Thursday, July 05, 2007
Continuation - Conservative vs. Liberal on UHC
In my previous post I used e-mails between my convervative friend R and myself to construct a debate or discussion about the merits and demerits of universal health care. I am a proponent; R is an opponent. I resume the discussion here with my e-mail to H, another conservative friend:
I wrote to H as follows, with copy to R:
Dear H, R does indeed make some good points. He cites statistics. I don't have access to detailed statistics on the effects he writes about. However, I think that he chooses statistics to bolster his arguments. I can't challenge his claim that the reduced life expectancy in the United States is a result of more violent crimes being committed here than in England or Japan or Canada. I have the feeling, but can't prove it, that people who do have access to the statistics took that effect into account when comparing life expectancies in the various countries with UHC and without. Since I can't prove it, I will have to abandon, for the time being, any argument in favor of UHC that relies on increased life expectancy.
You like to repeat the claim or "sound bite" of the odious Ann Coulter that "liberalism is a religion without God." I will start from that point and assert that my first reason for supporting and advocating UHC is a moral one. It is moral and just that everyone in our society should enjoy access to the best health care, just as we all enjoy access to the best police system, the best fire protection system, a uniforn system of money, and so on. We have, or should have the right to life, liberty, and the pursuit of happiness. Implicit in that is the right to good health and the right to good medical care.
I believe this. I will continue to believe this in the face of any statistics you or Roy can throw at me. I have values - liberal values.
My second reason for supporting UHC is that I believe that it works, and works well. I discount the anecdotes you Cons like to bring up about long waits for this and that. What I believe is that waiting times in hospital emergency rooms are shorter than in American hospitals because there is no problem of determining who is going to be able to pay and how, and of making sure that the paying patients are tended to first. I know that in countries with UHC the actual cost per resident of medical care is substantially less than it is in the US.
This is my response.
R then wrote:
I then wrote to R as follows:
Regarding UHC, I take it you are happy with the present situation in which some of us have good medical care (we can afford it or we are lucky enough to belong to a good insurance group) and others of us don't. In your letter (below) you respond to my moral argument in favor of UHC with your own arguments, as follows:
(1) To achieve UHC, it is necessary to have everybody pay. For people in very good health (who live like the Costa Ricans, for example) that means that they are paying more for health care than the value of the medical services they receive. In other words, and to quote you,
(2) You then argue that since only 10 -15 percent of the population needs additional health insurance, why impose a single plan on everone? Why not just provide the additional insurance to the 10 to 15 percent who need it? My response is, who is going to pay for the additional insurance? The 10 to 15 percent who need the additional insurance can't afford it. You are trying to apply fire or flood insurance rules to health insurance. I have a choice to live or not to live in an area subject to floods and fires. I do not have a choice to need additional health care that a low-cost policy won't cover. It's not my choice to be badly injured in an auto accident; it's not my choice to have some unusual and debilitating medical condition. In view of your objection to having money "stolen" from you to benefit other persons, there seems to be no way in your world view to provide the necessary additional insurance.
(3) Regarding the efficacy of UHC, you ignore my argument about hospital emergency rooms. It is reported that many hospitals have closed their emergency rooms because they can not afford to take care of all the uninsured poor people who use these facilities as their only source of medical care. Unfortunately, closing the emergency rooms also denies needed help to patrons who are affluent, who have insurance, and who are stricken with real emergencies (e.g., heart attacks) and now must travel half an hour to reach the nearest available emergency room. In your world view, perhaps we should apply tattoos to people who are entitled to use emergency rooms. Anyone arriving without a tattoo is simply left outside in the street.
R wrote as follows:
For the record, I'll mention that there is a list of federal government functions that must be provided. These include the military and the Post Office. So there is no opting out of those. Health care is not on the list.
I then wrote that I had a few comments on R’s recent e-letter. Excerpting from my letter, here are the comments:
R: I think our health care system can be improved. Of the solutions I've heard, the most appealing is to establish a system of low-cost drop-in health clinics. One can suppose that they have to be government subsidized, although that might not be the case. The idea is to unburden emergency rooms from ordinary health care, and to provide services to people who could not otherwise afford it.
Al: A generation or two ago we had such clinics here in Los Angeles. My wife and I visited such a clinic to obtain flu shots. It was about 30 or more years ago. The "taxpayer rebellion" and Proposition 13 reduced the funds available to the County to fund these clinics and they were closed. I think they were good and I wish they could be created again.
R: I also advocate government-paid "health disaster" insurance to cover strange diseases and improbable occurrences. The fact is that people between about seven and fifty have very few health problems, on average, so such disaster insurance is actually not a major cost item.
Al: In a previous letter, I wrote that “to achieve UHC, it is necessary to have everybody pay.”
