Wednesday, October 15, 2008


Let me get this in right before the debate. There was a question in the last presidential debate about whether health care should be a privilege, a responsibility, or a right. That is, should it be up to each person to do what they have to do to get health care or not, or should everyone be entitled to health care? (There's not actually much difference between calling it a privilege and calling it a responsibility. A privileged person explains that you don't have a privilege because you were irresponsible.)

This boils down again to the partisan divide on systems. A staunch Republican will say that we have set up a health care system that basically functions like a market. Over time, the system will derive appropriate health care costs. If you can't pay your health care costs under the system, the Republican finds fault with you, not with the system.

John McCain's health care plan revolves around you making even more decisions in the market, essentially driving a wedge between you and your employer-provided health care, cutting you loose with five grand to pay for an individual health plan. And if you can't do it because he didn't give you enough money, don't come crying to John McCain.

A Democrat like me would point out that the health care system we have has gotten stuck in a local maximum.

A free market functions well when consumer choices are real and varied. The choice of a consumer for one provider or another puts pressure on the other providers to improve value. But a free market breaks down in the face of an oligopoly, a market where there are few choices. An oligopoly, or monopoly, has strong incentives to lower value and raise prices because there is no competitive pressure. History abounds with examples.

Ask yourself whether we have a competitive health care market.

That's just one among many reasons that people can't pay the costs of health care. Democrats see that as a failure of the system, not a failure of the people. So first, we have to fix the system. An interesting way to do that might be to open the government health plan, the one that John McCain is on right now, to anyone who wants to join.

Making health care a right is a way of saying a few things: "We guarantee that the system will not chew you up and spit you out. We guarantee that you won't have to go bankrupt because of necessary medical care. We guarantee that you won't have to choose between food and prescriptions." And we're also saying that an America where any of those things can happen to you is not an America we can countenance.

My dad used to tell us about evangelizing in the inner city. He said they would hand out tracts wrapped around sandwiches. The idea was that there are needs more urgent than religion. Maybe sandwiches are not as important in the long run, but they certainly are in the short run.

Health care is like the sandwich. There's little point in talk about high-minded ideals like freedom of speech, religion, and press for people who do not have basic access to doctors and health services.


travis said...

Finally, something on your blog that I agree with that doesn't make me swear to myself that I will never under any circumstance read your blog again.

Health care is one issue where I completely side with the Democrats. I too am a firm believer that health care should be a right, not a privilege - especially in America. I have a hard time buying the argument that we still have the best health care in the world - if you can afford it. Just recently my cousin was hospitalized with a kidney stone of all things, that sent her body into septic shock and caused her to have to be in a medically induced coma for nearly a week. Oh, did I mention that she had to be hospitalized in Idaho and her insurance (which had nearly lapsed) was based in Utah? Hundreds of thousands of dollars later, she's fine, but how in the world is she, a single mother of 2, expected to pay what her insurance won't? It's ridiculous, and the biggest reason that I voted for Hillary in the primaries.

What I'm having a hard time with right now is how on earth our government can be expected to pay for insurance for everyone given the current economic situation (which, by the way, is a result of mismanagement by both parties - didn't subprime lending begin under Clinton's watch? What about Barney Frank? There's no denying the blame lies squarely on the government as a whole). I'm afraid that any sort of national health program may be a pipe dream, even though I would love to see the day that we (or any other country who is currently trying it) could make it work the way it should (i.e. not running out of ambulances because every ambulance in London is currently lined up outside the ER because they passed legislation that you can't wait in the ER without treatment for over a certain number of hours, thus patients are required to wait in the ambulance before they can wait in the waiting room).

This issue alone is almost important enough to me to cause me to vote for Obama...but I'm just not sure my conscience will allow it. Sometimes other convictions supersede the "clear light of reason."

Dan Lewis said...

I'm sorry if I've been giving you mixed feelings about my blog. I have mixed feelings too, but all I can do is talk about them... and I'm glad you're talking to me too. I can't stop talking about the Palin thing, because she really doesn't belong within a mile of the leadership of the free world... but I'll do my best to keep it civil going forward.

Just a few sentences about abortion and then I'll let it lie. The difference between pro-life and pro-choice is not a world where we don't have a lot of abortions and a world where we have a lot of abortions. If Roe v Wade is overturned, there are a lot of criminal abortions, a lot more unsafe abortions, a black market in RU-486, and more sick and dead women; there is not, however, less extramarital sex. And all these consequences fall less heavily on the rich, who can afford to pay for the illegal procedure, the illegal drugs, and the fines, should they be discovered. I think this is all a heavy price to pay to take a moral stand (even a correct, righteous one) on an issue that half the country can't agree on.

