Cultural Psychology

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The Moral Wrongs of Obamacare. Part 1. Entrenching the Medical-Industrial Compex

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I believe it is important to set down, in as methodical and systematic way as possible, the ways in which Obamacare is not only risky or potentially harmful, but actually something morally wrong.  Several times I’ve begun to write an article that does this, and each time had to quit as the task became simply overwhelming in scope.  It is a big issue, a huge one.  We’re talking about something that may constitute, both in what it is and what it may lead to, a fundamental restructuring of the system of American government and the nature of our society.  Yet, as many times as I give up and put the project aside, I feel dissatisfied for having done so and return to it again.

In part, what I face is what every person faces when, in a debate, they encounter the big lie.  The big lie is the tactic by which a party presents a falsehood so enormous, so outrageous, so utterly beyond the realm of plausibility, that it literally overwhelms the ability of the other party to refute it.  The opponent is simply flummoxed, bewildered by the sheer audacity.  The big lie changes the ground rules of a debate, transforming what should be an earnest attempt by two agents of good-will to find the truth, into something of bad-will.  The big lie is a power play, a trick, which seeks to win  by deceit and  subterfuge.

The big lie tactic therefore, is not used, or should not be, by decent people, either in debates between two people, or between groups of individuals in a social or political context.  However in the present case we are not debating an individual, nor groups of individuals.  We are ‘debating’ – in a broad sense of that term – a vast system, something intrinsically amoral.  It is a system like or analogous to the military-industrial complex, but something much greater; a system that includes our government, our political parties, Wall Street, multinational corporations, and our news and entertainment media.  Moreover, each of us is, to varying extents, consciously or unconsciously, part of this system.  Anyone who has a mutual fund or retirement plan with dividends linked to Wall Street profits, is, to some extent, part of this system.  This system is our opponent.  That it resorts to the big lie to sway public opinion is the least of our problems.

One reason the big lie tactic is so effective is that an opponent faced with the prospect of refuting it envisions how hard a task it will be, and simply gives up before trying.  Much as I might like to do that, I simply don’t see it at as an option.  The only alternative, therefore, is to try to make this daunting task more manageable by breaking into several smaller ones.  The present, then, will be the first of several installments dedicated to this.

Preliminary Remarks

Some preliminary remarks are in order.  First I wish the reader to know that I am most certainly committed to the principle of social justice – both in general, and in the particular matter of health care.  I *am* a health professional, and I chose that profession not to make money, but because helping people with health and psychological problems is in my nature.  It is my vocation (or, at least, one of my vocations).  In fact, it is precisely *because* I care about people’s health that I am opposed to Obamacare, which I see as ultimately harmful to public health. I have major political and economic concerns, also; but, frankly, I would be willing to overlook these were it not for the disastrous effects on public health.

Second, I should make clear that it is not Obamacare in particular that I am concerned about, but rather any attempt to place the healthcare system further under the management and direction of the federal government.  If a plan of universal health care administered at the level of local or county governments could be developed, I would have much less reason to object.  In any case, it is certainly not because the new plan is associated with President Obama that I object.  For me that is simply a term.

Third, I wish to clarify what I mean by “moral wrong.”  I mean this in the strictly technical sense of moral philosophy.  That is by “moral wrong” I mean (1) what is opposite or opposed to moral good; and (2) that which we therefore have a moral responsibility to prevent, change, or oppose.

Finally, it should be pointed out that I am not writing this out of any need or wish on my part to merely complain or criticize.  There is already too much emotionalism, antagonism, and partisan strife in society today.  I know better than to be part of that.  I am writing because I should.  I have many years’ experience in diverse facets of the health field, an insider’s perspective (including positions at
Duke University, Wake Forest University, and the RAND Corporation) and, it could honestly be said, a uniquely informed one.  Much as I might like to evade it, I have a civic responsibility to write about this.

These clarifications made, let’s proceed to the analysis.

Reason 1.  Industrial Medicine

The first and greatest reason why I see Obamacare as morally wrong is that it will consolidate and entrench the paradigm of modern industrial medicine in our society.

