Birth of a Single-Issue Voter, The Series: Part I
Posted by Savage Henry @ 3:03 PM
Let's get the whole series started. Consider this a warm up. A setting of the stage, if you will.
You are not owed good health.
There is no point at which, in any legal setting or document, you have been promised an ongoing, unblemished record of health and general wellness. And even if someone has attempted to sell this to you, there is no way to actually make it happen. Simply, we are machines, imperfect and prone to multiple part failure. It's built right into the system; planned obsolescence didn't start with car makers in the 80s.
Not even the time-worn phrase from the Declaration of Independence, that among man's unalienable rights we count "life, liberty, and the pursuit of happiness", suggests that you have some claim to a life without ailment. [Aside: (And note, be prepared for many of these. I am a notoriously non-linear thinker, and frequently interrupt myself. Hearing no objections...) You ought to familiarize yourself with the notion and usage of "in(un)alienable" here. The word choice, like so much of Jefferson's writing, is searingly specific. An inability to transfer those rights, by will or by force, through sale or granting, runs as a common thread through those rights considered to be basic or fundamental to all humans. Their inability to be repudiated, even by the holder, is of primary concern here.] In very basic terms, we can consider these delineation of a few negative rights: ones that demarcate how others are unable to act. At base, you are (if you choose to not trample these basic rights) prevented from acting in such a way as to deny me, well, life, liberty, and the pursuit of happiness. The emphasis is to indicate, again through Jefferson's mastery of both philosophy and language, the understanding that happiness itself is not the right, but rather the ability to follow your interests in attempting to achieve it, is.
Of course, positive and negative rights are a fairly simplistic view of the issue, and we have a strong and pressing concern with the fact that some basic behavior that, freely chosen, does impact the ability of others to continue with their lives unimpeded. The long and tortuous debates on this are not my point here. I concede fully that a total right to drink yourself into oblivion, mixed with the right to own a car, shaken with a liberal amount of the right to be a complete assclown (I'm looking at you, T. Kennedy) can and often will interfere horrendously with others. Some restraint must be in place. In the end, though, the stark, bright line between positive and negative helps frame the argument in a way that hopefully avoids the regular pitfalls so regular in such debates; shades can and do exist, but would only detract from the major topic.
A right to a certain level of health, however, is by construction a positive right. That is, it obliges others to act in a way to ensure that good health is yours for the taking. Of course, this does not stop numerous people from arguing that health is, of course, a basic right to be provided by the governing system. And thus does it enter our debates about the health system in use in the US. There seems to me be a reductio ad absurdum issue, however, if we are to consider health as a positive right. [Aside: The basic idea of a positive right to life is a sticky one, and not one I feel capable of, or compelled to, make. Do you have an obligation to help me out of a burning car? Help me if I'm choking? I'd like to think you might help, but if it were a legally recognized right, I might be able to sue everyone who passed by on the highway, or everyone seated in a restaurant who didn't attempt to help. I expect Chuck Palahniuk's sequel to Choke to cover this...] To be obligated to help you keep up good health, I could be liable for any action I take that allows you to engage in things that are unhealthy. I simply couldn't go out my door, knowing the statistics on deaths in cars every year.
To make a claim that health is a right, you must, I would say, have to be willing to also claim that everyone around you is obligated to contribute to your wellbeing. And vice versa. The next logical step is to suggest that you, as a trustee of my health, have a right to know those things I do that might result in poor health. This is the nature of a positive right. Either choose total ignorance, in which case you're choosing to avoid all instances where you might help (and are thus avoiding your duty), or take seriously the responsibility and make sure that I cannot do things that result in problems down the line.
The possibility for total deprivation of privacy is clear. But it's not much discussed. People might suggest that such extremes are impossible, and of no use in argument. Even if I concede that we're not on the track to living in 1984, there is still much use to be had in pointing out the end-point of a line of argumentation. At what point would it stop, this command and control of my habits by well-meaning others? Certain drugs are verboten. Drinking is limited, and public intoxication is against the law. But we have moved beyond this, to limiting the ingredients in mass-produced food, to banning foods because of fat content. We have told private business that their customers must not smoke. We have done this despite the complete ability of people to avoid the potentially hazardous situation. The negative right has been swapped, in legislation, for a positive one. And the results of the positive right are, I argue, clear and ludicrous.
Comments
(Alright, I'll raise my hand)
Positive vs. Negative rights: got it. Has the cost of healthcare made it prohibitive to everybody? In doing so, has the current system impede everyone's access to quality healthcare?
Yeah, I'm trying to be a shit. I totally agree that the concept of being owed healthcare by a gov't is absurd and a complete misrepresentation of the founding ideals. Since you started with a broad approach, I thought I would make sure that we really get to the bottom of it.
