Tuesday, September 16, 2008

Obama's Enigmatic Health Care Plan: Q & A (continued)

With your indulgence, Marcia, I'd like to continue to answer the question you posed about what I would suggest as an alternative to Obama's multi-billion-dollar insurance company support fund.

As an aside, I would have to say that I object to the way the argument is typically framed. I may be a dinosaur for feeling the way I do, but I don't think the first step in the debate process has been adequately explored - certainly it has not been concluded to my satisfaction. I'm talking about the central question underlying all questioning of the nature of yours - namely, "Is health care a right?". Following this question is the one, "If health care is a right, who is responsible for providing it?". Finally, the question that liberal progressives jump to, as if all of us are agreed on the first propositions: "Since health care is a right, and there are still some uninsured people, what are you going to do about it???".
Question 1: Is health care a right?
Answer 1: Not in the sense in which it is being used. One's health, much like one's fitness, is one's own responsibility. I do believe people should have equal access to health care without regard to their race, gender, etc. But I make no apologies about the fact that health care in the U.S. is a luxury service. Truthfully, what people are wanting is not free rudimentary health care - the kind that 99% of the world would be thrilled to have. What they truly want is free access to all the bells and whistles we've come to expect from our amazingly technological (and therefore amazingly expensive) system. Want a country where everybody has the same stuff? Take your pick. There are hundreds. But just realize that's not what this country has ever been about. The U.S. is a land of opportunity, but is also a land of risk. You may hit it big, or you may lose your butt. That is what we do here. Want a life free of risks and rewards? Try France, Spain, pretty much any of Europe. Just leave my country alone, okay?
Question 2 is similar, so my answer is similar. Since health care is not a right, it is your responsibility. In cases where the individual is incapable, local religious or service organizations, or individuals should step in to help. If help is still unavailable, the government should provide rudimentary services as a last line of defense.
Question 3: What are you going to do about all the uninsured?
Answer 3: I am going to trust that their survival instinct will drive them to discover what 20-thousand generations of their ancestors did - how to survive. Forced to reckon with the consequences and costs of their actions, people won't require additional taxes as some sort of carbon rods on the nuclear reactor of their bad habits. They'll quit smoking crack because they don't want to spend all their money going to the doctor all the time. Or they won't. The choice (and the power) will be theirs.
Don't let all the hype get to you - I work in this business, and I promise you, there are very few people who actually fall through the cracks. Those that do are much more likely to be helped in a meaninful manner by their neighbors, churches, or civic organizations than by the Feds. Shocking as it may seem, we survived and even thrived in this country without Obama's health care plan. We'll make it without it. I promise.


marcia said...

I don't have a solution to the healthcare dilemma, but I would like to comment on a few of your points.

Yours sounds like an elitist argument to me: Only those with means are entitled to healthcare. All others need not apply.

I think at the heart of the issue is the value one places on humanity over wealth and material goods. Apparently, you approach the problem from a paradigm that "some animals are more equal than other animals," to borrow a phrase from George Orwell; and therefore, more entitled. I find this position unconscionable.

Don't misunderstand me (because you read a lot into my last one-line comment). I believe doctors deserve to be compensated well for the time, money and effort they've invested in their medical careers. I do not, however, believe this needs to come at the expense of the masses, many of whom can neither afford adequate health insurance nor the cost of a standard office visit.

I understand you don't want your country spending your tax dollars ensuring other people have access to treatment, but this is my country and those are my tax dollars, too, and I believe that yes, adequate healthcare should be a fundamental human right. The U.S. government certainly has no qualms defining what it believes its citizens owe the nation: for example, dying in unnecessary wars begun under false pretense.

To return to your proposal:

I think it's commendable that you would provide free healthcare to all children under 18. Maybe you can enforce vaccination schedules while you're at it. That would be great.

What would become of the children who, for whatever reason, develop complicated medical problems that persist into adulthood? Suppose some are disabled (and therefore covered by your plan), but many are simply unable to work at an income that allows them to do more than put food on the table and a roof over their heads? Do you deny them care because they're undeserving?

What of the many, many people not fortunate enough to have an adequate IQ or financial means allowing them to further their education beyond high school? IOW, what of the service industry workers, burger flippers, and dwindling assembly liners who can barely earn enough to support themselves? What do they do when they become ill? Would you turn your back on them, too?

(Incidentally, in this scenario, the assistant chef is coughing on your freshly plated food. Unfortunately, he's too poor to afford time off work or the medical treatment he needs. Of course, if he's read the latest entries in your blog, he may actually be spitting in your food, but that's neither here nor there...)

What becomes of the people who planned well, went to college, bought insurance, saved money, and then encountered a financial hardship that limits their ability to pay co-insurance? Tough luck?

What happens to the elderly, whose meager savings dwindle during retirement? And so on.

You raised a point about how people survived thousands of years ago without health insurance, and I have to laugh. Thousands of years ago, there was very little medical technology and the average life span was something short of 40 years. Is that what you intend to promote?

