Al's Opinions

To save space, I have abbrreviated the title of this post from "Conservative vs. Liberal - What's the difference?"  The question came up this morning in the monthly first Wednesday meeting of the Men's Group at a church in Woodland Hills.  We geezers were talking about the new Congress, in which the Republicans have a majority in the House and an increase in the Senate.  We wondered why politicians don't talk to each other and try to find compromises instead of taking absolute stands and trying to suppress any ideas advanced by the minority.

My thought is that the difference between conservatives and liberals is that the two groups do not recognize the same problems as matters that ought to be addressed in legislation.  Consider the health care bill enacted by the previous Congress.  The House, with a Republican majority, is going to spend several days debating the proposition that the bill should be repealed and replaced with something more to the liking of Republicans.  This debate and the final vote will be taken in spite of the fact that we still have Mr. Obama as President and a Democratic majority in the Senate.  It would be a true miracle if the repeal were to be achieved.  (I write "miracle" instead of "calamity" because miracles do not happen in my world, certainly not in the last two thousand years.)  The vote is purely symbolic, a waste of time to please a few constituents.

We geezers still wondered why there are such strong feelings on the two sides.  One reason, I believe, is that conservatives and liberals are concerned about different problems.  Consider American health care.  It is very good.  If you need the latest advances in medical practice, you can get them here - if you have the money to pay or if medical providers will provide them pro bono.  However, a significant part of our population can not afford medical care at all.  This part comprises people without medical insurance to cover expensive medical treatments.  In Canada and in many European countries such care is provided under a system in which the cost is paid by the government.  In other words, the cost of medical care for all is borne by taxes which everyone pays.  In addition, medical practice in these "socialist" countries is less expensive than medical practice in most American communities.

I have written extensively by e-mail to my conservative friends about universal health care.  Neither one of them supports the idea.  One argues that we already have universal health care because hospital emergency rooms are legally obliged to treat everyone regardless of ability to pay.  The other argues that we simply can't afford to provide free medical care for everyone; the government is running big deficits as it is and there isn't the money to provide free care.  My point is that conservatives do not recognize uneven health care as a problem that government should do anything about.

On the other hand, my conservative friends are very much concerned about what I call the "Andy Cap" fraction of society.  Andy Cap is a cartoon character who lives in north-central England.  He lives on the dole and sedulously avoids doing work for money.  Conservatives see any public benefit, such as free health care for the poor (or for all) as a chance for "Andy Cap" or lazy freeloaders to get something of value without working or paying for it.  A related concern is the malpractice situation.  Conservatives see that malpractice lawyers encourage dissatisfied patients to sue their doctors and hospitals.  These lawyers earn enormous fees from successful lawsuits.  In addition, most trial lawyers are Democrats and contribute heavily to the Democratic Party.

We talked also about the influence of money, especially corporate money on elections.  In our country a successful candidate for office has to raise a lot of money.  Two candidates competing with each other vie for money.  The one who can raise the most money usually wins the election.  It is no surprise that the successful one will, in office, support legislation that benefits his wealthy supporters.  As a result, we have a plutocracy, not a democracy, even though the new Republican majority in the House intends to have the federal constitution read to the members.

Naturally, we talked about the "Tea Party" faction in the Republican Party.  Most of us think the Tea Party people have some quaint ideas.  They are sincere and angry.  In my view, they are angry about many things that make me angry but their anger is directed at other things than mine.  I think they are being misled and I hope that in time they will realize that their leaders are using them for some ends that are not good for the country.

Labels: ", repeal "Obama-care, Tea Party faction, Universal health care

There is a serious move afoot to challenge the constitutionality of an essential component of the new health care low.  The law requires everyone to purchase health insurance.  A federal judge has ruled that this requirement exceeds the power Congress has under the Interstate Commerce clause.  Congress does not have the power to require every person to engage in a particular contractual obligation.  The matter will be sent on to the Supreme Court for a final ruling.

The basic premise of the law was that health care was to be provided by insurance.  To achieve affordable rates, everyone must participate in the insurance pool.  If not, only the sick and those with probable sickness in the future will buy insurance.  No one will be able to afford the premiums.  The whole structure will fall.

One news commentator noted that if the "public option" had been included in the law, there would be no legal requirement for everyone to buy insurance.  Those who decline to buy insurance would instead join the "publilc option" group and pay into that.  The pool would be filled with a natural mix of healthy and not so healthy individuals.

Mr. Obama may now be wishing that he hadn't caved to the desires of the insurance lobby in discarding the public option.

Labels: " achieving a workable insurance pool, "public option, Universal health care

My Republican friends state that Obama and the Democrats have shut the Republicans out of the discussion of the changes in the health care system. I think about this assertion and I wonder about it. My Republican friends are sincere. The news media seem to lend credence to their claim. I still wonder.

It seems to me that Obama reached out and across the aisle from the very beginning. He took a proposal to reform the health care system that was very similar to a plan Republicans had presented as an alternative to President Clinton's plan. Obama's plan is very similar to the plan enacted in Massachusetts and to a plan proposed by some Republican legislators here in California a few years ago. The features of this "Republican" plan are as follows:

• Tort reform, to relieve doctors from excessive punitive damages in malpractice cases
• Require that everyone have health insurance, so that insurance companies can base their premiums on the entire population and not just the population that needs and buys health insurance. This feature provides that the cost of caring for the sick is borne by everyone, not just other sick people.
• Require that insurers insure everyone and do not reject applicants for insurance because of pre-existing conditions.

The Republican plan does not include the option of "Medicare for all," or any other non-profit plan sponsored by government. Mr. Obama was careful not to include such features in the plan he proposed, although when his more liberal or progressive supporters asked, he said he wasn't opposed to such features.

Obama proposed that the nation enact the Republican plan (of a few years ago) for reforming the nation's health care system. If that isn't "reaching across the aisle to Republicans" I don't know what is. I have to believe that the Republicans really don't want any reform at all.

Labels: Universal health care

There is a saying "The mountain labored and brought forth a mouse." I feel like that about the health care bill in the Senate. In my view, the bill is a "mouse." It provides no escape from the health insurance industry in the form of a "public option" or a chance for younger people to enroll in Medicare. These ideas are anathema to the Insurance industry, to the Republican Party, and to a few Democrats. What we are offered instead are new rules that state that health insurers can not deny insurance coverage to individuals because of a preexisting condition, change of employment, contracting some new and horribly expensive condition, and the like. In other words, the insurance companies are going to be told to behave like the "public option" or lime Medicare if the one existed and the other were available to younger individuals.

