Why the nation will embrace universal health care

The Seattle Times ^ | 6/3/05 | Lance Dickie

[bagocookies]

If the engine of change in most democracies is a disgruntled middle class, then I am emboldened to make a prediction. The U.S. is headed toward a single-payer system of universal health care.

Everyone keeps his or her doctor and, more to the point, everyone will have one. The medical-delivery system — physicians, hospitals and pharmaceuticals — stays private, but the paperwork and bills are routed through and paid by the federal government.

Spare me the shibboleths and scare tactics — — Hillarycare, waiting lines for MRI's in Canada, the government picking your doctor, the Prussian and commie menace of socialized medicine. Disinformation and selective data from the usual think tanks has lost their sting.

Expect national health insurance to be demonized; it always has been. The fundamental change is that a broad swath of the public knows it is poorly served by an inefficient and bureaucratic system, and increasingly cannot afford what is available. Beyond the estimated 45 million Americans without health insurance, legions more have skimpy coverage, ever higher premiums, growing copayments and soaring deductibles.

People find out how little coverage they have as they parse the medical and insurance jargon of what is routine and required, and fumble for the right questions to ask.

Their kids are coming out of college into extended temp jobs that either offer no health benefits or provide better-than-nothing catastrophic coverage.

Sixty-five percent of Americans support the U.S. government guaranteeing health insurance for all citizens, even if it means raising taxes, according to a survey by the Pew Research Center for the People & the Press. The number stays strong across the ideological spectrum because poor access to health care affects red and blue states alike.

So how can I be so confident change is coming? Corporate America will embrace universal health care as a way to shift the cost of insurance expenses for workers and retirees to the federal government and the public.

Big business is already testing themes, hinting that burdensome insurance overhead makes them less competitive overseas. The expenses are real enough, but premiums growing by double digits could be replaced with a modest payroll tax and an income-tax bump for workers.

I am betting business would take a defined contribution to a health plan, federal or otherwise, to escape sole responsibility for a defined benefit. Think 401(k)s versus pensions.

Adios to negotiations with employees and insurance companies and the paperwork for both. No more premiums and no more copayments, and even the Wal-Marts of the world get tapped for a contribution for their workers.

For doctors, the direct savings are in administrative costs. Instead of hiring staff to file claims with any of 1,200 insurance companies, they deal with one plan administrator, one set of forms.

The one sweetener I would add is having the new health system pick up the costs of medical-malpractice insurance. Spread the cost and create more financial and political incentives for doctors to support the new plan.

Unions have fiercely opposed national health insurance all the way back to early in the last century. Their ability to bargain for medical coverage was a huge incentive for workers to organize, and unions did not want to forfeit their leverage. Even as union membership shrinks, there is resistance.

That is just nuts.

One indication of the fear factor in the insurance industry is the frantic, belated effort to help the uninsured with tax credits and grants — the same old nostrums within a health-care system that is falling apart.

Thoughtful alternatives exist, and leadership comes from within the medical profession. The Chicago-based Physicians for a National Health Program has 12,000 members and a template for a single-payer health plan.

The group's current president is a veteran of rural medicine, teaching, academia and health policy. Dr. John Geyman is professor emeritus of Family Medicine at the University of Washington, where he chaired the department from 1976 to 1990. He practiced medicine on San Juan Island the next seven years.

Geyman sees national change driven by runaway health-care prices, the failure of the marketplace to contain costs and the inability of people to afford medical care. He is not promoting the government-run health system of the loaded poll question — rather, full coverage at no more cost.

That will resonate with the middle class, and that will grab the attention of the political class.

[Cincinna]

"Efficiently:
Nothing in a democratic, federal, pluralistic government is efficient, because everything is subject to oversight and appeal. The Post Office is not efficient, but it is certainly effective at delivering the mail.

Effective is good enough for most of these things."

If a private corporation were run as inefficiently as the US Postal Service, with as much waste, scamming, and just plain loafing, it would be bankrupt in a year.

[hosepipe]

If you think health care is expensive now, just wait until it's 'free'- PJ O'Rourke

[lucysmom]

...people will be stunned to find that they are not candidates for the most advanced and effective treatment because, frankly, they are not worth it.

