Al's Opinions

I had occasion to depend on both the Los Angeles Fire Department Paramedics and the Emergency Room of the Kaiser-Permanente Medical Center in Woodland Hills last Friday (February 25).  About 9:30 in the morning I got out of my car and carelessly closed the door on a piece of the tip of my right ring finger.  The piece of flesh remained on the car door and the rest of my finger bled dark blood.  I was able to go into my house and wrap some Kleenex tissue on the wound.  I dialed 911 and asked for help.  In a few minutes the ambulance arrived and the paramedics took me to the emergency room of my choice, the one at the Kaiser facility about three miles away.  By 10:30 an ER doctor had seen the wound, had anesthetized my finger and cleaned the wound, and was installing a gauze bandage.  I won't bother you with the precise structure of the bandage.

Monday (yesterday) I had an appointment with a plastic surgeon at Kaiser.  He looked at the wound and pointed out that it was already starting to heal.  His recommendation, which I accepted gladly, was to continue to let the healing proceed by itself.  He predicted that it would take about four weeks to heal.

My finger will continue to have a gauze bandage for a while.  That's fine with me.  I know it's healing.

This episode in my life illustrates how valuable to me a good hospital emergency room can be.  If I had been unable to obtain medical help for several hours, the wound might have become badly infected and I would have lost most, if not all of the finger.  This ties in with my own belief about government.  I follow the advice of our greatest President, Abe Lincoln, who said that government should do for the people those things that the people can not do for themselves.  Prompt medical attention is one of those things.

Labels: Abe Lincoln, hospital emergency rooms, Kaiser-Permanente

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

The recent decisions of the Supreme Court exhibit a mixture of pure "movement conservative" and "pro-authority" beliefs. The pro-authority beliefs are shown in the decision about the "Bong hits" sign and the "right" of a manufacturer to set a minimum price for its product sold by an independent distributor. The movement conservative belief is shown in the two school desegregation cases.

I've been having a running discussion, argument, or debate with some conservative friends, one of whom I would call a movement conservative. He argues, for example, that there is nothing about our health care system that government ought to change. The overload in emergency facilities in cities that have high concentrations of illegal immigrants is not a consequence of any government action regarding the health care system; hence, government should not undertake to modify the system. Instead, government should take steps to get rid of the illegal immigrants who are causing the problem and who are present because government hasn't enforced the existing laws regarding immigrants and their employment. I would summarize the movement conservative belief as including the theorem that government is not responsible for problems that government did not create. The storm that damaged New Orleans was not caused by government; hence, government has no responsibility to repair the city or do anything for its dispossessed citizens. Schools that happen to be segregated as a result of residential segregation should not be desegregated by government because government was not responsible for the segregation.

You'd think that I, after 84 years on this planet, would have learned by now what conservatism is all about. Yet, the mind set of the movement conservative still astonishes me.

Labels: Conservatism, hospital emergency rooms, housing problem, immigration, price fixing

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

Writers Michael Tanner and Michael Cannon have an opinion article in the Los Angeles Times for Thursday, April 5 in which they present the Libertarian argument against universal health care or universal health insurance. Mr. Tanner and Mr. Cannon are scholars at the Cato Institute. In their argument they make the following points:

1. Providing universal insurance does not necessarily provide universal or equal access to medical care. Many countries that provide universal health insurance still require waiting periods for many more expensive procedures, such as joint replacements or organ transplants. The patient may die while waitint.
2. In our own country, lack of health insurance does not deny medical care. An uninsured person can always obtain medical treatment at a hospital emergency room. Hospitals are legally required to provide such care.
3. The writers cite studies that show that having health insurance does not correlate with having better health.
4. The writers cite a report that shows that the cost to society of providing health care to uninsured persons amounts to no more than three percent of the total cost of medical care in the United States.

The writers conclude that, rather than concentrate on providing affordable health insurance to everyone, politicians should work on fixing some of the other problems and applying other solutions,

such as enacting a standard health insurance deduction, expanding health savings accounts and deregulating insurance markets.