Some politicians are cheering the result. At last the insurance industry will be prevented from denying health insurance to anyone for any reason.

Do you believe this? If so, I have some shares in a bridge between two populous islands in New York State that I'm willing to sell to you for a very low price.

The insurance companies are not objecting about requirements to insure everyone, regardless of present or past illnesses. I figure that their lawyers already know how to get around these requirements as soon as they appear to be hurting the business. We Americans abhor a government requiring a private company to operate at a loss. The Supreme Court will declare the laws requiring the insurance companies to operate at a loss to be unconstitutional. After that happens, we will be right back where we were before the Administration and Congress decided to reform the health care system.

The more things change, the more they remain the same.

Labels: restrictions on insurance companies, Universal health care

Many people think of health insurance as though it is similar to insurance on a home, a car, or a business. To achieve a large pool of participants so that an occasional big loss by one requires only a slight increase in the premiums of the others, it is either customary or legally required that everyone who owns and drives a car or who owns a home or business have insurance coverage. That's what insurance is all about: sharing the risk of a disaster.

Health insurance is different. With health insurance, the participant doesn't want an arbitrary cap on the maximum payout. A person doesn't think of his health and life in the same way as he thinks of his house or his car. If the car is totaled, the insurance company will pay the cost of a replacement. The replacement is not a new car; it is another car of the same make and age and condition as the one lost. The same rule applies to a house. In fact, a house is never insured for its full replacement cost; to do so would tempt the owner to destroy his house to collect the insurance if he was having difficulty selling it for the insured value. A participant with health insurance wants the cost of even the most expensive medical procedure paid by the insurance company. If he needs a $500,000 liver transplant he isn't interested in a policy that covers only the first $100,000 of the cost. He wants one that covers the total cost, less a reasonable co-payment.

From the insurer's point of view, the problem with health insurance is that a cap on the maximum pay-out is unacceptable to most subscribers. In self defense, the insurer has to insert the cap in the policy, making sure that it is in the very fine print that the buyer won't notice. It's a way of being able to sell policies with low or competitive premiums and still stay solvent in case a subscriber has a medical problem requiring an astronomical sum of money.

This line of thinking leads me to conclude that the only way to provide real health insurance is for the U.S. government to stand behind the organization that pays the claims. The payer does not have to worry about making a profit each quarter. The payer doesn't have to worry about being wiped out by an extraordinarily large claim. In other words, the solution is a "single-payer" insurance system. To provide the largest pool possible, single-payer covers everyone, including felons in prison and immigrants without papers. Covering the entire population also reduces the likelihood of epidemics of serious diseases, such as smallpox, since everyone will be treated at the first indication of illness.

Since single-payer gets rid of the high overhead costs of private for-profit insurance firms (by getting the firms out of the business altogether), it can and should provide good medical care at a lower cost than our present hodge-podge system of private insurers, self-insurers, and the like. Single-payer by itself will not rein in the escalation or inflation in the cost of health care. That rising cost will have to be covered by changing the way doctors practice medicine. Doctors working on salary at the Mayo Clinic in Minnesota, for example, provide excellent medical care at a cost far less than the same doctors and other providers would charge if they were each operating as a private for-profit busines, with individual malpractice insurance, office staff, and other overhead costs. We need a change from private fee-for-service medicine to cooperative clinical medicine.

Labels: covering illegal residents, high overhead of private insurers, Mayo Clinic, single-payer, Universal health care

Conservatives like Richard Viguerie are fussing and fuming about the trend of the recent national election. How is conservatism to regain its influence on national policy unless more genuine conservatives can be elected to office?

I think they have nothing to worry about. Recent events here in California and in the nation's capital prove to me that we live in a deeply conservative country. California in particular seems to be a leader in conservatism.

I know that sounds counter-intuitive. However, look at what California is doing with the popular idea of public funding of election campaigns. Maine and Arizona have already enacted legislation that provides public financing of election campaigns. California has hemmed and hawed about the idea and finally has agreed to submit a measure to the voters in the next gubernatorial election (in 2010) to provide public financing for one (1) state official: the California Secretary of State. Why just that one? Well, providing public financing for all state elections is just too radical an idea.

In the nation's capital, the President and Congress are determined to have another go at reforming our tattered health care system. One popular reform, one that has the support of a majority of the public, is one that has operated successfully in Canada and in many other "advanced" countries for decades: a national system funded by the state that provides health care to all residents, just as the local fire department provides fire protection for all residents or the local police protect all residents from crime and criminals. One would think that, viewing the problem of health care world-wide, a universal system paid for out of tax revenue would be deserving of serious consideration. Well, not so. Neither President Obama nor the Chairman of the Senate Committee that's dealing with health care have much interest in promoting a single-payer system. They intend to keep the present system of private insurers, with regulations that make it difficult for them to drop subscribers. The closest they will come to a universal system is to provide a government-sponsored system that individuals can join, if they wish.

In both examples, conservatism wins the day. California is not going to have public funding of campaigns soon. The nation is not going to have a truly universal health care system during my remaining life time.

Labels: public funding of election campaigns, triumph of conservatism, Universal health care

Neither candidate favors a single-payer system like the one in Canada. Obama does not rule it out, but instead advocates some mild tinkering with our existing system in which employers provide subsidized health insurance as a fringe benefit. McCain would tax the employer's contribution to the subsidy but would grant a tax credit of $2500 per person or $5000 per family to buy insurance.

On the face of it, McCain's proposal is terrible because it would, in the long run, encourage employers to drop health care as a benefit and would encourage employees to agree to the change. However, the result might be so bad that the public would then clamor for a universal system, such as "medicare for all" instead of just the elderly. By making things worse, McCain's program might hasten the day when the nation will finally adopt a real universal health care system in which, in Obama's words, health care is considered a right, not a responsibility or privilege.

Labels: McCain's tax credit, single-payer, Universal health care

I've decided I don't like any of the leading contenders for the Presidency of this nation. I don't like McCain because he will appoint more federal judges like Alito, Scalia, and Thomas. We have too many conservative "federalist" judges now. I don't like Clinton or Obama because they won't be advocates for a universal health care plan that gets rid of the profit motive in deciding which medical procedures to pay for and which ones to deny. I also don't like them because recent polls indicate that neither of them can beat Senator McCain.

