The Flight Deck

Comment from unkawill
Time: March 18, 2007, 8:32 pm

Michelle states ” For me, it all goes back to the social contract. In my version of the social contract, your property is NOT more important than my health, just as my property is NOT more important than your health.”

Ah the crux of the matter. Socialism rears it’s ugly head.

My property is more important than your health Michelle, because with access to and use of MY property I can and do support myself,my family and my employees, to include health care. Nobody has given me this property.

I have WORKED my butt off for every thing I own and don’t take kindly the notion that I MUST support people that can’t or won’t support themselves or whose lifestyle engenders dependency.

Life is not Fair. It never has been. It never will be.

Comment from unkawill
Time: March 18, 2007, 8:48 pm

Also stated by Michelle “But for me, all of this still begs the somewhat larger question, what will we do about healthcare for those without access to private insurance? Care to take that one on?

The vast majority of people on this planet don’t have any healthcare at all and never will.

Life is nasty, brutish and short in most of the world, I for one am grateful that I live here in the US of A. I have been to many Hellholes, as I am sure many of the fine readership here have also.

You do what you can, but you can’t save the whole world.

Comment from Max Damage
Time: March 18, 2007, 9:37 pm

A fairly lengthy article, perhaps we should break the debate up into some logical sections? I’ll start with the idea of a right to health care, follow with health care as a service, then try to cover insurance and tort reform with respect to medicine. Finally, we can discuss the fantasies we both have about dealing with insurance providers and lawyers. For once, the lawyers seem the lesser of two evils in that regard. I think this will make it easier to discuss specific points and, since I’m taking the position of Bad Guy^H^H^H^H^H^H^H Loyal Opposition here, it will make it easier for me to keep up with my part of the impending brouhaha.

OK, a right to health care. I just can’t see it. If we posit that health care is a service provided by professionals or at least those educated in specific areas (midwives, chiropracters, first responders, your uncle Louie who grabs you in a bear hug and cracks your back), then a right to health care would impose an obligation upon them. No other right in the Constitution imposes a burden upon a fellow citizen. A burden upon government, sure, but exercise any right in the Constitution and your fellow citizens can applaud, condemn, ignore, or otherwise not be directly affected one whit.

Cogitate on that. Free speech doesn’t require the newspaper to print your letter, or the postal service to deliver it at no charge. Speech over the public airwaves costs money in the form of a license for the broadcaster, who isn’t obligated to let a speaker use that license for free. The Right to Bear Arms carries with it a cost of purchasing that arm. Right to counsel? It’s only if you’re destitute that counsel is provided, and it wasn’t until Guideon vs. Wainwright that you even had a right to counsel for less than a felony offense. There’s a right to vote, now, but no obligation for the state or your fellow citizens to get you to the polls. Even if your vote does carry the day and you elect Congressman X to power on a “No Guiness” platform, that only indirectly causes an obligation to your Guiness-swilling fellows.

To sum, while rights carry responsibilities, they carry obligations only for oneself and the government those rights are meant to protect us from. (That’s a personal definition, of course, and one the courts have not yet advised me on.)

Not so in health care. In health care that claimed right would impose an obligation upon the physician, orderly, nurses, and the facility they work in. It would impose an obligation upon your fellow citizens, not only in terms of confiscating their wealth to pay for the care needed, but in the case of these health care providers it robs them of their time, a portion of their life, which is truly a finite gift they and they alone can choose how to spend.

Looking at this further, one given is that all resources are finite. The only exceptions to this are stupidity and rhetoric (with the spam in my inbox fighting for a distant third). If there is a right to health care, what limit could there be to the resources expended, even if those resources were not yours? Is the organic chemist who comes up with synthetic insulin not entitled to compensation for his work? Is the physician not entitled to compensation for his time, not merely the 30 minutes he spent treating your ingrown toenail but the 7 or 9 years of college and the year of 20-hour shifts in residency that prepared him for that moment and qualified him to perform the procedure? If you’re flat broke but have a “right” to health care then he has an obligation to spend his time on you, that research chemist has an obligation to give you the fruit of his labors, the drug company has an obligation to give away their products, and that means pretty soon you’ll have a right to health care and the only person still around to provide it is uncle Ernie.

Unless you care to hold a gun to their head. Holding a gun to their head by having the government exercise its monopoly on force to take their wealth is really the same thing, just through a third party.

We talk a lot of social contracts. Homeowners without kids pay property taxes to finance schools for other people’s kids, civilians pay taxes to finance the salary of the police and fire departments and the military, etc… That’s fine and dandy, but in those cases the social contract is enforced and changed at the ballot box via a representative form of government, so the people funding these things have a say in how they’re managed. Not so with your health, unless you want me to use that same police power of government to require you exercise 2 hours per day, eat only the highest-quality oat bran, give up the smokes and “I don’t care if you are 42 mister you wear a helmet when you ride that bicycle!”

Clearly if you can impose obligations upon me I can likewise impose obligations upon you in that regard, which brings about an interesting scenario. Let’s say I’m a booze-hound with a right to health care and a failed liver. Have I a right to a transplant if prohibition is the law of the land? Have I a right to one of your kidneys since, you know, you have two of them and I’ve none that are functional? At what point does that social contract start to get too personal?

I admit it’s a slippery slope argument, of a sort, but take a look around. Helmet laws, gun laws, no-smoking laws, seatbelt laws, little-orange-flags-on-bicycles laws, blue laws… When did what I chose to do in the privacy of my property become of such interest to the populace in general and the government in particular? I’d answer it happened when they were oblidged to pay for the consequences of my actions, and *I* for one do not recall ever asking them for that favor.

– Max

Comment from Max Damage
Time: March 18, 2007, 10:25 pm

I seem to have overlooked a central thought I was going to work in there: To an individual, their right to life is paramount. Nothing else matters save that they continue on. To the rest of the planet, they are insignificant. One person? We’ve nearly 300 million in the USA and I believe China has eclipsed three billion. People often say “If it saves one life it’s worth it” but they generally say that having given no value to the life vs. what cost they’re imposing.

Perhaps my property is not more important than your life. If given a chance to trade I’d probably give up my home to save your life, and I’d most certainly give up that ’52 Buick that’s rusting away in the windbreak. Heck, if I can I’ll trade it down to that old Palm Pilot in the desk drawer that doesn’t work. But what if it were the food that sustains me and mine, or our shelter from a harsh and barren snow-swept midwestern plain?

Stealing a horse used to be a hanging offense in this country. That wasn’t because the life of the horse was more valuable, it was because as a beast of burden the horse enabled a family to live. It transported that family to civilization, it plowed the fields that produced that family’s food, it provided food in the worst of conditions. Livestock, so-called because it’s on-the-hoof wealth and like any wealth it can be traded or bartered for needed items to continue sustinence.

To the individual his or her life is paramount. To everybody else it is worth something, but generally less than their own. What that value might be is subject to individual interpretation.

– Max

Comment from Max Damage
Time: March 18, 2007, 10:53 pm

Health Care as a service. This ought to be fairly short. If I have a bad tooth I seek out the services of a dentist. If I have a deep cut I seek out the services of one who can suture. If I’m feeling good and have no worries at all I seek out a good book. In all these cases I am the customer, and I’m looking for somebody with a talent I do not have in order to fill a need I cannot fill myself.

Thus laws of supply and demand must naturally follow. If I want a cavity filled I can shop dentists by price, by speed to get me in that chair, I can shop for the one who hands out a nice lollipops afterwords. I’m the customer, I have money to spend on this, they have skills I need, I go for the best deal I can find. Maybe Dr. Joe fills cavities for $5 and offers a 12lbs hand-sledge for the relief of pain at no charge, while Dr. Jack fills them for $15 but offers novacaine for an additional $10. Decisions have to be made, and money in hand it’s up to me to decide what is the service I want at a price I am willing to pay.

Neither Joe nor Jack are any good to me if I’ve no teeth. They cannot perform their service for me, and I do not want them.

Thus health care is a service performed that the customer wishes and the cost is weighed by the consumer. I’ve yet to see doctors surrounding random people in the street and performing surgery — clearly their services are not always needed nor always wanted. Likewise, I’ve yet to see healthy people enter a hospital and throw a wad of cash on the table and ask for whatever it will buy.

Health care is therefore a service, a trade of abilities for compensation. As such it is subject to the laws of supply and demand.

– Max

Comment from Michelle
Time: March 19, 2007, 4:17 am

No, capitalism at all costs rears its ugly head. You don’t have a purely capitalist system now you know and if you did, something tells me you might not be so enamoured of it, despite what you might think. Because everything appears to change when it becomes personal, doesn’t it?
Me taking your property doesn’t sound so good. But how good would it sound if your child or your parent was deathly ill but still could be “fixed”, to use Max’s vernacular? Only one problem, for whatever reason – perhaps you recently changed jobs only to find out after the fact that your new insurer doesn’t cover your loved one due to a “pre-existing condition”, perhaps the cost of their needed care is exempted out of coverage by the wording of the policy, perhaps……you pick the poison. Any change in your viewpoint? Or are you comfortable with the thought of sitting back and watching them die even though the necessary drug or treatment is sitting out in the hallway? In reach but out of reach due to the cost? Answer that in all honesty. And not off the cuff but after seriously considering it for awhile.