Isn't that the case now? The difference is that rationing is based on ability to pay.

[lucysmom]

When Congress enacts statutory privileges, not found in nature, there are natural and statutory responsibilities that come with it, because there is no such thing as a free lunch.

I've noticed that you use the phrase "not found in nature" a lot. Does that mean that living like an animal is the highest function of being human?

In any case, you "nature" argument does not support your position. Many relationships are found in nature including parasitic relationships, the "free lunch".

[William Terrell]

I've noticed that you use the phrase "not found in nature" a lot. Does that mean that living like an animal is the highest function of being human?

You can have no natural right to something that others must must expend their substance to provide you. That right is not found in nature. Can you reason out why?

In any case, you "nature" argument does not support your position. Many relationships are found in nature including parasitic relationships, the "free lunch".

Not natural philosophically, on which we base the principles of large groups living together, like a nation. In the jungle, you can be as parasitic as you can get away with, what we call criminal or immoral as civilized beings.

Only God knows the relationship of a parasite to its host in the animal world. It may symbiotic in way not apparent to us. But, as you point out, we are not animals.

[ArmyTeach]

That's true. Today we have free market rationing. The new system would be rationing determined by the government. Control is taken out of the hands of the individual medical consumer and given over to anonymous bureaucrats who have priorities other than any given individual's health.
Anyone other than the very rich and powerful, who can easily afford any health care procedure and won't be getting it from the state system anyhow, will have problems accessing anything more than routine health care in either case. The question is who holds the right to make the decision, who has the choice.

[Fabozz]

"It's not bad, it's just expensive."

And as we all know, the way to make anything cheaper is to have the government sell it!

[ArmyTeach]

Addendum. There is very little that the federal government has undertaken to control that it has not - excuse my phraseology - royally screwed up and then made worse by trying to fix it. The list of successful, well managed federal undertakings can probably be counted on one hand, one reason being that whatever the fed take over becomes intimately a political football.
Sorry. I'm becoming ponderous and tedious, losing my sense of humor.
Everyone have a great day. Adieu.

[lucysmom]

You can have no natural right to something that others must must expend their substance to provide you. That right is not found in nature.

Whether one would call it a right of not, the behavior does exist in nature, reciprocal altruism. It seems that some sort of system that provides health care to everyone could fall within this category.

Only God knows the relationship of a parasite to its host in the animal world. It may symbiotic in way not apparent to us. But, as you point out, we are not animals.

And perhaps only God knows too the relationship between those who for any reason don't have the ability to fully provide for themselves all the time, and those who have the means to contribute to, or fully support their survival. If a person with cerebral palsy requires more in services than he is able to pay for, does he have a right to live even if his life depends on others expending their substance to keep him alive? It doesn't make sense to claim that a relationship does not exist in nature, and then assert that if it does, it may have a deeper meaning than we are unable to ascertain without acknowledging that the same may be true among human beings.

[lucysmom]

Today we have free market rationing. The new system would be rationing determined by the government. Control is taken out of the hands of the individual medical consumer and given over to anonymous bureaucrats who have priorities other than any given individual's health.

Again, this is not much different than what we have now. We just trade government bureaucrats for insurance bureaucrats. The profit motive doesn't always deliver the best medical care. In fact, as a customer, if you are nolonger profitable, you may well have your coverage dropped.

[ArmyTeach]

I really do agree with in some principles. But case in point. We read on FR about a British girl being treated - for I believe, a seizure disorder, correct me if I'm wrong - had her first surgery postponed. Before her appointment for her second surgery came up, the system ran out of funds, another postponement. She died, and all the British system had to say to her parents was, "Sorry, SOL."
We've heard of medical care and resources being donated to help a child in an extreme condition. Unfortunately, it's often a child from another country and intended as PR for the institution. It would be nice if the same could be done for our own children in extreme need.

[William Terrell]

Whether one would call it a right of not, the behavior does exist in nature, reciprocal altruism. It seems that some sort of system that provides health care to everyone could fall within this category.