The only hope I see is that the Democrats will prevail in several Senatorial contests this coming November and get rid of several Republican obstacles to progress. Perhaps the country can tolerate President McCain if he has a Senate with fewer than 40 Republican supporters of his war and his judges. The Democrats may pick up a few House seats. However it's unlikely that they will pick up many because House districts have been gerrymandered to protect incumbents.

Another bit of cheerful news (I grasp at straws for this one) is that our Republican Governor here in California is now willing to talk about doing away with some tax loopholes to increase the State's revenue. I guess getting rid of a loophole doesn't count as increasing taxes, a phrase that Republicans choke on. Closing some loopholes, according to our governator, will raise an additional two billion dollars or so. The additional money can be used to reduce the proposed cut in the State's budget for schools.

Every little bit helps. I'm still a grouch this morning.

Labels: Arnold Schwarzenegger, Barack Obama, California budget, Hillary Clinton, John McCain, Universal health care

It has been written of President Franklin D. Roosevelt that he would first decide what he wanted to do or accomplish. Having decided that, he would then see how close he could come to accomplishing it. He was lauded for following the course of a realistic and practical politician.

There's another side to this approach to governing. If you can not achieve all of what you want to achieve, is it worth while working on something that achieves only a part of what you want? I apply this question to the health plans promoted by several Democratic and Republican politicians: Clinton, Schwarzenegger, Nunez, Romney, and others. These plans all amount to an effort to fix or improve our existing system of providing health care to Americans. Although the supporters of these plans are sincere in wanting to do something to improve a poorly functioning system, I think they are like applying band-aids to a severely injured individual who needs surgery to stop internal bleeding.

The essence of the Clinton-Schwarzenegger-Romney plan is to require all employers (of more than just a few employees) to provide subsidized health insurance for their employees. If an employer wishes, he can instead pay money to the State which will be used to subsidize health insurance to those individuals who are not covered by an employer. There are differences among them as to how much the non-insuring employers should pay, whether all persons are to be required to purchase insurance, and what coverage the insurers are required to provide. Basically, they are all attempts to make a system, originally designed by some employers to attract skilled and expensive workers, provide affordable health care for everyone. These plans are attempts to make a system which was never intended or designed to provide universal health care provide it.

In spite of my criticism, the C-S-R plan does amount to doing something. It won't provide universal health care. It may provide universal health insurance, which is not the same thing. Experience with private for-profit insurers shows that having insurance does not necessarily guarantee having adequate health and medical care. My question is, is it worth while doing?

One can argue that enacting a plan that provides good medical and health care to every American is not politically possible at present. Too many people will argue against it with arguments about "big government," bureaucratic control of medical decisions, inefficiency of government, and the like. I argue that, in spite of the difficulties, our political leaders should try for a universal health plan and not an almost universal insurance plan. The President should be committed to it and should use his press conferences and other unique opportunities to speak to the American People to explain why a universal health provider plan is better than any insurance plan. And that means that we need a President who is committed to the idea of universal health care. The candidates among the Democrats who are committed to this goal have been discarded by the primary voters. There is no hope, in this generation at least, that a Republican candidate would be so committed.

Perhaps, in the end, we will have to accept, for the time being, a half-measure or a band-aid. Winston Churchill once observed that the "American People will always to the right thing, but only after trying all the alternatives."

Labels: Arnold Schwarzenegger, Hillary Clinton, Massachusetts plan, Mitt Romney, univeral health insurance, Universal health care, Winston Churchill

My Conservative friends continually press upon me their objection to such good things as Universal Health Care (UHC) because the plan for UHC is to create a single entity that will either provide payments from a universal insurance pool or provide the needed medical services as a government agency, in the manner of a fire or police department. My friends point out that the UHC entity would not have any competitors because it would be a monopoly. They believe without any doubt that competition is always good in that it compels providers to furnish good quality services at low prices.

I think differently. I recently traveled to Grand Rapids, Michigan by air. My itinerary was San Francisco to Grand Rapids, then, a week later, Grand Rapids to Los Angeles. I had not traveled so far by air since my wife and I took a cruise from Auckland, New Zealand, to Sydney, Australia. We traveled from Los Angeles to Auckland by air. In fact, we rode the same airline as the one I rode from San Francisco to Grand Rapids to Los Angeles. I find that travel by air, particularly in economy class, is uncomfortable. The seats do not provide much leg room. As a passenger you have to sit in one position for up to three and a half hours. Getting out of the seat to use the rest room requires physical agility that I no longer have. It is especially difficult to leave the seat if the passenger ahead of you has his seat tilted back as far as it will go.

It seems to me that air travel used to be more comfortable and enjoyable. On long flights you were served a hot meal. Some of those meals were pretty tasty and helped make the flight enjoyable. Those were the days before deregulation when the airline companies had no difficulty in making a profit. Deregulation and increased competition brought cheaper fares and took away the meals. Now it appears to me that an airline company is interested mostly in crowding as many paying travelers as possible into each plane. That means the seats are closer together than before. That means that there is a confusing set of special prices for tickets. If you order tickets far enough in advance of your flight, you can get a bargain, with some strings attached. Typically the bargain flight is not refundable. The best you can hope for if you have to cancel at the last minute is that you will have a credit that can be applied to some future flight.

If you consider only the cost of air travel, you can convince yourself that competition has brought bargain prices in certain conditions. To that extent, competition works in your favor. However, competiton also forces airlines to skimp on comfort (leg room, meals) and safety (less rigorous inspection of each plane before sending it off with its load of passengers).

Past experience has shown that competiton is not a universal "magic bullet" to force purveyors of goods and services to provide good quality at low cost. We at one time had competing fire fighting companies. As a home owner, you could subscribe to any of several companies. It turned out that not everyone subscribed to any service. A house would be left to burn, either because the owner hadn't subscribed to any fire fighting service or because the particular service wasn't able to get to the house in time to save it. The notion that competition among competing fire fighting companies would provide low-cost and effective fire protection was discarded when the public decided to create a government-run fire department, paid for by the taxpayers.

