Friday, October 10, 2008

I fear the day...

The debate the other night was okay, nothing impressive, basically two stump speeches given in debate form. It was hardly a typical town hall and frankly I think the American people were cheated. However, Brokaw did somehow manage to ask an interesting question that grasped my attention: Is health care a right, a privilege or a responsibility? McCain answered – correctly of course – that it was a responsibility. Obama said – in a rather flip, immeasured way – that it was a RIGHT.

Let me explain why this is so wrong on so many levels. Healthcare is a service. A product. The result of a person’s labor. When he says that other people have a RIGHT to your labor he begins to walk a very dangerous line. If the product of my labor is the right of others, then that makes it a bit difficult for me to charge them for it. We’re getting much too close to socialism for my comfort and I wish someone else would start voicing these concerns as well. The notion that people are rightfully entitled to the labor of other people is about as Marxist as it gets and I think Obama should be very careful in how he chooses his words. It didn’t appear to me that he thought much about his answer, which makes him reckless, and if he did think about it then that only confirms my previous notion that he is a socialist.

When we say that healthcare is a right, then we are basically saying that the government must provide it for the people. How? The government doesn’t have money of its own and doesn’t employ medical professionals. So the government will take money from some of its citizens to spend on the healthcare of others. Again, this is a socialist notion. Redistribution of wealth, unequal protection. Justice is not blind, instead she removes her blindfold long enough to ask what you do and how much money you make. I have similar problems with the progressive income tax, but that’s another post.

And how, exactly, does Obama plan to define “healthcare”? When we say this is a right, how far are we going? I could argue that the nation’s network of emergency rooms meets the obligation. People can receive life-saving care regardless of ability to pay. No, it’s not the ideal place to get basic healthcare, but it does serve as a safety net. But that’s obviously not enough for Obama. So he’s not saying that “healthcare” is a right, but is saying that having healthcare from a primary care physician is a right. This opens another can of worms. How will a doctor’s practice be restricted? If I identify “drug seeking” behavior from a patient and refuse to continue caring for that person, have I opened myself to a lawsuit for violating someone’s rights? What if I refuse to prescribe an antibiotic for a common cold, have I just violated someone’s rights? What if I get behind and patients are in my waiting room too long? What if I’m booked full and don’t have appointments available? Are we prepared to say that people have the right to Viagra? Narcotic pain medications? Cosmetic surgery? Weight loss surgery? And what about the pharmaceutical industry? If I am the CEO of a drug company and the POTUS states that people have a right to my product, then I’m going to demand government subsidies. In fact, expect the entire medical community to do this once Obama opens his Pandora’s Box. God knows there are enough lawsuits in the medical field, Obama threatens to create even more.

When we say that the people have a right to a doctor’s labor, then we aren’t far from saying that the government should be the doctor’s employer on government salary to administer to the rights of the citizens; and that hospitals should be public, nonprofit, government operated facilities. What this does is effectively removes the profitability in the medical field. And I’ve long argued that if you ever do that you will see quality of care plummet to something unimaginable. Access? Forget it. Getting an appointment with a doctor will be very difficult. Quality? Once you remove market competition you remove the motivation for quality care, top to bottom (this includes the nursing and rehab fields as well).

Look at Medicaid, it’s a complete disaster. I have trouble finding consultants and specialists willing to see my Medicaid patients because it usually results in a loss of money. Just recuperating one’s expenses is difficult. When I order something for a Medicaid patient I often find myself having to call and explain my actions to some government bureaucrat who has absolutely no medical background…NONE! This is like having my mechanic call a local high school cheerleader to tell her what he wants to do to my car. What’s worse is that sometimes the bureaucrats tell me that I can’t order a particular test and have to try something else instead. Who has the medical degree here?! Do people want their doctors delivering medical care or fighting with government bozos over their decisions? Because of red tape and bureaucracy Medicaid patients have been stigmatized in the medical world, and medicare isn’t much better. Every year Congress discusses cutting medicare payments. Do they want these people to get healthcare or not? Doctor’s offices are businesses and we have bills to pay. And another thing, the old notion that doctors make lots and lots of money is bogus, consider me a living testament to this. Many of us are middle class citizens and now Obama wants to say that people have a right to my services!

Now, the AMA favors universal health care but that’s basically because the AMA is a lobbyist organization and they want access to government money. I’m not a member of the AMA for this reason. I want people to have quality healthcare and I don’t believe the government is capable of delivering that and I don’t believe the AMA is looking out for patients.

The shame of it is that these patients are good people and should be cared for. The government is clueless to this fact and clueless on how best to do it, and now Obama wants to further the government’s involvement. This will be a disaster!