Comment from Michelle
Time: March 19, 2007, 4:21 am

For the purposes of this discussion, let’s limit our right or lack of right to health care to the developed world. Completely unfair at one level but to do otherwise will take us further afield into the world of international development and other areas. And we can only go so far in “saving the world” on this blog.

Comment from Michelle
Time: March 19, 2007, 5:11 am

The right to health care I am postulating only poses a direct corresponding obligation on government, not other citizens. Your doctor, chemist, pharacist, research scientist, whomever, IS being compensated for their time and effort. I’m not asking anyone to “work for free”.

However, if the market controls what a doctor can charge per patient visit (whatever the market will bear), then in the interest of saving human life I have no problem whatsoever with some body imposing reasonable limits on a health care professional’s compensation in order to keep the rest of us alive. Do you think this doesn’t happen now? And for much less “noble” reasons? Don’t HMOs “negotiate” or tell their physicians how much they will receive for their services? How much time they will spend per patient? Which tests and procedures they can order on thier own initiative and which they can’t? Oh wait, if you don’t like it, go work for some one else. Or, better yet, don’t work for any of them. Just strike out on your own. Set up your practice. Put out your shingle. And let the market work its magic. Nice theory but in reality, since the majority of people aren’t paying directly for their own healthcare, aren’t insurance companies, as an industry, effectively operating as a monopoly in the system? Aren’t they affecting my business and how much I can charge? Not directly, no, but if they won’t allow any of their insureds to operate within their own free choice and retain my services (unless the insured pays out of pocket), in today’s reality, isn’t the effect nearly the same? Only way to get rid of that little tickler is to get rid of health insurance full stop. Are you prepared to go that route?

But know what, no matter what I argue or how well I might argue it we might as well acknowledge that we are just going to keep running smack dab into the same wall – I’m very sorry but I simply am not and never will be able to accept the idea that it is “okay” to sit back and watch someone die whose life could be saved for the simple fact that some great sin would be imposed by the government taking some of your tax money to fund a healthcare system that could save that person’s life. Are you prepared to let the newborn baby die when medical intervention could save their life simply because the parent isn’t insured? Maybe you are. But I’m not. And if that’s where we are, I don’t know any method of coming to a meeting of the minds on that most basic of issues.

Now, in my world, no right is absoloute. Any and all rights can and do have their limits. I will not oblige you to give up your food and shelter to pay for the operation to save my life. However, I will oblige you to do something which in theory you might find just as painful. And that’s give up a portion of hard-earned income in the form of tax dollars. I will not harm you physically in order to save me. But I will harm your pocketbook. At least up to a point.

In my mind, the whole issue of going into your home and mandating what you can and cannot do there (ie. smoke, drink, how much fibre versus how much sugar you eat) is a good example of where the rights become less absoloute. No, I am not going to tell you what you can and cannot do in regard to behaviour that effecs only your own body. That whole stew is just ridiculous in my opinion. But there will come a certain point where I may put limits on your right to health care based upon your choices. For example, if the law of the land was prohibition, it wouldn’t surprise me to see insurers insert a clause in their policies providing that your liver transplant necessitated by your drinking will not be a covered service. I would be a little “nicer” than your insurer. I would put in place services to help your alcoholic stop drinking, in this scenario, but if after a reasonable period of time no progress was being made, I would consider limiting their right to healthcare.

Comment from Michelle
Time: March 19, 2007, 5:27 am

Healthcare is not, in all respects, a service like others services and simply subject to the laws of supply and demand. To view it that way is to put blinders on in regards to the reality of the situation. Becasue it is a service that not just touches on, not just impacts but is inextricably tied up with human life, it is a unique service.

Sure, I can pick and choose my dentist based on the best value for my particular needs. Well, at least in theory I can, if I ignore things like the demands of my insurer (if I have insurance) or how I will pay for that service if I don’t have insurance. Having a cavity filled may be one thing. Having a root canal performed may be quite something else.

But when I am seriously injured in a car accident, am I really going to go doctor shopping based on things like price, speed or lollipops?

“No, wait! Don’t let that doctor remove my spleen or do anything with that perforated bowel, he charges too much! Get me someone cheaper!

That fellow – his bedside manner sucks – find someone else to resuscitate me!”

Doctors may not suround me on the street to perform surgery but when I need surgery in a hurry, from a practical point of view, I may not have much choice in what doctor does the job.

Comment from KrisinNewEngland
Time: March 19, 2007, 5:42 am

So you want to take care of everyone who doesn’t have access to healthcare? Who pays for that? Would doctors and hospitals just absorb the cost out of the goodness of their hearts? Likely not. Would pharmaceutical companies absorb the cost to advance their own medicines? Nope. In the end, as ugly as some people may find it, it IS about money. Period. And if we are to give healthcare to all – someone is going to have to pay for it. And that someone will be those of us who work hard for what we have, make sacrifices for what we have – and pay more than we should to ensure that others have the “right” to free healthcare.

And while we are at it, let’s talk about the level of that care. Should someone who milks the welfare system have access to the same level of healthcare that I do? We haven’t even begun to address the idea of the illegal resident – do they get the same level of care as someone who is here legally, working 3 jobs to make ends meet but still can’t afford healthcare premiums?

The hubby and I pay a HUGE amount of money every year for health insurance – our employer is a Fortune 100 company that cuts the amount they contribute every year – the amount of premium we pay has increased 25% in the past 5 years. The hubby and I work hard and long hours to earn the right to this healthcare. Do I believe that everyone has the right to the same level of healthcare? No. I don’t. I agree with Max – it’s not a right, it’s about making a contribution to get something in return.

As for national healthcare…we have friends who live the U.K. who desperately want to live in the States, for the health insurance. I have a story to tell about that, but will wait for Michelle’s 2nd post…

Comment from Michelle
Time: March 19, 2007, 5:45 am

Unkawill, in countries that have as much resources as the US and Canada do, are you really “okay” with people effectively having no access to healthcare because they have no means of paying for it? Is it just a matter of “mine are taken care of” (not denying how hard you may have worked for that); to hell with the rest?

Comment from Michelle
Time: March 19, 2007, 5:51 am

Kris said:
“I have a story to tell about that, but will wait for Michelle’s 2nd post…”

And I will address your comments in my second post since they cover a fair bit of what I planned to address there anywhere.
Just one comment: The UK – I don’t know what’s up with their system or how it works. I too have a friend who lives there and would have to say it appears not to work. So my only response to that at this point as that perhaps not every “national healthcare system” is the same.

PS Kris, that song “To the left, to the left….” just came on the radio as I was typing this. What are the chances? So do you think its trying to tell me something or tell you something?

Comment from unkawill
Time: March 19, 2007, 7:09 am

Michelle, Everybody in this country has access to health care.

All you have to do is show up at the emergency room.

By law they have to treat you, regardless of your ability to pay.

I am not heartless, I do care about other people. But being animals we all have to die sometime.

Comment from unkawill
Time: March 19, 2007, 7:12 am

Oh, and regarding the vast resources of our countries, you are talking about the money in my pocket and yours that the gov. takes by force.

Comment from Michelle
Time: March 19, 2007, 7:24 am

You have your ER law BECAUSE government intervened in the system. Hence my previous comment that you don’t have a completely capitalist system now. So who pays for that service? And out of curiousity, I have heard that some ERs still turn you away – the remedy, sue after you die? But if you show up in the ER and need a life-saving operation, will you get it? Is that covered by the law? Including your care afterwards? Honestly asking the question, I don’t know much about how that law works.

And if your family doctor runs tests, makes a diagnosis and prescribes the treatment, but you haven’t hit the ER and you can’t afford the treatment, then what happens? How about preventative health care? Wouldn’t that actually save the system money as opposed to being forced to deal with the emergency?

The ONLY resources any democratic country has comes from its citizens, don’t they? You know, that money in your and my pocket that the government takes by force to provide police service, roads, infrastructure…..

Comment from unkawill
Time: March 19, 2007, 7:26 am

Michelle, Please provide the model of a well run, efficient national health care system.

Comment from Michelle
Time: March 19, 2007, 7:42 am

“Michelle, Please provide the model of a well run, efficient national health care system.”

IF I was going to attempt that, I would do so in my second post. But I won’t because I can’t. The problem now is we have both gotten somewhat off target in this post where I was attempting to respond to Max’s comments, one of which raised the issue of whether or not there was a right to healthcare. Which I think there is. At least to a point. But I didn’t say I had or was even aware of the “fix” to that particular problem, how to provide for that right in a well-run, efficient manner. Doesn’t mean there’s not one out there, just that I haven’t researched it enough.

I will, however, discuss what you call national health care (I never actually heard that term before I came here) in my next post with the point of attempting to show that it’s “not as bad” as many seem to think.

