Michael Moore's Sicko

[Miami_med]

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You put "ideal" in quotation marks, but I didn't use the word "ideal" in my post. I said that the economy grew and nothing terrible came to pass.



Um . . . no. That is a distorted, heavily slanted, and oversimplified history of the economic growth of the past fifty years. You explain away rapid economic growth when taxes are high, and you do not hesitate to pronounce Reganomics to be the cause of economic growth in the eighties. Clinton's even larger boom, while raising taxes, is completely ignored.

But you do a nice job of proving my point that the economic debate is moot. Reagan and Thatcher, hand in hand, right? Yet even Margaret Thatcher was forced to proclaim "The NHS is safe in our hands" in order to be electable. The NHS under Thatcher continued to be free and universal (some small co-pays existed, as they do today) -- and an economic boom swept through Britain reguardless. Egro, universal health care can coexist with your right-wing economic theories and -- equally signifigantly -- once people have tasted universal health care, not even so formidable a personality as Lady Thatcher can turn the clock back.

I never claimed that high taxes were all that was relevant, but it is certainly a major factor. I could go into a thorough analysis of the impact of "funny money," printing excess currency through the fed, and the impact on the business cycle within such a scenario. I'd attribute Clinton's success much more to this, but that is a topic for another conversation.

"Continuously" seems out of place in that sentence. How could I be claiming it continuously on an internet forum?

It's a well-documented economic statistic, and it's true, as you go on to concede.

You would do so continuously by including it in numerous posts. I neither accepted or denied the statistics. I said that the point was moot in an economy with heavily restricted work weeks.

There's that word again. Have a bit of a love affair with it at the moment? I get that way with words. Unfortunately, you are again incorrect. French unemployment stands at 8.1% as of May, down from 8.7% as of 2006. Not only is it not "continuously" in the double digits, it's not in the double digits right now.

OK. My stats might be a little old. I'll concede.

In the larger sense, the question is, who cares? 6% of the French live in poverty. 13% of Americans do (and 22% of all children.) It is an accomplishment that millions of Americans work and still live in poverty? It is a failing that France's unemployment rate is 3-4% higher than America's, when the consequences of unemployment are far less severe?

Poverty is a nebulous concept in which we draw a fake line and say that anyone below it is in poverty. This line is also not drawn at a uniform location from country to country. Also, this has nothing to do with the quality of life of the remaining 94 and 87% respectively. It says nothing of what defines quality of life. It says nothing about why impoverished people in the US insist on having more kids than impoverished people in France (As your statistic above seems to show).

We just have different ideas of the purpose of an economy. You appear to think that a successful economy is one in which the maximum amount of people work the maximum number of hours, and which gives rise to "dynamic" companies like Walmart, the world's largest. I, on the other hand, think that the purpose of an economy is to produce things that people need and want, and a successful economy is one in which people get those things. And have enough leisure to enjoy them. What good is a fat paycheck while one in four Americans do not get a single day of paid vacation a year, and half of those that get vacation don't use all of it? French workers get five weeks of paid vacation a year, period. Think about it. It's one of the things that slows job creation in France but, once again, who cares? Lowest poverty rate in the world. And you don't have to wonder if tomorrow you'll get sick, be unable to work, and lose everything.

France's economy provides a good life to the French. That's what an economy is for.

I don't think that an economy is specifically "for" anything. An economy is an aggregate of decisions made by individuals that result in the exchange of currency for goods and services. Most of histories economic boondoggles are the result of people thinking anything else. Quality of life is a very subjective thing. 5 Weeks of vacation is more important than more money to some and not to others. A free economy lets people choose. I have no desire to work a mandatory 35 hour work week and sit around leisurely drinking wine or taking long vacations in all of my spare time. This doesn't sound ideal. There is a whole subset of French youth currently fleeing to London in order to gain access to any social mobility at all. The entrenched French system provides very little of that. A controlled economy doesn't let me pursue what I think is a quality life. I buy insurance to prevent myself from being screwed if I become Ill, and I firmly believe in charity for those who genuinely need it. This can be teased out by letting private individuals determine if the need and cause is legitimate.

Your argument is essentially that the current economy fails to live up to what you want it to do, but it is a poor argument as to why that gives you the right to force others to operate by those standards. By all means, start a commune, but please leave me out.

Again, you are the one who keeps introducing the concept of a "perfect" or "ideal" system, which you have previously identified with pre-civil rights, pre-women's sufferage, 19th century robber-baron America -- the era of using the National Guard to attack picket lines. I, on the other hand, am interested in improving our current situation in the realm of healthcare by bringing us into the modern era of universal coverage, where the rest of the developed countries have preceeded us. Perfection is not on my agenda. Le mieux est l'ennemi du bien.

I'm actually a fan of woman's sufferage 😉. I also don't believe in having the national guard attack non-violent individuals who are committing no crime. I do believe in using force to remove people from private property who refuse to leave. I also believe in a right to associate. I belive however, that a private owner may choose to fire individuals who choose to associate in a manner he disapproves of. If he can't replace them, he'll lose his business. A truly valuable union wouldn't need protection, because it's workers would be irreplaceable and in a good bargaining position. If they are, then the union simply drives up prices for consumers or makes its parent company less competative in the market. I actually never claimed that robber barron america was "ideal." I agree in the freedom within which free enterprise was allowed to operate.

 

[HamOnWholeWheat]

...
Quikclot, there is a fundamental difference between you and I. You value equality over freedom, and I value freedom over equality. I'm not sure why you feel this way, but I value freedom over equality because human beings developed to function in a free, unequal environment for millions of years. I believe that we function best and are happiest when we live in such conditions. Sure, we may grumble, but, rich and poor alike, we have our best moments in this sort of environment.

...
I really am awed by those of you who are so dedicated to "from each, to each" philosophies, but they will always be marginalized and unsuccessful. 😉

Not to but in on your conversation, but I think your criticism is unfair. Your argument seems to imply that freedom and equality are oppositional, and that freedom is somehow more valuable. If that were the case, you'd have to justify the case of civil anarchy, or my "freedom" to kill your family and steal everything you own by force, just as "human beings developed to function in a free, unequal environment for millions of years". Its a ridiculous example, I know, but it just illustrates that people tend to use the word "freedom" jingoistically as a 100% positive cure-all for the nation's woes. If people have the freedom to not care about each other, with the "fend for yourself" type of medical system we currently have, is the nation really better off?

With that said, I'm assuming your metric of success is in terms of economics. History is littered with examples of extremely successful economies which attained their status on the backs of subjugated races. Of course I'm sure that's not what you were implying, but its just illustrative of the fact that economic success doesn't always ensure the best humanitarian results. Capitalism is a very efficient machine to make money, but that's about it. There's no good way to ensure morality in a free-market without government regulation. So in terms of healthcare, maybe a little less "freedom" is the better solution. If everyone had free healthcare, sure the country may be economically "marginalized and unsuccessful" 😛 , but what are we really losing compared to what we're gaining?

The value of equality is civility, and to value each person enough to provide socialized health care is a worthy sacrifice, regardless of the risk of becoming "marginalized and unsuccessful" economically.


HamOn

 

[Miami_med]

Not to but in on your conversation, but I think your criticism is unfair. Your argument seems to imply that freedom and equality are oppositional, and that freedom is somehow more valuable. If that were the case, you'd have to justify the case of civil anarchy, or my "freedom" to kill your family and steal everything you own by force, just as "human beings developed to function in a free, unequal environment for millions of years". Its a ridiculous example, I know, but it just illustrates that people tend to use the word "freedom" jingoistically as a 100% positive cure-all for the nation's woes. If people have the freedom to not care about each other, with the "fend for yourself" type of medical system we currently have, is the nation really better off?

It depends how you define freedom doesn't it? Freedom and equality are independent, but the desire for one may infringe on the other. There can be an intrinsic equality of rights without anything that resembles an equality of results, as people with equal rights will pursue different ends in different ways.

And I'm pretty sure that no one can make you care, no matter how much force is used to take your money and redistribute it.

With that said, I'm assuming your metric of success is in terms of economics. History is littered with examples of extremely successful economies which attained their status on the backs of subjugated races. Of course I'm sure that's not what you were implying, but its just illustrative of the fact that economic success doesn't always ensure the best humanitarian results. Capitalism is a very efficient machine to make money, but that's about it. There's no good way to ensure morality in a free-market without government regulation. So in terms of healthcare, maybe a little less "freedom" is the better solution. If everyone had free healthcare, sure the country may be economically "marginalized and unsuccessful" 😛 , but what are we really losing compared to what we're gaining?

#1: Define Morality
#2: Please give me an example of any time that the government has actually exhibited morality.

The value of equality is civility, and to value each person enough to provide socialized health care is a worthy sacrifice, regardless of the risk of becoming "marginalized and unsuccessful" economically.

Because all societies that preach equality have great track records of civility
(Don't look at the former USSR, Cuba, Venezuela, China under Mao, etc...)

 

[HamOnWholeWheat]

It depends how you define freedom doesn't it? Freedom and equality are independent, but the desire for one may infringe on the other. There can be an intrinsic equality of rights without anything that resembles an equality of results, as people with equal rights will pursue different ends in different ways.

