Comment of the day.
Maybe it’s a bit early to decide, but with most of the nation bathed in sun, it could be a slow day for dotCommonweal. The comment comes from Commonweal contributor Jean Raber (most recent piece on the new Beguines here–subscribers only). Jean was responding to the following comment from Mark Proska in Eduardo’s thread below:
Let’s start with something we can all agree on: Every U.S citizen has access to healthcare and healthcare insurance. Those in the US who don’t have health insurance fall into one of the following buckets:
1) Illegal aliens, in which case the immigration system, not the healthcare system is the problem.
2) Those who can’t afford health insurance, in which case it’s a welfare issue, not a healthcare issue.
Mealy-mouthed whining about the “lack of access” and imprecise formulations of the problem are not helpful.
Here’s Jean:
Help me stop whining, Mark Proska! I certainly don’t want to be a drain on society’s resources or sympathy!
My employer needed to cut health care costs. It has done so by moving those of us who are not represented by unions onto part-time contracts that have no benefits. Problem solved! For them.
I can afford health care for my kid, even with his asthma, so things seem to be better there.
I can’t find it for myself. I’m 55, have pre-hypertension (possibly self-inflicted from reading your posts, and based on newer medical guidelines that have lowered the bar for what’s considered pre-hypertension), so I now have a pre-existing condition and affordable coverage is zippo, even though I’ve been on the horn with all sorts of companies, legit and otherwise, who purport to offer me a “good deal.”
I can pay for routine doc visits, flu shots. I can get a freebie once in awhile on pap and memmo screenings, but I can’t see the point, because if they told me I had cancer, I couldn’t afford to have a catastrophic illness treated.
My best bet for affordable health care is to quit one of two jobs and go on Medicaid. Six- to eight-month wait on that, but, better than waiting another 10 years until I’m eligible for Medicare. However, that means I’ll have health care, but not enough money to meet our very modest financial obligations, and I prefer to stay solvent.
Jean –
This is infuriating. To help with the anger and with the prohypertension, do learn Centering Prayer. Medical sience has clearly established that CP can reduce hypertension. Not to mention the remarkable spiritual benefits. It (the Holy Spirit) will help you. No, it is NOT Zen.
To learn how, go to: http://www.contemplativeoutreach.org
There search for “Summary of the Centering Prayer Method”.
Cyber bully Gallicho deleted my comment!
Would you settle down if I left this one, Robert? You wrote “Incredibly immature” as a response to the post; that was the entirety of your comment. Is that better or worse than being a cyber bully?
I say let Aeodatus/Robert Evans/Whatever his name is rave on, Grant.
I keep up with my bills, I pay my taxes, I take care of my kid, I don’t feed at the public trough, and if exhibiting frustration with being dropped from insurance and trying to replace it is “incredibly immature” by the lights of the Republican Catholic Church, people should know it.
Ann, I’ve never had much luck with CP. I’m sure it’s a failing on my part. The good thing about my second job is that you have to walk a good distance from parking lot to classes, and walking is one of the things I have to do.
I also knit incessantly, which lowers BP.
So if anybody needs some real good knitwear, let me know. Attention Fr. Komonchak: I’ve started a big stack of those fingerless gloves just the thing for gathering eggs on cold mornings!
I will settle down. But I don’t know why you would delete a post pointing out how immature this entry was. I think it is a rather petty contribution to a site that often manages to stay somewhat above the fray. And it seems to be an increasing trend here, mainly as a result of two contributors who simply cannot help themselves.
That’s pretty rich, Robert, coming from someone who feels impelled to describe a post as “incredibly immature.” You explained nothing. You just hurled an insult. No interest in providing a forum for that (no matter what it reveals, Jean). Jean’s story is what I wanted to highlight, and in order to do that, I provided its context.
Grant—now that you’ve deputized me as a Commonweal contributor, when should I expect those royalty checks to start rolling in?
By the way, for those interested in my response to Jean, just follow the link above to the original thread.
I would say at least by the eschaton.
Jean, you can call me Adeodatus or Robert Evans. Both are pseudonyms, though Adeodatus was chosen particularly for this site as it calls Augustine to mind.
Grant, I’m sorry that I seem to have gotten under your skin. I was just responding to a post that I thought was rather unfair. For what it’s worth, I thought Ann’s post in that same thread was more worthy of expanded discussion as opposed to the two you highlighted.