Comment from KrisinNewEngland
Time: March 19, 2007, 8:32 am

Michelle – I only referenced that song (the title is “Irreplaceable” by the amazing Beyonce’) as a counterpoint to the title of your post “A Little to the Right…”. Just seemed silly – no deeper message implied. The refrain “to the left, to the left, everything you own in a box to the left”…based on the message of the song, I took liberties in interpretation…

You are right, there is no perfect solution to the healthcare issue as a whole. I still agree with Max and Unkawill – it’s not a right guaranteed by anything or anyone. ER’s make their own “laws” read “rules of care” – I could be wrong but I don’t believe our government has told them they have to provide care to anyone who enters no matter what their insurance status is. Teaching hospitals tend to take everyone; Catholics hospitals reserve the right to refuse treatment based on religious (Catholic) teachings. Most hospitals are a for-profit enterprise, so they operate just like any business.

At the heart of this debate, IMHO, is the issue of “rights” – what exactly is a right and who gets what rights? Ours are guaranteed by our Constitution – and that doesn’t include healthcare. And as cold as this may sound, until a law is written covering that right, then it’s up to the individual. And if they can’t afford healthcare, there are teaching hospitals that will not refuse them.

I’m not interested in paying more of my hard earned dollars (as Unkawill said, forcibly taken by my government) to support the “rights” of people who just stand their with their hands out, waiting for someone to give them what they believe they are entitled to. (I’m not saying that everyone who can’t afford healthcare falls into the category but I’m sure the majority does…).

My niece and her husband each toil 60+ hours a week at a Wal-Mart store. Their takehome pay is beyond a scandal for how hard they work. They have minimal healthcare. Do I feel bad for them? Yes. Do I want to pay out more money so they have healthcare similar to mine? No. They have made their choice – either one could apply to schools for aid (they’d certainly qualify for alot) so they could learn a trade at least. But they’ve chosen this life – does that give them the right to better healthcare?

Comment from doorkeeper
Time: March 19, 2007, 8:34 am

Hmmm……much thought must go into this before I weigh in at length. There’s a lot I want to say, but for now, this question….

Who says it’s broke? (besides Hillary and her ilk)
And, what qualifies as broke?
Because NO system will ever be perfect, so how close do we try for? And if “fixing” leads to more trouble, in a long “short-term” is it worth it?
Who gets to decide which end of the spectrum is perfect?
Because we can’t have it all….cheap healthcare for everyone just isn’t do-able.
just my not-so-humble opinion,
doorkeeper

Comment from Michelle
Time: March 19, 2007, 8:51 am

I was desperately looking for a title for this post last night. “Healthcare – Part I” sounded just too mundane. And since Max’s comments came out of the Walter Reed thread (where I think I can reasonably submit that something is broken), I decided to run with that title.

My point (which I will point out again in my next post) is not that the Canadian or any other system is necessarily better than the American one. Although I do think ours might be marginally better but I will “leave that for another day”, so to speak. My real point in wanting to take on the subject of healthcare was a need to deal with the occasional comments/remarks I had seen on TOS (the other side) concerning how a “national health care” system would be the end of it all. Which I don’t believe (speaking from personal experience) is so. But since I first brought up the issue at all by asking Max for his “fix”, I first responded to his comments.

As far as the potential for “fixing” leading to more problems, I am a proponent of short term pain as long as you can promise me long term gain. But too often I’ve seen short term pain with no long term gain.

Comment from doorkeeper
Time: March 19, 2007, 8:54 am

And yet another comment.

There seems to be a lot of judgement, quite a bit of harsh speaking, on this topic, and I am a bit unsettled, to say the least.

I’m having trouble seemingly hearing the attitude that everyone SHOULD work and get their own healthcare, and that if we have lower paying jobs with limited healthcare, we should WORK to improve our own state. I agree with that in principle, but it’s simply not the case in real life, for far more people than it seems you are aware of.

I’m here to represent the working poor, and the disabled. While not disabled myself, I am a caregiver, both in my own family AND as my profession. I chose this profession, yes. I get no healthcare benefits from it. At this time, it is a compromise my husband and I chose to make. In a few years, I will probably have to look for a job with benefits, as my dh will retire and be unable to get healthcare for a few years. Although I don’t consider myself young, the way the Soc. Security system is set up now, I will be unable to get anything there for over 24 years. Dh will have quite a gap, also.
We perhaps made choices early on in life which could have been better considered, but at the time, the choice of career (?) for my dh was good. Now, it’s not so much, since his occupation hasn’t kept up with others….for instance, the schoolteacher with the same amount of college, who made the same wage 30 years ago, now makes double and triple what he does. And they say school teachers are poor……

But the things which happened to us were not a matter of choice. I was forced to quit working and stay home, income and benefit-less for over a decade. And we struggled on an income which would drive many to suicide. And we survived.

I was told, when my son was diagnosed, that I would soon become a Democrat because of all the lovely social programs which would help us out……I am still waiting.
Even though we’re severely below the “poverty level” and spent all our (limited) assets, we still do not qualify for anything EXCEPT the basic medicaid card, for our son. And, we don’t use it…(much)…because our primary insurance picks up most of the cost of his care, and his needs aren’t “medical” in nature, that is, we can’t put a band-aid on it.

But his needs are so expensive, so desperately time- and resource-consuming, that we can never see a way out of poverty, both financial and time. He can’t be healed.

So to some here, he’d be at the bottom of the list for everything, simply because he has no value to anyone.
Sorry to phrase it so harshly, but that’s what I’m hearing.

To move on…I am currently a home health care aide for an elderly woman. She is severly disabled and her husband is elderly. They are both veterans of WWII. He will not put her in a nursing home, even if he could (and that’s a whole ‘nother topic) because the quality of care there is so terrible. Believe me, I know. If you’re not independantly weathly, or have INCREDIBLE nursing home insurance (or even if you do) you’ll never be able to afford decent care. Nursing homes are so short-handed that the care given, in spite of wonderful, caring, desperately over-worked aides, is criminal. And I mean that literally. If anyone tried to prove it, our whole nursing home system would shut down while everyone went to jail.

So…this woman will never be useful to anyone again. Her life has no value. To anyone except her husband, and herself. And to me, and the other girl who works for them. 70 hours/week. yep, I said 70.

Since they have no value, this woman, my son, and all they represent, are we to “triage” them to the “bottom of the list”?

And what if we don’t, what if we try to give them what they need just to survive decently?

I fear, deeply, that the costs of caring for the elderly, and for the explosion of autism we are seeing, will destroy this country in my lifetime. I can see it coming.

I have no answers, do you?

sincerely,
doorkeeper

Comment from Michelle
Time: March 19, 2007, 9:03 am

Kris, two thoughts:
1. Does your Constitution include any right similar to “life, liberty and security of the person”?

2. Whatever the answer to #1, above, are you referring to an ordinary law or a constitutional amendment when you say “until a law is written covering that right, then it’s up to the individual”?

At any rate, governments pass laws all the time that we may or may not agree with. When I use the word “right”, I am using it more as a moral imperative. Although, personally, I think that any government that doesn’t legally recognize that moral right in some way, shape or form has more than a few screws loose.

I believe the US does have an emergency care law in some form. You also have …..is the correct term medicaid? Perhaps the term varies by the state. But isn’t it federally mandated? If I am correct, than I would submit that your federal government (throughout its various stripes of Pub and Deb over the years) has recognized some form of “right”.

Comment from Michelle
Time: March 19, 2007, 9:13 am

doorkeeper
You have raised an issue with no easy answers for any system, I think. And in any system you will have those who will argue, either explicitly or implicitly, that those such as you describe should be at the bottom of the triage list, the bottom of the resource list. They may try to soften it a bit, “This person has lived a full life, just because we have the technology, is it really right to keep them alive indefinitely?” Or, for the children, one of my all time favourites heard on a local radio station when education was being discussed – “Take them for a walk in [a] park. That’s all they need. That will make them happy”. And save the system a fortune no doubt as an added benefit too, no?

And now I am completely off topic. So I will stop.

Comment from Michelle
Time: March 19, 2007, 9:18 am

Assuming this conversation is continuing, would anyone be adverse to me adding Max’s subtitles to my original post and then inserting the appropriate title in the top of their comment boxes? Just so we could see what’s where?

Subtitles: Right to Healthcare; Healthcare as a Service; Insurance; Tort Reform

Comment from KrisinNewEngland
Time: March 19, 2007, 11:02 am

Michelle: I had started putting a rather long comment together, but in the interest of space and consideration, I’ve boiled it down to this:

Our Declaration of Independence provides for “…certain unalienable rights…Life, Liberty and the pursuit of Happiness.”

The first 10 Amendments to the Constitution, known as the Bill of Rights provide the following, in part:

2nd amendment allows for the “right to keep and bear arms”, which addresses the issue of personal security.
4th amendment addresses personal security, with regard to search and seizure.

Medicaid “…is available only to certain low-income individuals and families who fit into an eligibility group that is recognized by federal and state law.”

Yes we do have regulations about medical care to the neediest among us. But even that isn’t a right – it’s an available program to take advantage of should circumstances make it necessary.

