AFF's Doublethink

Ben A — August 13, 2009 at 6:36 pm

Oy vey, that *is* an irritating post of Freddie’s. I never understood the logical move from “the poor and destitute lack X” to “let’s have a government take over of the production of X.”

Maybe zombie Ayn Rand is out there, arguing for an end to food stamps and Medicaid. But as you note, this has nothing, zero, to do with the current health care ‘reform’ debate, which is largely about a) creating a new middle class entitlement, and b) expanding coverage to members of the uninsured who are by no means exclusively poor or desperately lacking in health care. If the concern that Medicaid doesn’t cover enough of the poor, then *let’s expand medicaid.*

Will — August 13, 2009 at 8:18 pm

Well said.

Sonny Bunch — August 13, 2009 at 9:56 pm

I mean, Freddie knows what he’s doing: It’s the sort of post that is hard to argue with because it’s about a dead kid. It’s like he came up to you on the street and said “You don’t hate kids and want to see them dead, do you? Then how can you disagree with stopping kids from dying by supporting plan xyz, the only way to stop them from dying?” Without devolving too far into a concern troll, he’s better than that.

thanks — August 15, 2009 at 12:08 am

I really appreciate the fact that someone was willing to call out the parent on this story. Thanks for linking to it.

Mikeybackwards — August 15, 2009 at 1:48 am

This is to me one of the weakest forms of syllogism to be employed. Unfortunately, just as Freddie and others wield this to bludgeon and stifle those who would oppose a particular type of healthcare/insurance reform, Grassley, Palin, and others have similarly done so with the so-called ‘death panels’ claim (inverting the argument from “Megan McArdle would prevent us from saving the life of Deamonte Driver” to “The America I know and love is not one in which my parents or my baby with Down Syndrome will have to stand in front of Obama’s “death panel” so his bureaucrats can decide, based on a subjective judgment of their “level of productivity in society,” whether they are worthy of health care. Such a system is downright evil.”).

Neither of these arguments are valid or honest.

The O himself — August 15, 2009 at 3:31 pm

Well, Mikey, I think that there is going to have to be a conversation that is guided by doctors, scientists, ethicists. And then there is going to have to be a very difficult democratic conversation that takes place.
It is very difficult to imagine the country making those decisions just through the normal political channels. And that’s part of why you have to have some independent group that can give you guidance.
It’s not determinative, but I think has to be able to give you some guidance. And that’s part of what I suspect you’ll see emerging out of the various health care conversations that are taking place on the Hill right now….
So that’s where I think you just get into some very difficult moral issues. But that’s also a huge driver of cost, right?

Mikeybackwards — August 16, 2009 at 11:39 am

TOH –

While the US has a long and frequent history of being a leader on human rights, economic, and political issues, provision of/access to healthcare is one area where we not only trail all other industrialized nations, but many Second World nations.

It is true that if one can afford it, the medical services available to one are world-class, however, increasing numbers of Americans can not afford such care. Further, while healthcare costs are rising across the world and causing concern even in countries that have universal healthcare/universal health coverage, costs are rising far faster in the United States. Currently the United States spends approximately 15.3% of its GDP on healthcare (with 5% of its population accounting for almost 50% of those costs). Only the tiny Third World country of East Timore spends a greater share of its GDP on healthcare.

Further the U.S. spends more on a per capita basis than any other country in the world (approximately $7,439 per person). This is nearly double the per capita spending of any other country. However, that greater spending does not result in more access per capita, nor does it result in better outcomes per capita. Americans see a physician less on a per capita basis, are less likely to receive regular screenings than may detect serious medical conditions earlier resulting in treatment and melioration, thus preventing the need for more costly interventions and treatment later, and generally report less satisfactory outcomes from the medical treatment they do receive.

While some of the difference can be attributed to cultural differences, much of this is attributable to cost. If one does not have access to health insurance, one does not go to a doctor or dentist regularly, but rather waits until a problem has become a medical emergency, much as Deamonte Driver’s mother did. Then when one does go to seek medical assistance, one is more likely to utilize hospital emergency rooms and other similar services which are the most expensive on a per treatment basis (this is because hospitals are required to provide treatment without regard to pre-established ability to pay while a private practice physician is not). Other reasons for delaying treatment are associated with the costs and coverage limits even if one does have insurance coverage (co-pays, deductibles, etc.).