I enjoy reading Dickensian tales of woe. It was always my favorite portion of the John Edwards stump speeches. Unfortunately, we all have experienced horrible misfortunes, and some even in countries that have extensive universal health care. Denial of care and scant access to resources seem endemic to any system of health care, free market or universal. I do not believe that the conservative people commenting on this site hold some kind of Calvinistic view of how health care ought to be doled out.
I don’t know if this is a controversial statement on this site, but I do not believe that enacting a form of universal health care has any eschatological significance.
if Robert’s post was “incredibly immature,” I think that’s like saying ‘tough spit, Jean.”
And I find that kind of comment incredibly immature – immature because of its lack of empathy – a major constituent of maturity.
I am aghast how little catholics see the moral imperative of universal healthc are and I thought Jean’s post nicely underlined the problem of middle class folks needing help too, not just the poor (often sterotypcally divided from “the hard working.”)
I find it condescending to say how horible things are but God forbid we should do anything about in government.
Didn’t we just have the St. James Epistle about telling the poor bugger with nothing to go eat and sleep well.
Or maybe that’s the Calvinist position or another intellectualization/rationalization of not meeting our neighbor’s needs.
Jean, thanks for a good post.
In this divided world, I don’t think many who have ears though will listen.
The current health care debate reminds me of an experience I had in Israel a few years back on an interfaith pilgrimage.
Our group was delayed in entering Bethlehem because of construction of the Wall. We sat on the bus for nearly half an hour as construction gear guided a massive concrete section of the Wall into place. I’m not good at estimating size, but I’m guessing it was 50 feet high. We could clearly see watchtowers along the Wall and see it snaking for miles. We were witnesses to history, as this was when the wall was first being built.
The next morning at breakfast I was reading the newspaper, and I turned to one of my Jewish friends and said, “I can’t believe the Israeli government insists on calling it a ‘fence.’” (This was their preferred term at the time).
My friend’s face turned red. “It IS a fence!” he angrily retorted.
The point is that when opponents of health care reform state positions, they are operating from a position of belief. That is why we hear statements such as “Every U.S citizen has access to healthcare and healthcare insurance.” and “The United States has the best health care in the world.” These categorical statements are professions of belief, and no amount of reasoning can counter them. The second is an especially strong tenet of American Exceptionalism; one can insert anything into “The United States has the best _________ in the world” and it becomes an article of faith. To deny any such a statement is considered traitorous.
This is why the right can mount a campaign against health care reform without proposing any alternate solutions or often even denying there is a real problem — beyond some vague statement that things could be improved. One side states facts and discusses solutions; the other states beliefs and seeks to maintain the status quo as a testament to their faith in American Exceptionalism. For them, to change would be to somehow indicate that the United States is not already perfect, and for them that is not an option.
Jean: Thanks for the offer of the gloves. Two pairs, please, one for my borther and one for me. The big move is next Tuesday. I am surrounded by boxes–mostly of books.
Adeorobertus: You keep asserting that some portion of the post was “immature” or “unfair.” Yet, cipher-like, you haven’t explained what you find objectionable. And if you consider Jean’s story Dickensian, I recommend rereading Oliver. I’m afraid it won’t do to wave it away with a simple “we all have problems.”
Fr. K., good luck with your move.
Write me where to send on the gloves! My beautician sells eggs and chickens out of her shop fridge to make extra money (which I hope does not seem too Dickensian, but Michigan still isn’t out of the skids, no matter what Bernanke and co. say about the recession in general), and she likes hers.
Yr. pal, Little Nell (cough, cough)
Jean –
What is particularly unjust about your situation is that *you* have to pay taxes so *other* people can have Madicare and Medicaid, while you have to go without. Outrageous.
Thanks, Jean Your story only underlines the obvious risk the US worker has when almost all insurance comes via your employer.
Here is another piece of the puzzle via Open Minds, a health research and practice management consulting firm. It details what happens when HMO patients of the largest insurers in California tried to have their claims paid but were denied:
Saturday, September 19th, 2009
What California HMOs’ Denial Rates Mean for Behavioral Health Provider Organizations
Recently published data on claims denial rates have become an element of the health care reform discussion. A recent analysis conducted by the California Nurses Association found denial rates varied greatly between California HMOs:
Aetna 6.5%
PacifiCare 39.6%
Anthem Blue Cross (California’s largest for-profit health plan) 28%
Kaiser (California’s largest nonprofit plan) 28%
Cigna 33%
The study examined state government-collected data received from California HMOs by the California Department of Managed Care, from 2002 through June of 2009, and found that the five largest insurers (listed above) had rejected 31.2 million, or 21%, of all claims for medical care.
