Archive for the ‘Health policy’ Category
The other day I noticed in a local newspaper an articled titled “What’s Wrong with Healthcare for Everyone?” The author affected amazement that people could be so dense or evil as to oppose the laudable and lofty goal of universal healthcare.
Now I am myself not in favor of any of the recently proposed plans for national healthcare reform, including and perhaps especially ‘Obamacare.’ I have, I believe, many valid reasons for opposing these plans – reasons technical in nature, and based on my 30 years’ experience as a health and policy scientist.
Many people give massive financial infeasibility as the main reason for opposing ‘Obamacare’. I agree that ‘Obamacare’ would utterly ruin the US economy (and so does every impartial expert who has examined the plan in detail.) Nevertheless that is only my second-greatest objection.
My strongest reason for opposing ‘Obamacare’ and similar plans is that they would entrench as a permanent fixture in our society a system of healthcare that is radically wrong. Today in America we practice industrial medicine. The incentives that drive the system are corporate profits. The consequence is that we spend far too much money one invasive, expensive, and dangerous treatments, and nowhere near enough on preventing illness. By giving the federal government a much larger presence in healthcare, ‘Obamacare’ would give even more power to the same corporations that are causing the present problems. These corporations lobby Congress and control policy; you and I do not.
If we spent 1/10 as much on preventing disease as we now spend on treating it, the health of this country would improve 50% or more. However the present system is so designed that prevention is not taken seriously. Illness is more profitable than health. That’s the problem. It’s a problem nobody is willing to face, and a problem that is literally killing us.
Yet as important a topic as that is, it is still not the reason for my writing now. I realized this after I outlined an elaborate article, amplifying the preceding points, and adding further comments about the basic ineptness and corruption of the federal government (why place the same federal government that has taken the country through two pointless multi-trillion dollar wars in charge of healthcare?)
But when I finished the outline, I thought to add one final point; and when I did, I realized that this point was the real reason why I felt a response to the article, “What’s Wrong with Healthcare for Everyone?” was necessary.
That more fundamental issue is this: the author of that article dove deeply into the realm of irrationality. The tacit premise of the rhetorical question posed is that everyone who opposes ‘Obamacare’ must be callous, selfish, or evil. That this premise is not valid is patently obvious: there are dozens of serious reasons to oppose Obamacare. Anyone with an ounce of sense should know this. In fact, everyone does know this.
So when a person titles an article, “What’s Wrong with Healthcare for Everyone?” it is nothing short of an affront to civil society and the principles of democracy; because it is not only failing to contribute to a genuine dialogue, it is an obstacle to it.
It would be bad enough if someone actually believed that people who oppose ‘Obamacare’ do so out of hatefulness or selfishness. That would be a mere wrong opinion. But here the author knew full well how groundless the question is. It was not posed as part of a social dialogue aimed at gaining mutual understanding, agreement, and cooperation. The naïve-sounding question is merely a tactic aimed at winning an argument by any means possible. In that sense it is like sophistry, but worse. Sophistry at least has the superficial appearance of intelligence. This question is merely a power tactic. It is vacuous, and the person asking it knows it is vacuous. It is an aggressive non sequitur that removes all possibility of intelligent discussion. The point is to forestall a discussion by presenting oneself as entirely unconcerned with even the appearance of reasonableness. It is the holding of reason and reality itself hostage. It is saying, “I’m not being rational, and you can’t make me; I have enough power to get my way so I don’t want to be reasonable.” And this tactic has been played out countless times by radical progressives insisting that the only way to proceed is to adopt some immediate, radical, and massively government-run reform plan.
There’s an even dark side to this. The real question is why people are willing to debase themselves, and all of civil society, by resorting to such tactics to promote a plan which is plainly infeasible and aversive. The sobering answer is this: a collective self-destructive urge. ‘Obamacare’ is more than bad; it is suicidal, and the frightening prospect is that a large segment of the American population wants a suicidal plan for precisely that reason.
I’m not going to explain this further now, but maybe I’ll revisit it. For now my guess is that either you’ll see my point or not. If you do, further explanation isn’t needed, and if you don’t, it’s probably useless.
When 9/11 occurred, when those terrible images of the Twin Towers crashing down appeared across the country, my first reaction was basically that it seemed like a wake-up call to America. Maybe if I had been on the East Coast, closer to the tragedies, or if I knew someone who was killed or injured, I would have reacted differently; I would have likely been more immediately affected by the grief and sense of loss. But I was in California, 2000 miles away. To some extent, the events were an abstraction — just as if a typhoon or other natural disaster struck half-way around the world.
At the time I was very much involved in an attempt to rescue a large tract of land from the hands of real estate developers. I was carefully reviewing an Environmental Impact Report, and preparing a scathing critique to send to a local government office. This is what was on my mind: how people in California could be so preoccupied with wealth and real estate speculation that they were willing to literally sell their souls, paving every field and meadow, destroying every other life form, poisoning their air and water, stressing themselves to the point of physical and mental illness, and severing their life-sustaining connection with nature.