Agreed. But I think we can all agree that equal rights to healthcare supercedes the freedom to make money at the expense of someone else's health, right?

And I'm pretty sure that no one can make you care, no matter how much force is used to take your money and redistribute it.

My point exactly. If the government is acting on behalf of those who can't afford healthcare, then you don't have to care. You don't have a choice but to do the right thing (via your checkbook) and make sure everyone is insured. Right now with the insurance companies dictating coverage policies, there's an incentive to not care about the health of the poor.

Simple example of the role of gov't:

1) Corporation makes a widget and incidentally pollutes a stream. No harm is intended, but the economics make sense.
2) People get cancer -> a caring minority make a fuss to their representatives
3) Gov't responds with legislation that all corporations must follow.
4) People stop getting cancer.

At no point did the gov't or the corporations care, but the public interest was served. That's how its supposed to work.

#1: Define Morality
#2: Please give me an example of any time that the government has actually exhibited morality.

#1: Not making money by denying procedures to the poor.
#2: Medicare, Medicaid, Social Security, The Peace Corps.

Because all societies that preach equality have great track records of civility
(Don't look at the former USSR, Cuba, Venezuela, China under Mao, etc...)

I'm not sure what you're getting at there. Of course that wasn't my point. My point was that you have to have a mechanism that places some value on equality. A purely capitalist healthcare system places no value on caring for the poorest, least capable of its population by design. This would apply to all institutions that protect basic human rights (police, fire, healthcare). Excluding those areas of obvious conflict of interest, capitalism is ideal.

I don't think a capitalist model should be applied to issues of what most would agree are basic human rights. That's why the police and fire departments are socialized. Can you imagine what a disaster it would be if the police were privatized? Without a law dictating corporate behavior, would the public be served impartially, or would the police department selectively enforce the most profitable laws in the most influential areas, thus denying protection to the least fortunate? Even in a socialized system we still see some of that now, but at least now its a source of shame. In a capitalist system, it would be a source of profit.

HamOn

 

[chef_NU]

Not to but in on your conversation, but I think your criticism is unfair. Your argument seems to imply that freedom and equality are oppositional, and that freedom is somehow more valuable. If that were the case, you'd have to justify the case of civil anarchy, or my "freedom" to kill your family and steal everything you own by force, just as "human beings developed to function in a free, unequal environment for millions of years". Its a ridiculous example, I know, but it just illustrates that people tend to use the word "freedom" jingoistically as a 100% positive cure-all for the nation's woes. If people have the freedom to not care about each other, with the "fend for yourself" type of medical system we currently have, is the nation really better off?

You know what I'm going to say, but I'll say it anyway. The interactions of free individuals necessitate society, and when such interactions occur, freedoms conflict (as in your conquest example). This is precisely why we need government, and for nothing else. Government exists to protect the freedom of individuals so long as protecting that freedom reserves the freedom of other individuals. For example, your freedom to kill me is denied because it compromises my freedom from assault by others. Notice that I didn't say anything about positive rights: I'm not making a claim to any commodity, just a claim to the right to be left alone. This is why I'm not an anarchist: we need government to protect negative rights. This means that we do need to publicly fund national defense, police, and to some extent, environmental protection. All these government services prevent other people from actively ruining the liberty of other citizens.

With that said, I'm assuming your metric of success is in terms of economics.

Nope. You missed my point. My metric of success is that each and every person is left to define life as they want it. They choose what makes them happy, they choose what they value, and they can pursue their wishes however they want as long as they are not actively restricting others' freedom to do so (read Free to Choose by Friedman). This is in stark contrast to the vast majority of people in this country who believe that they are smartest, they are right, and that everyone should be forced to do what they agree with. In general, self-described "liberals" claim the right to command and control the economic sphere, and self described "conservatives" claim the right to command and control the social sphere. I think both are wrong. The beauty of a free, limited government is that it is ultimately humble. I know that all human beings aren't perfect and therefore none of us reserves the right to tell another how to live. In a free, limited government, people can still care for the poor, form communist communities, bang hookers, and do whatever else they want to do. They just can't force others to do the same.

The value of equality is civility, and to value each person enough to provide socialized health care is a worthy sacrifice, regardless of the risk of becoming "marginalized and unsuccessful" economically.

The value of equality is that no one is offended by the actions of anyone else, and the majority power imposes their will upon the entire population. Valuing each person is a noble attitude, but forcing everyone to do the same is silly.

 

[HamOnWholeWheat]

...

Nope. You missed my point. My metric of success is that each and every person is left to define life as they want it. They choose what makes them happy, they choose what they value, and they can pursue their wishes however they want as long as they are not actively restricting others' freedom to do so (read Free to Choose by Friedman).


The value of equality is that no one is offended by the actions of anyone else, and the majority power imposes their will upon the entire population. Valuing each person is a noble attitude, but forcing everyone to do the same is silly.

We're still talking about healthcare, right? I don't see how "being free to define life as you want it" applies to a poor person who can't afford healthcare. That's not a choice. Its a right that's being violated by another person's freedom to have a highly profitable capitalist healthcare system.

Let me put this back in context:

"Valuing each person's right to healthcare is a noble attitude, but forcing everyone to do the same is silly."

In context its not as "silly".

HamOn

 

[chef_NU]

We're still talking about healthcare, right? I don't see how "being free to define life as you want it" applies to a poor person who can't afford healthcare. That's not a choice. Its a right that's being violated by another person's freedom to have a highly profitable capitalist healthcare system.

Let me put this back in context:

"Valuing each person's right to healthcare is a noble attitude, but forcing everyone to do the same is silly."

In context its not as "silly".

HamOn

Why don't you explain how healthcare is a right. I'm really curious to see your argument. I said that government's job is to protect people from the intrusion of others. I never said that it's job is to provide everyone with the same opportunity to do anything they choose. I never said that everyone has all the opportunities, or all the choices. We are all different and we all rolled the dice differently when we are born. Poor people and rich people alike should be free to define life as they want it by their own means.

Your parallel criticism of "right to healthcare" vs. "right to profitable capitalist healthcare system" to my conquest example seems misbegotten because I've never defined either of them as rights.

 

[QuikClot]

Miami:

You have repeated the same assertions that you have made before without introducing any evidence to support them. You describe a fantasy society imagined by the radical right, never realized anywhere, and you opine that if I don't want to live in your fantasy world, I should go live on a commune. Oh, and poor people have too many children. There we have your argument in a nutshell.

You also, and not for the first time, dismiss evidence that damages your position on specious grounds. The poverty rate doesn't measure anything real. Per hour productivity is meaningless because the French don't work enough hours (which is relevant because?) You have done the same with per capita income, life expectancy, infant mortality, and the WHO's comprehensive study of healthcare. Any statistic you introduce, be it unemployment or economic growth in the Reagan years, is presented as self-evident and conclusive.

I realize that we are, in a sense, trying to defeat one another, to "win" the argument. But that doesn't mean anything goes. If you play tennis, there is a net. Now, I know you wouldn't make the case for a diagnosis in the way you are making a case for what you regard as free-market policies. You wouldn't dismiss a CBC as unreliable because the results contradicted your initial impressions. You wouldn't dismiss a fever by the logic that 39C is an arbitrary number. You wouldn't withhold medicine from a COPDer because, in an ideal world, they wouldn't have smoked. You wouldn't, in short, use the kind of dishonest reasoning and selective regard for the facts that characterizes your socio-economic-political thinking. I would suggest that, even as you argue for your theory (and after all, we do that in medicine as well) that you hold your arguments to a more rigorous standard and be open to the possibility that you are on the wrong track.

We live in a society that taxes its members and provides social services. You don't want to live in that society. I don't care. As long as you live in America, you will have to deal with the reality that the voters decide who should be taxed and what for, and for the moment, the voters want universal care. You may think that's unfair; but since you have no argument other than to claim that it is so, and the arguments you do make (mostly negative) are crippled by errors of fact and defective reasoning, your chances of persuading anyone (as you must, since you are arguing for a radical change in our nation's laws and institutions) are next to nil.

 

[QuikClot]

Chef NU:Quikclot, there is a fundamental difference between you and I. You value equality over freedom, and I value freedom over equality.

Chef, the fundamental difference between you and I is that I am an adult and you are a child. You are enraptured of a absolutist theory of human behavior, while I have moved beyond absolutism. Your beliefs have been formed by your reading; my reading has been informed by a rich if checkered past.

Someday, I expect and hope, you are going to be embarassed both by the ideas you put forth here and the arrogance with which you asserted them. When that day comes, be assured that I for one hold nothing against you. "[W]hen I was young I shoved my ignorance in people's faces. They beat me with sticks. By the time I was forty my blunt instrument had been honed to a fine cutting point for me."

 

[QuikClot]

We're still talking about healthcare, right?

Sadly, the answer to this very understandable question is no, not really. At some point in the recent past, SDN fell prey to an infestation of Rand wannbes (the writer or the think tank, take your pick.) For them, everything comes back to the idea that taxation is theft and any and all social services are a slippery slope to Stalinism.