When I asked OPEN MINDS Senior Associate Dee Brown, M.S.M., for her thoughts on the implications of the study for management teams of behavioral health provider organizations, she said, My experience shows that the majority (50%) of denied claims are for lack of provider compliance with authorization requirements. Denials are often related to provider compliance with contract requirements, such as obtaining preauthorization for care.
This is another part of the “game” that large insurers, paid for by our employer benefit plans, are able to direct, deny, and make a profit on care. Nowhere do you see a discussion about the appropriateness of care, did someone get healthy or well – it is only about a gatekeeping measure – pre-authorize or no full coverage.
I guess someone forget to tell Jesus his story about the Good Samaritan is faulty. The Samaritan should have told the man he chose the wrong route or the wrong market. While we are at it throw out the other beatitudes. Which would make sense since they have been ignored for centuries.
“These categorical statements are professions of belief, and no amount of reasoning can counter them.”
Hmmm. So, Eric, are you saying that your disagreement with the contention that US citizens all have access to healthcare is not a profession of belief on your part? And what do we do with your categorical statement that “no amount of reasoning can counter them?” If you are open to engaging the argument, check out the original thread, where you can find the reasoning you’ve been looking for.
By the way, loved your work in Some Kind of Wonderful.
Mark – why don’t you take the time to review these resources – most are based on fact, not opinion.
Confused About Health Care Reform?
Confused about health care reform? I am. It’s a complex topic with lots of moving parts’ that affects over 10% of our GNP. Here are a few resources from the OPEN MINDS Circle Library that can help you cut through the noise’ and get a bead on the issues.
America’s Healthy Future Act (FREE)
Congressional Budget Office Analysis of America’s Healthy Future Act (FREE)
Statement of Senator Edward M. Kennedy on Integrative Medicine: A Vital Part of the New Health Care System (FREE)
Health Care Reform: An Introduction (FREE)
America’s Affordable Health Choices Act (H.R. 3200) Section-by-Section Analysis (FREE)
How Will the Uninsured Be Affected by Health Reform? Childless Adults (FREE)
How Will the Uninsured Be Affected by Health Reform?: Children (FREE)
How Will the Uninsured Be Affected by Health Reform?: Non-Elderly Uninsured (FREE)
How Will the Uninsured Be Affected by Health Reform?: Parents (FREE)
Health Policy Brief: Key Issues in Health Reform (FREE)
At a Crossroads: The US Human Services System and the Impact on Its Workforce (FREE)
Health Reform: The Cost of Failure (FREE)
The National Council’s Health Care Reform Agenda (FREE)
How Does the Quality of U.S. Health Care Compare Internationally? Timely Analysis of Immediate Health Policy Issues (FREE)
Changes in Health Care Financing & Organization: Impact of the Economy on Health Care (FREE)
Sorry – thought the links would appear rather than the word FREE. Here is a summary from one document by the Robert Wood Foundation published in May, 2009: Health Reform: The Cost of Failure:
http://www.openminds.com/circlehome/indres/052109hreformfailure.pdf
Highlights:
How Will Employer Costs Be Affected?
Under all three scenarios, there would be substantial increases
in employer premiums for businesses of all sizes.
We estimate that employer spending on premiums would
increase from $429.8 billion in 2009 to $885.1 billion in 2019 in
the worst case scenario, and to $740.6 billion in the best case.
Spending on premiums by small firms would grow considerably
more slowly, simply because small firms are much more likely
to drop coverage. In contrast, large firms would see increases of
123 percent over the 10-year period in the worst case. In the best
case, such firms would see increases of 77 percent.
As a consequence, premiums would increase as a share of worker
compensation – from 9.6 percent in 2009 to 17.0 percent in 2019
in the worst case scenario, and to 12.6 percent in the best case.
These costs would eventually mean lower wages and incomes
for workers, but until these adjustments are made, business
profitability would be adversely affected.
What Will the Costs Be to All of Us?
Individual and family spending would increase significantly
– from $326.4 billion in 2009 to $548.4 billion in 2019 in the
worst case scenario, and to $478.2 billion in the best case.