What happens in flu pandemics? What happens if people, unable to obtain routine medical care, contract drug-resistant TB and spread infection through the entire population (including the priveleged elite)? What if, what if, what if... there are plenty of plausible scenarios that would actually create worse living conditions and greater hardships for the United States as a whole.

What if, instead, we stop allowing so many parents to dictate whether their children will (or won't) receive vaccines or antibiotics?

What if we take discretionary power away from families that insist on futile care when someone is actively dying, and place it in the hands of doctors?

What if we actually institute strict tort reform in a responsible way, and reduce malpractice premiums?

What if we forgive medical school debt for people willing to spend a limited number of years providing care to the un- or under-insured?

What if we actually allow doctors and triage nurses to redirect ER abusers to appropriate services such as urgent care, primary care, or rehab, rather than be seen and worked up in the hospital?

What if medicare patients had to make a small co-pay to receive services?

What if we actually regulate insurance companies for a change?

And so on.

Imo, there have to be solutions other than turning our collective backs on people who can't afford the current outrageous cost of medical care, as the GOP would like to do. Frankly, I think this is a matter of ethics -- an area where the Republican party consistently comes up short.

I would really like to see a solution that benefits both doctors and patients, rather than one that pits them against each other as enemies.

(Not edited... the little comment box is too damned small to bother)

mockbadoc said...

Interesting. No solutions, but more than ready enough to try to shoot holes in mine. I would remind you that the current medical welfare system you advocate the expansion of has had forty years to work, and has yet to lift a single person out of medical indigence, to my knowledge.

Please don't presume to tell me about the realities of the under-insured. I work with them every single day of my life. I also work with the truly uninsured migrant workers who are in greater need than anyone. While some sit on the sidelines and find fault with the way doctors practice medicine, I am in the trenches actually doing something. I think I've earned the right to have an opinion on the subject. I've watched as the same system abusers rob the taxpayers of the money they send to the government in good faith, while the truly needy are denied benefits because they're all used up foolishly. The government has failed miserably and completely to come up with an equitable solution. Continuing to prop up or expand this system is about as naive as it gets.

Don't fret, Marcia. I know better than anyone that you will get what you desire. The system will only get larger and more intrusive (forcing parents to get their children vaccinated against their will, for example) and less effective. We will continue to pour good money after bad, and the system will continue to benefit people only in the moment, doing little or nothing to address their true problem. After all, if people were elevated out of poverty, they'd have no need for the massive and all-powerful government you espouse. Bureaucrats need their job security too, I suppose.

When people payed for their own health care, doctor visits were less expensive and longer. Prevention was practiced more effectively, because people took their health as their own responsibility. Specialists had to answer to their customers directly and they performed fewer unnecessary procedures. People who couldn't pay were given services free, as part of the doctors' commitment to their community and their oath. In other cases, their communities themselves came to their aid, thereby strengthening the community itself.

I am hardly an elitist. I actually have a higher opinion of the common person than you apparently do. I believe that the vast majority of people have the capacity to do better for themselves.

I will choose not to engage you on the matter of dying for one's country "unnecessarily" - although it was that comment that gave me more insight into your opinions than any other. I sense that you, like so many others of your particular sociopolitical world view, think that the military is made up of the ignorant and poor, those without recourse. I will choose not to engage because I disagree so profoundly that to discuss our differences would be like conversing in two different languages. I spent my first four years of adulthood as an enlisted member of the U.S. Marine Corps. My wife served for six years as a field medic in the Air Force. We served proudly and honorably with some of the finest Americans we've ever met. We were hardly the stooges people like you make us out to be. We believed in something, and we did something about it more than simply talk. We gave our youths and our bodies and sometimes our lives in service. I'm sure this sounds very foreign so I'll leave it there.

Suffice it to say that I believe that a return to the past is better than a continuation of the failures of your system. In the past, the needy were cared for more effectively and equitably than they are now. People had the opportunity to better themselves.

marcia said...

I don't think you actually read more than three or four words of my post; otherwise, your reading comprehension is abysmally low for someone with so much education.

My husband served honorably in the Vietnam war as a helicopter crew chief. He can tell you, as can many who served during that time, that the enlisted (air cavalry, infantry), those on the front lines, were drawn heavily from the ranks of the poor and uneducated. Remember the college draft exemption? No? Too young?

My father-in-law was a marine who served at Peleliu (look it up; only 300 men survived) and Okinawa. So your "pedigree" does not impress me.

What does impress me is the outrageous amount of hubris you exhibit in your writing. Do you actually think, as a doctor, you're the only one with the opportunity to observe current social conditions?

You don't even know me, yet you presume to imply that of the two of us, you are the only one entitled to an opinion. FYI, I also work with the poor, many of whom are working, and most of whom would suffer under your proposals.

And incidentally, I did offer some suggestions. And yes, I did raise questions about yours. Rather than address them, you chose to get defensive, argumentative and arrogant. That tells me a lot about you, as a human being.

I had hoped my former post would result in some form of reasonable and civil discourse on the topic, but I see you are too far neocon to participate. Hostility is the trademark of your party.

One can only hope that years -- and wisdom -- will soften your opinions. But I won't hold my breath. All hail BillO.

No need to reply; I'm done with your blog.