Human beings are not naturally altruistic. That is a socialized behavior. When you have group A who gets benefits they have not earned, and group B that pays for those benefits, group A gets bigger and group B gets smaller.

We learned this lesson as far back as the Plymouth Colony. Read Bradford's diary.

If a person with cerebral palsy requires more in services than he is able to pay for, does he have a right to live even if his life depends on others expending their substance to keep him alive?

No one has a right to live at the expense of another. Other's may voluntarily, of their own choice, without any coercion at all, help him using their own resources. Beyond that lives the destruction of a civilization.

Can't you reason out the principles of human behavior that apply here on your own? As I mentioned above, we have an actinicly clear example of the inherent unworkability of such a system in our own early history.

[Bogey]

Correspondingly, look for physicians to leave the industry in droves as Federal price controls greatly reduces the profitability of private practice.

---

I totally agree. Doctors deeply regret ever signing on to HMO'S and even worse PPO'S. Great for the patient, but the Doctors and Hospitals are getting less than 1/2 of normal charges. I'm with Cigna, and my statements always show what
the doctors accept as a fee. A normal visit with my Gynocologist is 238.00. He gets 65.00.
NHS can only be worse.

[DLfromthedesert]

So true. The biggest problem we have today is that the feds have taken over so much of healthcare and the costs have risen exponentially along with the rules and regs that benefit no one.

Also, states and feds have increased mandates on private insurance companies.

It's a shame so many Freepers have been brainwashed to think being compassionate means turning over our lives to the care of a behemoth that cares nothing for us as individuals, but just craves increasing power and control.

[DLfromthedesert]

So isn't the solution to have MORE control by individuals and LESS by BIG business and/or BIG government?

Why are you so willing to turn over the care of yourself and your loved ones to a bureaucracy that just wants more control over us, more power? This is NOT benevolent.

Look at Holland and see where government health care leads.

[DLfromthedesert]

I remember a time when doctors and nurses did a LOT more voluntary work, and county hospitals and other charitable institutions were the ones people turned to in time of need.

And it worked very well before the feds stepped in and took over.

[m87339]

Spare me the shibboleths and scare tactics — — Hillarycare, waiting lines for MRI's in Canada, the government picking your doctor, the Prussian and commie menace of socialized medicine. Disinformation and selective data from the usual think tanks has lost their sting.

IOW: It doesn't matter what anyone else says, I have my fingers in my ears and going "nya nya nya!"

[ArmyTeach]

...in a nutshell...

[ArmyTeach]

I worked at one of those county hospitals as a candystiper when I was 17. My friend and I picked up the Red Cross station wagon (yes, age 17) at 6:00 am every Saturday and drove ourselves 20 miles to Salinas to work 4 hours on the wards. Did a lot of the routine non-medical nursing jobs.

[Vicomte13]

I have excerpted large parts of your post in full, because they require a full response.

You wrote, among other things:
"They should get help from their family and church.and would if the "public" hasn't taken over that task through forced wealth distribution.
Caring, compassion and the desire to help the needy is an individual trait, sourced from the individual connection with the spirit and laws of God.
To turn it over to a collective administration is to advocate the exercise of one's God given empathy and avoid direct personal involvement, leading to a self-centered and heartless society.
Jesus never advocated the government care of the infirm and needy. He taught it as a form of individual love.
I find your theology questionable. Note my tag line. To depend on any kind of collectivist administration of human compassion leads to tyranny.
As for "dying". Don't you believe in eternal life? Do you think anyone will live forever? Dying is a natural part of life and leads to another.
You love someone, you force them to accept the consequences of their choices, or they remain a child in spirit, one is supposed to put away childish things on becoming an adult.
No one on the face of this earth has a right to health care. They only have a right to provide for themselves. When you discover a "right" to something you can't afford, you have to depend on others, at the point of a gun, to provide it for you.
The is not a Godly remedy. If you care, then why don't you give money directly to a needy family, or spend time physically taking care of those who need it."

Yes, indeed, charity is an individual obligation. And just as surely, Jesus did not speak about a health care administration.