Medicaid and CHIP spending would grow substantially, both
because of increased enrollment and because of higher health
care costs. In the worst case scenario, Medicaid and CHIP
spending for the non-elderly would increase from $251.2 billion
in 2009 to $519.7 billion in 2019. In the best case, spending
would increase 61.7 percent to $403.8 billion.
Health reform will change who bears the burden of financing
the health care system and how this burden is shared – between
employers and individuals, between direct payments and taxes,
and across income groups. It will stem the continuous erosion
in the number of Americans with health care coverage, decrease
financial pressures on the hospitals and clinics that provide
care to the uninsured, reduce many system inefficiencies, and
ultimately improve both the health and financial security of the
American people. While enacting health reform will be difficult
and expensive, the cost of failure is substantial.
Another oft quoted remark is that other international countries healthcare is not as good as the US market based healthcare systems. Link: http://www.openminds.com/circlehome/indres/080109internationally.pdf
Statement by Ted Kennedy: http://www.openminds.com/circlehome/indres/022609kennedyreformstatement.pdf
It concludes:
Bill
Please please stop with Good Samaritan thing. The Samaritan stopped and helped – the virtue is in making the choice. Now, if the parable had been the virtue of a soldier standing by the side of the road who forced passers by to pay for the care of the victim (while keeping some of it himself for expenses) – then you have a valid comparison.
Is there a moral obligation to care for the sick – absolutely. Catholics also have a moral obligation to feed the hungry and shelter the homeless, but that doesn’t mean that we should make the state the primary provider of food and housing. There are many ways to meet these obligations – for example, Jean says she pays her taxes – why not give her a one for one – or even a 1.5 to one tax credit so she can afford insurance?
If a single-payer system or a government mandated system is the only way – OK, but those who support this approach have to start being more clear about what that means and convince others about very real concerns. Virtually all of our experience with large government run systems runs counter to the president’s promise of a more efficient, less expensive, and more accessible system. Also, the constant refrain – nothing will change for you – is simply false. Anyone with an ounce of common sense knows you can’t make the kind of sweeping changes proposed without affecting almost everyone in some way.
In fairness, those of us who oppose most of the approaches being proposed aren’t saying there isn’t a problem, and it’s not just selfishness that motivates us. The problem, as I see it, is that the reformers are asking the large majority of people who are generally pleased with health health care to trust the state – which as I said doesn’t have a great track record on these things – to change the entire system, including the good parts, to fix problems that are more limited.
I commend to all the current America editorial on the topic which notes:
-the need to act now is urgent
-the use of government to meet needs the private sector has not met is upheld by “long Ctaholic tradition”
-the threat of big government to delay action is unwarranted .
How good is health care for the “vast majority?”
I thought today’s NPR report on gamilies with the Federal Health plan shows growing problems.
The Catholic position of the moral imperative of universal health care should be the strating point in our discussion.
The propaganda of big government being the problem is deterring facing real problems in enacting what our value sytem should be, including the issue of coming doctor/nurses shortages.
Sean – read the links that I provided. These are in-depth studies by groups that are about as neutral as someone can be in looking at the total, universal US healthcare system.
Look at what they way about the current employer supported healthcare system – it is rapidly approaching implosion (see GM). You may be correct that a majority are currently happy with their insurance but how many truly study and look ahead. Your statement is actually incorrect for an estimated 30-50 million folks and growing every day.
But, you have the right to stick your head in the sand. Also, your exegesis would get you a D+ in my theology class.
Sean – I think it is important to first decide what it is that we are trying to do.
Are we trying to help those who currently do not have health insurance, or do we want to put everyone in the USA on the same national health insurance plan?
First of all, caring for the poor and yes, even the working poor, includes providing medical care and – as you mention – is only our Christian duty. Paying for that care and indeed, forcing all Americans to sign up to the same health insurance policy, is another matter altogether.
If our objective is limited to helping the poor and the working poor obtain health insurance coverage, the matter is straightforward enough; put them on either Medicare or Medicaid. I understand that at this point many will wail, “But those systems are broken”. I agree, those two bureaucracies need help; they need to be re-vamped and better funded, and in my opinion, that should be the main thrust of any reform effort; to reform and expand Medicare & Medicaid.
It is worth noting that if we cannot effectively operate these two smaller, but still national health care plans we already have, why should anyone think we could manage a third, much larger, much broader, national health care system?
In fact, if we reform and expand Medicare & Medicaid to help the folks about whom we claim to be concerned, once we get that system running in some reasonable fashion, it would then be much easier to make the case that we should expand it into a broader national health care system; one where we are all covered via the same, national, basic policy.