As far as funding health care goes, there is so much wasted money involved in health care that it is tempting to say that, unlike Bush's tax cuts, health care investment might even pay for itself... ha ha ha, we all had a good laugh at that one. Except that's pretty much what Obama said in the debate, and I think he's been more right than wrong on these kinds of issues.

Here's Obama again:
"So here's what my plan does. If you have health insurance, then you don't have to do anything. If you've got health insurance through your employer, you can keep your health insurance, keep your choice of doctor, keep your plan.

The only thing we're going to try to do is lower costs so that those cost savings are passed onto you. And we estimate we can cut the average family's premium by about $2,500 per year. If you don't have health insurance, then what we're going to do is to provide you the option of buying into the same kind of federal pool that both Senator McCain and I enjoy as federal employees, which will give you high-quality care, choice of doctors, at lower costs, because so many people are part of this insured group.

We're going to make sure that insurance companies can't discriminate on the basis of pre-existing conditions. We'll negotiate with the drug companies for the cheapest available price on drugs.

We are going to invest in information technology to eliminate bureaucracy and make the system more efficient.

And we are going to make sure that we manage chronic illnesses, like diabetes and heart disease, that cost a huge amount, but could be prevented. We've got to put more money into preventive care.

This will cost some money on the front end, but over the long term this is the only way that not only are we going to make families healthy, but it's also how we're going to save the federal budget, because we can't afford these escalating costs."

I think there is fairly strong evidence that it's not Social Security, it's the rising costs of Medicare and health care, especially caring for the uninsured, that are really poised to throw a live grenade into the shaking body of our comatose economy. Some of these promises may be overblown ($2500 per family per year? That's probably a pipe dream), but I think Obama is pointed at the real causes of these problems.

travis said...

Don't worry Dan, I'm not getting mixed feelings on your blog. I know two people can't be expected to agree on everything.

As I mentioned before, I really do agree with Obama's theory. It's probably much better than what we have going on right now (fortunately for me, I work for the State and pay next to nothing for health insurance anyway), but one fear is that if government makes insurance available, people who have policies that they are currently happy with (like me, for example), may soon find themselves without their policy because employers could ditch providing insurance for their employees, which in turn would put undue strain on the national insurance. This is just speculation, of course, but could happen. The State of Utah has a health insurance pool for folks who can't get insurance otherwise, and even with members paying exhorbitantly high premiums and having massive deductibles, the plan runs primarily on legislative appropriations...I fear what this would look like on a national scale. But I do agree with you, I don't think the free market alone will solve this crisis.

And since you brought up abortion, I feel I have to comment. I think I agree with your arguments and I don't necessarily think that overturning Roe V Wade will reduce unwanted pregnancies, etc, because it doesn't get to the root cause of the problem. For me, a candidate's stance on abortion speaks more to their character than anything. I know we can't force our morality on the entire nation, but it's my right as a voter that is a follower of Christ to stand up for what I believe to be the right thing, and that's what I will choose to do. I don't know whether you have heard this from Obama or not, but he has been quoted as saying that if one of his daughters were to become pregnant as a teenager, he wouldn't discourage them from aborting because he wouldn't want them to "ruin their lives." Doesn't this make you cringe even a little? As I said, I think it speaks a lot about character. Enough about abortion now.

Now about the Palin attacks...I think I've heard Keith Olbermann say nicer things about her than you, but I am prepared to admit that I don't think she's fit to be president, at least not right now. I think she's done a decent job of handling herself in the midst of fierce criticism (did you see her on SNL last night? At least she's not above making herself the butt of a joke), but again I argue that we're voting for the ticket as a whole, and she was chosen because of her experience in energy policy and her history (albeit short) as a reformer. McCain's got all the experience any voter could ever hope for, therfore I believe that the ticket as a whole is balanced. That's my logic and justification for being able to vote for McCain. I can completely understand how you and many others aren't fond of her. I too cringe when I hear interviews with her sometimes and believe that she has a long way to go before she's ready to be president, but I haven't completely dismissed her as a dimwit yet.

I hope you didn't think I was attacking you personally with my last post, because that was not my intention at all. I just want you, or readers of your blog, to know that there are some of us who are thinking critically about this election and will choose to vote differently and still feel like we've made an intelligent decision. But, this IS your blog :) And so you know, I feel like I need to start foamulating my comment for November 5 when you post something about Obama winning the election. Do you think you could give me a sneak peek as to what that post might look like so I can start working on it now?