I believe that competition does provide economical and good quality service in such things as hair cuts and dry cleaning clothes. If a barber does a bad job on your hair, you simply let it grow out and go to a different barber. If a dry cleaner does a poor job on your jacket, you use a different dry cleaner next time. Observe that you don't need to get a hair cut and you don't need to have your jacket cleaned. In my case, I did need to travel from California to Grand Rapids and back in a short time. One of my daughters was traveling with me and she, unlike me, is not retired and can't afford the luxury of taking all the time in the world to go some place.

Labels: air travel, competition, conservative belief in competition, government monopoly in fire suppression, Universal health care

Over the years I have received many requests by mail to sign a petition in favor of one thing or another. There is an organization devoted to "saving social security" that sends me a petition occasionally. I get petitions to save snow leopards, polar bears, wolves, and other forms of wild life. Just today I received a petition from AARP in favor of "Strengthening the Four Pillare of Retirement for America's Seniors." In case you're wondering, here are the four pillars of retirement:

1. Social Security
2. Affordable Health Care
3. Pensions / Retirement Savings
4. Supplemental Earnings

A petition to strengthen these pillars has to be addressed to the federal government, particularly the administration of George Bush. Mr. Bush has expressed himself as opposed to government-sponsored social security (it should be private, supported by savings accounts), to government-sponsored health care (except Medical and a shrunk SCHIP program), and to spending government money on anything that might smack of creeping socialism. It is clear to me that, until Mr. Bush leaves office and is replaced with a President with more compassion for the people in need, petitions are a waste of time and good paper. The AARP perhaps should devote its considerable clout to advocating impeachment of the Bush-Cheney team.

Labels: Bush Administration, Bush's Stubbornness, social security, Universal health care

There was an article in the newspaper today about Senator Clinton's plan for universal health care, or universal health insurance. It struck me that the outline of the plan was similar to the plan that Governor Schwarzenegger has proposed for California. As I understand it, the Clinton plan has the following elements:

1. Persons who are satisfied with their present health insurance will be allowed to keep it. They will not be required to enroll in the new plan.
2. Everyone, including healthy young people, will be required to buy health insurance. Adding these health people to the existing insurance pools will make it possible for insurance companies to reduce their premiums to make health insurance more affordable.
3. A government-sponsored plan will be set up for people who don't like the existing choices of health insurance or who are unable to afford health insurance, either through poverty or through a preexisting medical condition.
4. Large companies that do not provide subsidized health insurance for their employees will be required to pay a fee or tax, whatever you call it.

I have mixed feelings about this plan. Of course, I recognize that the devil is in the details. Perhaps if I knew all the details, I would like it, or hate it. Now I have mixed feelings.

First, the plan keeps in place the private insurers. Insurance companies, with their bureaucracies dedicated to maximizing the profit for their companies by denying benefits are a major cause of the rapid increase in medical costs. Clinton does not do anything to rein in the insurance industry. Instead, she hopes to keep the industry quiet and not run "Harry and Louise" ads against it.

Second, I would like to know more about the government-sponsored insurance for those who can't or won't buy private insurance. Perhaps this feature can grow and eventually become a single-payer insurer. Perhaps it will wither because insurance companies will offer loss-leader policies to healthy individuals who are considering choosing the government plan. This is a feature that would cause me to support the plan if I believed that it would grow into a single-payer. If I believed it would wither, I would oppose the plan.

Third, to her credit, Senator Clinton is trying to craft a plan that has some chance of enactment at present - or after George Bush leaves office, for he will certainly veto any form of universal health insurance that has a government component.

At any rate, I'll have to wait for more details before I decide whether to support or oppose it. (Not that my position will have any effect)

Labels: Hillary Clinton, insurance bureaucracy, single-payer, Universal health care

For more details on the past history of the State Children's Health Insurance Program, refer to this article in the Boston Herald. A large bipartisan bloc in Congress (both the House and Senate) want to enlarge the program to include children not now covered but whose parents still are not wealthy enough to pay for complete childhood medical care without having to worry occasionally about paying for it. Mr. Bush threatens to veto the bill if it includes money to add children to the program who are not already in it. His threat reveals the following:

1. He is a determined ideologue who would rather placate the extreme "small government" wing of the Republican Party than the more moderate majority of Republicans and Independents, to say nothing of Democrats. His guiding philosopher in this endeavor is Grover Norquist, not Jesus Christ.
2. He shows how hollow the slogan "compassionate conservative" is. Telling children of lower middle class parents that they can have all the health care their parents are able and willing to pay for is certainly "conservative." It is not compassionate, at least not toward the parents and children who are affected.
3. He argues that enlarging the SCHIP program is a step toward a publicly funded universal health care system and must be stopped because it leads to socialism. (Horrors!)
4. He has compassion for the plight of the poor tobacco companies whose products would be subjected to additional taxation to pay for the additional children.
5. He has compassion for the HMO's and insurance companies who might lose clients if the SCHIP program is enlarged. Parents might abandon their own unsatisfactory HMO or health insurance plan and enrol instead in SCHIP.

There is a lesson for us who voted hopefully for Democrats last year. Even with a Democratic majority in both houses of Congress, we are not going to see any progress toward providing access to good health care to those who don't already have it as long as George W. Bush is President.

Labels: compassionate conservatism, Grover Norquist, SCHIP, Universal health care

My conservative friends and I have a continuing debate by e-mail about such notions as Universal Health Care. Here is a recent e-mail from one of them:

Al,

I agree with you that both Parties are obsessed with policies affecting
small numbers of people, and they do so without much concern for
principle. I think this is a result of the era of scientific polling, which allows small groups of one-issue voters to be identified and subsequently catered to as a means of winning a narrow election. The nonsense of pushing up corn prices by mandating ethanol is a prime example. Politicians are tripping over themselves trying to buy votes in Iowa, even though ethanol makes no sense in terms of energy independence or reducing pollution, and it raises overall food costs significantly for everyone. Immigration policy is another example.

Both parties are trying to get a marginal number of Latino votes by totally ignoring border security.Insofar as the Democratic Party is dominated by Liberals, they do favor imposing national solutions as the preferred mechanism for solving problems. Perhaps 10% of the population has a problem paying for health care, so the solution proposed is to put 100% of the population under the control of the government. When the solution is universal, it will tend to benefit by lack of comparison to better alternatives.The current lot of
politicians are so bad, it seems to me that a third party would have a better chance than any time in the past century.