This is the view of a tiny minority everywhere, especially in medicine, and on SDN as well. Unfortunately, what they lack in numbers they make up for in hours spent hammering out post after post. All practical discussion of healthcare-related issues gets choked off by the kudzu weed of their faith-based economics. Well, not all. The anti-abortion crowd takes care of the rest of the threads. The best advice is not to engage them, but as you can see, I have trouble following that advice myself . . .

 

[happy snake]

Sadly, the answer to this very understandable question is no, not really. At some point in the recent past, SDN fell prey to an infestation of Rand wannbes (the writer or the think tank, take your pick.) For them, everything comes back to the idea that taxation is theft and any and all social services are a slippery slope to Stalinism.

This is the view of a tiny minority everywhere, especially in medicine, and on SDN as well. Unfortunately, what they lack in numbers they make up for in hours spent hammering out post after post. All practical discussion of healthcare-related issues gets choked off by the kudzu weed of their faith-based economics. Well, not all. The anti-abortion crowd takes care of the rest of the threads. The best advice is not to engage them, but as you can see, I have trouble following that advice myself . . .

I kind of gave up posting on this issue because of similar reasons. Any argument on helping a few more people becomes a grand argument on ethics. Soon helping more people is framed as unethical, uneconomical, and financing it seems to border on theivery.

I also see a very simple "argumenting" style in posts that argue against any form of socialized medicine. At first they site budget reasons...then when you show them where the money could come from, they move onto the moral hazard arguments, then onto fears of communist and socialist ideologies destroying the very fabric of free-economy America, and then when all else fails, fears of how free care at any level will make us all poorer. Dogbert said something of this style: http://photos1.blogger.com/img/206/1225/1024/dilbert.jpg

....and somewhere among all the posts, the health indicators (numbers) get lost.

 

[HamOnWholeWheat]

Why don't you explain how healthcare is a right. I'm really curious to see your argument.
...
Poor people and rich people alike should be free to define life as they want it by their own means.
...
Your parallel criticism of "right to healthcare" vs. "right to profitable capitalist healthcare system" to my conquest example seems misbegotten because I've never defined either of them as rights.

Wow. That explains our disconnect. To me, "right to life" and "right to life-saving healthcare" are synonymous. These are among the inalienable human rights spoken of in the declaration of independence which established this democracy. Even in its founding document, this capitalist society had established inalienable rights that were not intended to be subjected to the free market.

The police, a socialized institution, protect your right to life at the expense of someone else's freedom. Nobody bitches about that because its generally accepted to be an necessarily seperate institution. If we had no police, or a private police beholden to special interests, someone's inalienable right to life could be threatened without due process of the law. The same concept applies to medicine. But I guess if you really need an argument to convince you that healthcare is a human right, then our values are so out of agreement, it doesn't matter what I say.

Just on a side note, I think its funny how quickly people rally behind the "big government = no choice = oppression" argument in favor of privatization. Unchecked capitalism leaves you in the same situation, just a different oppressor (just ask Teddy Roosevelt). The difference is that the government is mandated to be responsive to the wishes of the people, whereas a corporation isn't.

If you don't agree, that's fine. Maybe someday we'll have a privatized healthcare system that is profit driven and your healthcare isn't considered an inalienable right. Maybe you'll get in a car accident in a bad part of town, and the hospital decides not to dispatch an ambulance because its too much of a liability risk or costs too much gas to get there. I'm sure you'll feel comforted in the realization that the hospital administrators got to "pursue their wishes however they want as long as they are not actively restricting others' freedom to do so (because they surely read Free to Choose by Friedman)".


HamOn

 

[Nasrudin]

Wow. That explains our disconnect. To me, "right to life" and "right to life-saving healthcare" are synonymous. These are among the inalienable human rights spoken of in the declaration of independence which established this democracy. Even in its founding document, this capitalist society had established inalienable rights that were not intended to be subjected to the free market.

The police, a socialized institution, protect your right to life at the expense of someone else's freedom. Nobody bitches about that because its generally accepted to be an necessarily seperate institution. If we had no police, or a private police beholden to special interests, someone's inalienable right to life could be threatened without due process of the law. The same concept applies to medicine. But I guess if you really need an argument to convince you that healthcare is a human right, then our values are so out of agreement, it doesn't matter what I say.

Just on a side note, I think its funny how quickly people rally behind the "big government = no choice = oppression" argument in favor of privatization. Unchecked capitalism leaves you in the same situation, just a different oppressor (just ask Teddy Roosevelt). The difference is that the government is mandated to be responsive to the wishes of the people, whereas a corporation isn't.

If you don't agree, that's fine. Maybe someday we'll have a privatized healthcare system that is profit driven and your healthcare isn't considered an inalienable right. Maybe you'll get in a car accident in a bad part of town, and the hospital decides not to dispatch an ambulance because its too much of a liability risk or costs too much gas to get there. I'm sure you'll feel comforted in the realization that the hospital administrators got to "pursue their wishes however they want as long as they are not actively restricting others' freedom to do so (because they surely read Free to Choose by Friedman)".


HamOn

Well stated. Your example was particularly adept at making the extension of the opposite argument out of the purely theoretical and into the streets of America.

 

[Nasrudin]

Sadly, the answer to this very understandable question is no, not really. At some point in the recent past, SDN fell prey to an infestation of Rand wannbes (the writer or the think tank, take your pick.) For them, everything comes back to the idea that taxation is theft and any and all social services are a slippery slope to Stalinism.

This is the view of a tiny minority everywhere, especially in medicine, and on SDN as well. Unfortunately, what they lack in numbers they make up for in hours spent hammering out post after post. All practical discussion of healthcare-related issues gets choked off by the kudzu weed of their faith-based economics. Well, not all. The anti-abortion crowd takes care of the rest of the threads. The best advice is not to engage them, but as you can see, I have trouble following that advice myself . . .

I think after considering the Miami Med econ-theory position in relation to my own bad experience in a big unionized work place I am returning to a more common sense, reality based picture that you have articulated for my benefit. Cheers.

 

[chef_NU]

Chef NU:Quikclot, there is a fundamental difference between you and I. You value equality over freedom, and I value freedom over equality.

Chef, the fundamental difference between you and I is that I am an adult and you are a child. You are enraptured of a absolutist theory of human behavior, while I have moved beyond absolutism. Your beliefs have been formed by your reading; my reading has been informed by a rich if checkered past.

Someday, I expect and hope, you are going to be embarassed both by the ideas you put forth here and the arrogance with which you asserted them. When that day comes, be assured that I for one hold nothing against you. "[W]hen I was young I shoved my ignorance in people's faces. They beat me with sticks. By the time I was forty my blunt instrument had been honed to a fine cutting point for me."

Quikclot your namecalling really makes me hold a deep respect for your rich and checkered past, as well as your enlightened movement beyond absolutism. I suspect that your resignation to advocating 35 hour work weeks and the like is not the result of careful consideration of arguments, but rather bitterness and crushed ambition. Unhappy with how life turned out? Sorry buddy, but offhanded dismissal of people who still value their future and the opportunity to become successful don't want to listen to the emotional appeals of an angry old man.

Thanks for giving a thoughtful response to the arguments in my post, but oh wait, they don't exist. I post on this forum to think about objections to my viewpoint and create as consistent an argument as I can. It would be nice if you would do the same.

 

[chef_NU]

Wow. That explains our disconnect. To me, "right to life" and "right to life-saving healthcare" are synonymous. These are among the inalienable human rights spoken of in the declaration of independence which established this democracy. Even in its founding document, this capitalist society had established inalienable rights that were not intended to be subjected to the free market.

The police, a socialized institution, protect your right to life at the expense of someone else's freedom. Nobody bitches about that because its generally accepted to be an necessarily seperate institution. If we had no police, or a private police beholden to special interests, someone's inalienable right to life could be threatened without due process of the law. The same concept applies to medicine. But I guess if you really need an argument to convince you that healthcare is a human right, then our values are so out of agreement, it doesn't matter what I say.

Let me continue your argument. You say healthcare is "part" of right to life. By that same argument, can't you also say that food, clothing, and shelter are "part" of right to life? After all, we need them to live. And corollary to that, shouldn't government provide all these things for me? The "founding document" says it should by your calculations. You can see that this is isn't a consistent position because I doubt you believe that it is government's job to provide these amenities to all of it's citizens.

This brings me back to the concept of negative rights: life, liberty, and the pursuit of happiness are all in this spirit. But if owning and flying my own airplane is part of my "pursuit of happiness", I don't rely on government to provide the means to this end, I rely on myself.