R: That's like saying "To guarantee that everyone dress like Chairman Mao, it is necessary for everyone to comply with the dress code rules." The objective should not be to achieve uniformity, the objective should be to achieve a good health care system.
Al: I don't advocate that everyone dress like Chairman Mao. I seem to be unable to make it clear that a UHC system should cover everyone, not merely the sickest or those most in need of special medical care. My idea of UHC is that everyone would receive needed care regardless of ability to pay. I don't see that a "one size fits all" criticism applies. If not everyone is covered, what will happen is that private insurers will pick off the healthiest individuals and offer them insurance at rates that are less than what the UHC system is forced to charge. As a result, we would then have two systems: a private for-profit system that covers healthy individuals and a government system that covers the sicker. It wouldn't take long for the public to lose confidence in the "expensive" government system. We'd be back where we are now.
R: For the record, I'll mention that there is a list of federal government functions that must be provided. These include the military and the Post Office. So there is no opting out of those. Health care is not on the list.
A: Right here is our basic disagreement. I think that health care should be on the list. Whether provided by the federal, state, or local government is a matter for discussion and disagreeement.
R: I refuted the false assertions you made. To my knowledge, the only places where emergency rooms have been shut down are in cities near the Mexican border flooded by millions of illegal aliens. This is a consequence of our immoral federal government refusing to provide any assistance to localities, even though the problem is caused by a refusal of the government to enforce immigration laws on the books. The uninsured poor people are illegal, and however we want to treat them, it should be a federal, not a local problem.
A: Emergency rooms have been closed here in Los Angeles. We are a considerable distance from Mexico. There are many people in Los Angeles who don't have and can't afford medical insurance. Not all of them are illegal aliens.
I wrote to H as follows, with copy to R:
Dear H, R does indeed make some good points. He cites statistics. I don't have access to detailed statistics on the effects he writes about. However, I think that he chooses statistics to bolster his arguments. I can't challenge his claim that the reduced life expectancy in the United States is a result of more violent crimes being committed here than in England or Japan or Canada. I have the feeling, but can't prove it, that people who do have access to the statistics took that effect into account when comparing life expectancies in the various countries with UHC and without. Since I can't prove it, I will have to abandon, for the time being, any argument in favor of UHC that relies on increased life expectancy.
You like to repeat the claim or "sound bite" of the odious Ann Coulter that "liberalism is a religion without God." I will start from that point and assert that my first reason for supporting and advocating UHC is a moral one. It is moral and just that everyone in our society should enjoy access to the best health care, just as we all enjoy access to the best police system, the best fire protection system, a uniforn system of money, and so on. We have, or should have the right to life, liberty, and the pursuit of happiness. Implicit in that is the right to good health and the right to good medical care.
I believe this. I will continue to believe this in the face of any statistics you or Roy can throw at me. I have values - liberal values.
My second reason for supporting UHC is that I believe that it works, and works well. I discount the anecdotes you Cons like to bring up about long waits for this and that. What I believe is that waiting times in hospital emergency rooms are shorter than in American hospitals because there is no problem of determining who is going to be able to pay and how, and of making sure that the paying patients are tended to first. I know that in countries with UHC the actual cost per resident of medical care is substantially less than it is in the US.
This is my response.
R then wrote:
I don't have access to detailed statistics on the effects he writes about.Nearly everything I cite is obtained by using Google on the Internet. I am a compulsive reader, but I figure it is better to link things so people can get right to them. It is not too easy finding things on the Internet and so I don't really blame people too much for failing to do so. But access is available to anyone. If I find information contrary to my point, I think I am obliged to disclose that information. The trick is that I've been doing this for years, so I usually can avoid points I know are wrong!
I have the feeling, but can't prove it, that people who do have access to theYou are completely wrong about the health statistics, but you make a good point about Liberals putting feelings ahead of facts. The Liberal idea is that there must be facts somewhere to support whatever it is they feel, so there is no reason to be concerned much about facts. Imagine if science worked that way: all the data says "x is true", but but it can be rejected on grounds that that it contradicts the scientist's feelings. The truth should always found by examining the data, pro and con. It is moral and just that everyone in our society should enjoy access to the best health care, just as we all enjoy access to the best police system, the best fire protection system, a uniforn system of money, and so on.It is not true that we should all enjoy equal access to the best. If I choose to live in some remote area, I choose to give up access in favor of other preferences. Equality is only possible without choice.The problem with your moral argument is that it ignores the moral problem of stealing from one person to give to another. It is quite one thing to say that you wish to give all your money to achieving equality in health care. It is another think to say that you have a right to take all of my money and give it to the cause you espouse. In the case of health care, it could easily consume 100% of the resources of society -- if there is no consideration other than the moral argument.A second problem is that by Liberal argument, about 10-15% of the population needs additional health insurance. OK, so what is the moral argument for taking my money to impose a system that you want, and which I do not want, upon 100% of the population? Why would it not be a better moral decsion to just take give it to people who have the demonstrable need? I think the answer is that believe fairness is achieved only when every citizen is under equal subjugation of the federal government. How, after all, could it be fair if Big Brother orders "left face" and not everyone need comply?The third problem, is that your belief in the efficacy of the UHC system is solely an article of faith, or if you prefer feelings. In a separate e-mail, I cited an article comparing life expectancy in Costa Rica with that in the US. The facts are that Costa Ricans do about as well, but not due to any system of UHC, but rather due to a dramatically more healthy life style. This would be very important if facts were allowed into the discussion, which Liberals do not allow. So Libs are imposing a quasi-religious belief upon the whole population, at enormous expense, on grounds of their particular non-factual morality.
