Monday, July 02, 2012

Am I my brother's keeper?

Alright, I lied.  But honestly; this is from the man who told a constituent to get her untrained  neighbors to help her provide professional nursing care to her invalid husband:
HOST NORAH O’DONNELL: What did you mean by that, Sovietize?
COBURN: Well it means the bureaucrats and politicians are in charge of your health care and that’s exactly what this has done there’s not going to be individual choice. Remember the components of this bill. There’s an IPAB bill, the preventative services task force, that is going to mandate what care will be given and what care won’t be. There’s the innovation council that will approve or disapprove of any new innovation. We have three agencies that are totally going to take away the options of your freedom about your care and about what you and your physician decide is best for you. So Soviet style — what I’m saying is you’re going to have a bureaucracy … government bureaucracy is one of the reasons costs are out of control.
"Sovietize" is obviously aimed at the Tea Party crowd, since almost no one younger than me will get the reference.  But has this idiot tried to get healthcare lately?  In America you get the healthcare the insurance companies allow you to get; unless you are on Medicare.  In that case, from what I see and hear, you seem to get all the healthcare you want, and on an expedited basis.  And as far as I can tell, "bureaucrats and politicians" are in charge of the healthcare of the population that's covered by Medicare.

As for allowing/disallowing innovations, all I have to say is:  if the drug is too new, even if it's newly generic, my insurance won't cover it:  I pay full price, or I don't pay for it at all.  That's how much choice I have.  I suppose I should be grateful no government bureaucrat or politician is involved in that process.

It's so much nicer to be cared for by faceless bean counters who take my insurance premiums and haggle over how much healthcare I am thereafter entitled to.  Still, it could be worse....

And because I'm getting tired of this subject and the half-thought it seems to engender ("Gov't can't make me buy something!") let's look at the other side of that coin (dare I call it the "Christian" side of the coin?  Okay, I dare...):

 The individual mandate, of course, is the most debated. Critics denounce it as a violation of our liberty. Paradoxically, the slim majority on the court that affirmed the mandate’s constitutionality seemed to embrace that view, likening the mandate to requiring citizens to eat broccoli for their own good. The court defended the constitutionality of the mandate by calling it a tax rather than a penalty.

But that interpretation will strike many economists as a misreading of the mandate’s purpose. It isn’t that people should buy health insurance because it would be good for them. Rather, failure to do so would cause significant harm to others. Society will always step in to provide care — though in much more costly and often delayed and ineffective forms — to the uninsured who fall ill. To claim the right not to buy health insurance is thus to assert a right to impose enormous costs on others. Many legal scholars insist that the Constitution guarantees no such right.
 Let's put it this way:  if you want to ride a motorcycle, you need to wear a helmet.  If you don't,  and you wind up injured in Harris County, you are likely going to Ben Taub (lucky you; it's one of the best trauma units in the country).  Here's the catch:  Ben Taub is a county hospital.  My taxes support it.  You don't want to wear a motorcycle helmet, but you want hospitalization when you get injured.  What right do I have to make you pay something for that?  What right do you have to get health care at my expense, especially if you're just passing through?

Alright, now let's say you're just passing through and you collapse at the bus station with a heart attack.  You didn't choose to do something stupid like ride a motorcycle without a helmet.  You were just alive and tried to die in Houston.  Do we let you die, or do we care for you?  Obviously, we care for you.  Failure to do so would do significant harm to you and to others, to put it bluntly (let's leave squishy concepts like "morality" out of this, since everybody else does.  Thus is our public discourse degraded, but I can't help that right now.).  To claim the right to health care in Houston (where it affects taxpayers very directly) is to claim a right to impose enormous costs on residents of Harris County.  Why is your right to impose that cost superior to our right to ask you to join the insurance pool?