If you don't agree, that's fine. Maybe someday we'll have a privatized healthcare system that is profit driven and your healthcare isn't considered an inalienable right. Maybe you'll get in a car accident in a bad part of town, and the hospital decides not to dispatch an ambulance because its too much of a liability risk or costs too much gas to get there. I'm sure you'll feel comforted in the realization that the hospital administrators got to "pursue their wishes however they want as long as they are not actively restricting others' freedom to do so (because they surely read Free to Choose by Friedman)".
HamOn

What's wrong with hospitals performing a cost/benefit analysis on saving and treating patients? Putting a price tag on human life might not sit well with you, but you really need to grow up if you can't accept that. Stephen Landburg discusses this concept in "More Sex is Safer Sex: The Unconventional Wisdom of Economics". The example he gives is that we value identified people over unidentified people and that this is inconsistent. We are willing to spend $20,000 to rescue a stranded miner in Virginia but we won't spend that money to put a guardrail on a highway which would prevent 100 deaths a year. Providing personal anecdotes as justification for extravagant expenses is accepted in society, but it's pretty clear that these arguments don't hold any weight. Economic healthcare considerations aren't for making people feel comfortable, they are for making decisions that best reflect the preferences of people.

 

[HamOnWholeWheat]

Let me continue your argument. You say healthcare is "part" of right to life. By that same argument, can't you also say that food, clothing, and shelter are "part" of right to life? ... I doubt you believe that it is government's job to provide these amenities to all of it's citizens.

What's wrong with hospitals performing a cost/benefit analysis on saving and treating patients? Putting a price tag on human life might not sit well with you, but you really need to grow up if you can't accept that.

I was talking about "life-saving healthcare". Food, clothing, and shelter ARE provided by the government in life-saving circumstances (homeless shelters, natural disaster trailers, etc). I can't imagine you're arguing that disaster relief shouldn't be provided.

What's wrong with cost-benefit analysis in life saving healthcare? Its inhumane. To see an immediate need for lifesaving care and not act is criminal in some states. Your coal-miner analogy missed that obvious point. A guardrail probably would be a better use of money, but the need may be harder to perceive immediacy of, so people are slower to act (kind of like healthcare). Both situations require action, and the government should be mandated to provide it.

Before you make the "it may seem inhumane, but its necessary" argument, take a step back and think about what kind of society you'd be arguing in favor of. There are enough people in the world trying to kill people to make money. As doctors we have to at least try to make the argument that life is more valuable than profit.

Also, if your wife/husband was trapped in that coal mine, would you tell them to stop digging because it was too costly? Of course not, because some things are more important than someone's right to make that choice for you.

HamOn

P.S. - Your airplane analogy was ridiculous. We're still talking about the government ensuring the minimum lifesaving NEEDS of the people, remember. Not every socialist service is a slippery-slope to government-issue clothes and bowl haricuts.

 

[Miami_med]

Agreed. But I think we can all agree that equal rights to healthcare supercedes the freedom to make money at the expense of someone else's health, right?

No, that's a false dichotomy. People can only make money in a capitalist system if someone willingly gives it to them either as a gift, charity, or in exchange for a good or service. I don't believe in an equal right to healthcare, so that "right" doesn't come into conflict with anything.

My point exactly. If the government is acting on behalf of those who can't afford healthcare, then you don't have to care. You don't have a choice but to do the right thing (via your checkbook) and make sure everyone is insured. Right now with the insurance companies dictating coverage policies, there's an incentive to not care about the health of the poor.

You seem to define the right thing as giving health insurance to everyone, which not everyone agrees is the right thing. It is nothing but an attempt to impose a personal moral value on the population at large.

Simple example of the role of gov't:

1) Corporation makes a widget and incidentally pollutes a stream. No harm is intended, but the economics make sense.
2) People get cancer -> a caring minority make a fuss to their representatives
3) Gov't responds with legislation that all corporations must follow.
4) People stop getting cancer.

At no point did the gov't or the corporations care, but the public interest was served. That's how its supposed to work.

This is nothing like universal healthcare. In your example, the government should step in and protect people from being assaulted by a chemical released in a way that finds it impacting their own personal property (their homes or their bodies). The company has infringed on the rights of the people, and it makes sense that the government should interfere in this case. Your example is more akin to telling the corporation that because everyone needs the widget, they should be forced to give it to the people at a rate set by the government with no choice in the matter.

#1: Not making money by denying procedures to the poor.
#2: Medicare, Medicaid, Social Security, The Peace Corps.

That seems like a relatively subjective definition of morality. I also assume that you've never actually dealt with any of these entities in real life. I have.

I'm not sure what you're getting at there. Of course that wasn't my point. My point was that you have to have a mechanism that places some value on equality. A purely capitalist healthcare system places no value on caring for the poorest, least capable of its population by design. This would apply to all institutions that protect basic human rights (police, fire, healthcare). Excluding those areas of obvious conflict of interest, capitalism is ideal.

I'll let Chef Nu's post on negative vs. positive rights stand on its own.

I don't think a capitalist model should be applied to issues of what most would agree are basic human rights. That's why the police and fire departments are socialized. Can you imagine what a disaster it would be if the police were privatized? Without a law dictating corporate behavior, would the public be served impartially, or would the police department selectively enforce the most profitable laws in the most influential areas, thus denying protection to the least fortunate? Even in a socialized system we still see some of that now, but at least now its a source of shame. In a capitalist system, it would be a source of profit.

HamOn

There is no agreement that this is a basic right. 100 years ago, no one had basic healthcare in the modern sense, and something can't be claimed as a right that required 100 years of human ingenuity and effort to create. It isn't basic if someone else has to make it for you.

 

[Miami_med]

Miami:

You have repeated the same assertions that you have made before without introducing any evidence to support them. You describe a fantasy society imagined by the radical right, never realized anywhere, and you opine that if I don't want to live in your fantasy world, I should go live on a commune. Oh, and poor people have too many children. There we have your argument in a nutshell.

Not at all. First of all, I'm not a member of the radical right. That is unless you think that Hitler practiced libertarianism, which would show that our disagreement is really an argument about definitions first and foremost. You are the one who continuously expresses the ideal as being one in which everyone works together and the rich support the poor. I simply pointed out that you are more than able to do that right now. I just wanted to be left out. Your desire to force me into the commune is my problem.

I never said that poor people had too many or too few children. I said that the reason that a high percentage of children are below the "poverty line" is because people below the poverty line have more children than those above. I never claimed that this was a problem. The statistic comes from your own statistic, as the only way for a child to be below the poverty line is to be born to parents who are there as well. I currently live below the poverty line AND have children. I made no moral judgement at all.

You also, and not for the first time, dismiss evidence that damages your position on specious grounds. The poverty rate doesn't measure anything real. Per hour productivity is meaningless because the French don't work enough hours (which is relevant because?) You have done the same with per capita income, life expectancy, infant mortality, and the WHO's comprehensive study of healthcare. Any statistic you introduce, be it unemployment or economic growth in the Reagan years, is presented as self-evident and conclusive.

It's relevant because I care more for results than statistics. A 35 hour work week limits total productivity, and the ability to cram a slightly higher amount of productivity per hour into far fewer hours still makes you less productive. In the end, I think you are using flawed indicators, so the superiority or inferiority is irrelevant. Also, since most of these things are calculated differently in different countries, it is more akin to arguing to statistically similar lab results obtained in two different labs.

[QUOTE[
I realize that we are, in a sense, trying to defeat one another, to "win" the argument. But that doesn't mean anything goes. If you play tennis, there is a net. Now, I know you wouldn't make the case for a diagnosis in the way you are making a case for what you regard as free-market policies. You wouldn't dismiss a CBC as unreliable because the results contradicted your initial impressions. You wouldn't dismiss a fever by the logic that 39C is an arbitrary number. You wouldn't withhold medicine from a COPDer because, in an ideal world, they wouldn't have smoked. You wouldn't, in short, use the kind of dishonest reasoning and selective regard for the facts that characterizes your socio-economic-political thinking. I would suggest that, even as you argue for your theory (and after all, we do that in medicine as well) that you hold your arguments to a more rigorous standard and be open to the possibility that you are on the wrong track.[/Quote]
When I evaluate fever in a patient, I look at lot of things. I don't say, "well this patient has only had 100.3 for 6 hours instead of 100.4, so it isn't a fever. It also depends on the result I'm going for. The COPDer is more than welcome to purchase medicine or insurance that covers the medicine. I'm not looking for a perfect world outside of freedom. The world isn't such. The smoker can adapt to whatever decisions he has made and use whatever resources are available to him. You'd also be surprised to know that I treat public patients at my hospital, and I am not even opposed to accepting aid. The problem comes from the theft of the money originally, not the person accepting offered help. I am not using selective regard, but instead, we are looking at different end points. I may sometimes lose this in some of my posts, but I simply value freedom over any indicator of anything. That is my endpoint. Any statistics that show freedom overriding another way of doing things in accomplishing anything are simply a bonus. Thankfully, these come up often.

We live in a society that taxes its members and provides social services. You don't want to live in that society. I don't care. As long as you live in America, you will have to deal with the reality that the voters decide who should be taxed and what for, and for the moment, the voters want universal care. You may think that's unfair; but since you have no argument other than to claim that it is so, and the arguments you do make (mostly negative) are crippled by errors of fact and defective reasoning, your chances of persuading anyone (as you must, since you are arguing for a radical change in our nation's laws and institutions) are next to nil.

But that's just it, the US has a constitution with a limited role for the federal government, a role that the government vastly supercedes. There is no provision in the consitution for the government to ignore it if it is the "will of the people." There are methods to change the constitution. These are often not done, as the attempt to pass them might show that the "will of the people" doesn't always support what people wish it would. I only argue for our nation's institutions following the law, and I believe that the blatant violations of the 10th amendment that make up about 90% of Federal activity should be repealed.

Do what you will. I'm not sure why you feel such a strong need to co-op me into whatever scheme you believe is fair. I just want to be left to my own devices. I have no desire to ever interfere with you. It is you who pursues me. Remember that. I simply long for a society where someone has the right to be left alone.

 

[Miami_med]

I kind of gave up posting on this issue because of similar reasons. Any argument on helping a few more people becomes a grand argument on ethics. Soon helping more people is framed as unethical, uneconomical, and financing it seems to border on theivery.

I also see a very simple "argumenting" style in posts that argue against any form of socialized medicine. At first they site budget reasons...then when you show them where the money could come from, they move onto the moral hazard arguments, then onto fears of communist and socialist ideologies destroying the very fabric of free-economy America, and then when all else fails, fears of how free care at any level will make us all poorer. Dogbert said something of this style: http://photos1.blogger.com/img/206/1225/1024/dilbert.jpg

....and somewhere among all the posts, the health indicators (numbers) get lost.

The arguments for helping these people are also arguments in ethics, which have profound implications for lots of other people. There is plenty of support for all forms of healthcare on these forums, and I apologize if it offends your finer sensibilities that some of us who are generally silenced in public are using these forums as a place to express our freedom of speach.

Looking at health indicator numbers is only helpful to a degree, and using them as a sole means by which to establish healthcare policy would be akin to diagnosing a patient with nothing but a blood gas. It's far more complex. I've posted 100 times on the problems with these indicators, and my failure to accept them as something more than they are doesn't reflect at all on me ignoring them.

 

[Miami_med]

As a final note:

Let us refrain from calling each other children or bitter old men. This is not a forum for personal attacks. Attack arguments at will.

 

[HamOnWholeWheat]

There is no agreement that this is a basic right. 100 years ago, no one had basic healthcare in the modern sense, and something can't be claimed as a right that required 100 years of human ingenuity and effort to create. It isn't basic if someone else has to make it for you.

We're not talking about CT scans or MRI's here. We're talking about people being treated equally. And the fact that 100 years ago inequality existed, moreso than today, is what we like to call 'progress'.

I think I see why people may be frustrated with this discussion. It seems to me it boils down to whether or not you think everyone should have equal access to healthcare. I thought this was a universal assumption that everyone should have equal access, and that this should be considered a human right. I guess I didn't expect people would make the argument that people shouldn't necessarily have equal access, for whatever rationalized reason.

I realize I'm not going to convince you of anything, but I'm just curious. If your wife/husband was dying of cancer, and it cost $50,000/day for their treatment with a fair possibility of permanent remission, but you couldn't afford insurance, what would you do? (I'm honestly interested in the answer)

HamOn

 

[chef_NU]

I was talking about "life-saving healthcare". Food, clothing, and shelter ARE provided by the government in life-saving circumstances (homeless shelters, natural disaster trailers, etc). I can't imagine you're arguing that disaster relief shouldn't be provided.

There's been a lot of material to get through since yesterday, so I'll try to respond more as time allows here.

First:

If by life-saving healthcare you mean emergent care, you needn't seek additional political action. EMTALA already mandates that emergency rooms must treat patients regardless of their ability to pay. Another way of saying this is that doctors who work in these emergency rooms are forced to work for free by the government some days of the week. I'm sure EMTALA would have made the founders proud.

If by life-saving care, you mean things such as kidney dialysis, cancer treatment, and bypass surgery, I'd ask you this: who determines the standard of care that is "life saving"? In some western countries standard of care would never entail the heroic measures that American doctors undertake today. If you say yes to cancer treatment but no to kidney dialysis, why? Let's remember that these are cutting edge technologies developed within the last few years. Should they be part of standard of care?

If you say that everyone deserves the best possible treatment regardless of the ability to pay, then you are living in a fairy tale. We have unlimited demand for healthcare and limited resources. Usually, the market limits demand by pricing a service. But when you say that everyone deserves the same standard of care in this environment, would you also deny people with a little extra money the right to purchase VIP ICU suites? Would you deny them the right to purchase brand-name drugs, or the highest quality nursing staff? In other words, would you force them to accept a lower quality of care than they could otherwise afford just so their neighbor is "equal"?

 

[happy snake]

The arguments for helping these people are also arguments in ethics, which have profound implications for lots of other people. There is plenty of support for all forms of healthcare on these forums, and I apologize if it offends your finer sensibilities that some of us who are generally silenced in public are using these forums as a place to express our freedom of speach.

Looking at health indicator numbers is only helpful to a degree, and using them as a sole means by which to establish healthcare policy would be akin to diagnosing a patient with nothing but a blood gas. It's far more complex. I've posted 100 times on the problems with these indicators, and my failure to accept them as something more than they are doesn't reflect at all on me ignoring them.

Numbers don't lie. When the richest nation in the world with the best diagnostic technologies at its disposal is getting poorer results, something is wrong. Maybe blood gas alone is of little use, but surely there are more numbers at your service!

Maybe free basic preventative care provided for everyone across the nation, might help actually bring costs down. I am sure that an early appointment with your GP, and an advice to watch your diet and take some statins would cost per annum much less than the advanced care to invasively treat full-blown atherosclerosis. Early access, that's the key.

And you can't argue that we don't have the money for that when we are going about our lives perfectly well after spending >$100 bill a year on war. Why do you think we'll feel the pinch when we use just some of that money to fund basic care? And how is it unethical to provide such care? How will it tax "the most productive" of us any more than it is already?

 

[happy snake]

If you say that everyone deserves the best possible treatment regardless of the ability to pay, then you are living in a fairy tale. We have unlimited demand for healthcare and limited resources.

I have to agree with this. There is a very limited supply and virtually unlimited demand. Therefore, the differential pricing and qualities of care. And it may not work to have a black Model-T for everyone. Some people can afford better care.

We could have two systems running in parallel, whereby a federal program does its part and if you don't like the lines and the waiting, and you want better or need more, you visit a private practice. That could work.

 

[Miami_med]

We're not talking about CT scans or MRI's here. We're talking about people being treated equally. And the fact that 100 years ago inequality existed, moreso than today, is what we like to call 'progress'.

I think I see why people may be frustrated with this discussion. It seems to me it boils down to whether or not you think everyone should have equal access to healthcare. I thought this was a universal assumption that everyone should have equal access, and that this should be considered a human right. I guess I didn't expect people would make the argument that people shouldn't necessarily have equal access, for whatever rationalized reason.

I realize I'm not going to convince you of anything, but I'm just curious. If your wife/husband was dying of cancer, and it cost $50,000/day for their treatment with a fair possibility of permanent remission, but you couldn't afford insurance, what would you do? (I'm honestly interested in the answer)

HamOn

#1: I can't afford insurance now, but I still buy it, and I am in a situation as we speak that has made me very happy that I did.

#2: I would look for whatever aid was available from any source. As I said, I don't blame people for taking aid, I blame the government for taking the money inappropriately. I would look for private sources of funding if these programs didn't exist.

#3: I would negotiate with the hospital and the doctors involved. I could request a reduced fee, or a payment plan, or a combination of the two.

#4: I would work to repeal government mandates that private insurance companies cover everything from birth control for nuns to IVF, which would lower the price of insurance so that I might be able to afford it.

Also, considering that humanity by and large started in relatively egalitarian hunter-gatherer groups, and that major inequalities didn't spring up until the age of chiefdoms, it appears that inequality is actually a greater sign of progress. From a purely scientific perspective, inequality grows as society advances from Tribes to Chiefdoms to States.

 

[Miami_med]

Numbers don't lie. When the richest nation in the world with the best diagnostic technologies at its disposal is getting poorer results, something is wrong. Maybe blood gas alone is of little use, but surely there are more numbers at your service!

There are a million statistics showing better results in many areas here as well. The numbers are corrected. What I am continuously quoted as proof of US inferiority are infant mortality, life expectancy, and health equity. I don't believe that health equity is an indicator of anything except for equity, and it says nothing of the overall quality of the system for the average person involved. Infant mortality is calculated differently in different countries, and it can't be compared unless a standard formula is used. I promise that Cuba doesn't count a baby that dies at 24 weeks gestation a dead infant, but we do it all the time. Life expectancy is impacted by a million other things, and rates of obesity or malnutrition on the extremes are much better indicators of this across the board in any society with even minimal healthcare structure.

Maybe free basic preventative care provided for everyone across the nation, might help actually bring costs down. I am sure that an early appointment with your GP, and an advice to watch your diet and take some statins would cost per annum much less than the advanced care to invasively treat full-blown atherosclerosis. Early access, that's the key.

I'm still waiting for a study that shows a strong correlation between consistent primary care access and longer life expectancy. I'd love to see one actually. However, since everyone gets sick and dies eventually, and 50% of all healthcare dollars are spent on the last year of life, the end result is really just paying for more years of primary care visits. That's great for the patient, but it doesn't save money.