But there is a fly in the ointment in all of this.
Jesus was addressing individuals, individuals who all lived in a world in which they were in turn ruled by individuals. Everyone was ruled by a king, and the king was ruled by Caesar. That was the world in which God walked.

So, when Jesus spoke to the people following him around (who were neither Herod Antipas nor Caesar Tiberias) he directed them to be charitable to others, to care for the sick, to care for the needy, and the orphan, and the widow.
Actually, he did not make it optional: he said "As you treat the least of these, so shall I treat with you." Even worse (from a Randian perspective) he said that when people turned away from helping the poor and sick, they turned away from God. This was one of Jesus' famous parables.

So, that's you and me and everyone else who heard Jesus.
Now let's go back to Jesus' time and go up the payscale to Herod Antipas, the King, or to Caesar. They were individuals. Government was a matter of individual discretion then. What the king said was the law, was the law. So, let me ask you: was the KING in any way less responsible for the laws of his state, and not taking care of the sick and poor which is was in HIS INDIVIDUAL power to command, because it was "government"?
Not one bit.

The widow gave her widows' mite, and this was to her credit because it was more than she could afford.
The rich were expected, therefore, to give much more than they did.
And the richest and most powerful of all, the King, was accountable to God in his individual person for not using all of the power and wealth at his disposal to do what the widow, in her tiny little limited way, could do.

There was no special dispensation for Caesar, that somehow all the demands of charity and aid to the sick ceased when one came to an important and powerful man in command of everything. Actually, Caesar was accountable to God if he didn't use all of that power God gave him to do exactly what everyone else, in lesser stations, is commanded to do.

There is no firewall between what Caesar had to do, because it's government, and what was expected of the widow.

In other words, you say Jesus did not speak of government doing anything, and I agree. Government in Jesus' day was the king, and Jesus doesn't make any special rule for the king. The king was commanded by God to do everything in HIS power - and that means the "government of the state" (which was indistinguishable from the personal will of the King in those days) to care for the sick, the poor, the orphan. There was no special rule that said that the king could hold back some of his power and ability and did not have to do just as the widow did: reach deep and give more than she could afford. The King had to do that too, because, as you observe, Jesus didn't mention government. Meaning: he did not make an EXCEPTION for kings. Every individual, including Caesar, has to reach into his own and give and help. There's no government exception, no rule that exempts kings and emperors. Jesus doesn't mention government separately. You're right. And that means that Caesar and the King are just as bound to "give out of their want" - meaning largely and strongly - just like everybody else. Government erects no barrier for the personal demand on the king to aid the poor, weak and sick. At least not according to Jesus. Jesus doesn't mention government. And therefore Caesar is JUST a man, and the rule is no less for Caesar than for the widow. Caesar, of course, has more power, power granted by God, and by God Caesar is expected to use that power to a godly purpose, just like everyone else.

In our day and age, we have democracy. So, there is no individual who is king. Rather, we voters are all COLLECTIVELY the King, and the identical burden that Jesus laid on Caesar is laid upon us. By having revolutions and siezing command of government, we assumed the responsibilities that lay on the head of Caesar when he was an individual. We have the POWER to aid the poor and sick not just in our own economy, but in our fractionated role as Caesar.

Prescisely because Jesus didn't mention government, there is no special rule that reduces the individual burden on the king to take care of the poor and sick to the extent of his power. Thanks to revolution we wear the crown of the king. So, we have to share the wealth we have personally, but we also have to use the fractionated power we have as ruler to the same end. Government, which means us voters, does not get a "pass" from Jesus because when we vote we are government. We are the king. The King had to care for the poor and sick or he committed personal sin. Us too.

