Health Care: It's Not About Money (Part 3) - UPDATED

posted by Armadillo Joe

So, this one is for commenter Ed Darrell who seems to have appeared out of nowhere, fully formed, and armed to the teeth with smarts and all kinds of intellectual ammo to smash the wingnuts into oblivion, even the super-keen smart ones. In the comments to my last post, he came swooping in with all kinds of info and expressed an interest in reading the entirety of the exchange with the guy on Facebook. So, I am hereby obliging.

BTW, Ed, I note from your profile page that you live in Dallas. I grew up in the Dallas area and the particular wingnut in question is a high-powered corporate attorney who I went to high-school with and who still lives in Dallas. So, Ed, you can imagine the particular brand of insular corporatized arrogance that represents.

And while we're at it, Ed, who are you and where did you come from? Please feel free to comment all you like. And that goes for the rest of you, as well.

For all you other Blog-O-Maniacs, unless you are interested in a long, tedious and blood-pressure averse blog post, what follows is a tough and not terribly rewarding slog. I only edited the names out to protect the not-so-innocent and the order of a few specific posts for clarity. No words have been added or subtracted.

Enjoy?

UPDATE:
Rereading the thread this morning, I realized that who is whom may not be all that clear. The first commenter is another attorney friend of mine who also lives in Dallas and knows the doofus from later in the thread. She is nice enough, and book-smart, but also has that sort of smug sanctimony one finds in someone who has never really wondered where money for food or rent will come from. Her comments are in green. Mine are in blue. Corporate doofus is in red. All others are in purple.

Happy reading.

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You posted a link to a news story
June 26 at 9:20am.

Armadillo Joe would like to point out that if you think actual elected members of Congress will be the ones working on making this country's new health care policy, you haven't been paying attention.

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NPR: Turning The Camera Around: Health Care Stakeholders
Source: www.npr.org

When 22 senators started working over the first health-care reform bill on June 17, the news cameras were pointed at them -- except for NPR's photographer, who turned his lens on the lobbyists. Whatever bill emerges from Congress will affect one-sixth of the economy, and stakeholders have mobilized ...read more…

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Comments

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Lawyer friend #1 at 9:42am June 26
Ok, not all lobbyists are bad. Lots of healthcare company lobbyists, but also JDRF and American Heart Association and so on.

Armadillo Joe at 10:22am June 26
yes, that's true. Advocacy for a position is a necessary part of the American system of representative government.

And further, I'm sure even the biggest villains in that room also still love their spouses and children. The problem isn't with any one individual lobbyist's personal morality or professional ethics. The problem is the system itself, wherein the money to buy the access to affect policy is made by engaging in the very practices the policy-makers should be seeking to end.

Put less abstractly, the health-care industry is bloated and ineffective and a great many people make their personal fortunes in the ensuing chaos, which makes them the moral equivalent of war-profiteers. Those profits are then spent in defense of furtherance of the very system in need of reform.

Which is why we never get health-care reform.

Lawyer friend #1 at 10:36am June 26
Ok, so who has a better system?

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READ THE REST OF THIS EXCHANGE AT "ARMADILLO JOE'S LONG-WINDED OVERFLOW" BLOG-ETTE

Health Care: It's Not About Money (Part 2)

posted by Armadillo Joe

Just like last week, I'm still arguing with that guy on Facebook. Here's the latest exchange:

corporate lawyer/former high-school debater:

When you were talking about the economics, you dropped the inflammatory rhetoric and the ad homs. When you got back to the moral arguments, you started shouting and accusing again. Why is that?

Whether the US government should adopt a single-payer system for health care is not a moral issue, it is a public policy issue. It's an economic question: how much should the gov't tax people, and how much should it pay for their health care?

If you have a single-payer system, then the government will still have to make decisions about what to pay for and how to apportion the money it spends on health care. People who can't afford to pay for additional coverage still suffer and die in systems with government as a single-payer. You seem to imagine that if the gov't is paying, then everyone will get all of the care that they need, but when pushed on that you say you don't imagine everyone will get cradle-to-grave care for everything that affects them. You can't have it both ways.

The unavoidable fact is that resources are scarce, which means decisions must be made about how to apportion them. I get that you want to have the government raise taxes (or borrow money today, then raise taxes on future generations) and use more money on paying for health care. That's fine. I disagree with you that this is the best public policy, or that it will even have the great results you imagine.

The point about DDT is simply this: I think it is bad public policy to ban DDT when it could be used to effectively eliminate malaria-carrying mosquitos and thereby save hundreds of thousands of lives annually. You disagree with me. I don't think that this disagreement makes you an amoral, parsimonious tree-hugger.