Many state run Medicaid programs are deeply dysfunctional, but the national Medicare program is extremely robust and efficient, with easily the highest satisfiaction levels of any public or private health care program in the U.S.
Medicare is also efficiently run (probably too efficiently in some respects).
The biggest problem with Medicare is a physician reimbursement structure that is deeply flawed, and we need to fix it anyway. (Fixing that would have a big benefit for private insurers as well — something that ought to make you realize how important government intervention is to the function of the insurance markets even if you don’t agree that single payer is a good idea.)
And, indeed, there are third, fourth and even fifth government health care programs that are well-run: Tricare, VA system, FEHBP. Altogether, if you added up these programs you would get to more than 100 million people currently receiving government funded benefits, and that doesn’t even include state employees whose benefits are usually administered by a state agency.
Barbara – You make good points.
If then, our goal is to help the poor and the working poor obtain medical insurance, it seems clear that a good way would be to reform one of the existing government-run health plans so as to cover those groups.
On the other hand, if our goal is to ensure that all Americans have the same, national medical insurance plan, then of course we have a lot more work to do.
In any case, the US Bishop’s recommendations are valid;
1 – Any plan should be pro-life i.e., tax dollars should not fund the abortion industry,
2 – Coverage needs to be universal i.e., would cover all US residents; including the indocumentados.
Again, regarding all this talk about health care, we as a nation need to decide what it is that we are trying to accomplish.
Oops – I meant to say; “In any case, the US Bishops recommendations – and therfore the Catholic position on the matter – is valid.
Bill
Why is my statement incorrect? All I am saying is that a majority of Americans are satisfied. You reply by saying that’s not true of 30-50 million Americans – well, yeah, but it is true for 200+ million, the majority. In order for you to get what you want you have to convince the majority that it is in everyone’s best interest – not just the minority. The problem with the Obama administration and most congressional Democrats is that they are trying to have their cake and eat it too by claiming we will have universal coverage wiith no impact on anyone but the uninsured – a patently false and ridiculous claim.
For all who are enamoured with European style health care, how we will acheive all the supposed benefits of that care when:
The model for US physician pay is fee for service and US physicians make 2 to 4 times what European doctors do. This is an important reason for some of the US costs, yet it is something that the Democrats won’t touch for fear of losing the support of the AMA and physician’s groups that they now have.
Most European countries have limited recovery for malpractice, but the Dems won’t address this due to the influence of the trial attorneys. Many studies show that the waste from defensive medicine caused by this is 5-8 billion a year.
Most European countries explicitly – and through process limits – ration or deny care to individuals based on age and condition profiles – Obama says we won’t do that.
Most European countries limit payments for pharmaceuticals – Obama says we won’t.
In short, how can we get all the supposed great benefits without any of the changes necessary.
As far as Medicare’s “efficiency” – yes, it is simple for the patient and the provider to use. I have that on good authority from both sides. But it rides on the back of the private system. The same is true of things like Tricare and FEHBP – further, these government run programs are mostly adminsitered by private, mostly for profit, companies. I suspect once you remove the private system on which these programs ride, the satisfaction will be much less.
Sean – One of your points goes toward a basic rule of law-making and lwa-changing.
Under our system of government – a standard liberal democracy – it is the responsibility of the people who propose chaning a given law to prove to the majority that the change will either be good for society or at least, that the proposed change will be neutral toward it.
For example, if I propose changing the speed limit on the expressway near my city from 40 mph to 50 mph, it is then my job to convince the local county officials that my proposal is good for the people nearby, or at east that it will not make their lives worse.
And so it is with any proposed legislation or reform. Since in the end the majority rules, it is the job of those proposing the new program or reform to justify it to the majority.
I think Democrats have done a good job pointing out that some folks cannot afford medical insurance. I do not think they have yet made the case that all Americans – even those who are satisfied with their current medical plans – should scrap their existing medical plans in favor of a national medical plan.
Now, that Democrats and others have not yet convinced the majority of Americans, does not mean (at all) that there is no value in having everyone in the US on the same basic, national medical polify. It simply means that the folks proposing that idea have not yet made the case for it.
It means they have much more work to do.
Sure most folks say they’re satisfied with their current coverage (whatever it is and whoever is helping to pay for it). The issue is that the current system is sustainable. Claiming to be satisfied with the current system is like a passenger on the Titanic saying there’s no problem because his or her end of the ship is still afloat.
