Monday, November 28, 2005
An Argument about Universal Health Care
Well, that may be true. However, the Democratic Party has a lot of good “old” ideas that haven’t yet been tried. One of them is the idea that universal health care is a public good, something that would be of great benefit to everyone, whether sick or healthy. I present here a summary of a running debate several of my e-friends and I have had over this issue. When I quote an argument from a friend, I will identify that person only by an initial: H, S, C, etc.
H has some objections to universal health care (UHC). Here is a summary of some of them:
1. If UHC is “free” or paid for by government out of taxes, there are some who will take advantage of it. Hypochondriacs will overuse the system and make it very expensive.
2. Since there aren’t enough doctors and other health care providers, care will have to be rationed. Medical procedures will have to be denied or postponed. Canada has a system of UHC, but there are (said to be) waiting periods of several months for many kinds of surgery.
3. In addition to rationing, there will be certain procedures that the system can’t provide at all because of the expense. Some Canadians have to come to the United States for such procedures as heart transplants.
4. I ask you, Al and S and C and others, whether you want your tax dollars spent to take care of some individual who has ruined his liver or lungs by excessive drinking or smoking and provide that person an expensive organ transplant? You yourselves have been careful not to smoke or drink to excess. You would therefore be taxed for your abstinence.
At one time I wrote H a rather tart and unkind message:
Your continual argument against any form of UHC provided by society (e.g., government) seems to be of the following form: "I've got very good health care. Let those who can afford it have the best. Too bad about everyone else."
H responded as follows:
(1) You think because I think something would be thus or thus that I am for or against something. This is a Dem faulty thinking. I would be happy for everyone to have UHC. I just try and study what the effects of this would be.
(2) I say if we give all medical care the care will be substandard. I am not sure I can prove it right now. Those on Kaiser HMO are not getting the best care, they just don't have others to compare it with.
(3) Providing health insurance is a big problem. It may not be their major problem though, I think the unfunded retirement liability is looming large now and will be worse.
Your comment (1) is that you would be happy if everyone had UHC. However, in (2) you say that the care provided under UHC would be substandard. In (3) you say that we can't afford it.
H: You don't understand my logic and I am not sure I can make you understand. But, before I attempt to answer please tell me what you mean by UHC? Does this mean everyone in the US has the same full coverage paid by taxes? Or, some graduation (i.e., some GOV help…) of coverage based on ability to pay say a sliding scale of 0 to 100% ability to pay (this still would be UHC).
This would be the money side of it, then there is the availability and compensation for the medical industry and doctors. All these things and more have to be considered.
Here is an interesting exchange between H and S:
H: Most experts say Medicare is going to be much more of a expense problem than SS. Why would you want taxes to pay for those who can afford their own plans?
S: I volunteer at (the local) High School. Those students miss a lot of classes due to sickness. I am already paying taxes for school. Most likely, very few have health. Answer Yes
H: You can afford Cigna Traditional. Since Medicare pays 80 % you, like me are already on the dole somewhat. But you can afford your part. This means you can go anywhere and get the care which is the most advanced.
H: HMOs do not have the most modern care. Those on HMOs just do not know it. If there is a better way and it is not available in the HMO net you are out of luck. The HMO people will not even let you know there is something better elsewhere.
S: True but they have a profit motive.
H: HMO allows the more people to get care for less. In someway this is probably what will be available if they ever get Universal Health Care. We someday may have UHC but don't kid yourself that you will be getting the best care.
S: True but it will be available to more people especially children.
H: Have you done research on UHC in other countries? Those I have talked to who have lived in England and here say our our health care is much better.
S: I was in Canada this summer and two friends of mine are from England. One went back to England because he could not get the care he needed and could not afford it. The other friend is one that I often socialize with. He as a sever lung problem. (pulmonary hypertension) The only real cure is a lung transplant. His cousin is a doctor in England and informed him that he most likely would get one quicker in England. So far he lives on a soup of medications and oxygen. He has some money and for now is willing to stay and hope for relief through our medical system. He sees doctors at UCLA.