The language of morality shouldn't apply because it obscures and inflames the debate. It should be possible to disagree about how governments should spend and regulate without attacking the character of those who disagree.


Armadillo Joe:

Shouting? Ad hominem? Please. This is a spirited exchange of ideas. If I was shouting - I'D BE USING ALL CAPS.

That said, however, please refrain from trying to bait me by disingenuously including a flashpoint like DDT, because we both know that a debate over its use has raged across the political spectrum for decades. Inserting a reference to it is not value-neutral, it is a red-herring that deliberately chums the water.

Also please, stop attaching claims I've never made to my viewpoint via hedging phrases like "you seem to imagine..." then attacking that characterization instead of the specific claim I advance: the definition of a straw man argument. As much as you may wish that I had claimed everyone would get ALL the care they EVER need in life from cradle-to-grave if only the stoopit gov't would just pay for it, because that would be easier for you to rebut, I never did. I'm not a hippie-dippie moonbat imagining a world with no possessions, pining away for a money-free utopia.

Yes, people suffer and die and single-payer will not end that. I'm not trying to have anything both ways. I never claimed that universal coverage was a panacea but a government safety-net can moderate that suffering for the purpose of social stability and distribute the burden of the costs to promote the general welfare. And furthermore, I ask you, how is government bureaucrat making decisions about apportionment any different or worse than the current collusion of income-based rationing with insurance company bureaucrats operating under a steep financial disincentive to provide effective care? Any amount of nationalized health-care -- however mediocre for those who need to use it -- is still 100% better than no care at all and has proven elsewhere in the world to be better than the uneven, unfair, inefficient, often dangerous and grossly expensive system we enjoy now.

France spends half of what we do per capita on health-care and they not only get universal coverage for that money, but also cheaper drugs, lower infant mortality rates and greater life-expectancy. Those who want more coverage (and can pay for it) do so and almost everyone in France so chooses, which has resulted in a robust and very profitable private health-care sector parallel to and largely integrated with the public one. However, those who can't pay anything at all at least have a third option besides death or economic ruin when faced with mounting medical bills. The social instability engendered should that kind of human suffering metastasize should be easy to imagine.

And, finally, you dismiss the use of moral language as obscuring and inflammatory, but I posit that as long as the debate remains a dry, measured exchange of policy prescriptions -- as though we're debating a change in library hours at a town council meeting rather than mitigating preventable suffering -- we ignore to our peril the deeper structural inequities in American life as embodied in our broken health-care system. Moral language clarifies the stakes, whereas your framing of the issues -- trying to make it about nothing more than policy and economics -- obscures the deepening supremacy of this issue in so many American lives.

Policy and economics are but tools, means to an end. Morality is the impetus.

Thus, what you characterize as impugning the character of the opposition is in fact a reaction to complacency -- whether from apathy or smugness or fear or parsimony -- in the face of overwhelming evidence for action.

Health Care: It's Not About Money

posted by Armadillo Joe

For the last couple days and to the detriment of chores and personal hygiene, yours truly has been neck-deep in a scuffle at Facebook over health care. In some ways, it is just like the one I got into back in April over torture, wherein a fairly innocuous initial comment quickly escalated into a sort of Battle Royale in the comments section because Rethugli-goon trolls are the same everywhere on the inter-webs.

The difference this time is that my opponent, while still deeply, horrifically wrong, is smart. Wicked smart. Freaky smart. This guy was the president of the debate club when we were in high-school together back during the Pleistocene Era and his cockiness back then about his quick-wittedness gave him the aire of a weird sort of jock-nerd hybrid (who looks kinda like Ed Helms). Since high school, he went to a high-end, brand-name university and then law school and works now as a high-power corporate attorney in Dallas. The fairly innocuous post I referenced above was about this NPR photo and it was like red meat to hungry wolves.

We have exchanged almost a hundred comment posts totalling probably thousands of words by now. This is also the last post up by either of us as of 4:30 pm EST today and he has yet to respond.

Other than that, I think what follows is fairly self-explanatory.

Thank you for the fraud numbers on Medicare/Medicaid. I had not seen those and I grant that they are a matter of concern, but then fraud is always a risk no matter the source of financing - private, public or some manner of hybrid. You cite the better fraud numbers for private insurance -- which I acknowledge -- as though they are their own self-evident proof of the superiority or your position. I say they are not. I don't really see how the fraud numbers in-and-of themselves themselves constitute an argument against universal health-care. If we have fraud, so what? Investigate it and punish it where necessary.

Furthermore, you continue to insist that this is ALL AND ONLY about money, money, money -- which I contend is still very, very wrong on multiple counts -- and you have not offered a single counterpoint that wasn't an argument from a financial, fiduciary or economic perspective.