Sean, I appreciate your comments which indicate you certainly are interested in fixing the problem. I know it is a democracy yet one cannot always convince everyone about the need. Roosevelt pushed Social Security through amidst enormous opposition. Similar happening with Medicare.
We can argue about the applications. But the Good Samaritan was definitely in the minority.
Sean said: There are many ways to meet these obligations – for example, Jean says she pays her taxes – why not give her a one for one – or even a 1.5 to one tax credit so she can afford insurance?
Jean notes: Actually Sen. Carl Levin proposed this some years ago, and I supported his idea, but not enough people were suffering at that point, and I think this relatively simple and useful idea has been eaten up by grander plans for a bigger fixits. Which may may not address both prongs of the problem–the cost of health care and the inefficiencies in the health care system.
Update on my quest to find health care:
Two plans I looked at this week will take me. They cost about 30 percent more than what I was paying through my employer and cover about 30 percent less, but still doable.
These plans accept those with pre-existings b/c they spread the risk among several companies (limited liability) and put you in a PPO. So that means new doctor. Again, not thrilled with changing the clinic I’ve been going to for 20 years, but still doable.
For the average slob trying to find his own insurance, the biggest problem is trying to figure out whether it’s any good, though I have learned not to be impressed by an A.M. Best “A” rating (think “adequate, mostly”).
Michigan has a list of vetted insurers, all of whose “products” are beyond my reach. So a national clearing house that rates these plans and puts you in touch with brokers you can tust would be a good step forward.
This need not be done by the feds. Consumer Reports or AARP could step into the breach. Any disinterested third party.
Bad news is that my kid was rejected for the state’s kid’s plan (Medicare at the state level). Conventional wisdom there is that you always get rejected if you apply online; you have to get a paper app and truck it on down to the local health department. Apparently a way to stall the huge backlog of applications in a state with 15 percent unemployment.
The private plans I looked at will take my kid. Again for more than before and with less coverage, but better than zippo.
All of this means that replenishing savings will take longer, and at my age–55–this is not a good time to have to delve into savings. I worry that I’ll run the risk of not being able to pay my way when I retire because I’ve spent a good deal of money to get through this crisis.
However, we’re still solvent, not sick, and we’re counting our blessings.
I offer these thoughts not because I want to cry anybody a river, but in hopes of keeping discussions focused on reality rather than ideology.
Perhaps we can all agree, regardless of our views of the various plans coming out of Washington and the private sector’s response, that life in the middle class has changed a good deal from what it was 50, 40 or even 30 years ago. And we’re all going to have to learn to accept and deal with it.
Per Antonio “…Claiming to be satisfied with the current system is like a passenger on the Titanic saying there’s no problem because his or her end of the ship is still afloat.”
Ken sez; The discussion of health care reform should be about how we can best tend the poor and the working poor who cannot afford medical insurance. It should not be about sarcasm, childish name calling, or implying that others are stupid simply because they do not see the world as you do.
You underestimate the intelligence of the average American; many people do. Regardless of you error however, the average American tends to his or her own affairs, and those of their family. They understand more than you give them credit for regarding things financial.
You give the impression that if the average American does not agree with you, it is simply because he is stupid. If only those great unwashed masses would just listen to (and obey) you. Well.
It is far more likely the average American disagrees with you because he has listened to your point of view and given it due consideration (something most on the ideological Left are generally loathe to do), and has decided he does not want the change you propose.
I grant that the average American’s decision may offend you, but you should understand he or she routinely gives plenty of thought to their family finances and budget, and most probably they know far better than you or any government bureaucrat what is best for them and for their family.
No Antonio, I would not be so quick to judge people as being so stupid that they do not know what is best for themselves and for their families.
In any case, we live in a democratic republic, a representative form of government, and the majority will in the end rule.
Ken, your diatribe is uncalled for and basically inaccurate. I start from the premise that nearly all of us, except for those who are truly wealthy, are medically indigent. We could not afford to pay for a medical catastrophe except through willingness to pool risks.
Fundamentally, those who have insurance have been able to situate themselves in an acceptable risk pooling arrangement. Anything that upsets the balance of that arrangement casts you into the outer darkness that is the individual insurance market.
If you are fired or laid off.
If you become a contract employee.
If your employer decides that it can no longer pay.