By consolidate I mean it will strengthen and make more prominent the model of industrial medicine, and those organizations and institutions that promote it, and it will drive out competing, non-industrial health paradigms.  By entrench I mean that, once consolidated, it will be extremely hard, almost impossible, at least for many years, to change that paradigm.  We will watch in anger and disgust as public health and healthcare deteriorate, and be powerless to change it.

By modern industrial medicine I mean the prevailing system by which medicine is practiced today, which emphasizes (1) domination of healthcare and policy by large corporations, (2) treatment rather than prevention; and (3) expensive rather than moderately or low-priced alternatives.

The modern paradigm of industrial medicine is inextricably linked with profit motivation.  The innovations in healthcare, the new products that emerge, are those which deliver the most profit to corporations.  The nature of the system is that there is every incentive to develop expensive, invasive interventions, and virtually none to produce less expensive and less invasive treatments.  The paradoxical nature of “health for profit” can be illustrated with a hypothetical example: if we had the technology to develop a pill that cured the common cold that cost .1 cent per dose, we wouldn’t do so.  There’d be no profit in it.  But if the same pill could be sold for $10, companies would be fighting tooth and nail to develop and market it.

Similarly, it is well within our technological ability to wipe out a global scourge like malaria; but this receives comparatively little attention, because it isn’t seen as profitable.  I don’t know the actual statistics, but wouldn’t surprise me if more money is spent in the US developing new versions of Viagra and Cialis than goes into anti-malaria research.

Malaria doesn’t affect public health in the US, but obesity does.  So do the effects of alcohol and tobacco use.  The effects of this deadly trio alone probably account for at least half of all hospital admissions in the US.  We have virtually an unlimited ability to prevent these problems.  Anybody can stop smoking.  Most obesity can be prevented by intervening in childhood.  But, again, it’s much more profitable to treat the outcomes of these problems than to concentrate on prevention.

This problem affects the very foundation of medicine, the culture of it.  It affects how physicians, nurses, and medical researchers are trained.  It affects undergraduate education.  By the time someone gets an MD or a research PhD, they are fully indoctrinated in this model.  It becomes difficult to think of health in any other terms.

As long as the federal government stays out of healthcare there is some hope for change.  We always have the potential for new ideas and innovators to arise at the grass-roots level, to demonstrate new paradigms, which catch on and influence others.  But the danger of Obamacare is that, in centralizing healthcare delivery, planning, and policy to an unprecedented degree, and laying the foundation for still further centralization, we make it much harder for the grass-roots kind of innovation to occur.  Instead, will have a massively top-down model of dissemination of technology and practice.  Centralized boards will review and approve only certain medical procedures, and will pressure all players to use these methods.  Further, it is the large corporations who will have the most influence in choosing these methods and designing policies.  Naturally these policies will lean towards  practices and a basic philosophy of medicine that produces the most profits.

It is not just the actual dangers outlined above that concern me.  Beyond these is the fact that we will be placing literally our lives under the control of a vast, amoral, non-human system.  We have already seen, over the last 50 or 60 years, what happens when we place national defense in the hands of such a system: instead of peace, which is the natural desire of every human being, we have perpetual war.  Our collective policy becomes utterly dehumanized, and inimical to each individual.  I do not see how we can expect anything different when we hand over control of our health to the federal government and profit-driven corporate system.


On What’s Wrong with “What’s Wrong with Healthcare for Everyone?”

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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.

Religious Exemption from the Individual Health Insurance Mandate

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In view of today’s Supreme Court decision upholding the individual health insurance mandate, I’d like to make a few brief comments on certain legal, religious, and moral implications.

As the law now stands, (1) citizens may opt out of buying into the national health insurance system based on a religious conscience exemption; but (2) only members of certain state-recognized religions, like Christian Science, can apply the exemption.  This is a huge problem.  The federal government has no business telling us what is and what isn’t religious conscience.  If someone, unconnected with an established religion, were to decide, based on honest and informed examination of conscience, that buying into a national health insurance plan is immoral, then he or she should have the same right to exemption as a Christian Scientist.  This principle – which affirms the conscience of the individual – is explicitly stated in Article 18 of the Universal Declaration of Human Rights:

Everyone has the right to freedom of thought, conscience and religion; this right includes freedom to change his religion or belief, and freedom, either alone or in community with others and in public or private, to manifest his religion or belief in teaching, practice, worship and observance.