And you can't argue that we don't have the money for that when we are going about our lives perfectly well after spending >$100 bill a year on war. Why do you think we'll feel the pinch when we use just some of that money to fund basic care? And how is it unethical to provide such care? How will it tax "the most productive" of us any more than it is already?

We spend too much money now, and the fact that we currently print money at an unsustainable rate and take too much in taxes isn't a good argument for doing it more for a different reason. I've actually been pretty vocally opposed to the war. However, the constitution explicitly gives the government the right to provide for the common defense. In other words, defense is a legitimate role of government. There is no such provision for healthcare. The issue with the war in Iraq on my part has to do with the legitimacy of that particular war, rather than the right of the government to wage war. With healthcare however, I have a fundamental problem with ANY public health measures that go beyond the control of infectious disease (which I consider to be defense). I like the idea of living in a republic, with a defined role for the government.

 

[dilated]

I think I see why people may be frustrated with this discussion. It seems to me it boils down to whether or not you think everyone should have equal access to healthcare. I thought this was a universal assumption that everyone should have equal access, and that this should be considered a human right. I guess I didn't expect people would make the argument that people shouldn't necessarily have equal access, for whatever rationalized reason.

What it really boils down to is whether you think health care is a special, sanctified thing unlike everything else. For example food, or shelter. Nobody has a "right to food" that requires the government provide it, despite it being far more important to life. There is essentially nothing in our society from cars to welfare that is truly "equal" for every person. The question is whether or not health care is so totally different that it somehow generates a "right" to it that doesn't exist for anything else.

 

[happy snake]

About the numbers:

http://dll.umaine.edu/ble/U.S.%20HCweb.pdf - the basic question is: despite every variable, why are we spending so much to achieve just the average?

About better access to primary care-LE link, here's one from across the globe:

http://www.hno.harvard.edu/gazette/2003/01.23/07-iran.html - whereas they primarily deal with managing infectious disease there, I don't see why the lessons can't be applied to preventive care here.

Yes, eventually LE will top-off for any population. Yet, how will better access to preventive care not result in earlier (therefore, cheaper) management of chronic conditions or even a lower incidence of advanced disease?

I guess it's two opposing views on whether the government should involve itself in healthcare. I don't see how it can be reconciled though. One side wants little or no government role and the other side wants more government. And there, this issue becomes polarizing and political. And going by some of the posts, even personal.

Also, is there any material out there that supports the idea that the government will actually do a better job?

When I started to read on this issue a year ago, I thought I'd atleast have chosen a side by now. It's tough to take a side though. For every one study showing one result, there is another showing the opposite result.

 

[QuikClot]

Here are a couple of other things to bear in mind with regards to the supposed dichotomy of economic freedom and universal healthcare:

* The Heritage Foundation maintains a an index of economic freedom and ranks all the countries in the world according to how "free" their economies are (according to their lights). The US ranks fourth. Rounding out the top ten are Hong Kong,
Singapore, Australia, New Zealand, the United Kingdom, Ireland, Luxembourg,
Switzerland, and Canada. And of those ten countries (or nine countries and a region), nine of them have universal coverage for all their citizens. We are the only the that doesn't have it. All the others do, including those that beat us by this index. Britain, where every necessary medical service is provided by a government employee free of charge, is the sixth freest economy in the world.

* When George Bush was asked recently about what a sick child without health insurance should do, he did not say "poor people shouldn't have so many children, reduce the surplus population, etc." He said, "They can always go to the emergency room." Thus, George Bush, like the vast majority of American voters, agrees that sick people, rich or poor, insured or not, must be provided with healthcare. Which means that there are three types of rationale for rejecting universal coverage:

You can be part of the lunatic fringe that thinks it's fine and dandy for a sick child to die of an easily treatable condition because his or her parents have no money. These people are irrelevant.

You can be one of those people that doesn't understand that the go-to-the-emergency-room model of universal healthcare is a recipe for Ford Fiesta-quality care at Dodge Viper prices. These people are ignorant.

You can be one of those people that knows we could provide better care for less money than we're spending now, but are afraid that if we do that, people will realize that the government can do this job very well, and that if people realize that, they might be tempted to use the government to do other things, causing them to ultimately pay more taxes. These people are evil.

There is a philosophical argument (a bad one) for the government not to provide healthcare to anyone. There is no philosophical argument for government to guarantee care to people over 65, some poor children and not others, veterans, and anyone who dials 911, but not to give everybody access to primary care. Many of the "idealists" who talk a blue streak about economic freedom are really cynics who are afraid of what people will do if they realize that a social safety net is far from the communist horror the right would have us believe.

 

[Miami_med]

About the numbers:

http://dll.umaine.edu/ble/U.S.%20HCweb.pdf - the basic question is: despite every variable, why are we spending so much to achieve just the average?

Well, the government already wastes huge amounts of money now, considering that they pay out more than any other entity in the current system. 48% I believe. That's the point. I can tell you from personal experience that they are NOT efficient to deal with. Realistically, the government does misallocate its resources. You could argue that the government should pay for everyone's vaccines, instead of trying to save 1 child on Medicaid with Leukemia. This is sort of the Sophie's Choice made in Europe now in many cases. Your numbers would look better. Of course, I don't think that they should do either. In the US, we pay for everyone's dialysis or organ transplants, which are very low yield as far as the indicators go. Many people that we keep alive for years at considerable expense would be let go in Europe. I'm not judging that decision, but it does explain the difference.

About better access to primary care-LE link, here's one from across the globe:

http://www.hno.harvard.edu/gazette/2003/01.23/07-iran.html - whereas they primarily deal with managing infectious disease there, I don't see why the lessons can't be applied to preventive care here.

Yes, eventually LE will top-off for any population. Yet, how will better access to preventive care not result in earlier (therefore, cheaper) management of chronic conditions or even a lower incidence of advanced disease?

Controlling a Diabetic for 30 years until an MI is actually more expensive than the diabetic getting the MI 10 years earlier without care.

I guess it's two opposing views on whether the government should involve itself in healthcare. I don't see how it can be reconciled though. One side wants little or no government role and the other side wants more government. And there, this issue becomes polarizing and political. And going by some of the posts, even personal.

Also, is there any material out there that supports the idea that the government will actually do a better job?

Many people quote indicators from other nations. Of course, these are not the US, and many of these indicators are flawed. Some like them more than others. I don't see them as proof of anything, as they are largely statistically insignificant anyway. What all of it really proves is that we could save a lot of money by NOT paying for kidney dialysis.

When I started to read on this issue a year ago, I thought I'd atleast have chosen a side by now. It's tough to take a side though. For every one study showing one result, there is another showing the opposite result.

As Mark Twain Said, "There are lies, damn lies, and statistics,"

 

[chef_NU]

Here are a couple of other things to bear in mind with regards to the supposed dichotomy of economic freedom and universal healthcare:

* The Heritage Foundation maintains a an index of economic freedom and ranks all the countries in the world according to how "free" their economies are (according to their lights). The US ranks fourth. Rounding out the top ten are Hong Kong,
Singapore, Australia, New Zealand, the United Kingdom, Ireland, Luxembourg,
Switzerland, and Canada. And of those ten countries (or nine countries and a region), nine of them have universal coverage for all their citizens. We are the only the that doesn't have it. All the others do, including those that beat us by this index. Britain, where every necessary medical service is provided by a government employee free of charge, is the sixth freest economy in the world.

In case you haven't noticed, I don't think anyone on this board has been extolling the US medical system as significantly more or less free than other Westernized government healthcare systems. I know your point is to say that economies remain free in spite of government healthcare programs, but is this significant if the very "free" countries you are comparing to also have government healthcare?

* When George Bush was asked recently about what a sick child without health insurance should do, he did not say "poor people shouldn't have so many children, reduce the surplus population, etc." He said, "They can always go to the emergency room." Thus, George Bush, like the vast majority of American voters, agrees that sick people, rich or poor, insured or not, must be provided with healthcare. Which means that there are three types of rationale for rejecting universal coverage:

Saying anything short of government providing care would be political suicide. A vast majority of people believe government should provide healthcare. This doesn't mean they understand who pays for it, or how it is administered. Voters like "free" stuff. The problem is politicians give it to them.

You can be part of the lunatic fringe that thinks it's fine and dandy for a sick child to die of an easily treatable condition because his or her parents have no money. These people are irrelevant.

I suppose that you would place Miami and I in this category, though it's a simple wrongheaded conclusion. As I've stated before, I'll applaud every day we save a sick child. I plan to provide charity care as a doctor, and I volunteer at clinics now as a medical student. As much as you'd like to think, no one hates sick children. My objection is that government forces people to be charitable. Could you explain how forced charity is moral, as you are clearly making a moral appeal here?

You can be one of those people that knows we could provide better care for less money than we're spending now, but are afraid that if we do that, people will realize that the government can do this job very well, and that if people realize that, they might be tempted to use the government to do other things, causing them to ultimately pay more taxes. These people are evil.

I hope you really don't believe that anyone like this exists. If people believe government does such a good job at everything, wouldn't you want to be taxed more? The argument for lower taxes is that people accomplish things better than government does; this seems like a contradictory hypothetical you have proposed.