As for the eternal life question, it is strange.
Yes, everyone dies. All of those folks Jesus healed were going to die eventually. The ones he brought back from the dead already had. When he sent his disciples out to heal the sick, those healings were of mortal men doomed to die. When he admonished his followers to care for the sick, he was sending them on a fool's errand, since no care for anyone ultimately makes any difference. In the end, death wins over our physical bodies. In no sense did Jesus indicate that, therefore, we could treat the sickness of others with equanimity. No. He healed the sick. He sent his disciples out to do it. He commanded everyone else to care for them, and he did not make a distinction that reduced that personal burden when it came to Caesar. In a sense, it is a completely pointless exercise since, as you correctly point out, we all die in the end anyway. So, if the point is to defeat death, we lose.
But if the point is to cause us to become more godlike, by doing what we CAN, in our limited capacity, in mimicry of the great power and infinite mercy of God...well, that IS the point so why put an "IF" in front of it.
That applied to Caesar and the King to, and each of us today is both an individual and part of the king. Therefore, we have our individual duty, but that individual duty INCLUDES the excercise of our democratic duty. We are not separate beings when we vote, and our votes and decisions we take as part of our government are acts for which we are as personally accountable as any other acts. Jesus, after all, didn't carve out any exception for government. We dare not try to do it either.

You said that love is forcing someone to face the consequence of his choices. And what child CHOOOSES multiple sclerosis? What young man CHOOSES cancer?
Nobody.
These things just HAPPEN, quite randomly, and they are not the fault of the individuals who have to bear these crosses.
Your logic would force them to DIE, and would allow us to pretend that we can stand by without bearing any moral guilt if we did nothing about it, unless that child had the good fortune to be born into a family who happened to be able to bear the whole cost of multiple scleroris itself. I don't feel the need to belabor this point any further. The position you have staked out has obviously moral problems.
Everyone on the face of this earth has the right to health care, provided by the rest who can help them. This "right" is established by the God that gave us life and commanded us to live our lives based on certain moral instructions. He did not ASK us to care for the sick, he commanded it. We live at his suffrance. What we are obligated to do by God, others have a right to expect of us. Thus, a wife does not simply have to rely upon the faithfulness of her husband because he OUGHT to be faithful, she has the RIGHT to his fidelity because God commanded everyone not to commit adultery. God commanded us to take care of the sick, or else. The sick have the right, as children of God, to expect that the other children of God who have been blessed with health will help them. Of course, they cannot enforce that right. Nevertheless they have it.

As to the "gunpoint" business, we are collectively the king. Jesus made it clear that the kings and magistrates have the power to enforce laws, and that everyone has a duty to obey laws of Caesar, at least insofar as those laws do not command that a man break the laws of God.
We are Caesar. In our judgment, collectively, we have recognized that we have a duty to use our power as Caesar to take care of the sick. This involves taxing and spending. Caesar has the right to collect taxes, and people have a duty to pay them. Caesar has a duty to care for the sick. If Caesar decides, in his judgment, that the best way to care for the sick is through spending money of the state, then it is his prerogative to do so, and our sacred duty to obey. Those who refuse to obey and pay the just taxes demanded by Caesar are rightfully subject to the sword and correction. For Caesar has the right to tax. Jesus made that explicit, didn't he?
You and I and Jane and Mary are, collectively, Caesar.
Three of us have decided that we have to care for the sick as Caesar, and not just in our private capacity.
You disagree.
In a democracy, three parts of Caesar carry the day, and we have decided.
You have a moral and religious duty to obey.
To refuse to is to refuse to render unto Caesar the things that are Caesar's.
You may, of course, continue to argue that Caesar should not do these things. You can even try to argue it from a Christian religious perspective. But I don't think you've really got a pot to piss in when you do.

The answer to your final question is that if I care, as a private citizen, I can do all of those charitable things (and if I don't care and won't be charitable, I sin), but I am also a fractional part of Caesar, and that part of me is not sequestered from this moral duty to help the poor and sick. I have to do it in private life, Jesus didn't separate out government life as special or different in that regard...there was no charitable exception for kings...so, as part of the king, I have to do it there too.
We all do.
Inescapably.

So, when we speak of health care, the duty is there, and it is public as well as private.

The question from the public perspective is: what is the most effective way to accomplish aid to the sick?
I personally believe that the French health care approach is the best, because it maintains the quality and independence of the US system while covering everyone, thereby expanding the pool and reducing the unit cost.
On this there is certainly room for argument.
On the question of whether a democratic state (or any other state) has a moral duty to take up the question of health care and deal with it in its best judgment, I would say (and did say, above) that this is beyond Christian debate. Of course it does.