The operative words here are “either alone or in community”, with emphasis on “alone”:  you don’t have to be a member of any specific church to have a conscience, or to have the right to act on that conscience.

It is entirely possible that a person’s moral reasoning may following along these lines:

1. At least half of all health problems are the result of wrong moral choices (overeating, intemperance, risky practices, etc.).

2. When bad health is the result of wrong moral choices, the ensuing pain and inconvenience motivates one to improve morally (or to not make moral errors in the first place).

3. If medical treatment is too inexpensive, it reduces motivation to avoid or minimize the immoral choices that produce sickness.

4. To force other people to subsidize a system that, in a sense, encourages immoral/unhealthy life choices is unethical: it forces the moral people to be complicit in a system that hurts others.

5.  Moreover, it is basically unjust to require one person to pay for the consequences of someone else’s wrong moral choices.

6. Further, the entire health industry today is a Tower of Babble – a vast, corporate-run system that subordinates human welfare to profits and materialistic values.  By marrying this monstrous system to the federal government, it threatens to make things worse, and also more difficult to change.

An individual could therefore potentially conclude that he or she has a moral duty – to others, to oneself, and to society – to opt out of the national health insurance plan.

Where does this leave us?

We’ll have to see what happens in the coming weeks.  But it appears there will be an important opportunity here for philosophers, moralists, theologians and civil libertarians.  The first three groups need to flesh out the basic argument sketched above concerning the link between physical health and health of the soul, and the moral implications.   I would suggest that this argument is fully consistent with Greco-Roman philosophy (e.g. Stoic and Natural Law ethics), as well as traditional religious (Christian, Jewish, Buddhist etc.) thinking.  Civil libertarians will have to tackle the problem of the federal government presuming to require affiliation with pre-designated religious organizations as grounds for a religious conscience exemption.

p.s.  Here is the law relating to religious exemption from the Patient Protection and Affordable Care Act (PPACA):

RELIGIOUS CONSCIENCE EXEMPTION — Such term shall not include any individual for any month if such individual has in effect an exemption under section 1311(d)(4)(H) of the Patient Protection and Affordable Care Act which certifies that such individual is a member of a recognized religious sect or division thereof described in section 1402(g)(1) and an adherent of established tenets or teachings of such sect or division as described in such section.

and here is section 1402(g)(1) of the IRS tax code:

(g) Members of certain religious faiths

(1) Exemption

Any individual may file an application (in such form and manner, and with such official, as may be prescribed by regulations under this chapter) for an exemption from the tax imposed by this chapter if he is a member of a recognized religious sect or division thereof and is an adherent of established tenets or teachings of such sect or division by reason of which he is conscientiously opposed to acceptance of the benefits of any private or public insurance which makes payments in the event of death, disability, old-age, or retirement or makes payments toward the cost of, or provides services for, medical care (including the benefits of any insurance system established by the Social Security Act). Such exemption may be granted only if the application contains or is accompanied by –

(A) such evidence of such individual’s membership in, and adherence to the tenets or teachings of, the sect or division thereof as the Secretary may require for purposes of determining such individual’s compliance with the preceding sentence, and

(B) his waiver of all benefits and other payments under titles II and XVIII of the Social Security Act on the basis of his wages and self-employment income as well as all such benefits and other payments to him on the basis of the wages and self-employment income of any other person, and only if the Commissioner of Social Security finds that –

(C) such sect or division thereof has the established tenets or teachings referred to in the preceding sentence,

(D) it is the practice, and has been for a period of time which he deems to be substantial, for members of such sect or division thereof to make provision for their dependent members which in his judgment is reasonable in view of their general level of living, and

(E) such sect or division thereof has been in existence at all times since December 31, 1950.

An exemption may not be granted to any individual if any benefit

or other payment referred to in subparagraph (B) became payable (or, but for section 203 or 222(b) of the Social Security Act, would have become payable) at or before the time of the filing of such waiver.


Related posts:

Right to die might kill health care reform – Washington Times

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SMITH: Right to die might kill health care reform – Washington Times.