We already have healthcare rationing and ‘death panels’ in this country. The rationing comes based on economic status and race (recent studies show that physicians are less likely to recommend aggressive treatment protocols for minorities even where there is proven ability to pay by those minority patients). Another place healthcare rationing occurs is through insurance policy limits on the amount permitted to be spent on prescription drugs, particular treatments, drug or treatment exclusions in coverage, etc. So even if one has private or employer-based health insurance, one may experience healthcare rationing. A notable and infamous case is that of 17-year old Nataline Sarkisyan who died because Cigna refused to pay for a liver transplant.

Which of course brings us to the current ‘death panels’. These panels are staffed by insurance company bureaucrats who decide whether one gets access to necessary and life-preserving care. They do this routinely denying claims and withholding authorizations thus preventing individuals who have insurance from obtaining timely care.

Finally, the costs associated with verifying coverage, ability to pay, and authorization then feeds back into the cost loop as doctors must spend large amounts of money verifying what, to what degree, and with what limits a particular insurance carrier will cover a particular procedure.

Free market principles do not work with regard to healthcare because such principles require the consumer has the ability to make an informed choice and has access to adequate and equitable alternatives. This is not the case with regards to healthcare. For most, the only affordable health insurance option is that provided through one’s employer, over which one has little or no control as to the nature or scope of coverage. The complexities of treatment are beyond the ability of any except trained professionals to evaluate as to whether a particular procedure is either necessary or priced appropriately, and one frequently does not have the ability to ‘price shop’ for a particular service or treatment.

These are the reasons I am an advocate of universal healthcare coverage (preferring a single payer system that pays a mix of public and private providers, but willing to accept a mixed public/private insurer option). I understand creating such a system will increase the expense to government and thus necessitate tax increases on both individuals and corporations. However, the costs associated with lost productivity and with providing employer-subsidized health insurance are creating a competitive disadvantage for U.S. companies and U.S. workers against their foreign competititors who do not have to meet the same current and legacy costs of such coverage. I believe the costs savings realized by a streamlined provider/payer system would exceed any tax increase on either the individual or on a corporation.

One is free to disagree with my conclusions, of course. However, I think it is incumbent on one who does so, to present one’s reasons rather than simply engaging in selective out-of-context excerpting of the words of another.

The O himself — August 16, 2009 at 1:07 pm

Oh, so Palin was correct.
There will be death panels, in the same way they exist now, except they will all be filled by government appointees and ethical ethicists.
And surely Nataline would have gotten her liver on the new plan, but we’ll still reduce costs somehow. Preventive care costs more, collectively, so no one is serious about that ridiculous argument.

Maybe the new death panels will set up policies that are very specific and will clearly distinguish necessary and safe from unnecessary and risky in every case.
I’m sure the new insurance will be very generous though, even though we are told we must adopt it now to curb costs.

Since most of our burdensome cost of health care comes from end-of-life care, that would be where most policy makers would look to cutting back. And Obama has made this exact point.
Insurance is insurance – decisions about what care is necessary and what is not (who lives, who dies) must be made in order to insure anyone.
But this is somehow only acceptable if bureaucrats are in charge can, and we can be sure that we will all be subject to the exact same standards, and receive no more or less care than anyone else.

It is true that I personally, along with so many others, will be forced to get insurance I don’t want and can’t really afford. We must consider the collective cost before our personal needs. Because there is inequality and racism we must make sure everyone is getting the exact same quality of care, whether that means we all get livers, or no one gets livers.

This will be fair and just because only under these conditions, if health care is redefined as only what ethicists deem necessary, can we ensure everyone of the right to health care. We will all die with clean conscience, knowing that if some procedure could have saved us, it would not have benefited the collective for everyone to have the same treatment.

Of course, the rich and powerful, will still be able to choose the sort of care they need, just like now, but we can’t just overhaul the whole system can we?

waitasec — December 4, 2009 at 9:47 pm

that frum article is really weird. he concludes, “But no government program on earth can protect children’s health from a custodial parent who refuses to bestir herself in any way to help them,”

and i’m counting all the steps he has listed from the article that she took to try and get her children dental appointments. there are at least 7, which makes his comment about finding an appointment immediately odd. if he’s aware that there were problems with their paperwork that made them unable to get the medicaid appointments, then there’s no reason a simple search for appointments was going to help.

i’m sorry, but i think it’s sad that frum has tried to imply neglect when all the details he relates demonstrate that she went to far greater efforts than he did to get no care.