I didn’t use these words exactly, and in any case it didn’t imply lack of concern for the people directly harmed by the attacks, but my immediate private response was something like “America had it coming”. To the extent that I shared this reaction, however diplomatically, people were shocked. They asked, “how can you criticize America at a time like this!” I was accused of being unpatriotic. Unfortunately, things have played out in the intervening years consistent my reaction then. The societal problems I was noticing in 2001 were strongly linked to a lopsided and unsustainable economy, not just on the part of corporations, but with regard to individual people. The ethos of the times was to buy a house, let it appreciate in value, and sell for a profit; and at the same time to make any ethical compromises necessary in terms of work and job to insure enough income to make mortgage payments. That was considered the ticket to financial security. This led, in a way that might have been predictable had people thought things through, to the collapse of the mortgage industry and the financial meltdown.
After 9/11, some people called it punishment from God. That’s not what I was suggesting then or suggest now. ‘Punishment’ is the wrong word. It seems to me, rather, that, when people are messing up big-time and headed for ruin, that God gives them a message. It doesn’t come from wrath or anger, but from compassion and concern. Literally, then, we bring these things on ourselves. Hopefully we get the message, correct what needs correcting. Then hopefully go on to reap the joys and blessings that life truly promises, and can look back on the wake-up call with understanding and even gratitude.
For me, what’s happened with healthcare reform in the last year seems like a second wake-up call to America. The kind of reform proposed by the president and voted for by Congress amounts to the worst kind of socialism. It is antithetical to the principles of American society. It is not just the content of the reform — which puts government at the center of a malignant and malicious medical-industrial complex — but also the process: this was truly done without the consent and participation of the American people. The whole thing was an exercise in totalitarianism. The House and Senate bills were, for the most part, drafted in secret, allowing little opportunity for public scrutiny, debate, and comment. Meanwhile the president embarked on a shameless propaganda campaign, even to the point of bombarding constituents with absurd emails misrepresenting the plan and demonizing opponents. In the end, the House of Representatives relied on incredibly shabby tactics to bypass a Senate filibuster, effectively announcing the suspension of even the appearance of democracy in the country.
However as far as I’m concerned the biggest and most decisive issue concerning healthcare reform — one about which there should be complete agreement by any observant person — is that the whole thing is a farce, because the medical system in America is totally dysfunctional anyway. If you don’t know this, then either (1) you are as rich as Warren Buffet, and are insulated from what most people experience seeking healthcare, or (2) you haven’t been to a doctor in 10 years.
Doctors and other healthcare providers have traditionally been among the finest people in society. They are smart, unselfish, compassionate, highly skilled, and, more often than not, extremely spiritual. To be a physician used to be considered a calling from God. Personally I believe that is still the case. However the institutions in which care providers must operate today are aversive to the point of choking the life out of these genuinely good intentions, and bringing the noblest among them to the point of despair. I, for one, do not like to see this. When I visit a hospital now, I’m not sure who I feel more sorry for — the patients, or the staff. But in any event, I see that something is terribly wrong. (And in case you’re wondering, I enter hospitals these days to visit others. I’d rather die than be admitted myself.)
So now we’re faced with our second wake-up call. American society fell years ago off the cliff into materialism and affluence. But we still congratulated ourselves as being the bastion of democracy. But, with the events of the last few months, that illusion too has come crashing down. The United States is not a democracy. We are an occupied nation, each of us isolated, cut-off from others, and paralyzed with fear. What makes it especially difficult is that we do not even know who the enemy is. It isn’t Obama, and it isn’t Nancy Pelosi. It would be nice if it were that simple. Ultimately, it is just like those prophetic words of Walt Kelley, the famous creator of the ‘Pogo’ comic strip: “We have met the enemy and he is us”.
It comes as no news to say that we are, each of us, divided souls — part angel and part devil — each struggling for dominance and control within us. It seems that, in ways I’m not sure anyone has yet fully explained, these forces can collectivize. Just as our inner angel may work with those of other people to found churches, charities, and institutions of learning and art, our inner devils do this also. We probably don’t need to get too far into the psychology, and certainly not the metaphysics, of this here, because the practical implications are pretty straightforward in any case. The bottom line is that our inner angels have grown tepid and lazy, gradually being seduced, one degree at a time, by comfort and self-indulgence.
This happens. It’s part and parcel of being an angel. But when it comes to your attention that this has happened, you’ve got a decision to make: to let the slide continue, or to get back on track.
That’s where we are today. I believe that most Americans still believe in our country: that we have a special role to play in history. But we’ve fallen slack, and haven’t been doing our job. We’ve had two wake-up calls already, and I, frankly, don’t want to wait around to see what the third one might look like. It’s time to gird up our loins, step up, and do what it takes.
What that means can be said in a single word: Virtue. If that’s too vague, just refer to the time-honored division of Virtue into the four cardinal virtues of discernment (prudence), self-control (temperance), courage, and justice. And if, like most people today, thanks to the narrowness of modern education, you’ve never studied the cardinal virtues, then you need wisdom.