“Several aspects of the legislation are troubling from a constitutional perspective. However, not all of these aspects are raised in the state lawsuits. Ultimately, the Supreme Court may confront the constitutionality of the legislation in the context of a lawsuit brought by an individual citizen, not the state governments.

“For example, the mandate requiring individuals to purchase health insurance raises potential problems, not merely because the congressional authority to pass it is questionable, but also because it interferes with individual rights regarding health care choices…”

Read full article here.

Health Care Insurance or Else

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Health Care Insurance or Else.

Here is the video to go with the preceding post.

Sen. Orrin Hatch with Greta von Susteren: Insurance mandate unconstitutional, totalitarianism

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Health Insurance or Else

Sen. Orrin Hatch with Greta von Susteren: Insurance mandate unconstitutional, totalitarianism

On Wednesday, March 24, 2010, Sen. Orrin Hatch (R-Utah) was interviewed by Greta van Susteren, host of the Fox News program “On the Record.” In his remarks [video here] Hatch broached the real issues: that the way the Democrats have approached reform goes against our vision and deepest sentiments as Americans as to what this country is and should be.

Here are some quotes from the interview:

“Back on Hillary-care they had a mandate in there. I didn’t realize it, I didn’t pay any attention to it. We were trying to defeat Hillary-care. The more I studied since then, the more I’ve looked at it, the more I’ve come to the conclusion it would be unconstitutional to force people to buy something they don’t want to buy.

It would be the first time in history that the government could tell you that you have to buy something you don’t want to buy.

Now, they say you have to buy auto insurance. No you don’t. You don’t have to drive if you don’t want to. That’s just part of the privilege of driving. But in this case they are going to make you buy insurance even though you don’t have any desire to, any reason to.

And frankly, it would be the first time that your liberties would be taken away from you where you would be forced to do something you don’t want to do. I just don’t think that is constitutionally sound.”

Another quote:

“One of the things about this bill is the mandate is a big part of it. They want to force people to do whatever they want them to do. That’s what you call totalitarianism. It is not really good government.

And in this country we believe in liberty. We believe in freedom. We believe people ought to have choices. We believe they can make their own choices. If they choose not to buy something, that is their privilege. They can suffer the consequences if they don’t. But if they choose not to buy it, that’s their privilege.

But to have the government come in and say you have to buy this or we are going to penalize you, that’s not America. That’s not what we believe in. That’s not what helped build this country.

I understand the arguments behind mandating and everybody’s got to buy insurance. But then it comes down to what kind of insurance? A policy that the federal government designs for you? They are going to make a big determination as to what kind of policies you are going to have.

You basically lose your individual freedom if the government can tell you that you have to buy something you don’t want.”

He further remarked:

“If you look in the history of this country we’ve never had major sweeping piece of social legislation — that is any good — that’s been passed by just a partisan vote.

And Republicans want health care just as badly as they do. We think we should have started over and gone step-by-step to bring in the things that we mutually can agree on first, and then compromise on the things that we can’t initially agree on.

That’s how it’s done around here. That’s what brings people together. That’s what gets rid of the animosity. That’s what helps us to become functioning Americans working together.”

Government Healthcare Reform: Paradoxes and Quandaries

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Government Healthcare Reform: Paradoxes and Quandaries

Suppose a medical treatment costs $500 a year and will save a patient’s life with 100% certainty. (That’s more or less the case with HIV infection; if issues of drug royalties are put aside, it should cost no more than $500 a year to manufacture and administer a cocktail of antiviral medicines which are nearly 100% effective in suppressing the viral infection that leads to AIDS.) If an American can’t pay for this hypothetical treatment, should society provide it for free?

For this specific example, I say yes. Whether this is a right or not is another question. Perhaps it’s better seen it as an issue of social justice, not a right per se. A person doesn’t technically have a right to receive free healthcare, because that amounts to saying that another person can be forced to pay for it. With greater confidence we can say that there is a social obligation to provide for the health needs of the poor. People are required by conscience, duty, and justice to do this.

Consider now a second example: a medical treatment that costs $10 million per patient, and has only a 1% chance of success. If there were no other treatment, a billionaire, someone with plenty of money and nothing to risk, might choose this treatment. Does a poorer person, someone without $10 million, have a right to receive the treatment at the public expense? Common sense says no.