And don't talk to me about participation/non-participation; I consider that as much a red herring as the notion that children are not participants in this market.  This isn't about participation/non-participation, this is about simple human decency and the obligations of society to its members; and the obligation of its members to society.  We don't punish people stupid enough to ride a motorcycle without a helmet, or unfortunate enough to have a heart attack without health insurance, by refusing to treat them when their stupidity or their misfortune puts them in jeopardy.  But can we not ask something of them, as members of this society which does so much for them?

Thus did the Supreme Court re-designate a "mandate" as a "tax."  Because we all agree we must pay taxes, that we must participate in the tax system.  Failure to pay taxes would cause significant harm to others.

Just look at Greece, now world-famous for its inability to convince its citizens to pay taxes.

By the way, there is a difference between making people buy broccoli, and making people eat broccoli; the latter violates the 13th amendment as well as the long precedent of the common law.  Antonin Scalia is supposed to understand that simple concept, but then again, he's the "smart one" on the Court.  Keep telling yourself that, anyway.  And remember:  we can make you take vaccines from private suppliers, for public health reasons.  We can even make you pay something for those vaccines; or make you pay taxes for those vaccines to be supplied by the government.  But we can't make you buy health insurance, because that violates your ability to not participate in some mythical marketplace or something.

Because, after all, healthcare is all about the marketplace.  Unless its about disease; or actually caring for the sick and injured; or something.  It is all a darkness.

One of the problems with health care in America is that it isn't viewed as a public health issue.  From the public health point of view, our health care is disastrous.  In Texas alone, the news tells me this morning, more than 25% of the people are uninsured, and our political leaders are calling ACA "a monstrosity," even as they insist we will take care of the least among us (mostly by pretending the don't exist and that as long as we're not as bad as Mississippi it's a win).  There is a moral argument to be made, based on Christian doctrines if you like, or the life of ants if you like E.O. Wilson.  There is a simple argument to be made that a society which cares for the least among them, cares for everyone else as well.  That one should be obvious to all but the most obtuse, which means it would be plain to a simple majority.  But then, of course, we're constantly told we can't afford the rising costs of Medicare.  Uh-huh....


  1. this is about simple human decency

    Decency is a concept which a significant fraction of our society opposes on ideological grounds as "political correctness".

    and the obligations of society to its members; and the obligation of its members to society.

    "Obligation" is a concept a significant fraction of our society again opposes on ideological grounds as an assault on "liberty".

    Just look at Greece, now world-famous for its inability to convince its citizens to pay taxes.

    You would be hard pressed to know that's what's wrong with Greece listening to certain media outlets who would have you believe that what's wrong with Greece is that they are lazy, have too much bureaucracy or some such (and a little bit of racism certainly comes into play in reporting and popular discourse in the USA concerning Greece, as the Greeks aren't exactly all Nordic, shall we say).

  2. No fair! You can't use real-life, easily graspable examples to make the opposition look like a bunch of uncaring brutes. Have you no shame at all? Don't you know how badly people feel when you point out that the natural and normal consequence of their political position is that people will die on the street in agony? Conservatives feel just awful when you do that!

    Can we PLEASE get back to arguing about how put-upon it makes gazillionaires feel when they have to pay for stuff they get?

  3. I had an argument with one of my husband's relatives over the weekend. He insisted that people needed to live with the consequences of their bad decisions. When I pushed him to admit that, taking his argument to the logical conclusion, he was willing to sentence other people to die, he couldn't bring himself to admit it outright, because he knew how awful it made him sound.

    But he was not willing to back off of the concept---he just kept repeating that people had to be responsible for the choices they made. (No recognition that people make decisions in context either...)

    This was a smart man who clearly loves his family--but has absolutely no empathy for anyone outside his immediate circle. Sad, scary, and sickening all at the same time...

  4. Sherri5:45 PM

    The richer we are, the less painful the consequences of our bad decisions are. If you have money, you have a margin for error that poorer people don't have.

    Besides, in our current environment, moral hazard only applies to the little people. Wreck the global economy with pointless gambling to make yourself rich, no consequences.