statistics took that effect into account when comparing life expectancies in the
various countries with UHC and without.
What I believe is that waiting times in hospital emergency rooms areTotal nonsense, but of course you never have to prove anything you feel. Our local emergency room does not even ask about payment until after the patient is treated, and triage is strictly on medical grounds. I've been through it personally.Most countries have much less elaborate emergency facilities, because they do not have so many traffic accidents, drug OD's, etc.
shorter than in American hospitals because there is no problem of determining
who is going to be able to pay and how, and of making sure that the paying
patients are tended to first.
I then wrote to R as follows:
Regarding UHC, I take it you are happy with the present situation in which some of us have good medical care (we can afford it or we are lucky enough to belong to a good insurance group) and others of us don't. In your letter (below) you respond to my moral argument in favor of UHC with your own arguments, as follows:
(1) To achieve UHC, it is necessary to have everybody pay. For people in very good health (who live like the Costa Ricans, for example) that means that they are paying more for health care than the value of the medical services they receive. In other words, and to quote you,
"The problem with your moral argument is that it ignores the moral problem ofTo be logical, you must apply that same reasoning to paying taxes to support a police department, a fire department, etc.
stealing from one person to give to another."
(2) You then argue that since only 10 -15 percent of the population needs additional health insurance, why impose a single plan on everone? Why not just provide the additional insurance to the 10 to 15 percent who need it? My response is, who is going to pay for the additional insurance? The 10 to 15 percent who need the additional insurance can't afford it. You are trying to apply fire or flood insurance rules to health insurance. I have a choice to live or not to live in an area subject to floods and fires. I do not have a choice to need additional health care that a low-cost policy won't cover. It's not my choice to be badly injured in an auto accident; it's not my choice to have some unusual and debilitating medical condition. In view of your objection to having money "stolen" from you to benefit other persons, there seems to be no way in your world view to provide the necessary additional insurance.
(3) Regarding the efficacy of UHC, you ignore my argument about hospital emergency rooms. It is reported that many hospitals have closed their emergency rooms because they can not afford to take care of all the uninsured poor people who use these facilities as their only source of medical care. Unfortunately, closing the emergency rooms also denies needed help to patrons who are affluent, who have insurance, and who are stricken with real emergencies (e.g., heart attacks) and now must travel half an hour to reach the nearest available emergency room. In your world view, perhaps we should apply tattoos to people who are entitled to use emergency rooms. Anyone arriving without a tattoo is simply left outside in the street.
R wrote as follows:
I take it you are happy with the present situation in which some of us have goodI think our health care system can be improved. Of the solutions I've heard, the most appealing is to establish a system of low-cost drop-in health clinics. One can suppose that they have to be government subsidized, although that might not be the case. The idea is to unburden emergency rooms from ordinary health care, and to provide services to people who could not otherwise afford it.I also advocate government-paid "health disaster" insurance to cover strange diseases and improbable occurrences. The fact is that people between about seven and fifty have very few health problems, on average, so such disaster insurance is actually not a major cost item.
medical care (we can afford it or we are lucky enough to belong to a good
insurance group) and others of us don't.
To achieve UHC, it is necessary to have everybody pay.That's like saying "To guarantee that everyone dress like Chairman Mao, it is necessary for everyone to comply with the dress code rules." The objective should not be to achieve uniformity, the objective should be to achieve a good health care system.
To be logical, you must apply that same reasoning to paying taxes to support aOf course, and I do apply the same standard across the board. That basically means that we should make decisions democratically with the goal of minimum intrusion upon peoples lives and pocket books. Your concept, I gather, is that (a) liberals decide what is moral and (b) then there is an unlimited license for liberals to take my money and spend it as they like. So, for example, if 10 or 15% of the population needs more health care, there is no problem imposing an expensive system on 100% of the population for no reason other than imposing authoritarian uniformity.In areas such as police and fire, localities get to decide how fancy, elaborate, and complete a system the people want. Liberals cannot tolerate non-uniformity. They insist on imposing expensive and ineffective systems on everyone.
police department, a fire department, etc.