Between these two extremes are many actual disorders and treatments. For example, there are many very expensive treatments for late-stage cancer, often with limited chance of success, perhaps at best extending life at a low quality for a few months. Does justice require that society pay for these treatments for the poor?

These considerations illustrate how issues of social justice and ethics, some potentially involving intensely personal religious and spiritual values, must play a role in determining appropriate allocation of healthcare and associated financial resources. In a traditional society these issues would be sorted out with attentive deliberation, kindness, fairness, and wisdom. None of these are virtues which anyone suggests modern governments enjoy a superabundance of.

Does one have a social responsibility to contribute to the healthcare costs of the poor?

Does society have a right to fine a person who does not?

Does government have a right to require one to be employed in order to pay for healthcare of other people?

If jobs with good working conditions are scarce, does government have a right to require one to work for inconsiderate or exploitative employers? Is one required to work under conditions that may involve unreasonable stress and stress-related illness?

May government require us to work ourselves sick in order to pay for public healthcare?

Could a hypothetical evil society exist wherein corporations and governments cooperate to exploit the workers — the government forcing people under threat of fines and imprisonment to be employed? The element of choice being removed from the worker, would employers be tempted to neglect workers’ needs and welfare?

Would it be ironic if, under the name of socialist principles of justice and egalitarianism, a more capitalist (in the negative sense) system of worker exploitation is created?

There is no cure for the common cold. Therefore it cannot be that said anyone has a right to receive treatment for the common cold. If an effective cold treatment were invented tomorrow, would that create a right that did not exist before?

If a treatment exists which nobody can afford, does anyone have a right to that treatment? As soon as one person can afford it, does that immediately produce a right of everyone in society to receive the treatment?

Consider the issue of efficiency. Under the Obama healthcare plan, citizens would be required to buy insurance policies that are, compared to a few years ago, exorbitantly expensive. Many, if not most health economists would claim that healthcare costs today are unrealistically inflated. In theory we could design more efficient, alternative healthcare and healthcare financing systems that cut the costs by 1/2 or 2/3. Or said another say, many believe that government intrusion into healthcare financing (e.g., Medicare), has radically increased healthcare costs and inefficiency. If justice demands that poor people receive healthcare, does that also mean it demands their access to insanely overpriced healthcare? Or does justice only demand that richer citizens contribute towards the medical expenses of the poor at a level commensurate with reasonable and realistic prices?

When Robin Hood meets the rich man in the forest, well may he say, “Stand and deliver! I take from the rich and give to the poor!” The rich man, if he has a conscience, can little complain. Robin does him a favor, for all applaud justice truly served. Let him toss his bag of gold, have a jolly good laugh, and be on his way.

But what if Mr. Hood says, “Stand and deliver. Yield thee up three bags of gold. One for the poor man, one for my own services, and one for the extra fees I levy on the poor. For I run the clinics, which, though mean and miserable, are most expensive. They are staffed with my lazy friends, and we buy overpriced supplies from crooked merchants who bribe us. But none of this is your concern. Three bags of gold, I say, or else.”

Do people have a right to healthcare?
Do people have a right not to starve in a land of plenty? Does government policy officially prevent starvation?

It is commonly said that the three necessities of life are food, shelter, and clothing. There are people in America without food and shelter. Why is the government more interested in healthcare than in these more fundamental necessities? Could it be that the government is unduly influenced by special interest groups — pharmaceutical companies and insurance corporations?

Is the government’s interest more in justice, or power?

Suppose we allow there is a right not to starve. And suppose it should cost $5 per day to feed someone. What if the government created an extremely inefficient program that cost $20 per day to feed a poor person. And then the government said that all food distribution to the needy must occur within this program. Do the poor ehen have a right to demand that the rich pay $20 per day for their food? Or would justice require only that the rich pay $5 per day?

If the rich pay $5 per day towards the food of each poor person, and the government cannot spend this money efficiently, would it not be the government which is unjust? If the government is unjust, is it the duty of the rich to compensate for this? Would there be a stronger moral obligation to change the government?