Many of the "idealists" who talk a blue streak about economic freedom are really cynics who are afraid of what people will do if they realize that a social safety net is far from the communist horror the right would have us believe.

Nope, just asking to be left out of your "social safety net" program. I'm perfectly comfortable with government providing things like ELECTIVE Medicare, Social Security, healthcare. People who like these ideas can be taxed separately to fund them. And they can all have one big happy pow-wow when they reap the benefits of their efficient government system. I just want the f*ck out.

 

[Miami_med]

Here are a couple of other things to bear in mind with regards to the supposed dichotomy of economic freedom and universal healthcare:

* The Heritage Foundation maintains a an index of economic freedom and ranks all the countries in the world according to how "free" their economies are (according to their lights). The US ranks fourth. Rounding out the top ten are Hong Kong,
Singapore, Australia, New Zealand, the United Kingdom, Ireland, Luxembourg,
Switzerland, and Canada. And of those ten countries (or nine countries and a region), nine of them have universal coverage for all their citizens. We are the only the that doesn't have it. All the others do, including those that beat us by this index. Britain, where every necessary medical service is provided by a government employee free of charge, is the sixth freest economy in the world.

I'm surprised that you listen to anything the Heritage Foundation says. As someone who doesn't believe that freedom supercedes equality, I never thought I'd see you quote them. My understanding of their calculations come from the relative regulation of business in general. It doesn't speak of universal healthcare or not, relative personal income tax, or a number of other indicators. Besides, this kind of sounds like what you often accuse me of. It's essentially like, The Heritage Foundation says so, so it must be true.

I'd like to see a copy of this "economic freedom formula," used to determine these things anyway.

* When George Bush was asked recently about what a sick child without health insurance should do, he did not say "poor people shouldn't have so many children, reduce the surplus population, etc." He said, "They can always go to the emergency room." Thus, George Bush, like the vast majority of American voters, agrees that sick people, rich or poor, insured or not, must be provided with healthcare. Which means that there are three types of rationale for rejecting universal coverage:

If this was supposed to convince me, I'll point out that I'm actually pretty unfond of Mr. Bush. His argument is irrelevant to me.

You can be part of the lunatic fringe that thinks it's fine and dandy for a sick child to die of an easily treatable condition because his or her parents have no money. These people are irrelevant.

This really doesn't and hasn't happened for many years. See, many private charity hospitals existed long before any government healthcare. In fact, many modern high level hospitals started as charity hospitals for the poor. I'm very fond of this practice. No mandates or entitlement, no guns or taxes, just people willingly being charitable to a fellow man. I promise that they WERE NOT abused like the modern public hospital, because they could deny coverage to those that abused the system. You seem to think that the only way to help people is to involve the government, and I find that point of view amazing in the face of watching what the government actually does.

You can be one of those people that doesn't understand that the go-to-the-emergency-room model of universal healthcare is a recipe for Ford Fiesta-quality care at Dodge Viper prices. These people are ignorant.

I don't think that most people think that this is a good idea (except for maybe the head of the government, which should get you wondering about putting them in charge in the first place). EMTALA in combination with the current malpractice crisis (both government) create an unsustainable cost structure in the ER of uncompensated defensive medicine. What entity would set that up? Oh yea.

You can be one of those people that knows we could provide better care for less money than we're spending now, but are afraid that if we do that, people will realize that the government can do this job very well, and that if people realize that, they might be tempted to use the government to do other things, causing them to ultimately pay more taxes. These people are evil.

No one has ever called me evil before. I'm getting used to it I guess. I'm not too concerned about the government ever proving it can do its job well. Your right that I'm concerned about rising taxes, but I wouldn't mistake that for fear that any of it will be put to remotely efficient use.

There is a philosophical argument (a bad one) for the government not to provide healthcare to anyone. There is no philosophical argument for government to guarantee care to people over 65, some poor children and not others, veterans, and anyone who dials 911, but not to give everybody access to primary care. Many of the "idealists" who talk a blue streak about economic freedom are really cynics who are afraid of what people will do if they realize that a social safety net is far from the communist horror the right would have us believe.

That "safety net" is really an ever growing vortex, in which every generation gets just a little more government than the generation before. The "projects," government subsidized housing, EMTALA, and all of the other safety nets have just worked out so well. I agree that the government shouldn't provide healthcare to anyone, so I guess I make the bad argument. The exception to that would be veterans, if they receive it as a job perk for working in the military, no different than a pension or employer sponsored insurance, neither of which I have a direct philosophical conflict with.

 

[QuikClot]

I'm surprised that you listen to anything the Heritage Foundation says. As someone who doesn't believe that freedom supercedes equality, I never thought I'd see you quote them.

There are two general ways to show that an argument fails; you can show that the facts are wrong, or you can show that, even assuming the facts are true, that the reasoning is wrong. When it comes to the "public services violate my freedom" argument, one is spoiled for choice, because both your facts and your reasoning are wrong.

By showing "economic freedom" can coexist with universal care, I show that even if one (unwisely) takes that to be the be-all and end-all, it is irrelevant to the discussion of universal care.

If this was supposed to convince me, I'll point out that I'm actually pretty unfond of Mr. Bush. His argument is irrelevant to me.

No, it is not an attempt to convince you. You have chosen to reject any evidence that contradicts what you want to believe. It is therefore futile to try and convince you of anything. The purpose, as I clearly stated, is to demonstrate that those, like yourself, who say it is acceptable for people to be denied care, are marginal to the discourse. You simply don't matter, because you have neither popular support nor any compelling moral, legal, or practical argument for your position.

You seem to think that the only way to help people is to involve the government, and I find that point of view amazing in the face of watching what the government actually does.

Governments all over the world deliver better health outcomes at lower cost. Our government does a bad job, and needs to change. If you really were confident that government couldn't do the job well, you wouldn't be so afraid of universal care. If it functions badly, it's no threat.

You believe -- because your ideology tells you it is so -- that government can do nothing well.

No one has ever called me evil before.

No one is calling you evil now. You clearly fit in to the irrelevant category, with a touch of ignorant.

That "safety net" is really an ever growing vortex, in which every generation gets just a little more government than the generation before.

Thanks, Father. Do we get grape juice and bread with that liturgy? Sometime you should crack open a history book and look at what it says. Government never works, blah, blah, blah, always gets bigger, blah, blah, blah. That is conservative mythology, not reality. You can stop reciting it; I know your talking points by heart. I would remind you once again that repeating your belief is not the same thing as making an argument.

 

[Miami_med]

There are two general ways to show that an argument fails; you can show that the facts are wrong, or you can show that, even assuming the facts are true, that the reasoning is wrong. When it comes to the "public services violate my freedom" argument, one is spoiled for choice, because both your facts and your reasoning are wrong.

By showing "economic freedom" can coexist with universal care, I show that even if one (unwisely) takes that to be the be-all and end-all, it is irrelevant to the discussion of universal care.

Well, a comparison between someone's opinion on relative economic freedoms and universal healthcare doesn't really prove anything.

No, it is not an attempt to convince you. You have chosen to reject any evidence that contradicts what you want to believe. It is therefore futile to try and convince you of anything. The purpose, as I clearly stated, is to demonstrate that those, like yourself, who say it is acceptable for people to be denied care, are marginal to the discourse. You simply don't matter, because you have neither popular support nor any compelling moral, legal, or practical argument for your position.

Your evidence doesn't prove the endpoint that I care about. I firmly believe that some European nations have longer life expectancies and lower infant mortality than the US. I also believe that these endpoints don't really prove a better healthcare system. They also favor equal distribution of care over creating a system where the best options are available for those willing to go after them, and I don't. It's not that I choose not to believe the evidence, it's that the evidence isn't particularly convincing.

Governments all over the world deliver better health outcomes at lower cost. Our government does a bad job, and needs to change. If you really were confident that government couldn't do the job well, you wouldn't be so afraid of universal care. If it functions badly, it's no threat.

Again, it depends on the outcome. If we use length of wait for imaging or how long the average person who needs a hip replacement has to wait for care, we get a vastly different picture.

You believe -- because your ideology tells you it is so -- that government can do nothing well.

My ideaology is born from experience.

No one is calling you evil now. You clearly fit in to the irrelevant category, with a touch of ignorant.

You're spending an awful lot of time arguing with an irrelevant person.

Thanks, Father. Do we get grape juice and bread with that liturgy? Sometime you should crack open a history book and look at what it says. Government never works, blah, blah, blah, always gets bigger, blah, blah, blah. That is conservative mythology, not reality. You can stop reciting it; I know your talking points by heart. I would remind you once again that repeating your belief is not the same thing as making an argument.

I just use the ever growing government of the last century as proof. If you need a source, I'll point you to the federal budget. Since you want it to always get bigger, and it is almost irrefutable that it has done so over the last century, you and I should atleast be on the same page with this one. Making my argument would be like trying to prove that the sky is blue. It seems self-evident. Look at ANY GOVERNMENT PROGRAM IN THE US IN ANY STATE. That's my evidence. Look at Medicaid or Medicare now. That's my evidence.