H: Al said if he got less than the best care but everyone had UHC that that would be OK with him. Let me add for Al that means you won't live as long.
S: Longevity depends mostly on your genetic makeup and lifestyle. Mental outlook also plays a big part too. Don't you think Al is thinking compassionately?
H: I will ask you the same question, would you accept a sub (compared to the best) health care so everyone had some health care?
S: Fortunately, I do not have to make that sacrifice. I recently got my flu shot. I feel I must have it to tutor sick students. I do it because of my lung problems and to be able to continue working with the kids. If it met that all my students and others were to do better in school, be better prepared for the future and have more income, Yes. You might read my "A Democrat raising Hell" e-mail and better appreciate my opinion. Reference: Scientific American.
H: I suspect places that have UHC piggy back on our research.
S: Questionable? I now take a new inhaler. It is called Spiriva. It just became available in this country six months ago. The doctor estimated that it would increase my lung capacity by 15%. After Thanksgiving, I am scheduled for a capacity test. My estimate is that this estimate will easily be accomplished. It has been available in Europe for some time. Furthermore, my wife's hip replacement was available earlier in Europe then this country. Others having UHC might piggy back on our research but make use long before we start. This gives their medical companies a jump on us. This also includes stem cell research. I guess they might do the testing but their doctors see the results or failures first.
Finally, my own latest word in this debate:
Dear H (and others):
To me UHC means that everyone receives as a public benefit the same level of health care. Of course, if an individual has the money, he can pay for more expensive treatments. I recognize that there isn't enough money in our economy to provide everyone with his own kidney dialysis machine, with his own mechanical heart, heart transplants, liver transplants, etc. UHC would be something constructed by us humans and would not be perfect. Only God (assuming He exists) can create something that is perfect. My argument in favor of UHC is that there are many people in our society who do not get any health care at all except what they can get free at an emergency room. There are so many of these indigent people that they are straining our existing health care system to shreds. Our existing system, based on buying services from doctors and other medical people and paying for the services, is breaking down. Only a small portion of the population is affluent enough today to forego all forms of health insurance and simply pay the doctor and the hospital out of their income and savings when they have a medical problem. It is to our advantage to provide a reasonable level of health care to everyone, because the poor now can spread dangerous diseases (SARS, bird flu, small pox, clap, TB, syphilis, AIDS, etc.) because they are not treated. It is better to provide the treatment than to take a chance on epidemics. Therefore, UHC should be paid for out of taxes on everyone. That is, a portion of my income tax money should be devoted to providing health care for some poor illegal immigrant who might otherwise spread his disease.
I grant all the objections you raise. UHC can not be perfect. There will always be better and more thorough health care for the very rich than for the rest of us. However, providing everyone with a suitable standard of health care would be beneficial to everyone, not merely in preventing the spread of epidemics but in reducing lost work time due to illnesses.
In order for the public to understand and accept it, UHC has to be simple in concept. The Canadians have a system that is easy to understand. Everyone pays what he is able through taxes and co-payments. Everyone is taken care of. Expensive or rare treatments may be postponed or even denied. These expensive and rare treatments are not generally available to most of us under our present system either, so what's the objection?
Saturday, November 12, 2005
Failure of California Proposition 77 (Redistricting)
I can think of a few reasons without spending much time in thought. First, most voters realize, whether they agree with him or not, that Mr. Schwarzenegger is a very partisan Republican and was using the election to weaken his Democratic opponents. Schwarzenegger has discarded the mantle of “non-partisan reformer” that he wore during and for a time after the recall election of two years ago. Hence, many voters ignored the TV and radio ads for and against the proposition and voted their party preferences. Democrats outnumber Republicans in California.
Second, the average voter in this State is not greatly bothered by living in a gerrymandered district. Voters may despise the legislature generally and other members of it, but they love their own representative. In particular, they like being represented by a member of their own Party. Hence, the members of whichever party is in the majority in the district are willing to accept the gerrymander.