R

My response was that I don't believe the ten percent figure R cited. I haven't seen any data on the fraction of Americans that have problems paying for health care; if such data exist, I suspect the number is greater than ten percent. The data I have seen is that public opinion polls show that more than half of the population favors some form of Universal Health Care, whether it's a Canadian-style single-payer, a subsidy to enable everyone to buy a good health insurance plan, or a National Health Service, such as what Britain adopted after WW-2. Because UHC is so popular with the public, I have to believe that a lot more than ten percent of the public is worried about whether medical expenses can be paid. In our system, in spite of what R and other conservatives assert, if medical expenses can't be paid, they won't be delivered. Getting emergency medical treatment at hospital emergency rooms is not a substitute for good medical care, a fact that the public recognizes even if R doesn't.

Labels: National Health Service, popularity of the concept of UHC, single-payer, Universal health care

In a previous blog I displayed an exchange of e-mail between me and my conservative acquaintance R. I've never met R and I don't know much about him. He was introduced to me by an old friend from Graduate School at the University of Illinois. R has turned out to be a formidable debater for the conservative side of several issues. I will have to call R an acquaintance. My conservative opponents H and M I have to call friends. I know them and I worked with them at my last place of employment.

It bothers my conservative friend H that he is unable to convince me of his side or position on an argument. He was unable to persuade me that I should enthusiastically support the exploration and drilling for oil in ANWR. He couldn't understand why I would accept the proposition that we import a lot more petroleum than we should and pay a lot more for it than we should and yet would not support the proposition that we need to drill and extract petroleum from ANWR. He dismissed my argument that we should instead devote money and effort to developing and building new facilities for generating power that don't rely on fossil fuel and don't exhaust megatons of CO-2 into the atmosphere each year.

R was also bothered by my refusal to accept the argument for drilling in ANWR. Of course, to him, I am just another liberal that he sometimes converses with in internet chat rooms. He finds liberals to be persons who ignore facts and statistics. His positions on drilling in ANWR, on opposing universal (free) health care, etc., are, in his words, based on facts and statistics.

I don't know anything about R's chat room liberals. I know about three conservatives: R, H, and M. My opinion is that they tend to be short-sighted, looking to the immediate future (present shortage of petroleum, etc.) and not the more distant future (need for alternate energy sources because the world is running out of oil). On some issues I think they are completely unrealistic. They say the same thing about me on some of the same issues.

H tried to irritate me by quoting from the odious Ann Coulter who pronounced that liberalism was like a religion. Being a professional conservative, Ms Coulter has to bash and insult liberals and do it in a way that generates a wide audience for her work. Rather than express indignation at the presumed insult, I wrote H that I agreed that many of my liberal ideas are matters of faith. I believe that all members of a society, or of our society at least, are entitled to good medical care. There should not be a price on someone's life. I think that entitlement is just as solid as the right to police protection, fire protection, property title protection, a stable monetary supply, and protection against foreign terrorists. I can not justify any of these rights or entitlements on the basis of statistics. I believe that there are more important things than profit. A business is not only tolerated but supported by society because it provides a useful or necessary service, not because it makes a profit for some investors. I believe that the primary responsibility of a manager of a corporation or other business is to the public, including the employees and customers of the business. Responsibility to the investors is secondary. These are things that I believe. Some of them are heresy to conservatives. In that sense, I accept the verdict that liberalism is like a religion. So also is conservatism.

Labels: Ann Coulter, Conservatism, Drilling in ANWR, Liberalism, Universal health care

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 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 the
statistics took that effect into account when comparing life expectancies in the
various countries with UHC and without.

You 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.

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.

Total 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.

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 of
stealing from one person to give to another."

To be logical, you must apply that same reasoning to paying taxes to support a police department, a fire department, etc.

(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 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.

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.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.

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 a
police department, a fire department, etc.

Of 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.

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 need
it? My response is, who is going to pay for the additional insurance?

I 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.

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.

No, 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.

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.

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.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.

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

Occasionally in this blog I present opinions of my friends whom I identify only with their initials. S is a Democrat who doesn't consider himself a liberal, but compared with my conservative friends, he is rather liberal. H is a conservative who tries sincerely to get me to agree with him. R is a conservative who likes to debate because it hones his skills. He knows that it is hopeless to try to convert me to conservative ideas and so he contents himself with trying to undermine my liberal ideas. M is a conservative who tries to play "gotcha" by interpreting my ideas as helpful to mortal enemies of our country.

Here is a series of e-mails between S, R, and myself. My friends all have access to this blog and they can judge for themselves whether I have faithfully presented their arguments and opinions in these e-mails. The series starts with an e-mail from S to R and others:

S wrote:

What does Socialized medicine buy Canada versus our patch work of medical coverage?
It buys a lot if you look or compare two statistics.

1. Canada infant mortality rate within 24 hours is 4.6 per 1000 live births and the U.S is 6.4.
   
2. Mean life expectancy is 80.3 years for Canada and 78.7 for the U.S.
   

How to fix this for the least amount of dollars? Yes, it costs to fix anything, even your car, house and an appliance.

I came up not with socialized medicine but a public health plan. This thought occurred to me while sitting in the waiting room at a woman's clinic. Jean was sent there to see a gynecologist. Poor Jean, she was by far the oldest and the only one positively diagnosed as not pregnant.

Attempting to study the group indicated most were by far much over weight. If overweight and lack of prenatal care were publicly available, could this reduce infant deaths? Not much there as training is very important in prenatal care. Trained nurses could handle this. The Red Cross offers classes to train parents for the new born in the home. Jean and I took the course and poor Jean was out of place as we were adopting and in our thirties.

Now on to longevity. Most people get some training in health in high school. However only something like 85% graduate by eighteen. Adult school does not cover health very much. I think this area would be another boost to senior's longevity.

My mother spent a huge number of volunteer hours with the county health department. She knew what it took to provide clinics of various types and some of her greatest friends were public health nurses. The nurses keep my Typhoid shots current as I was often drinking water out of North Georgia springs. nutrition was a big thing with the prenatal and post natal clinics. Doctor's cost was very little and often was a donation.

So conservatives, what is wrong with such a start towards some UHC by this method? Will it not help the most in need? I do not want to hear an answer about how one can not purchase batteries for a hearing aid in Canada.