Healthcare is a responsibility. PERIOD. People have a responsibility to obtain healthcare for themselves and their family. The medical community has a responsibility to deliver QUALITY care to the community, something government involvement will hinder. Doctors have a responsibility to care for a certain number of people who, yes, can’t afford to pay. Drug companies have a responsibility to manufacture quality products and keep prices reasonable. The insurance industry has a responsibility to keep premiums low and relax their restrictions on pre-existing conditions. And the government has a responsibility to allow the healthcare industry just compensation for their labor to ensure that QUALITY is not sacrificed.

Rest assured and mark my words. Each day the government furthers their involvement in this industry is another day that healthcare becomes more mediocre. I fear the day that my words become reality.

13 comments:

allison said...

The problem is that although it is the responsibilty of people to obtain healthcare for themselves and their family, that is becoming nearly impossible for a growing number of Americans. And that is wrong. It shouldn't be a privelage of the wealthy--all Americans should be able to receive quality healthcare. If you listen to the stories of ANYONE who can't afford medical care or prescriptions, it should be easier to understand how unfair this system is. Maybe universal healthcare isn't the perfect solution, but something big must change, and I for one am glad that Obama sees that.

Nannykaren said...

As a senior citizen, who is below the poverty level, I still manage to pay for hospitalization insurance because I know it is my
responsibility, and It is NOT a privalege.
I am a widow, and because I do not want my children stuck with my medical bills, I made buying Insurance a top priority, even though I have to live with one of my children in order to make it now.
Having said that, I would NEVER want a socialist form of health care. I want to be able to make
the choice of what doctor I want, etc. So I will vote republican! Nuff said.

allison said...

So while you are not burdening your children with your medical bills, you are still relying on one of them to provide housing for you. I don't really think that proves anything...

Auntyem said...

Nanny - You said you pay for hospitalization insurance? Is that through Medicare? Medicare is one of the programs that I thought Republicans wanted to eliminate or privatize along with eliminating Social Security and Medicaid.

John,

I know your frustrations first-hand having worked in the medical field (middle management) for almost 35 years in a government-run facility. It would break my heart to see a tired surgeon come down to the clinic and diagnose a patient that needed surgery be told by a nurse that he couldn't order such and such because of this or that and hand him a pile of pre-authorization forms to complete. The people making the decisions on approving or denying services were RNs, NPs or MDs, but some of the MDs had specialized in pathology and had never treated patients hands on. In an urgent case the surgeon had to call the authorizing physician and be put on ignore. Most urgent authorizations had to be discussed physician to physician. Emergent authorization could be obtained after the fact.

Private physicians are not required to provide free services; they can refer patients to those local clinics and hospitals that accept Medicaid, or have HMO plans that are the cheapest, that is why those places are overrun. And services in those places aren't free either; all of us who work or have worked are paying for them. I am very fortunate I can be seen by the highest qualified people in a thriving private group, am seen quickly and receive any service I need.

As for your obligations, you know it would be a moral obligation for you to try and stabilize a patient after calling an ambulance, although I know of some physicians and nurses that avoid getting involved in any way when coming upon an accident, or other medical emergency in a public place, etc. for fear of a lawsuit later. Yes, people whose lives you have saved can be such ingrates as to later sue you for something you did to try to save their lives.

Also, physicians working for government-run hospitals such as the military or county or state facilities get paid good salaries and get good benefits; I saw many of our doctors come from private practices they could no longer afford to run, could not support their families on their own or with a failed group. You are right about doctors no longer being the richest guys in town--the money now goes to those in the high tech industries or to greedy stock brokers, etc.

We do need a safety net, and Obama isn't asking any physicians to provide services for free, or not give patients a choice in getting the care they desire from highly qualified physicians anywhere they choose. He says he would like more people to have at least what he and other federal employees have, and I don't see him or any other senator wanting to sit for hours in some clinic's waiting room.

I wonder how many physicians in private practice are supported entirely by patients who can pay for their care without the help of at least Medicare or other insurance. Not many anymore I would venture.

What Obama wants to do is retain free choice but give the poor who can't work due to disablility or age as well as the working poor who live hand to mouth a safety net with less red tape and restrictions on pre-existing conditions.

What I was afraid of was HILLARY'S plan to put everyone under a socialistic medical umbrella where there would be no choice. I don't want a Canadian style system. We used to get patients from Canada who got tired of waiting in the queue for services. Mexico is that way too. Sure, medical care in countries like that are "free", if you can live long enough to avail yourself of them. I also am not clear on McCain's plans. I feel the extreme right wingers would tie his hands and the poor and disabled and elderly would have less access to care. Social conscienceness is not their forte, and free market priciples should not be applied to something that everyone is bound to need sooner or later. Those working poor who were not born with silver spoons in their mouths are only a broken neck or paralyzing stroke away from poverty and loss of income for their families, and in such cases medical care should be a right.

Emilie
Port Orchard, WA

NannyKaren said...

Emilie, I have BCBS...I don't expect my doctor to provide free service. They have to eat and pay bills too.

allison whatever you want to think is ok w/me cause I am not trying to prove anything.You see, my children do not concider me a burden, they wanted me to live with them.

allison said...