I don’t need to spell out in detail what needs to be done, because you already know where the answers come from: conscience. My job — both a psychologist and also as someone who’s been fortunate enough to have a traditional religious and classical education in an age where that’s rare — is just to help remind you that you have a conscience. Consult your inner compass. It exists. It’s a spiritual reality. Everything begins there.
But just as evil has now collectivized itself in unprecedented ways, creating terrible, global anti-humanistic power structures, so too must our inner angels organize and become effective in unprecedented ways. This is the challenge of history now.
First we must individually get our acts together, shrugging off the lethargy and dross of bad habits and thought. Then we must learn to new ways to work together. We must found new institutions, and new kinds of institutions. We must transcend the limitations of personal ego that have rendered previous institutions incapable of preventing the evils we see today.
I will close by singling out for emphasis one of the cardinal virtues: courage. It is not that courage is, per se, more important than the other cardinal virtues, but it does seem particularly important to these times. The events of 9/11 achieved the aim of instilling widespread fear. And the federal government, too, has lately used fear to drive the populus into submission. In both cases the antidote is courage: the courage to endure and to believe in oneself, in ones ideals, in others, in ones traditions, and in ones instincts.
As I write I am reminded of the great book of the eminent theologian, Paul Tillich, The Courage to Be. The title alone reminds us of a vital connection between courage and being. To be who one truly is requires great courage. And, conversely, to lose courage is to cease to be.
Let us all take courage, then, and more forward — together.
Law professor Steven Willis suggests that the strongest argument against the constitutionality of the Health Care Act is that it involves an un-apportioned capitation tax.
According to Article 1, section 9 of the U.S. Constitution:
No capitation, or other direct, Tax shall be laid, unless in Proportion to the Census or Enumeration herein before directed to be taken.
The Patient Protection and Affordable Care ACT of 2010 requires all individuals… to pay a ‘penalty’ on their failure to act, i.e., on their failure to purchase proper health insurance or to enroll in a proper plan… Certainly, the ‘penalty’ is not a ‘duty’ or an ‘impost’ and is not constitutional under either of those terms. Hence, in my opinion, the only thing the ‘penalty’ can be is a direct tax and, more particularly, a Capitation or per person tax. Such a tax is constitutional, but only if apportioned among the states consistent with the census. This Lack of Health Care Tax is not properly apportioned. Hence it is unconstitutional.
Proper apportionment (i.e., amount of tax) could potentially reflect factors like age distribution of a state’s population and their general health status, and whether the state has its own provisions for public healthcare.
For details read the entire article here.
So far, a lot of discussion about challenging the individual mandate of healthcare reform centers on the Commerce Clause of the Constitution: does Congress have the right to mandate purchase of private health insurance by virtue of its Constitutional authority to regulate interstate commerce?
It’s possible that all this concern with the Commerce Clause is obscuring and taking attention from more fundamental problems here. Look at it this way. Western European governments tax people to pay for socialized medicine. Basically it’s part of the income tax. In theory the US federal government could do the same thing; nobody would claim that such an increase in federal income tax is unconstitutional.
One way to interpret what’s happened is that the government is saying, “We could just raise your income tax by 20% and put all healthcare financing under a government insurance program. But this would be unnecessarily expensive. So instead, we’re going to make you send your money to private insurance companies, not us. Because of the competition that introduces, this will be better for everyone.”
So, from a practical standpoint, given a choice between the former model, which is clearly constitutional, and the latter, which is questionable, the latter is better. Maybe it’s not “constitutional” in a strict sense, but it is better.
However it appears there may be a deeper philosophical issue here — one that pertains to the fundamental relationship of citizens to government, and the nature of the social contract. Functionally, the individual mandate serves as a kind of tax. But usually taxes are for things we do or use. We pay sales tax on items we buy, for instance. We pay tax on income we earn. If you don’t buy anything or don’t earn anything, you don’t have to pay these taxes.
But the individual mandate amounts to a tax on just being alive. Thus, it is really more like a subscription fee than a tax: one is required to pay it simply because one is a citizen. That strikes me as unprecedented. The principle it implies — that, basically, the citizen is owned by the State, and has an *automatic* obligation to the State — seems like a defining feature of Socialism. It is a truly radical change in the relationship between the individual and the State. And whether it is explicitly prohibited in the Constitution or not, that does seem like something the founding fathers did not intend.
So in summary the argument I’m raising goes as follows: (1) under the Constitution, Congress could legally raise taxes to pay for universal healthcare; (2) if they’re allowed to impose such a tax, they should also be allowed to make us send our checks instead to insurance companies — because that is cheaper (the insurance companies would be functioning like contracted tax collectors and administrators); (3) however there is a significant question whether fees for mandatory health coverage are a ‘tax’ in the usual sense (and the sense meant by the framers of the Constitution), as opposed to a subscription fee demanded of citizens.