At what point does any society – the US, Canada, the UK, or any other industrialized nation or territory – make its citizens at least partially responsible for themselves? Why do we continue to think it’s our “right” to have this or that? I’m not saying that the neediest among us – the severely disabled child or the elderly grandmother – don’t deserve decent healthcare, that’s not my point.

Comment from jpr
Time: March 19, 2007, 11:03 am

A quick comment or two– I don’t know what this is like nationwide, but where I am, the Illinois Attorney General’s Office has introduced legislation in our General Assembly titled, “Tax-Exempt Hospital Responsibility Act,” which, to quote from the bill, “(an Illinois) hospital must provide full charity care and discounted care to Illinois residents in order to maintain the hospital’s tax-exempt status under the Illinois Income Tax Act, the Use Tax Act, the Service Use Tax Act, the Service Occupation Tax Act, the Retailers’ Occupation Tax Act, and the Property Tax Code; amends each of those tax Acts to provide that a hospital may qualify for an exemption from the tax imposed by the Act only if the hospital is in compliance with the Tax-Exempt Hospital Responsibility Act.”

And, “…requires a tax-exempt hospital to furnish aggregate annual charity care in an amount equal to at least 8% of the hospital’s total operating costs.”

As well they should.

There are people who need health care, because either their job doesn’t provide it, or they’re indigent and cannot provide for themselves. Using an ER doctor as their Primary Care Physician is not the way to go.

Comment from KrisinNewEngland
Time: March 19, 2007, 11:11 am

Dammit – I had a nice, researched response to your questions Michelle, but somehow the comment I submitted has gotten lost. I don’t have time now to relink everything – and will likely forget by the time I get home later tonite – so a quick summary:

It’s the Declaration of Independence that provides for “…certain unalienable rights…life, liberty and the pursuit of happiness…”

Our Bill of Rights provides for the right to keep and bear arms, for our personal security (although the framers intended it for a well-armed militia).

Medicaid is a program that was designed to ensure healthcare for the neediest among us – whether it’s thru poverty or specific health issues that require long term care.

And even Medicaid isn’t a “right” – it’s available if you qualify depending on the individual state’s requirements.

I’m not saying that the neediest – the disabled child to the elderly infirmed grandmother – don’t deserve decent healthcare. But at what point to industrialized nations make their citizens accountable for themselves – personal responsiblity appears to be going the way of the dinosaur.

Comment from doorkeeper
Time: March 19, 2007, 11:27 am

Kris says: I’m not saying that the neediest – the disabled child to the elderly infirmed grandmother – don’t deserve decent healthcare. But at what point to industrialized nations make their citizens accountable for themselves – personal responsiblity appears to be going the way of the dinosaur.

I agree wholeheartedly with this, Kris…..but the point that most miss is that the lazy, spoiled and entitlement-minded are getting all they need and more–while the truly disabled, the elderly, those for who Medicaid/care was created–can’t get help. Don’t get enough to keep them alive, decently, (unless the lawmakers thought dying of bedsores was a natural death).

That’s what gets me…watching the able bodied (and minded) living far better than those who desperately need, and who can’t get through the paper-maze. Who don’t qualify. Who are left outside the “triage tent”

sincerely, doorkeeper

Comment from Michelle
Time: March 19, 2007, 11:33 am

Ah, but Kristen, there’s the crux of it……… getting so hung up on “making people accountable for themselves” (a goal which I am completely in agreement with BTW) that it blinds to all else. So let’s put aside the welfare bum, let’s even put aside your niece and her husband for the moment…….

“The neediest deserve decent healthcare”
Explain to me your distinction beween “deserving” healthcare and healthcare being a “right”. I am open to my language not being the best. But will you give me a “moral imperative” to provide at least basic health care to those who CANNOT provide it for themselves? Would you go so far as to agree that it is incumbent upon those of us who can to provide healthcare for those us of who truly cannot?

I could take it further but I won’t (not right now anyhow). But would you agree with any of that?

Comment from Michelle
Time: March 19, 2007, 11:42 am

jpr said:
“There are people who need health care, because either their job doesn’t provide it, or they’re indigent and cannot provide for themselves. Using an ER doctor as their Primary Care Physician is not the way to go.”

Not the way to go because:
1. It does not provide a good or even a sufficient quality of care.
2. Its extremely UNcost-efficient for the system.

Among other things.

Comment from Michelle
Time: March 19, 2007, 12:01 pm

Anybody care to respond to anything outside of the “Right to Health Care” debate?

Comment from KrisinNewEngland
Time: March 19, 2007, 1:05 pm

Michelle said: “Would you go so far as to agree that it is incumbent upon those of us who can to provide healthcare for those us of who truly cannot?”

Slippery slope – my gut response is no, why should I? I work hard for my insurance coverage and there are government programs that should provide for those who can’t. But then I know part of the taxes I pay go to just that.

And you can’t just dismiss the idea that people need to be responsible for themselves – because at some point this entire debate becomes ABOUT the welfare bum and those who feel they are entitled to healthcare. We really aren’t talking about the neediest among us when we talk about healthcare “rights” – if we are going to shine the light where it belongs, it IS about those people who have their collective hands out, waiting for someone to pay their way yet again.

I’d love to provide basic health care to everyone who can’t do it for themselves, but built into that will be the inevitable loophole that WILL allow the welfare bum access – on my nickel.

Comment from doorkeeper
Time: March 19, 2007, 1:08 pm

Tort Reform…….wow. I’d say most thinking people in this country believe that somehow, our legal system needs an overhaul, and none more than in this area.

I hate the idea of putting a monetary value on a life, or a limb, etc., but we already do it, at least, when I worked, we were guaranteed a certain lump payment if we lost a limb at work–less for a finger, more for an arm, etc.

And there is something to be said for “pain and suffering” or at least the stress and strain of dealing with insurance companies and etc., but seriously…

Life is hard. Bad things happen. Getting $$$ for burning yourself on McD’s coffee? sigh. There’s so much I could say, but I think it’s just gonna make me froth at the mouth.

doorkeeper

Comment from doorkeeper
Time: March 19, 2007, 1:12 pm

Kris, why AREN’t we talking about the neediest among us? Because we DO NOT get basic healthcare, or anything.
I am far more fortunate than many, as evidenced by the fact that I am discussing it with you–I own a computer.

So here’s the hard question–Would you rather save your nickel, keep the bum from getting anything, and let the neediest be warehoused in terrible conditions, while the gov’t employee who works 40 hours/week with decent perqs and GOOD insurance, bitches and wastes your nickel that was supposed to go to the truly needy?

Comment from Max Damage
Time: March 19, 2007, 1:25 pm

I’m at work right now, so will comment further after the day is through. One thing that seems to have been overlooked is that as a modern, industrial country approximately 16% of our GDP is in the health care industry (http://www.nchc.org/facts/cost.shtml), and health care spending is rising at nearly 8% per year.

That’s one dollar in six that’s already being spent on providing for our health. Compare to the military budget, even in wartime, of only 4% (https://www.cia.gov/cia/publications/factbook/rankorder/2034rank.html). Quite simply, this is not a problem that can be fixed by throwing money at it — there’s isn’t much left to throw. A different solution will have to be found.

My purpose in this initial discussion was to point out that there are finite resources we can bring to bear on this problem. Time, money, people, any of these things taken from one area to suppliment another will have ramifications.

– Max

– Max

Comment from Michelle
Time: March 19, 2007, 1:36 pm

“Slippery slope – my gut response is no, why should I? I work hard for my insurance coverage and there are government programs that should provide for those who can’t. But then I know part of the taxes I pay go to just that”

Me thinks you are trying to have it both ways my dear. If I am reading you correctly you don’t want your hard earned money going to provide health care even for those who truly can’t. And you justify that by saying that there are government programs for those who can’t. But how does gov’t fund those programs? With your hard earned tax dollars of course! Government has no resources of its own, it all comes from you and me. So you can’t rely on a government program to meet the need while at the same time saying your tax dollars should not be spent on such a thing. Unless you are only going to spend someone else’s tax dollars?

I’m not dismissing the idea of personal responsibility. I’m just trying to narrow the field. To see if we have any point of agreement, any meeting of the minds at all. So for now, for this point in our discussion, I attempted to put everyone else but “the neediest” out of the equation. We can pull the others back in later. But watch out for the other extreme too – because if you focus so hard on not helping the “welfare bum” that you can’t even see anything else, you risk, intentionally or not, throwing “the neediest” in the same garbage heap as that bum.

Let’s deal with the welfare bum later. We can’t solve all the world’s problems tonight.

Comment from KrisinNewEngland
Time: March 19, 2007, 6:04 pm

Michelle said: “…But how does gov’t fund those programs? With your hard earned tax dollars of course!…”

And that’s what I said in what you quoted from me – I know that part of my tax dollars goes to those programs. And no I don’t want it both ways. As I said, those programs exist for the neediest among us – the ones who CAN’T provide for themselves thru hardship, poverty, extreme illness, etc… The way I want it is to continue to provide for them, while most definitely blocking out those who feel they are entitled to it – for no reason other than their own greed.