The point is that not everyone can afford to house their parents when they can no longer afford their medical bills. Especially families who are struggling to pay their OWN bills.

NannyKaren said...

allison, i don't know a family who is NOT struggleing to pay thier bills. But thankfully i have a family who loves me enough to let me occupy a room in their home.

You know allison, my husband and I were blessed with five children. We struggled a lot of those years to pay our OWN bills. And when my dad needed help in his old age we took him in too.

I believe God honors those who care for the widows and orphans. He cares for them too.

Anonymous said...

John,

I appreciate your concerns, however, I was struck by th eirony of your concerns over the health care system sucumbing to socialism when it appears that some of our financial institutions will shortly be owned by the government

TLGK

Robert M. said...

It's scary that Obama can get away with saying things like that. Healthcare is not a right, and never has been. The only right anyone has is not to be coerced. All rights stem from this. Simplified, rights are freedom from coercion. The right of free speech is really the freedom from people telling you what to say. The right to bear arms is really the freedom from people taking your property. And so on.

Healthcare, on the other hand is something given, usually through the coercion of others. The "right" to healthcare is false. Healthcare isn't a freedom from anything; it's the government giving something to one group at the expense of another.

Two problems arise from socialized medicine. First, socialization of anything is essentially taking from the rich to give to the poor. It is one man benefiting from the work of another. In the nineteenth century we had a name for that. In fact, the "right" to healthcare would violate the rights of others, by taking their earned wealth and giving it to others who have done nothing to earn it.

The second problem is practical. Socialized medicine limits competition, leading to a loss of quality and consumer choice. Furthermore, the government is not equipped to deal with issues which are market driven, as evidenced by the current failures of government subsidization. (For example, would you rather use UPS or USPS?)

From another perspective, why is healthcare a "right" just because some people can't afford it? If that's how we're defining rights nowadays, the government should socialize housing on a massive scale. After all, some people don't have houses, and can't afford them. Some people can't afford food. We don't subsidize that on a mass scale either, for the reasons mentioned above.

The bottom line is that the right "to" something cannot exist without violating someone else's right from coercion. That fact cannot be escaped. Putting the label socialized or universal on theft and slavery do nothing to justify them.

John Washburn said...

Loop, you’re right about the new era of socialism in America’s financial markets. And I hesitantly supported it because I saw no other way to avoid financial catastrophe. I may have been wrong but for me the right thing to do to protect the economy was to revert to a socialist buyout, but I also urged an immediate reversal of that policy as soon as the markets were calmed, with the government selling off any assets and passing new legislation banning any future government bailouts of the private sector. Also, remember that I pointed out it was social engineering that ultimately brought us to this point, not free market failures.

Robert, your comments are well said and I couldn't agree more.

Anonymous said...

John,

If by "social engineering" you mean the Community Reinvestment Act, I disagree. The CRA never compelled lenders to make subprime loans. That is a myth, perpetrted by those who seek to make the CRA, which was passed in 1977, a scapegoat.

The meltdown occurred b/c lending institutions had no stake in whether loans were repaid b/c they could securitize the loans and sell them. Other acts and omissions compounded the problem, but start w/ the Gramm-Leach-Bliley Financial Services Modernization Act of 1999.

TLGK

John Washburn said...

Loop, I think you’re misstating the facts. The CRA didn’t directly force lenders to make bad loans, but it did grant power to community groups like ACORN to seek action against banks that didn’t loan to low-income or otherwise poorly qualified borrowers, and this action could prevent banks from expanding. That is not conducive to capitalism. This came in the mid-90s when Clinton strengthened the act. Clinton himself has admitted some fault in the matter.

You argue that the crisis wouldn’t have happened if GLBA were never passed. I argue that it wouldn’t have happened if the CRA were never passed. Look at the facts of the matter. Without the CRA, there wouldn’t have been all these bad loans, there wouldn’t have been a subprime fiasco, which is the ultimate cause of this mess as you yourself have pointed out. Without GLBA, we wouldn’t have had these gigantic “too big to fail” banks going down but we still would have a subprime crisis stemming from bad loans, and thus we would instead have massive failure of many, many smaller banks. Again, this is exactly what happened during the Great Depression.

I’m of the opinion that we need to either commit to capitalism or give it up, and that trying to create some hybrid of the two creates problems like we are currently experiencing. We can’t impose socialistic policies on our industries and not expect problems to develop.

Anonymous said...

John,

BS. Only 30% of subprime loans originated w/ institutions controlled by the CRA. 30%.

The CRA was designed so that places like South Central and Bed Stuy, and a host of others would not be condemned to perpetual ghettohood b/c people in those neighborhoods had no access to capital.

W/o the GBLA the subprime loan crisis could not have become systemic. The CRA may have reesulted in a few pimples. The GBLA alloweed for septicemia.

TLGK