Sunday, October 18, 2009

Health Care Discussion

I heard these sentiments in some recent health care discussions:

•Everyone has the right to healthcare.

•America is way behind other countries in that we don't provide health care to everyone.

•It is hard to get health insurance because of the expense and existence of preexisting conditions.

•There are lots of inefficiencies in our health care systems.

The underlying question, for me, is what should the haves give to the havenots.
And who should determine that?

One extreme is, as Karl Marx said, that we should work according to our abilities and get paid according to our needs.

The other extreme is that everyone has the right to keep what they have and earn.

It is pragmatic for the haves to keep the havenots happy so that

•they will not revolt

•will be available to provide goods and services for the haves
(hopefully a mutually beneficial position).

Beyond that, how generous will the haves be? Who should determine that?

Before taxes were so high there was much more private philanthropy (just a piece of trivia).

The other health care issues are (besides the one of whether the haves should give health care to the havesnots) are:

•Should gov manage health care insurance?

•Should gov manage health care?

Other than those committed to masochism we are all generous. The difference is in our circle of generosity, which can range from only wanting to give to ourselves to wanting to give to everything.

And there are the proverbs on giving:

•"The road to hell is paved with good intentions"

•"Give a man a fish and he eats for the day. Teach a man to fish and he eats for a life time."

I'd like everyone to be happy. I don't want to support everyone nor do I believe that it necessarily benefits one to be supported.

Those are the issues as I see them. I'd appreciate your comments if you disagree with anything I've said or just want to add anything.

Kim

14 comments:

bob vorel said...

Under proverbs, I believe that it is supposed to be "Give a man a fish and he eats for the day. Teach a man to fish and he eats for a life time." I could be wrong.

jashbaug said...

I have one thing, Health care cost, excluding elective surgery, should be 100% deductible off the gross income of the individual.

If you need a tool for business, paints for an art piece, or provide health care for employees it is deductible before taxes.

People should have the same right to deduct the expense of staying healthy off their income for obvious reasons.

Kim Mosley said...

There are many ways to subsidize. All of them, in the end, distribute income from the haves to the havenots.

The other examples, in my view, don't apply because they are business expenses and reduce the profit that is taxable.

The expense of staying healthy is a slippery slope. Being married adds years to one's life. If that were deductible, then those not married would have a greater burden.

There is no free lunch.

Jim Jordan said...

I have changed my mind recently about having and have not-ing. I think old proverbs are OLD proverbs. Here are 2 new ones: Our roads are paved with good intentions and teach everyone to fish but also feed them; some may not want to fish, so what? Havers should support not-havers and some not-havers will be bored and become havers; and some havers will get tired and become not-havers, and eventually.......what? SO what?

Kim Mosley said...

Luckily we have on earth those who want to give to everything... and those who just give to themselves, and as you say, those who get bored.

What I "worry" about in a welfare state is that more and more people will choose to take the welfare and pursue their dreams, putting even a greater burden on those who are working (good for the dreamers, but how about for their non-volunteering "patrons"?). It is hard for me to sometimes know when dana is dana.

Jim Jordan said...

But Kim, so....if those who are working are too burdened, then they quit. if they ALL quit, then what??
Sure, put in anything, I say it, then it floats off on its own...bye, bye.

Sheila Fling said...

love the photos and the health care issues list. "People" are always saying the USA has the best health care in the world, but I heard on NPR that the World Health Organization rates France #1 in health care and USA #37. I am blessed to have had educated parents who led me to get a good education resulting in a univ. job, which certainly didn't make me rich, but gave me good benefits, so I have both Medicare and Blue Cross/Shield. Obama says their plan will at least "break even" in 10 years. But I'd be happy to even increase my taxes for a "Public Option" similar to Medicare to cover everyone and compete with the expensive and seemingly unfair private insurance companies. I think the government probably should regulate both health insurance and health care, including pharmaceutical companies but not necessarily "manage" all aspects of it.

Anonymous said...

Hi Kim,

In skimming your writing on health care I'd say that you have it summed up fairly well. The only thing you have not put forward is ... your take on the whole thing.

