State overstep its bounds? Of course. So do individuals. They are human. But overall, I think the system does a pretty admirable job of ensuring liberty and equality under the law.

Anonymous said...

Michael, I define the state as an institution that claims the exclusive right to make and enforce the law in a given geographical jurisdiction, and that's how I reference it.

What Rozeff is basically saying is that the idea of unalienable rights of each human being and the idea that government must derive its just power from the consent of the individuals being governed, which are magnificent ideas, were not provided for when our government was formed. The Jeffersonian theory of government, which he articulated in the Declaration of Independence, was contradicted. So, if one believes that those ideas are true and must not be compromised, as we anarchists do, then, yes, the United States has been a failure so far.

This is not meant to trash what the founders established, but to point out that, in order for us to achieve the Jeffersonian ideal for a just society, we as humans need to evolve past the idea that we need institutions that employ aggression (states) to have peace and prosperity.

It's been a very interesting and stimulating exchange, Michael. Thank you.