Archive for the ‘Public health’ 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.
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?
The Individual Mandate is A Radical Alteration of the Social Contract
Part of the health care reform bill currently being debated by the House of Representatives is the individual mandate. By this provision, everyone would be required — by law — to have health insurance, or else be charged with a criminal offense and face fines or possible imprisonment.
This would be a radical and unprecedented change in relationship between citizens and government. The government would be saying, “you must be part of the system — our system — or we’ll fine or imprison you.” That violates your basic freedom as a human being.
At face value, the arrangement seems no different than mandated car insurance, which already exists. But there’s an important difference. Nobody has to drive a car. If you don’t want to be forced to buy car insurance, walk or take the bus. You aren’t compelled. You retain your freedom to participate or not.
Similarly, everyone is required to pay income tax – but only if you have income. If you really don’t want to pay income tax, you can, in theory, quit your job and just live off the land. Few do this, but the possibility of choice has a major implication. Since you’re free to opt out of the system, your participation is voluntary. That’s the essence of the social contract, and the basis by which governments are accountable to citizens. Without the voluntary aspect, there is no social contract, because a contract cannot be compulsory. If you’re forced to participate, your condition is that of slavery and servitude to the state.
A further implication is that you’d be effectively forced to have a job so that you can pay for health insurance. True, nominal programs would help the unemployed buy insurance, but these would likely be inconvenient and complicated. Most Americans would feel it necessary to work and to buy insurance.
People should work because they want to, not because they have to. When they have to work, it affects the workplace: companies then don’t need to supply good benefits or working conditions to retain employees. So with the individual mandate, not only would you be a slave to the state, but to the corporate system as well.
The individual mandate’s closest analogy is military conscription. But at least the draft — itself controversial — applies to a dire emergency — war. The individual mandate is, at best, a convenience of the government, not a social necessity.
Thus, as with 9/11 and the ensuing Patriot Acts, the government is trying to use problems in the health care system to justify an expansion of power – at the cost of your freedom.
What we have in the United States is a health crisis, not a health insurance crisis. Legislators seem unable to comprehend the difference. The problem is not that many Americans lack health insurance, but that health-care costs are too high. We should be focusing on new ideas for reducing costs – based on technology, innovation, competition, and individual initiative – not trying to expand the current insurance-based system that has produced the crisis.
Seven arguments against a doctor’s office visit for flu
1. Unless the patient has *serious* pre-existing conditions the flu will pass by itself.
2. After two days of symptoms, pharmaceutical treatments (i.e., Tamiflu or Relenza) will probably have little or no benefit.
3. The best treatment for flu in any case is to stay in bed. A trip to the doctor’s office places serious and potentially unnecessary stress on the patient and his/her immune system.
4. The patient exposes others to flu virus.
5. In principle, a prescription for Tamiflu or Relenza could be made without a physical examination. Patients can accurately take their own temperature and report their symptoms by phone.
6. The best reason for an office visit is indirect: to take a throat or nose swab/sample for flu virus confirmation, either via a rapid (immediate) test or by sending it to a lab for culturing and more accurate testing. This has public health value, because it helps track flu in the community, but does not benefit the actual patient.
7. There’s no logical reason not to sell rapid influenza test kits in pharmacies (without a prescription) and to let patients use these at home. Note that these tests have relatively low diagnostic sensitivity (50-70%): they produce many false-negative results. However the tests have diagnostic specificities of more than 90%: they produce few false-positive results; thus, if a positive result occurs, the patient probably has flu and Tamiflu or Relenza can be prescribed. This could be done by phone or fax based on a patient’s self-test. Thus, for 50-70% of patients with flu, an unnecessary and counterproductive office visit could be avoided by means of a self-administered rapid test.
The above just outline some of the obvious considerations. The main point is that this subject needs to be examined at the level of public health policy and some sensible guidelines established.
More information on flu testing: