The whole point of free speech is not to make ideas exempt from criticism but to expose them to it.

Sunday, September 13, 2009

Sam Hurst delivers the definitive health care argument.

Please read this. The whole thing. To further pique your interest, here's an excerpt from Sam's suggested solution — a REAL long range health and wellness plan. The driving moral thesis is that health care is a fundamental human right. But again, please read his entire argument, not just the excerpt. Many of your presumed possible rebuttals are covered there as well. I'd like for us to advance Sam's idea, not just rehash it:

We might begin by dumping the "public option" that Democrats hold to so tightly as a pale vestige of "Medicare for all", and move to an approach that honestly balances cost control with a revitalized commitment to social responsibility. Create a new battlefield.

"Medicare for every child in America." The current health system in America is upside down. The highest quality, lowest cost, gold plated system is reserved for the elderly. Children are the future, but their potential is framed by their parents' ability to pay if they are middle class, or navigate a complex of poverty programs that punish some children and promote others based on how poor their parents are and which states they live in. No one ever talks about children. They have no political voice. And yet children are the engine that could drive universal health reform. No principle of civilization is more universal than the belief that children are at the heart of a nation's social responsibility. Your children (or grandchild) are my future.

Abolish the Children's Health Insurance Program (CHIP), and state bureaucracies that administer CHIP and Medicaid for children. Remove children from employer-based health insurance programs. Take children out of the private health insurance system for those families that are self-employed.

Cover all children with Medicare until the age of eighteen, or up to twenty-five if they are full time students. Young adults living on their own would be given the choice to pay premiums into Medicare if they are satisfied with the quality of their care, or opt out of Medicare into a private plan or employer coverage. The most important new reality for young adults would be that their choices of health insurance would not be based on pre-existing conditions that were a legacy of inattention as children.

The current system of health delivery is built around the inefficient, expensive delivery of specialist care. We are a nation that celebrates the most complex, hospital-based health problems, but neglects the most preventable problems. The roots of this upside-down system lay in the fact that Medicare was created to serve the elderly, who at the end of their lives have the most complicated (accumulated), specialized needs. From the beginning Medicare favored specialists over primary care physicians.

If controlling costs is imperative, we must move to a preventive, primary care system, but creating such a system for middle aged Americans at a time when chronic long-term disease and health conditions are just beginning to emerge, is the least efficient, most expensive way to do it. Children, on the other hand, whose life style choices can still be influenced, are a perfect group to lay the foundation for a primary care system.

No single aspect of health care is more critical than addiction (including tobacco and alcoholism). Broadly speaking addiction intersects with myriad social costs, including the most expensive, fatal, and hard to manage chronic diseases such as cancer and heart disease, obesity and diabetes. Addiction is also at the center of worker productivity, domestic abuse, the public costs of state prison systems, and even foreign policy (the war on drugs, Mexican drug gangs, and Afghanistan opium poppy farming). Trying to address addiction in middle-aged patients is the most expensive, least effective way to confront the problem.


Sam Hurst said...

It is now four days since President Obama's speech, and I have just suffered through the first round of Sunday news talk shows. Neither in his speech, nor any of the pundit critique since, has there been a single, not one!, reference to children, or their relationship to creating a "preventive care" health system, or their relationship to cost control, or the role they might play in "phasing in" a new system. Let them eat Twinkies and get fat.

caheidelberger said...

Excellent argument!

Thad Wasson said...

Well checks and preventive care are included in insurance plans and also schip and medicare plans. It still falls on responsible parents to take the time for these checkups.

Wayne Gilbert said...

I like Sam's article very much but, alas, I think it advocates a pipe dream. I am very angry that President Obama utterly failed in leadership on health care--allowing August to go as it did with no response reminds me of Kerry ignoring the swift boaters for too long. It is too late to correct this failure of leadership for health care, and maybe too late to learn from it for future battles. In the meantime, could someone in the Democratic caucus please start taking steps to get Pelosi and Reid out of their jobs as speaker and majority leader?

Bill Fleming said...

Lead pipe or hash pipe, Wayne? (Sam's dream, that is.) Like you, I'm thinking it might be time to start knocking a few heads around... metaphorically, of course. Come on, people. Your voters put you in office for a reason, and it wasn't to suck up to big corporate and brown nose a bunch of stuffed shirt Republican butt.

Don Frankenfeld said...

Sam's plan has the virtue of being comparatively inexpensive, as health care for young people is still pretty cheap. I think it is a good idea, and for now, because I believe we are in crisis and something is better than nothing--in fact almost anything is better than nothing--mark me down as a Hurstian.

Cost and coverage are intimately related of course, but they can be dealt with separately. Start with coverage, I say; then worry, as we must, about cost.

Troy Jones said...

There is much to for me to disagree in the entire discussion. But most fundamental is the idea that "health care is a right."

First, it is not a "political right." Political rights are free speech, right to assemble, etc. Political rights rest with the individual but require nothing of others but acknowledgement. Others don't have to give someone the forum to make speech or the meeting place. To require another would be an infringment of that person's right to free speech. You can speak but I don't have to listen. You can have a meeting but I don't have to go.

So, when people say it is "a right" they are asserting it is an economic right. But "economic rights" must have a great deal of clarity before they can be "granted" as they require the consent of others unless paid for by the individual. For instance, if one had a "right" to a car and couldn't pay for it, either the car company must be REQUIRED to give it away, the laborer's work for free, the power company give away its energy, etc.

With regard to a right to health care that goes beyond the freedom for the individual to procure it with their own resources, somebody must be required to provide it. To require Doctors/nurses to do it for free is slavery. The analogy can be run out to mention hospitals, hospital suppliers, etc.

Alternatively, if it is an economic right, the taxpayer must be required to provide it. However, if it is a right, they can not limit it to anyone. For instance, the fact one smokes and otherwise treats their body with disregard can't be denied coverage or otherwise forced to live a better life. If there is a condition, it isn't a right but a privilege for privileges "one" can have responsibilities.

And this is where the debate is messed up. Proponents of health care wrap up their conversation in the concept of "rights" when they really mean it is a privilege that society should morally provide and for which there is responsibility (otherwise Obama's claim that it will reduce costs is unrealistic and frankly moronic).

Unfortunately, too much of the debate is centered around the liberal argument that it is a moral good society should undertake with insufficient discussion of the responsibilities and who will actually bear the economic cost of providing the privilege throughout society.

Until the liberals provide a comprehensive discussion of the matter in totality with right use of words, the discussion will continue to be nonsense.

Taunia Adams said...

Troy, children under 18 have very, very few rights. Under your argument, neither do they have a right to health.

Don Frankenfeld said...

I find myself disagreeing with Troy, whose definition of "right" is needlessly formalistic. Years ago, I would have agreed that health care is not a right, but today it clearly is. It doesn't matter matter much whether it fits the John Lockian (??) construct of "right." What matters is that it has become an almost universal expectation by the recipients, and close to a universal expectation by the providers, meaning us--taxpayers and voters.

In fact, Troy, hospitals and other beneficiaries of the Hill-Burton Act, which means nearly all hospitals, have an absolute obligation to provide health care to those who need it, whether or not they can pay. An absolute obligation by a caregiver is simply another way of defining an absolute right by the receiver.

So instead of engaging in stimulating but ultimately pointless definitional arguments, why don't we move on. The entitlement question has been resolved against you; so let's figure out the best way of providing for the entitlement without going broke.

Troy Jones said...


It isn't just an academic argument. Words mean something because they properly describe ideas. This is the only way to have truly intellectual discussion and find solutions.

Universal expectation doesn't create a right. Only a demand. If it becomes a universal expectation that everyone have a heart transplant, one doesn't have a right to take one from another.

Your Hill-Burton "argument" proves my point of a lack of intellectual vigor and logic. Hospitals choose to accept Medicare/Medicaid patients for which they agree to provide "emergency care" to any and all. To say, this free-will acceptance by most hospitals to provide this service creates a "right" would be like saying my agreeing to provide benefits to my employees creates an obligation on all other employers and a right to all employees.

Furthermore, if our government can require a business to give away its services for free, what makes you think they will stop at health care? Shouldn't colleges (private and public) give away their services? I hear that "education is a right" too. Or farmers give away their grain since "food is a right" too.

Plato said that the final stage before a civilization falls into anarchy and dissolution is one that begins to act based on the "passions" and not intellectual vigor and logic.

I'm ok with having a conversation about health care being a privilege for being an American citizen. And, with that will come the corresponding conversation:

What is entailed by the privilege and its limits as well as, if any, responsibilities of the recipient. Then, with that definition, we can properly ask ourselves upon whom we will force to pay for it.

So long as it is called a right, there are no limits to cost, no responsibilities on recipients, and no limit to what can be inflicted on the collective for "protection" of this right.

While Obama confuses the issue by using the word "right," he at least understands that if the government undertakes this obligation there will come limits to costs and responsibilities.

Wayne Gilbert said...

Calling something a "right" does not ordinarily mean that either the government or the private sector has to provide that something for free. It means that that something cannot be arbitrarily denied or taken away. I agree with parts of Troy's post and parts of Don's post. The labeling is not as important as starting to create and enforce certain "somethings" to the effect that, for example, people can't be denied health insurance for some pre existing condition. As to actually providing health care for free, doesn't this go on right now anyway in a kind of haphazard, maybe even chaotic, way that ends up costing both providers and paying consumers. I would hope that a comprehensive plan would do a better job of this aspect of health care.

Bill Fleming said...

"If it becomes a universal expectation that everyone have a heart transplant, one doesn't have a right to take one from another. "

On the contrary, this is precisely what the far right argues, albeit in a slightly different context. I would elaborate, but it's probably best for us to focus on one almost-impossible-to-resolve issue at a time.