Posted by: seed | July 21, 2007 1:48 PM
Other than here, I have yet to hear the argument that anyone is owed healthcare. However, the current system is broken beyond repair. I've never before been a proponent of socialized medicine, but something drastic must be done. The current system is more concerned with making a profit than with providing care.
As a civil service employee one would think that I have a pretty good health care plan, but any kind of serious illness would wipe me out--and the current administration has removed the possibility of getting out from under by declaring bankruptcy.
During my recent recovery from a car accident and surgery, I needed several months of physical therapy. My insurer would only approve 6 sessions at a time, requiring an unneccessary evaluation every 2 weeks even before I was given approval to bear weight on the leg. Treatment was stopped twice when they rejected the claim for no apparent reason, and approved it when it was resubmitted.
PS: I note in passing that most of the problems stem from the de-regulation of the insurance industry as a whole. As you may have noticed, de-regulating an industry has never had a positive result.
Posted by: ~Easy | July 23, 2007 4:54 PM
Owed healthcare? That's just semantics. How about shared responsibility?
John Edwards: Here.
And the first two points under his plan: Business Responsibility Government Responsibility. He puts personal responsibility... last.
But that's Edwards, and he won't make it out of the first round. If Savage won't get to it, I will definitely put the other plans on the chopping block.
In the meantime, here's some inside info on the medical industry. When a physician bills out a procedure they over bill. For my wife's industry (podiatry) it's about 2x. Here's why: the provider fixes the price. The most BCBS will pay for a nail debridement is say $40. This fee is not disclosed to the physician and is dictated by, guess who? Medicare. (As a point of order, Medicaid will pay $5.) If she bills $30 for it, they pay $30 - not $40. She wants $40, right? So she bills $80 to get it.
Now, that doesn't mean that self-payees cannot negotiate a price with their physician, anesthesiologist, oncologist, etc. It does tell you why there a considerable amount of padding in the medical bills.
The problem with our current heathcare is that it straddles the fence between single-payer and private coverage. Sure, there's a handful of providers that are available to patients. The issue is that the coverage is locked to your employer. That is a hold-over from when wages were fixed and employers used insurance as wage incentives to attract employees. But you know, that was the 50's, right?
I know you know that your employer pays half of your premiums (most likely) already. That total cost is shielded from the consumer, and in doing so, prevents them from making a market choice. Any plan that requires the employer to accept responsibility will not change this.
On the other hand, if you want to talk about extending the employer health care premium tax break to consumers, or allowing individuals to pool resources out side of employment to lower costs, or to allow consumers to purchase from plans out side of their states, now your are talking.
As for de-regulation, unless you think Ma Bell would have created anything like a Blackberry or iPhone, de-regulation can be a good thing. Or try the airline deregulation. I agree that healthcare is not the same as cable TV. Gov't oversight can provide needed barriers to private abuse. Gov't overhaul will prevent the market from doing what it does best.
Posted by: seed | July 23, 2007 11:08 PM
I agree that Edwards is an idiot, but "Shared Responsibility" is a term I can live with. I do believe that as a society we have a responsibility to care for our people, especially our children. Something needs to be done.
Interestingly enough, my wife also works for a podiatrist. She has a different take on things as she believes that he undercharges for his services. However, you raise a good point. The price should be the price no matter who's paying.
In the accident I mentioned, I was billed by the ER $680 for my visit. Yet, I noticed that my insurance had only paid $270. Since my responsibility was supposed to be %30 of the bill I thought these figures were odd. It turns out that the hospital has a pre-negotiated price for all services, but I'm billed at the normal rate. That bill remains unpaid while I continue to fight about it.
My employer pays for most of my premium. They pay nothing for my family. My premiums are $280 every two weeks. $560 a month is more than my mortgage payment and I'll still spend an additional $1,500 this year in meds and co-pays if everyone stays healthy. If there's an ER visit then you can--at the least--double that figure.
Here we agree completely:"..if you want to talk about extending the employer health care premium tax break to consumers, or allowing individuals to pool resources out side of employment to lower costs, or to allow consumers to purchase from plans out side of their states, now you are talking." These are excellent ideas.
I stand by my assertion about deregulation. Prior to airline deregulation there were about 15 or 20 airlines flying out of Lambert. Now there's Delta, American, United, and Southwest. Takeoff and landing times were fixed to allow for safe traffic flow. Now you have 2 or three flights scheduled to land at the same time. One of them will be late. 9/11 not withstanding, you cannot possibly assert that the industry is providing a better service than they did prior to deregulation.
Same with Ma Bell. Phone service is nowhere near as good as it was prior to the breakup. Hell, the equipment they provided 30 years ago is superior to what you can buy now. I still see the occasional home with an old Bell phone in it that works perfectly after 40 or 50 years of use.
The question is, which side are you looking at? Deregulation has definitely been good for the surviving airlines. Their profits went waaaay up. Ditto with all of the baby Bells. But the rest of us got the short straw.
Posted by: ~Easy | July 24, 2007 6:41 AM