A third, more subtle reason, has to do with why gerrymanders are created in the first place. A famous (or infamous) redistricting took place a number of years ago when the Democrats had, for the first time in years, a majority in the legislature during the session in which redrawing district lines took place. The Democratic majority redrew the district lines in such a way as to produce the same proportion of Democrats and Republicans in the legislative bodies as the proportion in the State as a whole. Previously, Republicans had managed to elect more than what many would consider a fair share of legislative members. There was good reason to suspect that the result of the proposed redistricting would restore a situation in which Republicans would be over-represented in the State legislature and in the California delegation to Congress.
How could a truly non-partisan commission achieve such a result? It would be easy. All the commission would have to do is draw compact districts with mostly rectangular shapes. Rural districts would contain slight majorities of Republicans – 55 to 60 percent. Urban districts would contain overwhelming majorities of Democrats – 85 to 95 percent. To persons not concerned with demographics or the partisan make-up of the legislature, the redistricting would look just fine. The result would be a legislature with more Republicans than at present, perhaps even a majority. The proposed commission would also redraw the district boundaries for members of the national legislature. These new boundaries would increase the proportion of Republicans in the California Congressional delegation and help to the National Republican Party to retain control of Congress after the election of 2006.
An editorial piece in the Los Angeles Times today suggests that our chastened Governor and the Legislature are going to work together to produce some sort of commission to do redistricting. The editorialist proposes a commission of seven, with no more than three members of any political party. However it is done, redistricting will always be a political process. If either of the major parties decides that the commission’s district boundaries are unfair, the party will sue. Such lawsuits occurred in past years when one party didn’t like the result of the Legislature’s redistricting plan.
So far, no one in California has publicly proposed abandoning our tradition of single-member districts and adopting some form of proportional representation. A well-designed system of proportional representation would produce a Legislature with Democrats, Republicans, Greens, Libertarians, and Independents (non-partisans) in the same ratios as in the State as a whole. There would be no incentive to produce districts that were safe for particular incumbents. In fact, district boundaries might not have to be changed at all for decades.
Illinois had a rudimentary system of proportional representation for its lower House for more than a century. Each representative district elected three members. The majority party in the district was given two members, the minority party one. The system was abandoned in 1980. Before the days of the Communist scare, New York City elected borough representatives to the City Council by proportional representation. In the 1930’s the system was abolished to prevent Communists from obtaining positions on the City Council.
There are some serious changes that a system of proportional representation would make in the State Legislature and in the political landscape in the State. One effect would be to weaken the influence of the two major political parties and encourage the growth of small “third” or “fourth” parties. There would be no point of a member of the Green Party voting for a Democrat if there were a good chance of electing at least one Green candidate to the State Legislature. Similarly, there would be no point of a Libertarian Party member voting for a Republican rather than a member of his own party. Our State Legislature would resemble the parliaments of several European countries, in which no one party has a majority and laws have to be enacted by coalitions. I think this would be a good thing. What do you think?
Saturday, November 05, 2005
Election Woes: Proposition 77
The best argument for this method of redistricting the State is that it would create districts that are more competitive than they are now. In theory at least, candidates in a competitive district would have to take seriously the concerns and complaints of all factions in the district, not merely those who tend to vote for the incumbent. Representatives would have to try to represent all their constituents, not merely their political supporters.
Another argument is the existing set of district boundaries, established after the 2000 census. Districts were distorted into weird shapes to make it easier for incumbents of each major party to be reelected. The result was that in the 2002 election, every incumbent running for reelection was elected. There was no competition. Republicans felt safe to be Republicans; Democrats to be Democrats. One can argue that there was little incentive for members of either Party to compromise.
Of course, that’s only a partial truth. The argument that “safe” districts produce a legislature in which compromise is impossible omits the effect of party discipline. Even in a safe district, a candidate has to spend a large sum of money just to present his message to the voters. California legislative districts are the largest in the country. State Senate districts contain more than eight hundred thousand inhabitants. Assembly districts contain half that many. It is, therefore, unusually expensive to run for office in California. Party discipline comes into effect when the Party chooses which candidates to support. Candidates, including incumbents running for reelection, are more likely to receive this support if they agree to support the Party’s position on several key issues, such as reducing taxes on the wealthy. The effect of party discipline and support would be just as strong, if not even stronger, if all districts were competitive.
