Posts tagged with: health care

Blog author: jballor
Wednesday, August 26, 2009
By

In an Acton Commentary this week, I argue that a critical piece of any comprehensive and meaningful reform of the health care system must include malpractice litigation (tort) reform. Part of what makes this so urgent is that the litigious climate in which we live has eroded the doctor-patient relationship. In “Patients and Doctors: Partners not Adversaries,” I write that “patients are less inclined to trust doctors whom they believe are ordering tests and procedures out of a desire to protect their own economic interests. Patients in turn are much more apt to turn to legal remedies when they feel that doctors have not been forthcoming and trustworthy.”

Last week President Barack Obama spoke on a conference call to thousands of faith leaders from around the country to try and enlist them in his fight for health care reform. Highlights of the president’s remarks, as well as full audio of the proceedings, are available here.

I should note that I was not (at least intentionally) channeling Sarah Palin when composing this piece. But last week Shane Vander Hart (at the ever-worthy Caffeinated Thoughts) pointed out that the former Alaska governor wrote in a recent Facebook memo that “we cannot have health care reform without tort reform.” Of course my (and Gov. Palin’s) argument is not novel with either of us.

But what is novel is the particular concrete approach that I highlight in the commentary. The University of Michigan Health System has implemented policies that encourage doctors to be upfront and honest about the regret for procedures gone awry and admit when mistakes might have been made.

As David N. Goodman of the AP reports, “The willingness to admit mistakes goes well beyond decency and has proven a shrewd business strategy,” citing an article in the Journal of Health & Life Sciences Law, “A Better Approach to Medical Malpractice Claims? The University of Michigan Experience,” by Richard C. Boothman, Amy C. Blackwell, Darrell A. Campbell, Jr., Elaine Commiskey, and Susan Anderson (PDF). The article cites a case that “illustrates how an honest, principle-driven approach to claims is better for all those involved—the patient, the healthcare providers, the institution, future patients, and even the lawyers.”

For some basic facts on health care, visit the Health Insurance Costs page at the National Coalition on Health Care. And for more information about the widespread practice of defensive medicine, see the PDF report from the November 2008 study, “Investigation of Defensive Medicine in Massachusetts” by the Massachusetts Medical Society. For more Acton resources, check out the institute’s Health Care media page.

Hunter Baker examines the push for the “public option” — the creation of a government backed insurance system — as part of health care reform in his commentary.  Baker takes an interesting approach at examining the push for a public option by dropping his readers into the life of a doctor, articulating the stress and sacrifice of the job:

Imagine that you are a physician. You have made it through four years of college on a steady diet of biology, chemistry, and calculus, four years of medical school so demanding that you have no life outside of school, and at least three years of residency in which you have regularly worked 100 hours a week for a very low salary. You have been the first to get up and the last to go home. And somewhere in there your third decade of life, commonly known as your “twenties” (normally a fun time), has disappeared. Along the way, you have probably racked up an astronomical personal debt because there is no time to work a second job to help pay it off. The first professional hurdle you set out to clear will be six figures accumulating interest. Forget family. If you have a spouse at this point, he or she is probably full of resentment at never seeing you.

After all this, have you made your way to an easy job? No. You are likely spending four days a week seeing patients, another day in surgery, taking a 24 hour call every four days, and working one weekend out of every four. The only time you are ever off is when another doctor can be found to cover your responsibilities while you are out. The job itself is rewarding, but incredibly difficult.

Furthermore, Baker addresses the argument that a public option is basically the same thing as Medicare, and demonstrates just because we already have Medicare does not mean that we should have a public option.  Taking it a step further, Baker points out the flaws of Medicare and parallels this flaws to those that may occur under a public option:

Why the big protest? Doesn’t Medicare do the same thing? Doesn’t Medicare dictate prices? It does, but it works for one reason. Medicare is essentially parasitic on a functioning free market for medical services. Doctors are willing to accept low compensation at the margins because they do want to help people and programs like Medicare help them pay the cost of treatment for those who can’t pay. But if the whole market became like Medicare, the economic freedom of doctors would disappear. And that is the problem with an open-door public option that could expand to envelop the practice of medicine.

Blog author: kschmiesing
Wednesday, August 19, 2009
By

Since it appears the health care reform debate isn’t going away any time soon (and, just maybe, has moved in a positive direction from where it started several months ago–e.g., one of the most dangerous proposals, the public option, is itself in danger), we’ll keep pressing the issue.

Two recent articles of interest:

David Goldhill in The Atlantic. Outstanding exposition of the dysfunctions of American health care and which policies will ameliorate rather than exacerbate them. It’s imperative that we revise our thinking about “health insurance,” returning it to a standard model of insurance. A key step is to shift the insurance tax break from employers to individuals.

Martin Feldstein in the Wall Street Journal. Agrees that tax reform is crucial, but, supposing that doesn’t happen, makes an interesting point about rationing and national spending on health care.

Blog author: jballor
Tuesday, August 18, 2009
By

A great deal has been made in recent weeks about Ronald Reagan‘s critique of nationalized or socialized health care from 1961:


We can go back a bit further, though, and take a look at an intriguing piece from 1848, a dialogue on socialism and the French Revolution and the relationship of socialism to democracy, which includes Alexis de Tocqueville‘s critique of socialism in general.

One interesting note is that Tocqueville identifies one of the traits common to all forms of socialism as “an incessant, vigorous and extreme appeal to the material passions of man,” including the exhortation, “Let us rehabilitate the body.” Reagan’s point of departure in his broadcast is the observation that “one of the traditional methods of imposing statism or socialism on a people has been by way of medicine. It’s very easy to disguise a medical program as a humanitarian project.”

And here’s Tocqueville on socialism in America:

America today is the one country in the world where democracy is totally sovereign. It is, besides, a country where socialist ideas, which you presume to be in accord with democracy, have held least sway, the country where those who support the socialist cause are certainly in the worst position to advance them[.] I personally would not find it inconvenient if they were to go there and propagate their philosophy, but in their own interests, I would advise them not to.

It may well be that ideologically democracy (as Tocqueville conceived it) and socialism are opposed, as Tocqueville claims. But historically they may well be linked. Lord Acton connected “absolute democracy” (something like majoritarian rule) to socialism: “Liberty has not only enemies which it conquers, but perfidious friends, who rob the fruits of its victories: Absolute democracy, socialism.” And once the majority discovers that it can use the power of the State to plunder the wealth of a minority, the road is well-paved toward socialism.

[UPDATED BELOW] The DNC has released a political commercial and an email warning Americans about dangerous mobs gathering to do dangerous things (protest socialist health care reform). Meanwhile, the White House has issued a call for loyal citizens to report fishy behavior to a special White House website. Well, I want to do my part to inform on my fellow Americans. The three images below show just how deep the problem runs. It’s fishy mobs all the way down. [UPDATE: ANOTHER OLD FISHY MOB HERE]

Civil Rights March

Suffrage Movement

Boston Tea Party

With health care continuing to be a hot button issue, Hunter Baker brings to light a new argument in his commentary.  While Baker provides us with many prudential reasons to oppose the expansion of government health care, such as the currently proposed government plan not having any provision for preventing the trial lawyer windfalls that have helped contribute to medical inflation, he also articulates the fundamental problems that arise with the expansion of government health care:

If we move from being a republic where certain freedoms (not only freedom of speech and religion, but also freedom of contract and freedom to own private property) are basically non-negotiable, to a simple mass democracy in which shifting coalitions of voters extract resources from their opponents, then we have lost the American genius of ordered liberty. The American founders did not set out to achieve a more perfect democracy. They set out to create and maintain a free republic.

The key to running a free republic characterized by ordered liberty is the citizens, themselves. Unless the citizens embrace virtue, convicted by God that they must do what is right rather than merely indulging their wills and appetites, their hard fought liberty will be lost. The fate of a people who will not restrain themselves is rule by a government that will increasingly exercise control over them. The American idea was that our people should be citizens rather than subjects. American citizens, once far more country than city in origin, were to be free to provide for themselves rather than gathering in coalitions to ask for government largesse funded on the backs of the productive efforts of others.

Baker reminds us of the importance of the health care debate, and amongst all of the discussion that is occurring we must not forget the principles that our government is founded upon.

In his commentary, Matt Cavedon, communications associate at the Acton Institute, addressed new taxes that are being proposed to combat the high obesity rates in the United States and to provide financial support for health care reform.  The new taxes proposed to help fund health care reform will begin to tax what Congress deems junk food or unhealthy food.  Cavedon exposes the hypocrisy fostered by taxes on such junk or unhealthy food:

In “The Sin Tax: Economic and Moral Considerations,” the Rev. Robert A. Sirico, president of the Acton Institute, has argued against the idea of taxing sins to pay for public services. If the government relies on taxes on unhealthy foods to pay for health care programs, how can it both fight obesity and maintain steady revenue? Sirico says it cannot: “Under a sin tax, the state finds itself professing to discourage certain behaviors while relying on their continuance as a source of revenue.” The government may say unhealthy eating is bad, but it would rely on it for tax money.

The problem of hypocrisy leaves aside the question of whether government is qualified to be the moral police officer of our pantries in the first place. Sirico points out that “the government’s sense of morality, especially when it is influenced by excessive power, is often at war with traditional standards and common sense.” With food taxes, eating apple pie would become more of a punishable sin in the eyes of the government than cheating on a spouse.

Cavedon further explains the hypocrisy of taxes on junk and unhealthy food while also articulating the moral disorientation of such taxes.  “Obesity is a problem” Cavedon states, “but higher taxes are not the answer.”

One of the main arguments for nationalized health care is a moral argument: Health care is a right and a moral and just society should ensure that its people are taken care of–and the state has the responsibility to do this. Bracketing for the time being whether health care is actually a right or not–it is clearly a good, but all goods are not necessarily rights–whether the state should be the provider of it is another question.

But there is another question as well: It is often assumed that those arguing for national health care and socialized medicine have the moral high ground and those of us who oppose it are always arguing on economic terms. I would argue that this is a ground too easily given and not deserved. While the economics are pretty clear (see Hunter Baker’s post), the moral arguments against nationalized health care are sometimes overlooked. Here are a couple of reasons why nationalized health care is in fact not a morally pure as proponents would like us to believe.

