Archive for the ‘Health policy’ Category
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.
The Essay, “I, Pencil”: Why the Government Cannot Run Healthcare
Would you like to read a compelling argument against government-managed healthcare? It is this found in the simple, charming, famous (but not famous enough) essay by the economist Leonard Read, called “I, Pencil“.
Here is a paragraph to whet your appetite:
I, Pencil, simple though I appear to be, merit your wonder and awe, a claim I shall attempt to prove. In fact, if you can understand me—no, that’s too much to ask of anyone—if you can become aware of the miraculousness which I symbolize, you can help save the freedom mankind is so unhappily losing. I have a profound lesson to teach.
With some reluctance I refrain from talking more about it — you’ll just have to read the essay yourself:
Liberals, Conservatives, Joan Baez and the Nation-State
The other night I saw a reprise performance of the recent American Masters episode on the life of folksinger and political activist, Joan Baez.
It was a good program and showed what a remarkable person Joan Baez is. She walked the walk, even to the point of voluntarily accepting incarceration several times because of her (nonviolent) opposition to the Vietnam War.
But one detail that caught my attention was a brief remark by Joan in a film clip from an early 1970′s protest: she was exhorting people to “end the nation-state”.
End the nation-state? Sounds like a good idea to me — where do I sign up?
And here was Joan Baez, one of most visible “liberals” of the second half of the 20th century, saying something I agree with, even though I am a political libertarian — which most people consider a conservative position.
But there was no mistake. Joan Baez wanted to end the nation-state. That was the wish of liberals in the 1960′s (as with John Lennon’s song, “Imagine there’s no countries; it’s easy to do….”). It seemed obvious to anyone with good sense that governments were the cause of wars, and that governments served generally to suppress what is best in human nature.
To liberals, the government was the problem, not the solution. The government was causing the war in Viet Nam, and hurting everyone. Liberals wanted to reduce government power and to end the cultic worship of governments.
But roll things forward 35 years. Now so-called liberals are supporting massive government-run healthcare.
They’re militant about it, insisting that “poor people have a right to healthcare, and the government
should supply it, whatever the cost.” This is not only different from the liberalism of the 60′s, it’s really the complete opposite.
In the 60′s and 70′s, the view was that if governments would get out of the way, people could sort out their own problems. I can say that for sure, because, at least in the 70′s, I was there marching and singing “give peace a chance.” People were thinking, “Life is good. If governments would get out of our lives the natural impulse to enjoy life and to love and help others would manifest itself spontaneously.”
That’s still my view. If John Lennon were alive today, I’d like to think that would be his view, too. Somehow I just can’t imagine him singing, “Hooray for government! Let’s give them more power! Let them pick our pockets and design aversive, government health programs, so we can all stand in line, put up with terrible service, and be at the mercy of arrogant public officials.” No, that’s not how a working class hero would see things.
So the great irony is that true conservatives and true liberals are on the same side: both groups want a world which affirms human values, welfare and happiness. And opposed to these things is an ever expanding “statism” — a vast, inhuman, oppressive machine.
This is a rather important idea, and bears further thought. Consider how much the media makes of the supposed opposition between “conservatives” and “liberals.” What if this turned out to be all bunk! Could it be that human beings are in basic agreement about core values — and in an instinctive aversion to abusive government power? And could it be that the dominant economic institutions try to invent a false conflict in order to divide and conquer the population?