Comment from Michelle
Time: March 19, 2007, 6:17 pm

All right. Finally. A point of agreement. Thanks for putting up with me.

Now I will take my life in my hands and ask for a point of clarification – the ones who CAN’T provide for themselves thru hardship, poverty, extreme illness, etc… those that you want to provide for, is it only out of charity that you wish to do so or do you think that the rest of society is morally obligated to provide THOSE people with basic healthcare?

Comment from Max Damage
Time: March 19, 2007, 10:40 pm

Michelle asks the sticky question: “the ones who CAN’T provide for themselves thru hardship, poverty, extreme illness, etc… those that you want to provide for, is it only out of charity that you wish to do so or do you think that the rest of society is morally obligated to provide THOSE people with basic healthcare?”

Why can it not be both? The Judeo-Christian moral framework says to take care of those less fortunate, less able, the old Good Samaritan parable and such. This country was founded upon and continues to believe in such a moral framework, as proven though our charitable giving. But there’s that key word, charity. It is charity when I choose to give a portion of my wealth or time towards helping another. It is robbery when it is taken from me against my will, no matter how moral the cause or desperate the need.

Our social contract ensures somebody will always be unhappy funding a military or police or farm subsidies or health care, but all in all those are functions I have a say in via my vote. I posit that my taxes are the charity required in our social contract.

And you’re right, we are not a perfectly capitalistic system, nor would I wish for us to become one. In spite of my libertarian leanings, even I recognize that there is a need for things such as eminent domain, that the good of the society may outweigh the good of a specific individual. I temper this with the thought that society is made up of individuals, so what serves individuals best will ultimately serve society best. Capitalism so far has a track record that beats any other economic system, and the market forces it uses have lifted far more people out of poverty than any other experiment. Ultimately, compared to socialism, fascism, communism, and communalism, capitalism has proven itself to be best able to adapt to change and provide rewards for those successfully meeting a need.

Like all such systems, capitalism does need some regulation, some common framework so all parties are approaching commerce with the same assumptions. Laws are that framework. To attempt it without rule of law would be anarchy.

The stickler here is that a moral obligation quite soon leads to a choice of allocating resources, and resources are finite (there’s that pesky economic problem again!). Many churches say tithes should equal 10% of income, some calculating that after expenses (disposable income, in other words). Our government says tithes should be closer to 25%, 35% if you happen to make too much income by whatever scale it is they use to decide these things, with a few deductions to encourage us to do things beneficial like donate to charity.

But I still have expenses. Let’s say I’m not quite living paycheck to paycheck and have a good 20% of my income as disposable, and let’s further say I’m a really generous guy and want to give half of it away. Well, that’s 10% of my income, how do I dispense this largess responsibly? Do I give it to a homeless shelter, research into breast cancer, research into chemotherapy drugs, or maybe to the kid down the street who needs an operation? I can fund one fully, I can fund many insignificantly, ultimately the choice comes down to which one will do the greatest good for the most if I’m in a logical frame of mind (chemo drugs) or to the kid if I let my heartstrings decide for me.

So the kid gets his hernia fixed and a new chemo regimen takes another six months and some random number of people die in that time. Or I fund the chemo and the kid’s intestines knot up and he dies.

That’s the decision. Michelle is arguing this from her heart, which I view as a perfectly valid but also perfectly selfish point of view. Given limited resources, and a need that is for all intents limitless until we’ve all personal physicians living with us, this allocation of resources — an economic problem — will continue to remain the ultimate point of contention in the argument. How we allocate those resources determines who lives, who dies, and who gets inadequate or stellar care.

You can’t have it all. You have to settle for what’s possible, and there’s always going to be somebody under-served by the only possible.

I think we’ve established the health care as a right, service industry, and economic arguments. Little more can be added there. Shall we move on towards the current system of insurance to see how that affects who pays and how much? I’d be much interested to read Michelle’s thoughts on socialized medicine as the opening salvo in this battle of thoughts in the marketplace of ideas.

– Max

Comment from Max Damage
Time: March 19, 2007, 10:52 pm

Oh, Michelle? On the whole “shoot all the lawyers” comment, its not the lawyers I dislike. Their job is merely to work within the legal system. It is the legal system, the law of the land, that I believe to be at fault. Just as we are not a truly capitalist system we are no longer a nation of laws. We are a nation of loopholes and special circumstances and vague wording that can be interpreted. That’s not the fault of the lawyers, that’s only the fault of the legislatures writing the laws the lawyers must work with. Unfortunately, this has serious side effects in that our tort system is costing us billions for courts to tell us what the law supposedly means.

I’d be much oblidged, given your background, if you could address that in one of your responses.

– Max

Comment from Michelle
Time: March 20, 2007, 4:25 am

Max, one or two quick comments before “moving on”.

I see no reason why we can’t provide for the neediest among us both from the recognition of a moral obligation and a sense of charity. In fact, I think it should be that way. Charity is one method of recognizing a moral obligation; problem is that its not enough, its an insufficient and inefficient way of providing health care to those who cannot provide it for themselves. Funding research into breast cancer and chemotherapy drugs or helping the kid down the street who needs an operation are all worthy and laudable endeavours. Unfortunately its not going to provide every day needed medical care for (as examples) the disabled or the elderly.

And I would like to put my previous questions of Kris to you:

Will you give me a “moral imperative” to provide at least basic health care to those who CANNOT provide it for themselves? Would you go so far as to agree that it is incumbent upon those of us who can to provide healthcare for those us of who truly cannot?

I like clarity. It’s important to me. And in the meantime I am happy to be “selfish” and “argue from my heart”. Although I must say that, at least from my point of view, some of the comments that came initially following my post sounded a lot more “selfish” than my reasoning.

And now I must “move on”, as in literally out the door. More later.

Comment from KrisinNewEngland
Time: March 20, 2007, 5:24 am

Purely by the numbers, my husband and I pay nearly half of our income in taxes, which in part fund the previously mentioned Medicaid program. Our personal healthcare costs are pre-tax, as are our maximum contributions to our 401(k) plans, which all reduce our tax obligations – yet we still pay nearly half. How much more should we pay to ensure we satisfy the moral imperative? Is it selfish to want to take home half of what we earn? At some point we’ll be taking home less than half of what we work hard for – and that’s a shift I’m not going to be too thrilled about.

Comment from Michelle
Time: March 20, 2007, 8:08 am

Kris, why should you take home less than half of what you make? I think that’s ludicrous.
Excuse me, I have to duck the rotten tomatoes being thrown by those who will likely tell me that my arguments and positions are contradictory. But here’s what I think – JUST BECAUSE you pay half your income in taxes doesn’t mean that any of that tax money is being spent wisely. I will assume that some of it is but………
My reasoning does not call for someone who is already paying half of their income to the government to pay more, it calls for the government DOING something differently. Not necessarily more, more, more……..just take what you already have and do something different with it. How different? How radical? I dunno……..

Comment from KrisinNewEngland
Time: March 20, 2007, 8:22 am

Michelle – it’s all about the taxes in the States. The old adage is – the more you make, the more they take. At this point the hubby and I are perilously close to the 50% tax bracket; we are in the 45% right now (meaning the government – Fed & State – takes that percentage of our income). One more raise or an unexpected bonus could push us into the next bracket – terrible to think I’d rather NOT get that bonus or raise, cuz in the end we’ll loose most of it to taxes anyway.

But that’s a WHOLE nuther subject.

And there it is – I pay my taxes but have no real control over how the money is spent. You are right, it’s likely NOT being spent the way it should be, but my only control over that is my vote.

Furthermore, with the state of Social Security here – the “contract” we have with ourselves, in that what I’m paying into the system pays for the current retirees, and what the next generation pays into the system should be for my generation – will likely be bankrupt by the time it’s my turn to collect on that contract. So in reality, unless the hubby and I set aside some SERIOUS money for our hopeful aged-ness, we’ll be one of the neediest among us and there won’t be anything left for us.

Again – a whole nuther subject. This whole thing is like a rotting onion.

Comment from Michelle
Time: March 20, 2007, 8:25 am

Kris
I should have put this in the previous post.
But there is a difference between whether or not we recogize a moral imperative and the discussion around how to fund that obligation. I feel like I made great strides in just getting one recognized

Comment from doorkeeper
Time: March 20, 2007, 10:04 am

somehow, I think many of us are talking from different starting places. The title of this post was, “If It’s Broke, You Gotta Fix It.”

And what I am hearing is, some saying it isn’t broke.
Some saying it’s broke, but, there’s no fix, or no good fix, or why bother, I’ve got mine.

And some assuming it is broke and therefore must be fixed.
so……..now what?

Comment from Michelle
Time: March 20, 2007, 10:23 am

Now………doorkeeper, on that point……….I would respectfully request that we wait until my next post, Part II. Which will soon be forthcoming. Promise.

Interestingly enough, although when I first started this discussion, I was of the opinion that the US healthcare system was in definite need of a few “tweaks”, to put it charitably (just my opinion), my point was NEVER to convince anyone of that fact or to presuppose that I had something better to offer. My only intent on starting a discussion on health care was to point out and provide some evidence that, contrary to what some (many, oh what the hell, most!) here seem to believe, were the US to decide to embark on some form of socialized medicine it would not be neither the end of the world nor the US, itself. And that, while far from perfect, there are some aspects of socialized medicine to be recommended.

Have we got slightly off track that original intent? Sure, but I haven’t regretted it for a minute. Its been an interesting discussion. And although I really do want to respond to the tort system issue, I’m afraid I can’t right at the moment. But I will before the day is out. Just bear with me please.

Comment from unkawill
Time: March 20, 2007, 1:13 pm

The real problem as I see it , is that we, as a country already have close to, if not over 20% of the population working for the Gov. in all it’s forms. IMO this is an unsustainable situation. These employees contribute nothing to GDP. They are a drain on resources, to say nothing of the Massive Waste, Fraud and Abuse endemic to the system. Let’s get rid of the Dept. of Education, which hasn’t educated anyone and promotes Revisionist History,Communism and Socialism among other equally distasteful things. Let’ also get rid of HUD, INTERIOR, INDIAN AFFAIRS, HOMELAND SECURITY, IRS, social security and YES MEDICARE/MEDICADE.

THE LAST thing we need is more Government

I have heard that “THE POOR” in this country have a better standard of living than the average European. Maybe it’s because “the Poor” don’t pay taxes. I know I do. As a small business owner I am subject to 15% SSC withholding, FICA and FUTA plus $1400 a month workman’s comp, health insurance, Income tax, ect… it all adds up to about 60% of my Gross Income when all is said and done. In addition I typically spend 12 hours a month + 50 hours at tax time in uncompensated labor complying with regulations.

So Yeah Michelle, or whomever said it I’m selfish.

Comment from doorkeeper
Time: March 20, 2007, 3:10 pm

I agree with the first portion of what you said, unkawill. I agree that the current system is an incredible waste and should be changed. But what will you replace, say, the Dept. of Ed. with? What about Medicare/Medicaid?

I am truly interested in your answers, but will be out of town for two days–don’t be disappointed if you hold forth and I seem to not pay attention, I will.

As for the second part of your comment, I’d ask just who you label as the “poor” I certainly pay taxes, as does my husband. I believe we fall near the “poverty line” but since we live in an area with fairly low cost-of-living, and rural areas are generally easier (cheaper) to live in, perhaps that doesn’t count.

I am sorry about the 60% of your gross that goes to taxes. Let me assure you that we are getting very little of it, especially my profoundly disabled child. What will you do with him if you stop Medicaid? Or if the Dept. of Ed doesn’t have to educate him–oh, I forgot, they’re not, really.

On a related note…..I should really ask the question in a separate post, maybe M will do it for me
What do you think of the flat-tax idea?

sincerely,
doorkeeper (learning more than I believed I could stuff into my head!)

Comment from KrisinNewEngland
Time: March 20, 2007, 3:19 pm

Doorkeeper: how would you apply a flat tax rate? Who would bear the greatest burden?

Comment from Michelle
Time: March 20, 2007, 3:40 pm

Tort Reform
I thought I didn’t have a whole lot more to say on this issue other than what I already had in the main post. But that was until I started typing. Then it got substantially longer.

But first – knee jerk rerctions. We’re all subject to them, on certain issues more than others. One that I’m particularly good at involves insurance companies. I’m biased; I don’t particularly like them. But that said, knee jerk reactions (my own incluced) bother me. I have come to the conclusion that this where the majority of the “shoot the lawyer” comments come from, there’s not a whole lot of rational thought behind them. It’s always easier to blame the “other” and lawyers, like politicians and insurers (for some of us, mea culpa) make fair game.

On to tort reform – Acknowleding that statistics are often just lies looking for an an argument (or something like that), my understanding is that lawsuits contribute less than 1% of all healthcare costs in the US. Perspective. But if my statistic is wrong, please correct me.

That being said – assuming the 1% figure to be accurate and if you still find it necessary to blame the courts for the cost of medical malpractice insurance, maybe you should blame the juries instead……….. In my opinion, the cost of American jury awards in general (including malpractice) is astronomical. Through the roof. Way higher than you would find in Canada. I’m fairly confident in stating that the US likely leads the world there. And unfortunately the precedent-value of past awards leads to expectation of more every time.

Example – as a junior (first year) associate in a law firm I was assigned to be the first contact for the phone calls arising from the personal injury ad in the phone book. One gentleman called with a story of a slip on the ice. He fell. He cut his finger. It hurt. I enquired whether he had went to the hospital, whether he had required stitches. No, to both questions. At which point I struggled big time to maintain professional decorum and explain to him that, putting the issue of liability aside, it likely wasn’t worth his while to proceed legally.

Where do these people come from?

I have my own theory on that – these people watch too American TV shows, read about too many American jury awards. I don’t know where the US is (or if its anywhere at all) with the idea of capping jury awards in personal injury cases (medical malpractice or not) but personally, I don’t think its a bad idea.

What you have to get here is I live in a very conservative province. Hard to believe, eh? We call British Columbia the California of the North because any wacky idea will get tried out there first. And personal injury awards are significantly higher in BC. In fact, they essentially get lower the further east you go. So sure, I would seriously consider the idea of capping personal injury awards in the US.

But beyond that, think carefully – do you really want to remove the court process from the equation? If so, what (if anything) will you put in its place? Are you prepared to remove all redress from victims of medical malpractice? Vaccination damage? Gross medical incompetence? Because these things do happen.

And what happens in Canada (and I will assume the US until shown otherwise) is that the medical association which insures doctors will fight to the death even when they know liabiltiy is fairly clear. They do not want the precedent value of a finding of liability against a doctor. And they have deep pockets, a hell of a lot deeper than your average, or almost any, plaintiff.

Lawyers taken these cases on a contingency basis meaning they are not paid for their time as they go but receive a percentage of the award or settlement, if any, at the conclusion of the case. In the interim, and no matter whether or not the plaintiff is ultimately successful, the plaintiff will be liable for the cost of disbursements (out of pocket expenses such as filing fees, cost of discovery examinations and the cost of expert witnesses). Although some lawyers can afford to carry these costs to the resolution of the claim (at which point the plaintiff will ultimately be responsible for them whether their claim was successful or not) most lawyers cannot afford to do this. The lawyer is already effectively “working for free” in the interim (and may well be working for free period if the claim is unsuccessful) and is not going to want to cover the cost of those out of pocket expenses themselves and effectively “go in the hole”.

Expert witnesses costs, in particular, can be substantially prohibitive. In most provinces in Canada you are looking at going out of province and maybe even to the US to find an expert willing to testify on your behalf. Not because your case is so bleak that you need to find a “gun for fire” but because the majority of doctors are not prepared to testify against a colleague, not one they might personally know or that at least moves in the same circles as they do.

Medical insurers know all this and know they can often wait out the plaintiff and make the claim “go away” long before its judged on its merits Around here at least a lawyer would think long and hard before taking on a medical malpractice case. Liability would have be pretty clear. And damages substantial enough to make it “worthwhile” from the lawyer’s point of view. And that’s a very real issue on the other side of the equation for which I have no answer.

Comment from Michelle
Time: March 20, 2007, 3:55 pm

Has anyone noticed that other than one comment from jpr, the only participants in this thread have been max, unkawill, Kris, doorkeeper and myself?

No one else brave enough to enter? Or no one else stupid enough to enter? Think anyone else is reading? Things that make you go hmmmm…….

As an aside:
I HEREBY PROMISE TO POST PART II SOMETIME TOMORROW. IN SOME FORMAT. BUT I MAKE NO PROMISES AS TO HOW WELL ORGANIZED OR INTELLIGENT IT MIGHT BE.

Comment from Max Damage
Time: March 20, 2007, 6:00 pm

Michelle is fattening me up for the slaughter, I can tell. “Will you give me a “moral imperative” to provide at least basic health care to those who CANNOT provide it for themselves? Would you go so far as to agree that it is incumbent upon those of us who can to provide healthcare for those us of who truly cannot?”

Indeed, I would go that far on moral grounds, but looking at the definition of “incumbent,” an obligation or duty, I hesitate to use this incumbency as the justification for coercion of others. It’s a fine system of believe for a theology, not necessarially for a government.

I’m also reminded of an observation P.J. O’Rourke once made regarding the tenth commandment. To paraphrase, you’ve only 10 rules to put down for your society to live by, and the last one you give them is don’t be jealous of your neighbor’s wealth, get off your butt and go earn your own. As moral arguments go, that’s not a bad one to keep in mind.

- Max

Comment from Michelle
Time: March 20, 2007, 6:58 pm

Not so much fattening you up Max as just selfishly trying to keep my own neck off the slaughter block.

But I would hate to think that after two days of discussion you still don’t get the point. Oh well, we will see what the ‘morrow brings.