I'll tell you what I'd like to see (subject to change upon further reflection and more information):

1. Price controls and caps, plus better management of the existing health care system so that there are no reasonable life-time limits on the coverage.
2. Reasonably priced private insurance used for "normal folk like us" for most "regular" things such as office visits, mammograms, reasonably-priced Rx's
3. A govt. run option to keep the health insurance companies "honest"
4. A change in leadership / vision / philosophy that would allow hospitals & insurance companies run like not-for-profit corporations, where it would be obscene for executives to receive high salaries and large bonuses, and where the emphasis is on quality of life, generosity, -- basically a modfied Marxist system :-).
5. A govt. run program to manage "catastrophic" cases that would bankrupt a "regular" person -- which would be almost ALL of us, once we encounter something like major cancer, accidents, long-term illness, etc.

You see, half my family are Dutch and I basically have a socialistic side to me. Well, probably more like "ideal" Marxism, which doesn't work because human greed and lack of understanding inevitably creep into the system - although that Utopia would be my ideal.

Donn Harris said...

I am not sure we said anything about "haves and have-nots." I think it is a false argument to ask, What should the haves give to the have-nots? I don't think it's a question of "giving" anything. This is a conceptualization of health care as a "privilege," and I lean towards thinking of it as a "right." And I certainly don't remember anything about keeping the "have-nots" from revolting. Is your blog a summary of many conversations with many different people?

Kim Mosley said...

You certainly didn't say anything about the "haves and havenots." It was based on other conversations. Health care came up no matter whom I was visiting. I'd like to put your comment under comments. I can do it "anonymously" if you like.

An interesting aspect of the "have/havenots" conceptualization is that (according to a professor at Washington University) is that neither is a specific group, but rather people move in and out of poverty.

I'm not sure how whoever is poor (those below the poverty level) at a given moment can get anything without it being funded by the rich (those above the poverty level).

I purposely framed the issue as a "have/havenot" division because I think that is the elephant that is being ignored.

I see no problem with a group of people determining what is the right of all its citizens. That is common practice for any country. The question, when the rights entail expense, is who is going to pay for it.

Thanks Donn,

Kim

Donn said...

I still challenge the idea that those with money pay for the services of those without. Do we ever say that of the military as in, "People with money are subsidizing the national security of those without money?" No, we don't say that, because we consider the safety of citizens to transcend those divisions. I would put health care in the same category -- so fundamental as to be unquestioned.

Kim Mosley said...

I'm not sure that I'd buy the idea of anything being so fundamental that it shouldn't be questioned. What did Socrates mean when he said that the unexamined life is not worth living? I don't see the harm in looking at all the services provided and seeing who is paying what for what. Maybe health care should be included in the constitution as a "right." But we ought to be clear that it will not be funded by the gods.

robert said...

I love what Rob Brezsney has to say about this matter.

During the dialog about health care in the U.S., certain highly relevant facts are never discussed. For example, it's ludicrous for right-wingers to fear that a government-run health system would freshly infect our capitalist system with the stain of socialism. The truth is, America has long had the biggest socialist enterprise in the world: its sprawling military establishment, which is completely paid for by taxpayer dollars and run by the government! (For more discussion of America's long-running, thoroughgoing socialist tradition, go here.) Another unacknowledged fact in the dialog about health care is this: The single smartest strategy for financing a new system (as well as dramatically improving the economy) would be to reduce military expenditures. Americans don't seem to realize that their monstrously huge military empire is a case of supreme overkill: It girdles the globe in ways that are unprecedented in the history of civilization. We have 761 military sites in over 100 countries! "If you want to talk about suns never setting on empires, the Brits had nothing compared to this," defense analyst John Pike told the L. A. Times. I bring this to your attention, Scorpio, to illustrate the way that a seemingly serious discussion can be thrown off course and rendered unproductive when it ignores critical information. Please make sure nothing like that happens in your personal sphere in the coming weeks.

Kim Mosley said...

A few comments:

The inference is that most of the gov's money goes for the military. In fact, according to: http://en.wikipedia.org/wiki/Military_budget_of_the_United_States it is about 21%.

In addition, the author gives the slippery slope argument that we shouldn't be worried about socialism because we are already moving in that direction.

The two questions about socialism that I have are: 1) does it work and 2) does it take away our freedoms?