1. Handing something off to the state so citizens don’t have to take responsibility for themselves and others doesn’t doesn’t really contribute to the moral fabric of a society.
We love to talk about solidarity and the common good but too often solidarity gets turned into “let the state take care of it.” A broader and I would argue morally rich concept of the solidarity and the common good would look to human flourishing and a rich civil society and turn to the state only as the last resort.

It hurts the common good to have the state take over responsibilities that we should bear ourselves or for our fellow citizens. A large nanny state contributes to the “individualism” that Tocqueville warned about: a turning into self that isolates us from everyone but our nearest circle. If the state does everything for us then we don’t need to care about our brothers and sisters and fellow citizens. This means the breakdown of guess what–solidarity. Solidarity is the driving principle behind subsidiarity, voluntary organizations, and charity. Love of neighbor should prompt us to help each other not pass it it off to the state.

From a moral point of view, having the state take over health care breaks down solidarity and harms the common good.

2. At least equally important–how moral is a health care system based on utilitarian cost benefit calculus and consequentialism? Not very, but that’s how nationalized healthcare operates.

Think about what this means for a minute. Health care decisions are made based on cost benefit and utility which itself puts us on dangerous moral ground. This danger becomes clear when when we realize the consequences. A utilitarian, data driven or what ever you want to call it system ends up by putting pressure on the weak and especially targets the disabled and the elderly. Why? Because if decisions are make based on utility then why would we want to spend health dollars on the disabled and the elderly when their “usefulness” is minimal. Keeping the elderly and the disabled alive costs money. For Christians or other who accept the inherent dignity of life the value of this is obvious, but for secular utilitarians and a utilitarian health care system this is a waste of money–which means that after a time within a national health care system, pressure will mount to euthanize the elderly and infirm. If this sound ridiculous and conspiratorial to you I suggest that you look at Europe and what is beginning to happen there. After years of population decline Europe is a demographic disaster and guess what? Euthanasia has been legalized in three countries (Holland, Belgium, and Luxembourg), is widely practiced in a fourth (Switzerland) and many pro-euthanasia advocates are starting to introduce cost-effectiveness arguments into their position.

The facts are that a state run health system, while sounding very moral, actually undermines the common good and ends up putting pressure on the unborn, the elderly, and the disabled.

Proponents of nationalized health care attempt to make emotional arguments because economic and medical data supporting their position doesn’t exist. Let us not grant them the moral high ground on this debate. Nationalized health care is scientifically, spiritually, and morally bankrupt—oh yes as Europe is demonstrating, financially bankrupt as well.

The Radio Free Acton crew is back in the studio! On today’s broadcast, Dr. Donald P. Condit and Dr. Kevin Schmiesing join our host Marc VanderMaas for a discussion of the ins and outs of the US health care system. Dr. Condit gives us some background on how the current system came into being, the problems associated with it, and the pitfalls of the current healthcare reform proposals in Washington.

Next week RFA will be back for part 2, bringing us alternate ideas for reforming the system in ways that will both increase the availability of care for all who need it and make economic sense.

Audio clip: Adobe Flash Player (version 9 or above) is required to play this audio clip. Download the latest version here. You also need to have JavaScript enabled in your browser.

[update below] British physician Theodore Dalrymple weighs in on government healthcare and “the right to health care” in a new Wall Street Journal piece. A few choice passages:

Where does the right to health care come from? Did it exist in, say, 250 B.C., or in A.D. 1750? If it did, how was it that our ancestors, who were no less intelligent than we, failed completely to notice it?

When the supposed right to health care is widely recognized, as in the United Kingdom, it tends to reduce moral imagination. Whenever I deny the existence of a right to health care to a Briton who asserts it, he replies, “So you think it is all right for people to be left to die in the street?”

When I then ask my interlocutor whether he can think of any reason why people should not be left to die in the street, other than that they have a right to health care, he is generally reduced to silence. He cannot think of one.

Not coincidentally, the U.K. is by far the most unpleasant country in which to be ill in the Western world. Even Greeks living in Britain return home for medical treatment if they are physically able to do so.

The government-run health-care system—which in the U.K. is believed to be the necessary institutional corollary to an inalienable right to health care—has pauperized the entire population. This is not to say that in every last case the treatment is bad: A pauper may be well or badly treated, according to the inclination, temperament and abilities of those providing the treatment. But a pauper must accept what he is given.

After 60 years of universal health care, free at the point of usage and funded by taxation, inequalities between the richest and poorest sections of the population have not been reduced. But Britain does have the dirtiest, most broken-down hospitals in Europe.

[update] Also, later today we’ll be posting the first part of a conversation our multimedia manager, Marc Vander Maas, had with Kevin Schmiesing and physician Donald Condit on healthcare reform. Schmiesing is an Acton research fellow and has posted regularly on health care topics here on the PowerBlog. Condit is the author of Acton’s new monograph, A Prescription for Health Care Reform.