For the record, I'll mention that there is a list of federal government functions that must be provided. These include the military and the Post Office. So there is no opting out of those. Health care is not on the list.
Why not just provide the additional insurance to the 10 to 15 percent who needI have no objection to the citizens voting to pay for the additional health care. My preferred mechanism is through walk-in clinics, but it would be OK to provide insurance upon establishing proof of need. There is a moral obligation, I believe, to minimize public expense and government intrusion upon taxpayers.
it? My response is, who is going to pay for the additional insurance?
In view of your objection to having money "stolen" from you to benefit otherNo, citizens can vote to provide benefits. The binding constraints are minimum cost and minimum government control. Please clarify your theory about how it is moral for liberals to take unlimited sums of money from taxpayers and spend that money without any limitations or constraints.
persons, there seems to be no way in your world view to provide the necessary
additional insurance.
Regarding the efficacy of UHC, you ignore my argument about hospital emergencyI refuted the false assertions you made. To my knowledge, the only places where emergency rooms have been shut down are in cities near the Mexican border flooded by millions of illegal aliens. This is a consequence of our immoral federal government refusing to provide any assistance to localities, even though the problem is caused by a refusal of the government to enforce immigration laws on the books. The uninsured poor people are illegal, and however we want to treat them, it should be a federal, not a local problem.Throughout, you seem to maintain the notion that UHC would have some effect on life expectancy or infant mortality or some other health metric. There is no evidence of that. Such statistics are dominated by lifestyle factors, not the health care system. Researchers predict that in the US, life expectancy will be reduced in the future due to rising obesity. The effect of forcing everyone to conform to Big Brother's health care system will not be a measurable improvement in health.
rooms. It is reported that many hospitals have closed their emergency
rooms because they can not afford to take care of all the uninsured poor people
who use these facilities as their only source of medical care.
I then wrote that I had a few comments on R’s recent e-letter. Excerpting from my letter, here are the comments:
R: I think our health care system can be improved. Of the solutions I've heard, the most appealing is to establish a system of low-cost drop-in health clinics. One can suppose that they have to be government subsidized, although that might not be the case. The idea is to unburden emergency rooms from ordinary health care, and to provide services to people who could not otherwise afford it.
Al: A generation or two ago we had such clinics here in Los Angeles. My wife and I visited such a clinic to obtain flu shots. It was about 30 or more years ago. The "taxpayer rebellion" and Proposition 13 reduced the funds available to the County to fund these clinics and they were closed. I think they were good and I wish they could be created again.
R: I also advocate government-paid "health disaster" insurance to cover strange diseases and improbable occurrences. The fact is that people between about seven and fifty have very few health problems, on average, so such disaster insurance is actually not a major cost item.
Al: In a previous letter, I wrote that “to achieve UHC, it is necessary to have everybody pay.”
R: That's like saying "To guarantee that everyone dress like Chairman Mao, it is necessary for everyone to comply with the dress code rules." The objective should not be to achieve uniformity, the objective should be to achieve a good health care system.
Al: I don't advocate that everyone dress like Chairman Mao. I seem to be unable to make it clear that a UHC system should cover everyone, not merely the sickest or those most in need of special medical care. My idea of UHC is that everyone would receive needed care regardless of ability to pay. I don't see that a "one size fits all" criticism applies. If not everyone is covered, what will happen is that private insurers will pick off the healthiest individuals and offer them insurance at rates that are less than what the UHC system is forced to charge. As a result, we would then have two systems: a private for-profit system that covers healthy individuals and a government system that covers the sicker. It wouldn't take long for the public to lose confidence in the "expensive" government system. We'd be back where we are now.
R: For the record, I'll mention that there is a list of federal government functions that must be provided. These include the military and the Post Office. So there is no opting out of those. Health care is not on the list.
A: Right here is our basic disagreement. I think that health care should be on the list. Whether provided by the federal, state, or local government is a matter for discussion and disagreeement.
R: I refuted the false assertions you made. To my knowledge, the only places where emergency rooms have been shut down are in cities near the Mexican border flooded by millions of illegal aliens. This is a consequence of our immoral federal government refusing to provide any assistance to localities, even though the problem is caused by a refusal of the government to enforce immigration laws on the books. The uninsured poor people are illegal, and however we want to treat them, it should be a federal, not a local problem.
A: Emergency rooms have been closed here in Los Angeles. We are a considerable distance from Mexico. There are many people in Los Angeles who don't have and can't afford medical insurance. Not all of them are illegal aliens.
Labels: Conservatism, effect of illegal immigrants, hospital emergency rooms, Liberalism, Statistics, Universal health care