Comment from unkawill
Time: March 20, 2007, 7:19 pm

Michelle, you are so sweet! I’m not participating, I am Bitching and Bloviating.
” Or no one else stupid enough to enter?”
Judging the thoughtful and well written post’s throughout here and the home Blog, I am well and truly over my head just trying to hold an intelligent conversation here. My fault. My abysmal typing skills contribute to my lack of eloquence and my lack of a Degree qualifies me as UNEDUCATED by first world standards. I should have stuck it out, to get the sheepskin,in that you should finish what you start, alas, life got in the way. IOW writing is my least accomplished communication skill. However I can and will talk your ear off if given the chance.

There are no easy answers in this whole mess. The Federal government being involved just makes it worse for all.

Doorkeeper, I feel for you and your son. I have 2 Autistic nephews that require professional care. My father is in the early stages of Alzheimer’s onset. My mother has a litany of health problems including Diabetes,Hypertension and emphysema, is on OXY 24/7 and is facing an amputation of her left foot. Dad, being retired military/ civil service, has full health care, Government supplied, neither he or I am enamored of. I take care of Mom with the help of one of my sisters and her daughter who is a RN. I have converted my living room into a bedroom for her, ripped out my guest bath and expanded it so we could install a Roll in Roll out shower and other handicapped amenities. I will NOT put her in a nursing home. JUST. AIN’T. GONNA. HAPPEN.

Dept. of Ed. should be abolished. The necessary functions should devolve to the individual states to fulfill as they see fit.

Medicare/Medicaid, I have no answer to that. I just know/ FEEL that I shouldn’t be liable for other people’s DEBT’S.

As Far as the Flat Tax/ Fair Tax I am All for it!

Comment from Michelle
Time: March 20, 2007, 7:44 pm

unkawill
I give! I surrender! But only to you – and only on certain points. Just two minutes ago read your response to my moonbat comment at Lex’s. Didn’t know whether to laugh or repeatedly bang my head into the monitor in frustration – so I did both! Although I must say I am seriously (honestly) considering changing my online moniker to something with the word “moonbat” in it. Am starting to like the idea. But THIS response of mine is OFF TOPIC and that CANNOT be had – I won’t allow it!

So. Bitching and bloviating are participating………I think. At least you were. So keep it up! I often think that “degrees” only make people stupider…….as in stupid enough to think they are smarter. Trust me, I have some personal experience with that particular issue.

But…..you are a contradiction in terms to me unkawill. Much as another American friend I have is – no, not you doorkeeper. Yes, it was me who expressed that your comments up above came across as sounding rather “selfish”. Will stand by that. For those comments. Can’t quite jive them with the experience you express in your comment just above this though. You’re an enigma to me, I’m afraid.

But enough of this – I have an IPP to review and then I must off to bed. Apparently I have some type of a soliloquy or essay to deliver tomorrow.

Comment from unkawill
Time: March 20, 2007, 8:03 pm

I like you too Michelle. I hope that we will get to meet in person sometime in the near future. Maybe at the inauguration of the new “Nation”, or at Kris’s Bunker dedication

Comment from unkawill
Time: March 20, 2007, 8:20 pm

Michelle, As far as being an” Enigma”. I an just an average American. I don’t feel that I am anything special. I work hard. I take care of the people that I care about. I donate to, IMO worthy causes. Both Time and Treasure. Just trying to get through life as best I can.

Sleep Tight and don’t let the bedbugs bite. Yak back at Ya tomorrow!

Comment from Michelle
Time: March 20, 2007, 8:38 pm

Max
I do want to “move on” (and I will tomorrow) but was wondering what your response was to the points contained in my original post as to the potential effects of giving insurers more rights/say in the matter of health care.

And since I did my part today re: my thoughts on tort reform, I await that response. Both to my questions in the original post and any response you may have to what I wrote today.

Yeah, I am either very brave or very stupid. Or, possibly, just trying to avoid tomorrow. Hard to say.

Comment from unkawill
Time: March 20, 2007, 8:40 pm

I’m also reminded of an observation P.J. O’Rourke once made regarding the tenth commandment. To paraphrase, you’ve only 10 rules to put down for your society to live by, and the last one you give them is don’t be jealous of your neighbor’s wealth, get off your butt and go earn your own. As moral arguments go, that’s not a bad one to keep in mind.

- Max

truer words have never been spoken, Esp in this land of opportunity.

Comment from unkawill
Time: March 20, 2007, 9:40 pm

I think we have a record for the # of comments here on one post Michelle!

You should, IMO, as others have opined, start your own Blog.

Comment from Max Damage
Time: March 20, 2007, 10:10 pm

Michelle, my response to your question regarding giving insurers more rights/say into the matter of health care is, “It would be a bad idea.” Not that I have any problem with insurers contracting for specific procedures (mammograms, eye exams, etc..) but insurers have absolutely no incentive towards the insured. This is especially true since most folks think insurance is to be provided by their employer and not an item to be shopped for. To tie into the tort reform topic, how many dollars will you spend on a lawyer to convince the insurer that the procedure was diagnostic and not one of the many uncovered treatments? And who pays, ultimately? Give ya a hint, it’s not the insurance company — any losses are passed on to the premium payers.

My dog in the fight: diagnosed with a hernia in July while on vacation. Called it in to the insurance company. Policy renewal in August. Operated on at home in August. I hadn’t met my deductable by the end of July, no payment on the old policy. New policy took effect and I have a pre-existing condition, so no payment for that. Five grand for surgery, insurance all the way and none oblidged to pay.

I learned about insurance from that. I learned a lot.

Insurance companies take money from a lot of folks in order to pay a bit of money to a few folks and have some left over for a profit. I can’t fault that, it’s a good business model and we’re paying for a safety net to fall into. Life insurance, as an example, I’m paying $50/mo that I’m not going to die, and they in turn agree that if I die before I’m 70 they’ll pay a half-million or so. Actuarial tables quantify the risks, we enter this deal with eyes wide open and they get my blood to ensure I’m not lying on the application. It’s a gamble, but we both know the odds.

Contrast with health insurance. I’m given a $500 total cost for the year, or an 80/20 split. At those levels my incentive is to burn up that $500 fast and take the free lunch or go for the expensive treatment because I’m only paying 1/5th of the cost. Insurance eats the rest, thinks I. That’s kind of like thinking I got a check from the government, all the while knowing that money was taken from others to pay me.

I used to think insurance was to cover the unexpected. Today it seems insurance is to give us a fixed maximum for anything, and we seem to think it’s the responsibility of our employers to provide it. That is not a market-driven scenario, and hence as the consumer I’ve no incentive to keep the costs down. In fact, I’ve an incentive to use the highest-cost care available since my prices are fixed and I never see the actual cost. This has to change before health care can begin to respond to outside pressures with regards to costs.

I’ve a neighbor, had cancer in his chest. He went to the hospital, spent two days and had his bone marrow drawn, worked on, and re-inserted. Total cost was 1.2 million dollars. His cost was $200. That’s the problem. First, there are few things worth 1.2 million dollars that can be done in 2 days where all but 90 minutes of that time is spent in bed. Second, if he only pays $200 on a 1.2$M bill what incentive does he have to question the procedure that is recommended?

All things have value. Hiding those values, passing them off to others, I submit is part of the problem.

– Max

Comment from KrisinNewEngland
Time: March 21, 2007, 5:14 am

Unkawill said: “…As far as being an” Enigma”. I am just an average American. I don’t feel that I am anything special. I work hard. I take care of the people that I care about. I donate to, IMO worthy causes…”

I believe he just described about 90% of the American population. And If I may be so bold – perhaps the majority of just about ANY population, at least in the industrialized world. We all work hard to have what we have – some have more than others and it has ever been thus. We work hard and we’d like to keep a large portion of what we earn; we’d like to help our fellow man as much as we can, yet keep out the bums and abusers.

And there is NO easy answer to getting that done.

And yes, when I dedicate that bunker in my backyard – construction scheduled to begin this spring – Lex Babes and Lex Legionnaires are all invited. Cuz in the end, we all want the same things even if we come at them from different viewpoints.

Comment from Michelle
Time: March 21, 2007, 5:36 am

No easy answer – I agree 100% Kris. I certainly don’t intend to propose one cure-all solution. But discussion and the tossing around of different viewpoints and ideas is always useful for everyone (forced to be) involved.

Can just picture it in your bunker – I once described Lex’s as a small house party, serious political discussions in one room, laughing and carrying on in another. If the Lex Babes and Legionnaires were ever to actually meet, I think that’s EXACTLY what it would be like.

Legionnaires, heh, makes them sound kind of old, doesn’t it?

Comment from doorkeeper
Time: March 21, 2007, 7:25 am

writing on the fly…..should be packing…….
I love how much I am learning about all kinds of things here and on TOS. Thanks for bearing with me.
Unkawill, wish we could sit down with a Guiness, sounds like we have way more in common than different, the biggest thing which leaps out at me is that I type faster than I think!