P.S. We should really try to not get personal, which you seem to be having some trouble with. You may say that my argument is amoral or incorrect, but I really would encourage you to not directly call people names. It isn't particularly professional, and It really isn't allowed on this forum.

No one is calling you evil now. You clearly fit in to the irrelevant category, with a touch of ignorant.

 

[Chulito]

Quickclot-

You are a clear thinker and an articulate advocate of your position, and I'm predisposed to be sympathetic towards it. I enjoy reading your posts very much, and I seek them out frequently regardless of the topic because I find them rewarding and edifying. But Miami Med is correct to point out that you are too quick to hurl condescending insults, especially at him. Some of my favorite exchanges on SDN are between the two of you, and I appreciate the contribution that each of you makes. I've learned a lot from you guys, and have been goaded into significantly rethinking my ideas regarding universal health care by your conversations. I hope that both of you will continue to participate in this debate for the benefit of those of us who are still establishing our own positions; but I hope that you in particular will try to refrain from poisoning the waters of discussion with slights of character even if you feel that your "opponent" is not arguing at the same level of sophistication or intellectual honesty that you are.

 

[QuikClot]

You're spending an awful lot of time arguing with an irrelevant person.

I am not arguing with you. You are responding to my posts, which have not been directed at you for some time. It is entirely pointless to argue with someone who will not face the evidence honestly.

You may say that my argument is amoral or incorrect, but I really would encourage you to not directly call people names. It isn't particularly professional, and It really isn't allowed on this forum.

You decided to bring up the issue of which of those categories you belong in. You said "evil," and I corrected you. There is no way to relate to your argument without words like dishonest, distorted, irrelevant, faith-based and irrational. They are simply descriptive. Your posts here are worthless, but I have been at pains to suppose that you yourself are better than your opinions and capable of better. Sadly, it is that good opinion, not my criticism, that is based not in fact but in emotion.

 

[QuikClot]

But Miami Med is correct to point out that you are too quick to hurl condescending insults, especially at him.

I'll consider what you are saying. I feel -- as I'm sure we all do, when we get caught up in these things -- that I am more condescended to than condescending. But that is no excuse for being unpleasant. I left these forums for a while and it may be time for me to leave them again. I always try to come with information, not confrontation, but, and not for the first time, confrontation is where I've ended up.

 

[Chulito]

I'll consider what you are saying. I feel -- as I'm sure we all do, when we get caught up in these things -- that I am more condescended to than condescending. But that is no excuse for being unpleasant. I left these forums for a while and it may be time for me to leave them again. I always try to come with information, not confrontation, but, and not for the first time, confrontation is where I've ended up.

You'll do what you feel is necessary and best, of course, as well you should; but I'll miss you if you go. The "sides" of this topic are not evenly represented by posters on SDN, and it's good to have a strong defender of the minority opinion to keep people thinking. There are a lot of lurkers on SDN, as well as pseudo-lurkers (as I am) who are very interested in the issues surrounding problems of healthcare access, funding, etc., even if we don't feel confident enough in our own positions to post in these threads. I'd hate to see you go.

 

[Miami_med]

I am not arguing with you. You are responding to my posts, which have not been directed at you for some time. It is entirely pointless to argue with someone who will not face the evidence honestly.

Forgive me, I took the 5 or 6 posts with direct argumentative responses to my statements to be directed at me. I'm not sure where I have been dishonest, though you enjoy repeatedly saying that I am. I have admitted your correctness on numerous statistics. My issue is with what those numbers actually mean. You have to be above the argument that greater life expectancy is always a reflection of better healthcare, as though nothing else were relevant to the discussion. I've never argued that we don't misspend money. In fact, that's basically the crux of my argument and the most blatant example of government inefficiency that I've got. You consistently give examples of people or countries who spend less money as being better. My argument isn't about us being good now. US healthcare is a mess. I advocate a free market alternative. To find true free market statistics, one has to look back to the 60s, when the market sort of resembled a free market. I've quoted these in the past. I don't have modern day numbers, because no modern industrialized nation has true free market healthcare. You use that as an argument for the positive. I think that being like everyone else isn't an argument for or against anything.

You decided to bring up the issue of which of those categories you belong in. You said "evil," and I corrected you. There is no way to relate to your argument without words like dishonest, distorted, irrelevant, faith-based and irrational. They are simply descriptive. Your posts here are worthless, but I have been at pains to suppose that you yourself are better than your opinions and capable of better. Sadly, it is that good opinion, not my criticism, that is based not in fact but in emotion.

The problem is that some of these things couldn't possibly be correct. My argument is in no way faith-based, so that is incorrect. I've never used faith as an argument for anything. I don't think that I've ever blatantly lied on here, and I have often accepted corrections to my statistics when you have posted them, so dishonest also appears a bit harsh. I also happen to find my arguments perfectly rational, but you are more than welcome to say that they are the contrary, provided that it is directed to the argument and not to me.

Look, as irritating as you may find me, I enjoy these little debates. One thing that I will not deny, is that you are very good at having statistics to back up your claims. We can argue about the relevance of them all day. We can continue to debate or not. It's really up to you. Let's just attempt to keep it to the topic. Nothing is really meant to be personal here. That's the point of this forum. Both of our attempts to defend our positions at the expense of personal time represent atleast a touch of zealousness on both of our parts, but we really shouldn't let that go farther than defending the argument. Perception always changes things, and it is easy to feel like your position is in the minority. The reality is that we are probably the extremes, and most other posters are probably in the middle. I just like making the arguments, because most people are not exposed to libertarian or free market approaches in the typical forums for education.

 

[QuikClot]

I would be delighted to have a debate with you, and have tried to initiate one in the past, but the way you go about "debating" is not fruitful. You state the libertarian position, but you do not offer any evidence that it is true, you do not describe how the system you favor would work, and you have not provided any examples of such a system to date, much less any comparative data.

You believe -- and I have realized this for some time -- that you are introducing people to a viewpoint that they have little knowledge of or appreciation for. But on SDN, this position has been stated over and over. For my own part, I know it backwards and forwards, mostly because there was a time in my life when I believed it. So for me, and I would say for anyone else who follows these forums, you aren't telling us anything we haven't heard.

I consider your argument faith-based because you make a variety of sweeping generalizations about people and government that you haven't supported and can't support with facts. The idea that government does everything poorly is one example. The idea that government always and inevitably grows and expands is another (though it is always amusing to see anti-Marxists unconsciously echoing Marx).

I consider your arguments dishonest because you repeatly discount facts either by attacking their source, or questioning (without evidence) their accurancy, or dismissing their relevance (without subjecting facts you introduce to any similiar scrunity; indeed, as with France's unemployment rate, when you do cite a fact is it often simply wrong.) For what it's worth, I don't have any reason to think you are delibrately untruthful. I think you let your bias blind you to the facts.

If you want a free-market heathcare system, whatever that might entail, you are going to have to pursuade people to adopt a system radically different from our present system and from every other system used by democracies worldwide. I wish you and your fellow-travellers luck in that Quixotic enterprise, but in the meantime, your quest is not relevant to the present discussion, which is how to make the universal care mandated by law today better, cheaper and fairer by bringing it out of emergency room and into the light. Making the existing system work better shouldn't threaten free market "reform" -- unless you are afraid that a better functioning system would increase the public's support for public health.

 

[Miami_med]

I would be delighted to have a debate with you, and have tried to initiate one in the past, but the way you go about "debating" is not fruitful. You state the libertarian position, but you do not offer any evidence that it is true, you do not describe how the system you favor would work, and you have not provided any examples of such a system to date, much less any comparative data.

You believe -- and I have realized this for some time -- that you are introducing people to a viewpoint that they have little knowledge of or appreciation for. But on SDN, this position has been stated over and over. For my own part, I know it backwards and forwards, mostly because there was a time in my life when I believed it. So for me, and I would say for anyone else who follows these forums, you aren't telling us anything we haven't heard.

I consider your argument faith-based because you make a variety of sweeping generalizations about people and government that you haven't supported and can't support with facts. The idea that government does everything poorly is one example. The idea that government always and inevitably grows and expands is another (though it is always amusing to see anti-Marxists unconsciously echoing Marx).

I consider your arguments dishonest because you repeatly discount facts either by attacking their source, or questioning (without evidence) their accurancy, or dismissing their relevance (without subjecting facts you introduce to any similiar scrunity; indeed, as with France's unemployment rate, when you do cite a fact is it often simply wrong.) For what it's worth, I don't have any reason to think you are delibrately untruthful. I think you let your bias blind you to the facts.

If you want a free-market heathcare system, whatever that might entail, you are going to have to pursuade people to adopt a system radically different from our present system and from every other system used by democracies worldwide. I wish you and your fellow-travellers luck in that Quixotic enterprise, but in the meantime, your quest is not relevant to the present discussion, which is how to make the universal care mandated by law today better, cheaper and fairer by bringing it out of emergency room and into the light. Making the existing system work better shouldn't threaten free market "reform" -- unless you are afraid that a better functioning system would increase the public's support for public health.

You know, there are so many things that I could say at this point, but I think that the best solution would be to not. I'm not convinced that we've been having the same conversation. We'll leave it at that.