If you want to make it about money, though, then OK, let's make it about money for just a little bit longer. I will say that your fraud numbers pale in comparison to these numbers (from this link: http://www.nchc.org/facts/coverage.shtml) - you can check the link for the numbered footnotes.

• The United States spends nearly $100 billion per year to provide uninsured residents with health services, often for preventable diseases or diseases that physicians could treat more efficiently with earlier diagnosis.14


• Hospitals provide about $34 billion worth of uncompensated care a year.14


• Another $37 billion is paid by private and public payers for health services for the uninsured and $26 billion is paid out-of-pocket by those who lack coverage.14


• The uninsured are 30 to 50 percent more likely to be hospitalized for an avoidable condition, with the average cost of an avoidable hospital stayed estimated to be about $3,300.14


• The increasing reliance of the uninsured on the emergency department has serious economic implications, since the cost of treating patients is higher in the emergency department than in other outpatient clinics and medical practices.11


• A study found that 29 percent of people who had health insurance were “underinsured” with coverage so meager they often postponed medical care because of costs.15 Nearly 50 percent overall, and 43 percent of people with health coverage, said they were “somewhat” to “completely” unprepared to cope with a costly medical emergency over the coming year.15

We're already spending way too much money on health-care in this country (note the numbers I cited above about the growth of the health-care sector from 10% to 16% over the last 25 years). When I advocate for universal health care, I know that nothing is cost-free -- that's not what I mean when I say money should be removed from the equation, I'm referring to the depredations of a for-profit health-care system -- I instead contend that the much-vaunted free market hasn't delivered the efficiencies its advocates have been promising us for decades, that for-profit health-care is a self-defeating contradiction and that the federal government is the only organization large and powerful enough to bring this whole mess under control and thus prevent the current financial and bureaucratic chaos from swamping our whole economy, with ruined fortunes for some and illness & death for a great many others.

I'm heartened that you agree with me that we have a problem to solve, but once again you propose the same gussied-up retread of a solution that has failed us again and again: free-markets and competition. We've tried it your way. We've been trying it your way for close on 100 years now and all it ever brought us is a mess we try mightily to clean up once a generation or so. It isn't like we don't have other models for how to structure a working universal health-care system. Other countries have ironed out the problems with the various approaches over the decades, so we should just pick one and get this stupid thing fixed. I vote for the French model and Business Week agrees: http://www.businessweek.com/magazine/content/07_28/b4042070.htm

Although the Conservative Party of Britain think theirs is pretty keen, too: http://yglesias.thinkprogress.org/archives/2009/06/conservatives-for-socialized-medicine.php

And, with the above, I'm kinda done with engaging you on the money side of this issue. If you want to keep throwing money-based arguments out there, its your prerogative but each time you do it, you reinforce my contention that this is a profoundly moral issue and the opposition are a bunch of amoral, parsimonious bean-counters who care more about protecting a status quo that works for them than recognizing the existence of a social compact which would require them to contribute to the general welfare. This is about how our values as a nation are reflected in our public policy. If money were the only issue that ever mattered, we'd still have a slave-based labor force in the south and children working 90-hour weeks in factories in the north. Sometimes issues are about more than money and when they are, we find a way to pay for what is important to us.

But before you come back at me with more sophistry about DDT or the economically disadvantaged "choosing" not to buy health coverage or what have you -- in an attempt to change the subject by force-feeding some ridiculous or distasteful false dilemma on me by skewing my positions into your own straw-man argument -- I would like you tell me precisely why you don't think this is a moral issue when millions of Americans live in fear of illness and death and economic ruin amid the general prosperity. Enough with the ad absurdum arguments. I ask you to explain why you don't think the language of morality applies on this issue.

For your side, it always and only seems to be about the money and, it seems to me, the mysterious fairy dust of free-market forces are the only mechanisms for delivery of goods and services available to policy-makers. If that is true everywhere and all the time throughout history, then why bother having a government at all?

For my side, it is about social responsibility and, as I see it, the government is the embodiment of that shared commitment to the general welfare. It is the most efficient and equitable organ for the application of our shared values. In the end, if one side contends that they don't share those values, that we can't even agree that the state of our health care system is a moral problem, then merely agreeing to disagree and moving on maintains the grossly unfair status quo. In the last 150 years, we've moved forward on slavery, suffrage, labor rights and civil rights and at every junction we did so with a wealthy opposition that cried to the heavens about the end of the world. Each time civilization survived and people continued to be rich. On this issue, too -- as it always has -- history will move forward without your consent.