One question, comment, whatever….I thought part of the purpose of employer-provided health insurance was to ensure that PEOPLE WORKED to get it…..if it’s not part of an employment package, who decides who gets it? The gov’t? I think not!! And wasn’t (real ignorance showing here) the Medicare thing dreamed up as a help to Social Security for people who had worked their whole lives and needed that “security blanket”?
I know there’ll be a lot said on this, and I can’t wait, but a two-day trip and then two days spent with my client from 9-9, will ensure that it’s Sunday, at least, before I can say much.

Although, the MSG just volunteered his laptop for my trip…..
swimming in the hotel pool for hours, letting the stress fade away, or hunching over TFD on my bed???? what a choice.
d

Comment from KrisinNewEngland
Time: March 21, 2007, 8:23 am

Doorkeeper – what, you can’t have the laptop by the pool? Hope you manage to get some relaxation out of your trip, if there is a pool…

Michelle – it’s an interesting crowd here.

Comment from Michelle
Time: March 21, 2007, 8:54 am

“Michelle – it’s an interesting crowd here”

Hon, its a fascinating crowd over here.
I NEVER would have started this post on TFD if I didn’t feel that I already had a relationship with a lot of the people here. Would have been too “dangerous” for me – being a subtype (of the wimpy almost leftist type) that don’t much like confrontation, you see

And I had no other intention, when opening this discussion, other than being “true to myself” and expressing my ideas on this subject in an environment where I knew they would be a little-less-than-readily embraced. But much like what I wrote in “A Little to the Right Please”, while my foundational views remain unchanged (yet, please feel free to keep trying, as I will), I have been forced to think about private insurance and a few other things a little differently and confront my own biases.

In other words, damm it, you people are doing it to me again – forcing me to check out my peripheral vision! Which, I suppose (particularly for those flying types), can never be a bad thing. So……..I can only hope that I might be returning the favour to some others, just getting them to think in a little wider frame of reference.

Hey look, this comment could turn into a whole new post.
‘Nuff of that – see you in Part II.

Comment from Michelle
Time: March 21, 2007, 9:23 am

“Michelle, my response to your question regarding giving insurers more rights/say into the matter of health care is, “It would be a bad idea.”

Although somewhat confused, I will take that at face value. Its just that I read it as being your idea to give the insurance companies a bigger stake…..for example, with any hospitals and clinics they deal with. But whatever.

“To tie into the tort reform topic, how many dollars will you spend on a lawyer to convince the insurer that the procedure was diagnostic and not one of the many uncovered treatments? And who pays, ultimately? Give ya a hint, it’s not the insurance company — any losses are passed on to the premium payers.”

I must confess bewilderment here. Cannot compute. Meaning if you would like a response from me on that comment, you will have to clarify. Perhaps the disconnect comes from not being as familiar, not positioned on a regular basis in the world of skirmishes with healthcare insurers. You have my sympathies. As, I am sure, I have yours for other issues, perceived or real.

The story about your neighbour – ridiculous! Shall we assume he has been “cured” at that price? Something I have come to notice is that the cost of care, everything from complex “procedures” to a visit to your GP seems a lot higher in the US than here. For example, my child can visit a pediatric neurologist in his office or have visit her while she is hospitalized for roughly the same “cost”, “fee”, however we choose to language it. Nothing exact here, but I have the figure of roughly $75 in my head. GP visit – around $40 here. I am sure that a bone marrow procedure would be pricey here too but………. $1.2 million?? Whole other can of worms perhaps?

“All things have value. Hiding those values, passing them off to others, I submit is part of the problem.”

Very true. But unless you or I can cough up that $1.2 million or some other less exorbitant but still nonetheless pricey figure ourselves……….??

Comment from unkawill
Time: March 21, 2007, 7:55 pm

And Part II is….. sorry to prod, but, We Still WUV You! AND YOU ARE NOT A ” MOONBAT “.

Comment from Michelle
Time: March 21, 2007, 8:12 pm

Wanna bet? Wanna bet?! I am a moonbat at the moment.

And DO NOT push your luck, good sir. I do believe I said “sometime tomorrow” which would be “sometime today”. And I am taking full advantage of the East Coast time difference here. Cuz its only 7:55 in Lex Land……….

Don’t push it. Uh uh. No way. No how. See? Told you I am feeling like a moonbat tonight. This is worse than trying to get a paper done for school.
And BTW….and this is significantly important………IF I don’t start actually working soon (the kind that pays $$), well I won’t have a health care crisis (heh, take that!) but there will be severe consequences for my family!

And I am giving up blogging after this sucker. Which is not a blog. Its a treatise. And you will be sorry cuz you will have to read it!

okay, I’m think I’m done. Thanks for the chance to vent – really needed it. In case you couldn’t tell. Anyone got a beer?

PS One more thing – the majority of the readers of this fine…..blog…….have been conspicuous in their absence. Come on, people, this one unkawill is so anxioulsy waiting for took some work.

Comment from unkawill
Time: March 21, 2007, 8:23 pm

doorkeeper says “Unkawill, wish we could sit down with a Guinness, sounds like we have way more in common than different, the biggest thing which leaps out at me is that I type faster than I think! ”

doorkeeper, I would love to buy you and everybody else, who hangs out here a Guinness, or three.

Let’s plan on Kris’s Bunker dedication ceremony, it should happen in the Fall,which is the best time of the year to be in New England. By the way where is the En- Gland located anyway? And what happened to the Old En-Gland?
I unfortunately type much slower than I think. Orders of Magnitude slower!

Comment from unkawill
Time: March 21, 2007, 8:31 pm

“Come on, people, this one unkawill is so anxioulsy waiting for took some work.”
What? Dear Michelle, Please clarify. Beer on the way!

How about an Exotic Export? Lone Star Light?

It’s what I drink.

Comment from Michelle
Time: March 21, 2007, 8:36 pm

Whatever. Sounds good. Make it a double
And thanks. A friend in need is a friend indeed but a friend with beer…… is a very good thing!

Comment from unkawill
Time: March 21, 2007, 8:43 pm

I have always thought so myself!

Pingback from The Flight Deck » Finding the Balance – Healthcare Part II
Time: March 21, 2007, 8:56 pm

[...] than that.  But I really only came to this conclusion in the last couple of days (after I wrote If Its Broke You Gotta Fix It and then looking at some statistics in preparation for writing this [...]

Comment from Michelle
Time: March 21, 2007, 9:00 pm

There you go unkawill. Just for you. And anyone else who’s fooish enough to read it. I am, at least, a woman of my word. For what that’s worth.

I am hereby providing notice that I am taking a vacation from blogging. [BEEP]

Comment from unkawill
Time: March 21, 2007, 10:36 pm

Thanks Michelle, I’ll go check it out! Oh BTW one of my sisters is named Michelle also. You are much nicer than HER!

Yak at you later, Will

Comment from Max Damage
Time: March 21, 2007, 11:57 pm

Michelle, what I meant by saying giving insurers more rights/say into health care would be a bad idea is that I think it’s universally true that bean-counters have no business second-guessing doctors, or the patients, when it comes to care. I’m an engineer, you’re a lawyer (not entirely accurate, but good enough for the purposes of comparison) — I don’t tell you what the law is, you don’t tell me how to build bridges. We have room to work together, of course — I have to build bridges according to law and you can tell me what those laws mean, but all in all we each have an area of speciality and it’s best to let those with expertise in an area to have the final say when it comes to policy in that area.

As I noted, bean-counters have determined a human life is worth a specific amount of money. That’s what reducing human life to an actuarial table or a statistic does. That’s a reasonably good thing to know when formulating a strategy, but it’s useless when formulating a tactic for treating an individual.

Letting insurers bargain for services is an entirely different thing. Most dental insurance requires the insured to pay (I’m not looking it up, so I’ll generalize) $15 for a filling, $500 for a crown and $2000 for an implant. The dentist who accepts that insurance gets a fixed rate per job, and gets a large potential customer base. Here the insurance company basically raises the costs for the customer to promote early care, and promotes a large customer base to the provider in return for a lower, fixed rate. That works a treat for some types of standard care, particularly the diagnostic and preventative kind. Mammograms, colonoscopies, flu shots, annual checkups, eye exams, fillings and the like. It is not a good model when designing a chemotherapy treatment for cancer.

My neighbor is cured, by the way — cancer-free for three years and hopefully forever. A relative didn’t make it, died in his early 30′s from a rare cancer. At that time there were maybe a dozen cases in the journals to draw notes from, chemo for it had to be invented. In the case of my relative his contributions to the knowledge of that cancer led to others being cured, to new chemotherapy and advances in radiation treatment. I *still* get calls from the physicians who treated him, so closely did we bond over those agonizing years between diagnosis and death. To a one they each tell me of the knowledge gained by the experiments and the names of people they’ve successfully treated because of them. And I dare say no bean-counter in an insurance company or in a government office will ever stop looking at his spreadsheets long enough to ponder the potential benefits a non-standard treatment today may have 30 years down the road.

That is the fear of socialized medicine, that my choices will be limited and some faceless bean-counter will tell my doctor what he can and cannot do, and I’ve no recourse to appeal that decision. Nothing annoys a person like having somebody else tell them what they deserve.

– Max