R wrote:
Liberals, I have come to understand, have a protective shell that keeps out facts no matter how over repeated or how well documented. Facts are not just lamely refuted, they are totally ignored.

1.0 Canada infant mortality rate within 24 hours is 4.6 per 1000 live births and
the U.S is 6.4.

The reason infant mortality rates are higher in the US has nothing to do with the health care system, it is due to social problems. We have a huge population of drug-addicted mothers that Canada, nor any other country, cannot match. This is certainly a major problem, but it is not going to be cured by health insurance.

2.0 Mean life expectancy is 80.3 years for Canada and 78.7 for the U.S.

The lower life expectancy in the US, compared to other first-world nations, is due to the much greater number of deaths in the age group from about 15-45. These deaths are due to traffic accidents, violence (e.g. gang shootings), drug overdoses, and suicides. If you make it to 50 in the US, life expectancy is the longest in the world. Quite obviously, changes in health care insurance will have no effect whatsoever on traffic accidents, violence, drugs, and suicides.You point out correctly, that American high-fat high-sugar diets and lack of exercise are major problems. More can be done with educational programs, but changes in health insurance are not going to have any effect. Note, for example, that countries with a lot of mass transit involve their population in a great deal of walking. The US has too low a population density to support much mass transit outside of a few city centers. Health insurance is not going to change that. I have a profit-making health insurance plan. They contact me regularly by phone and by mail with all sorts of suggestions about a healthier lifestyle. They have an incentive to improve my health. Why would a non-profit care?Medicare lowers their administrative costs by never checking bills for error or fraud. They spend zero on that. Profit-making insurance plans comb hospital bills and dispute overcharges. I have little doubt that more than pays for itself. Why would a non-profit care?

Finally, note that countries like Canada can get away with imposing price controls on drugs. Since it is a small market, the drug companies do not cut them off. But try it in the the US, and you will drive drug companies offshore and refusing to ship. But facts are just to be ignored.

S wrote:
I specifically looked those figures up. Does that make me a Liberal?

At least we agree on one thing. Education helps. When I started volunteer tutoring years ago, the school was overrun with pregnant teens. Lots of effort of education was put forth by the school about protection with respect to aids. They had a guard who worked for the local prison talk on how he had contracted aids in a fight with a prisoner. We now have very few pregnant girls and a much larger coed enrollment.

I am proposing more health centers where teens can learn more about prenatal care plus child care. Schools hardly can afford full time medical trained faculty members.

Your point about the age group 15-45 has much merit. Canada has a much lower speed limit. You seldom even see a 100 KM speed limit which is close to 60 MPH in this country. I do not remember ever seeing a higher speed limit there. Their speed limit enforcement is well in place too.

I am not sure about the mass transit argument. Does this mean that our death rate is less in the bigger cities like San Francisco? I thought that most centenarians live in rural Midwest. Am I wrong?

Lastly, our schools now sell machine soft drinks and chips through machines. Not much help there if the student body has a number of pregnant girls.

I have no idea about the life expectancy over 50. Do you have a reference? IRS bulletin 590 has lots of longevity tables for IRA distributions. If this is so, our life insurance costs for those over 50 would be higher. Moreover, the other countries with a SS type plan would be more solvent too would it not?

The data you quoted is more elaborate then mine. Does this mean Conservatives have a better source. Who is using more statistics?

Pessimistic and Liberal, S

R wrote:

I specifically looked those figures up. Does that make me a Liberal?

Too soon to tell. If in a week or two you claim that life expectancy numbers prove the US health care system is inferior, then you are a certified Liberal.

At least we agree on one thing. Education helps.

We do agree on that.

Canada has a much lower speed limit. You seldom even see a 100 KM speed
limit which is close to 60 MPH in this country.

I don't think speed limits are the main problem. In this country, if a person has his driver's license suspended for DUI or whatever, he usually drives out of the courthouse parking lot -- ignoring the court completely. In Japan, by contrast, first DUI means you lose your license forever, second offense is a year in jail. Their tradition is that the youngest person in every group will be the driver, and will be served nothing but coke that evening.

I am not sure about the mass transit argument. Does this mean that our
death rate is less in the bigger cities like San Francisco? I thought that
most centenarians live in rural Midwest. Am I wrong?

I don't know. I was just observing that exercise is one factor in a healthy lifestyle, a factor often missing in the US. I lived in Tokyo for a while, and found mass transit to be quite a workout. One can easily climb 20 flights of stairs and walk four or five miles every day making connections. If the Japanese did not drink so much and eat so much salt, they would live forever.The broader point is that the quality of health care is not the only factor in health. It also depends upon the health habits of the population. The increase in obesity, for example, is expected to lower life expectancy in the US over the next few decades.

I have no idea about the life expectancy over 50. Do you have a reference?

From MIT course notes on Public Health Policy:
"Significant improvements in life expectancy lies not in cures for chronic disease—heart, cancer---but in reducing accidents, suicide, homicide, AIDS, the big causes of premature death."

Posted here "First, it would be great if people would recognize the limits to health care, even high-tech health care. Diet and exercise matter more to your quality of life than treatment does. For example, you could stop treating cancer completely and only drop the overall life expectancy by a couple of years. If this seems ridiculous to you, do the math. ...." [he does]http://www.oftwominds.com/journal/goodfellow5b.html

"... The United States spends roughly $4,500 per person on health care each year. Costa Rica spends just $273. That small Central American country also has half as many doctors per capita as the United States. Yet the life expectancy of the average Costa Rican is virtually the same as the average American's: 76.1 years."

How can that be? According to public health researchers, the biggest reasons are behavior and environment. Costa Ricans consume about half as many cigarettes per person as we do. Not surprisingly, they are four times less likely to die of lung cancer. The car ownership rate in Costa Rica is a fraction of what it is in the United States. That not only means that fewer Costa Ricans die in auto accidents, but that they do a lot more walking, and hence they get more exercise. Thanks to a much lower McDonald's-to-citizen ratio, the average Costa Rican thrives on a traditional diet of rice, beans, fruits, vegetables, and a moderate amount of fried food--and therefore enjoys one of the world's lowest rates of heart disease and other stress-related illnesses." http://www.washingtonmonthly.com/features/2003/0304.longman.html

Lastly, our schools now sell machine soft drinks and chips through machines.