I think that these writers are living inside a bubble. Even they concede that it would be good to provide everyone with health insurance. They don't think it would solve anything to do so. They don't recognize that our national health care system is broken and is deteriorating. It may be statistically true (I can't dismiss their statistics out of hand) that a person who must rely on a hospital emergency room for medical care is otherwise just as healthy as a person with health insurance or with enough money to pay for visits to the doctor. I do know that more and more hospitals are closing their emergency rooms. Emergency treatment is still available, but waiting times are longer and longer. I have good health insurance and I have enough money to pay for medical costs out of pocket, but if I have a heart attack I may not be able to reach a hospital with a working emergency room in time to save my life.

It is very wrong to argue that we don't have a pressing need for universal health insurance, at least, simply because emergency rooms are legally required to care for the uninsured and indigent members of our society. We all need access to emergency treatment from time to time. Such treatment should not be delayed because ideologues have objections to society providing afforcable health care to all.

Labels: Cato Institute, hospital emergency rooms, Universal health care, Universal Health Insurance

I've just received by e-mail exhibit 37b as to why California is ungovernable. We have problems in this State that our magnificent Governor and our fearless legislators seem unable to solve. Our public schools are suffering from insufficient funding. Teachers have to use money from their own salaries to buy supplies for the children. Hospitals are having to close emergency rooms because of the flood of uninsured residents who must use the ER for any health care they receive. Our prisons are overcrowded. Our highways need repair. There's a shortage of money everywhere - except in the campaign funds of some prominent politicians.

Anyway, here is a copy of the exhibit:

Albert, the package we sent your petition inlooks like this.

Name:
Mr. Albert Saur
Property address:
5416 Manton Ave, Woodland Hills, CA 91367
County of:
Los Angeles
Delivery date:
Week of 03/12

This e-mail is to confirm that your Official Petition to the California Legislature was delivered to your verified address on the date indicated above.Please sign and return your petition immediately so that we can forward it to your California State Legislators.Also, please say "yes" to our invitation to join the Howard Jarvis Taxpayers Association. Return the membership form along with your petition, or click on the red button to join online. Making your voice heard is important, but the only way to stop higher taxes is to get involved! Please join us today.

If you did not receive your package, or have misplaced it, please click on the red button to access our website for further instructions.

I did in fact receive the petition in the mail a few days ago. This exhibit shows that the anti-tax movement here in California is still strong and resourceful. I don't know yet what the constitutional amendment underconsideration is that has the Howard Jarvis Taxpayers Association so worried. I know that it is about time that someone tried to do something to restore some degree of equity and fairness to the property tax mess we Californians created when we adopted Proposition 13.

I think I am in position to talk. My wife and I bought our present house in 1968. It is a large tract house. We paid $39,000 for it. When Proposition 13 went into effect, the house was appraised at about $60,000 and was taxed at two percent per year on that amount. Since that time similar houses in the tract have increased in value. Not long ago some houses like ours were selling for $750,000. I am now paying in property taxes $1500 a year for a house that may be worth three-quarters of a million dollars. The people who bought houses in the tract recently may be paying a property tax as high as $15,000 a year, or ten times what I pay.

There is a nice Mexican restaurant near my house that has been in existence for longer than I have been living in my present house. I don't know what property tax the restaurant pays, but I suspect it isn't much more than what I pay. You may argue, even though I don't, that because of my advanced age and because I am retired, I am entitled to a reduced rate of taxation on my house. But, is the restaurant similarly entitled? A restaurant earns a lot of money. I don't earn any money; I live on my savings, my investments, on social security, and on some company pensions.

I think it's high time that California changed the Proposition 13 property tax law. The Howard Jarvis Taxpayer Association is determined that the law will not be changed. In a contest between the reformers and the Howard Jarvis people, I will bet on the latter.

Labels: Education, hospital emergency rooms, Howard Jarvis Taxpayers Association, prisons, Proposition 13

# posted by Albert Saur @ 10:51 PM 0 comments