I have another reason for my skepticism about this initiative: Mr. Schwarzenegger supports it. He believes that a redistricted legislature would be one more willing to do his bidding. I don’t know why he would believe that, since Democrats in California outnumber Republicans, and a fair apportionment of legislative districts would produce a legislature with about the same ratio of Democrats to Republicans as we have now. There may be something else involved. His criticism of the present apportionment includes “horrible examples” of weirdly shaped districts.
Let us suppose that the proposition passes and that a panel of three non-partisan judges draws up legislative boundaries that show nicely shaped districts, mostly rectangular in shape. Since these judges are truly non-partisan, they do not pay any attention at all to the party affiliations of the residents. The result is apt to be a number of districts in the cores of our big cities (Los Angeles and San Francisco) that are very strongly Democratic. Some of these core districts will be more than 80 percent Democratic. Most other districts will consist of rural and small city areas in which the majority of residents tend to be Republicans. We would then have a few districts that are 80 percent Democratic and the others 55 to 60 percent Republican. The result of this “fair” redistricting would produce a majority of Republicans in the legislature, in spite of the fact that Democrats outnumber Republicans among the State’s population.
My skepticism has led me to vote against this initiative. I hope my California readers do the same.
Tuesday, November 01, 2005
Thoughts about the Hon. Samuel Alito
I know nothing about Judge Alito except what I’ve heard and read in the past three days. It is generally agreed that his political and judicial philosophy is very conservative, somewhat to the “right” of Justice Antonin Scalia. I have a rather vague idea of what it means to be to the “right” or “left” of Scalia. I think it means applying one’s own political and social convictions to interpreting those parts of the federal constitution that are rather vague in meaning. Many parts of that document were deliberately written to allow various interpretations, depending on future social, economic, and political circumstances. A “conservative” and a “liberal” justice can arrive at quite different interpretations of a portion of the constitution, each claiming that his or her interpretation comes from strictly following the language of the document and the intent of the original framers. Conservatives have, in my opinion, unfairly and illogically co-opted the phrase “original intent” to justify their interpretations and have accused liberals of legislating from the bench.
For example, read the text of the Ninth and Tenth Amendments:
Article IX: The enumeration in the Constitution, of certain rights, shall not be construed to deny or disparage others retained by the people.
Article X: The powers not delegated to the United States by the Constitution, nor prohibited by it to the States, are reserved to the States respectively, or to the people.
Justice Scalia and other conservatives argue that the Constitution does not explicitly state that there is a right of privacy. They are correct. Liberals argue that a right of privacy is implied in such phrases as “certain rights” not to be denied, and “powers not delegated to the United States” being reserved to the States or the people. If you read the first ten amendments according to the conservative interpretation, those amendments simply specify certain acts and kinds of legislation that the federal government is not allowed to carry out or enact. Thus, the federal government can prohibit the growing and use of marijuana for medical purposes. The federal government can criminalize certain medical procedures, especially those that are repugnant to certain politically powerful religious groups.
The liberal or libertarian interpretation imposes more limits on the power of the federal government. Growing and using marijuana for medical purposes is one of the "other" rights mentioned in the Ninth Amendment, as is the right to make medical decisions about one's own body. The government should not interfere with either of these "other" rights. The government should not be hostile to expressions of religious belief, but at the same time should not appear to approve one particular belief. Thus, the Lord’s Prayer and the Ten Commandments are not and should not be presented as the sole basis of our laws. Other religions also contribute to our sense of morality and legality and their contributions should also be recognized along with those of Protestant Christianity.
I do not know where Judge Alito stands on any of the matters I have discussed. If I am to believe what some writers and commentators say, he believes in the conservative or Scalia interpretation of the vague parts of the Constitution. If so, and if he is also a social conservative and devout follower of his religion, we can expect interpretations of these vague parts that conform to his social and religious ideas. That is, unless the Senate refuses to consent to his appointment to the Court.