I am all in favor of parents exerting control over the diets of their children.some places are banning the soft drinks. Do you think Libs still have superstitious fears about dangers of artificial sweeteners?

Moreover, the other countries with a SS type plan would be more solvent too
would it not?

No. SS is a Ponzi scheme whose solvency depends upon the ratio of the number of active contributing workers to the number of recipients.The data you quoted is more elaborate then mine. Does this mean Conservatives have a better source. Who is using more statistics?I have been repeatedly criticized by Libs on message boards for citing facts. They tell me that facts are unreliable, whereas feelings are reliable. Therefore, they tell me, one should develop policy positions by cultivating sensitive feelings, and then reject statistics that contradict those feelings.
R

[The discussion is continued in my next post. - AJS]

Labels: Canada, Conservatism, effects of life style on longevity, Liberalism, Ponzi Scheme, social security, Statistics, Universal health care

I have an ongoing discussion (argument, debate, word fight) about universal health care, or UHC. I favor it. My conservative friends H, M, and R oppose. H and M tend to advance arguments or anecdotes to show that UHC either doesn’t work or works very poorly in countries that have it. R argues that health care is not one of the services government should provide. He agrees that government should provide military protection, postal service, and sound money. Health care, along with free food, free housing, and free clothing, is a service that government should not provide.

I presented the argument that countries with UHC (e.g., Britain, France, Germany, and Canada) spend less per person on medical services and have better outcomes in terms of longevity than the United States. R does not dispute my claim that we spend more on health care than these other countries. He argues instead that the longevity in various countries is not related to the existence or absence of UHC. Longevity in the United States is lowered because of the high incidence of murder and other crime here. Costa Rica, which does not have UHC, experiences longevity in the same range as Britain because the Costa Rican people have a naturally healthy life style.

I could not argue with nor disprove R’s statistics. After stating that I believe that government on some level (federal, state, or local) should provide basic health care for all I presented the emergency room argument. Emergency rooms are overburdened and some have closed because of the large number of uninsured patients who get all their medical needs provided at hospital emergency rooms. R stated that it is not true that emergency rooms have been closed because of overuse by the uninsured. I stated that many have indeed been closed here in Los Angeles.

Rather than concede that he had been mistaken, R’s response was that the situation in Los Angeles and Tucson was the result of large numbers of illegal immigrants who use the emergency rooms. San Francisco and other cities farther from the Mexican border do not have the problem and do not have hospitals that have had to close their emergency rooms.

R is arguing that none of my reasons have any validity. UHC is not a solution for emergency room overloads; the solution is, by implication, to get rid of the illegal immigrants. In R’s world, UHC is unnecessary. There is nothing wrong with our medical care system that can’t be fixed by getting rid of frivolous malpractice lawsuits. There is nothing else that needs to be done. Dolce far niente, as the Italians say.

Labels: effect of illegal immigrants, hospital emergency rooms, longevity data, malpractice lawsuits, Universal health care

My friend M, whom I consider to be a complete right wingnut, trades insults with me by e-mail at least twice a week. In his latest, he included this comparison between "conservative" and "liberal." I will leave it to you to decide which of us is the nuttier.

First, his definition is not new; I'm sure I've seen it before.

Conservative Beliefs:

• Free enterprise.
  
• Self reliance
  
• Second amendment right to bear arms.
  
• Freedom of speech
  
• Freedom of religion

Liberal Beliefs:

• Government regulation.
  
• The government takes care of everyone.
  
• Only government has (controls) guns
  
• Freedom of speech you agree with (witness the treatment of conservative speakers on campus).
  
• Blind belief in the only true religion (Global Warming)

What's new to me is that the RW nuts have added the line on global warming to make it a political issue. It shouldn't be.

I am not familiar with any "liberal" comparison of "liberal" with "conservative." I won't try to construct such a list myself. Rather, I choose to punch a few holes in my friend M's definition of the two. First, it's big news to me that free enterprise, freedom of speech, self reliance, and freedom of religion are beliefs that only conservatives have. There's a question about the meaning of the second amendment right to bear arms: is that an individual right or is it the right of the States to have their own independent militias? That's still an unsettled question. At any rate, conservatives in cities like Los Angeles are just as appalled as liberals whenever an innocent child is killed by gunfire from a street gang member, and when the police find that gangs have superior weapons to the ones we provide to our policemen.

My point is that, according to M's list, nearly all of us are "conservative." The only persons not included are some criminals and a few hard-core dedicated communists. Even communists believe in self-reliance. A fundamental flaw in M's list is that it isn't useful as a means of classifying opinions.

Now, what does M have to say about liberals? Obviously he regards them with scorn and contempt. Don't worry; that's just one of M's insults. I get even with him in the next round of e-mails. Aside from that, what is wrong about the list for liberals?

Government Regulation: Contrary to what Libertarians and the Cato Institute would have us believe, private enterprise does not remain competitive without some rules. Monopolies are forbidden. Conspiracies to fix prices are forbidden. Companies are required to label their products and provide printed warnings of any hazards regarding a product. These are sensible rules that we all agree with. Someone has to enforce them. An impartial policeman is needed to keep free markets free and competitive. We all pay the policeman to do that; it is one of the functions of government. You may argue that some regulations are unnecessary and burdensome. No one disagrees with that possibility. The necessity of a particular regulation must be settled by the public and not by industry.

The Government takes care of everyone: I certainly hope that government would treat everyone fairly. A great man, our sixteenth President, said that government should do for people what people can't do for themselves. Perhaps M favors a government that takes care of only a select few. We have a tendency toward such a government now. The Bush Administration is concerned about caring for the wealth of the rich, by keeping their taxes low, and caring for the feelings of the christian fundamentalists by forbidding federal funding of embryonic stem cell research and by advocating against abortion and gay marriage. It's not greatly concerned about the lives of the volunteers who are fighting Bush's War in Iraq nor about the lives of their families. The care or neglect is shown in the funding priorities of the administration.

Only Government has (controls) guns: People who call themselves liberals have all sorts of attitudes regarding the ownership and use of guns. You attitude depends on where you live. A farmer uses a gun to protect his chickens from the hawk. Men in small towns and on farms in some States like to go deer hunting in the fall. Rural people tend to regard a gun as a useful and necessary tool. City folk don't shoot at hawks and don't spend their vacation time hunting deer. To them, a gun is something a policeman uses to protect them, or something a mugger uses to rob them, or something gang members use to kill each other. City folk would feel more comfortable if guns didn't exist. If they didn't exist, the police wouldn't need them, either. There are certainly some liberals who passionately desire strict regulation of hand guns, dealing with who is allowed to own or use one, how they are marketed and sold, the kind of ammunition available for them, and what type of gun is allowed to be sold to the public. A lot of the controversy has to do with automatic or semi-automatic weapons: weapons that can fire many bullets for one pressing of the trigger. Farmers have no interest in such weapons. Neither do deer hunters. Gangs and other criminals like them. The police generally do not carry such weapons.

Freedom of speech you agree with (witness the treatment of conservative speakers on campus): It's just plain nutty to conflate the behavior of rude, impolite college students with liberalism. I suspect that what the students object to is not the "conservative" content of a particular speech but the obvious lies and half-truths that so many "conservative" speakers utter. If a speaker states that he believes in a society in which everyone has an equal chance for success but must achieve success through his or her own efforts, I don't see why anyone would object. However, if the speaker goes on to say, as Milton Friedman once said before a college audience, that there is no poverty and there are no poor people in the United States, he deserves to be booed.

Blind Belief in the Only True Religion (Global Warming): Now, there is an assertion that is just plain nutty. I won't bother to respond to it.

Recently, M, H, S, R, and other friends have been e-mailing me and each other about global warming and universal health care. Now I admit that universal health care is a rather radical idea. I'm not sure it's a liberal idea. It's probably to the ideological left of many liberals. However, the existence of Global Warming has been condeded by almost everyone except James Inhofe, a Senator from an obscure mid-western State. It is not sure what the consequences will be. One prediction is that the levels of the oceans will rise several feet.

I keep trying to think of a model for a system of universal health care. Some Republicans (e.g., Mitt Romney, Arnold Schwarzenegger) think of the model of auto insurance. Everyone is required to carry liability insurance for his car. Why not require everyone to buy health insurance? For those who can't afford the premiums, the State will provide a subsidy. Mr. Bush proposes that the federal tax code be modified to allow health insurance premiums to be counted as deductions. (They were allowed until about 1970).

One model I think of is fire protection. In Los Angeles City and County, everyone is protected by fire departments who try mightily to protect homes threatened by wildfires. We don't buy insurance so that the fire crew will come; we pay taxes that pay for the fire departments. We do have fire insurance on our homes, but that is to pay for repairing the damage done, not to pay the fire crew to come to extinguish the fire. If we followed this model, we would set up numerous free health clinics where people could get treatment for various medical problems. The free clinics would also encourage people to participate in preventive medicine, just as fire departments encourage us to install smoke and fire alarms, give us advice on how to protect out houses from wildfires, how to build houses that resist burning, and the like. Really serious medical problems would be dealt with in hospital emergency rooms. As to health insurance, that would pay for expensive treatment needed to restore good health.

I'm not sure I like this model very much, but it would be an improvement over what we have now. It would be like the health care system in Los Angeles in 1960, when the county had funds to operate free health clinics. My wife and I used to go to such a clinic every year to get our flu shots.

Anyway, that's enough odd thinking for a Saturday morning, especially as it is almost noon.

Labels: auto insurance, fire damage to homes, fire insurance, liberal vs. conservative, Libertarian, Milton Friedman, second amendment, Universal health care

In yesterday's post (see below) I commented on a recent Libertarian argument against a proposal to provide universal health insurance to all by means of a single-payer system. Canada has such a system, as do many other industrialized countries. I am not satisfied with my own critique of the Libertarian argument against such an approach. I know that there are others who are much more able than I am to mount a convincing defense of single-payer and a devastating attack of the Libertarian argument. However, I will attempt such an attack anyway.

The writers made the following four arguments against proceding now with setting up a single-payer plan:

1. A single-payer or universal plan doesn't provide timely access to certain expensive medical procedures, such as joint replacements or organ transplants.
2. Lack of personal health insurance or personal wealth does not preclude Americans from obtaining health care from hospital emergency rooms.
3. Statistically, one can not show that having health insurance correlates with having better health.
4. The additional cost of caring for the uninsured is no more than three percent of the total cost of the American health care system, the writers say.

Rather than proceed with a single-payer or universal plan, the writers recommend that we should try to do something about things that drive up the cost of health care to mericans. We should adopt such remedies as health savings accounts, a standard health insurance deduction in the personal income tax, and deregulating the insurance industry.

1. Access to such procedures as joint and organ replacements are delayed in some countries by a shortage of facilities to perform the procedures, not by the bureaucratic inefficiency of the government's health care plan. In addition, in our own country, these precedures are not available to persons who lack both insurance and the money to pay for them. We read in the papers of accounts of poor, uninsured persons who do receive such procedures, but they are the exceptional cases in which some generous person or organization pays the cost. Libertarian point #1 is not a valid argument against universal health care.
2. Emergency room care also does not provide expensive treatments like organ or joint replacements. It provides only the medical services needed to prolong a person's life or to treat an illness. If you have a weak heart and have a heart attack, the emergency room staff will resuscitate you but will not give you expensive treatment for your condition.
3. There are several possible explanations for the lack of correlation between having good health and having insurance. One is that a majority of Americans do have health insurance. The lack of correlation simply means that insured Americans, on the average, are as healthy as the average uninsured American. A good fraction of uninsured Americans are young people with good health who either can't afford the insurance or don't see any need for it. Another is private insurance is not structured to encourage one to stay healthy by having frequent check-ups. It is structured to enhance profit by discouraging visits to the doctor unless the patient has a case that is convincing to the insurance adjuster.
4. To argue that the cost of caring for the uninsured amounts to "only" three percent of the cost of the American medical care system and then to argue in favor of such controversial and untested remedies as deregulating the insurance industry, setting up personal health savings accounts, and an insurance deduction in the income tax seems rather hypocritical to me. I have no doubt that providing insurance to the uninsured would reduce that three percent cost to something less.

Anyway, for what it's worth, there is my answer to the Libertarian argument against universal health care or universal health insurance. I welcome your comments.

Labels: Cato Institute, delays in expensive medical treatments, Libertarian, single-payer, Universal health care