There are a lot of permutations through which one becomes less-well, poorly, and then un-insured. Each one of those can occur to most people. Hence, most of us are at risk, and many people who think they have adequate coverage learn the hard way that their coverage is full of holes even for things that they really could not have anticipated.
To call this a problem of the poor is to misunderstand the real problem.
Calm down Barbara, that was hardly a “diatribe”. However, your pouty retort is a light example of what I was saying to Antonio.
Simply because someone does not share your view does not make them less than you.
Chances are the person who does not agree with you has listened to you argument and has not found it convincing. For you or Antonio, at that point, to claim the person just doesn’t understand or perhaps is not capable of understanding is quite arrogant indeed.
The fact of the matter is that those who advocate changing (reforming) our health care system on such a radical and national scale as has been proposed are the ones who need to make the case to the majority of people who currently are more or less satisfied with their health care. It is your (and their) job to convince folks like me and Sean that we should change.
It is not my or Sean’s job to defend the status quo. The status quo is already in effect; it needs no defence. Those who would change the status quo need to convince society why we should change it.
And so far, while as I said earlier, Democrats and others on the left have done a good job of pointing out that the poor and the working poor do not have medical insurance, they have not yet made the case well enough to convince those of us who already have reasonable medical insurance (i.e. the majority of Americans) to abandon our coverage in favor of a national plan.
This is not to say there is no value in a national health plan. It just means you and Antonio and others have not yet made the case for a national health care plan.
Convincing the majority of Americans of the need for such a bold reform of our healthcare system is your job, and you won’t get far by insinuating that those who do not see your point are stupid or mean spirited. You need to draw people to your side, not alienate them with snootiness or cutting sarcasm. You will draw more flies with honey than with vinegar.
Without the support of the majority of average Americans, we will not have health care reform.
I never ceased to be amazed at how those on the Left always tend to insult the very folks whose cooperation they so desperately need.
Ken: you seem to be ignoring what people are actually saying so that you can accuse them of being “mean-spirited” and snooty. Putting words in people’s mouths (and intentions in their brains) is out of bounds.
Pouty? Are you kidding? Maybe you should ask Jean whether she considers herself to be part of the “working poor” and whether she would have said the same 20 or even 10 years ago (sorry, Jean, I’m not trying to draw you in, honest — that was rhetorical).
In Rome, the definition of “poor” was someone who had to work for a living. That’s most of us, and by tying the receipt of medical care to employment, that makes most of us poor. That we can “afford” health care is not a function of our wallet, but of our ability to participate in a social arrangement through which risk is pooled for our collective benefit. So far as I can tell, and I have a pretty good pipeline here, the changes being contemplated to those arrangements are about as minimal as you could make and still actually make a change.
Your projection of what you think I’m saying — or even what Antonio is saying — is just that.
It has virtually no relationship to reality. However, if you like to vent, go right ahead.
FWIW – my own touchstone to help understand ‘who needs medical insurance?’ is my brother. He owns a small property/casualty insurance agency. He’s not poor, but his very small business isn’t able to offer health insurance benefits. He has a wife and a growing family that needs medical care for everything from obstetrics/gynecology to children with ear infections to a child with special needs. That my family has employer-provided health insuranece, while his doesn’t, is about as clear an illustration of the inequity of the status quo as could be wished.
No, I’m not a member of the working poor, and only get pouty if somebody gets a bigger piece of key lime pie than me.
But I am stymied by people who see health care as essentially a problem of the poor.
I think it’s been adequately shown that health care costs are too high because the system is inefficient. Even if you’ve got the famous Cadillac of health care plans, it probably costs more than it should, and that’s probably robbing you of pay raises whether you know it or not. This is something people should have been more concerned about long ago.
In addition, the trend in business–and certainly academia, which is full of temporary adjunct faculty who often do the same work for much less money, often for decades–is to hire far fewer permanent employees and rely on independent contractors to reduce costs.
Any solution to health care has to address those two realities: How can we effect more efficient health care delivery? And if fewer and fewer of us will have employer-provided health care b/c we’re now contract workers, how do we get access to adequate and affordable coverage?
The poor will certainly continue to need help with health care costs. But we can probably cover more of the needy if we also tackle efficiency and access issues, because those are the things that will bring the cost of health care down.
In my view, a European-style system could be a solution. So could a combination of government and private sector moves that provide incentives/investment in efficiency measures and opening up more product lines for individuals who need health care.
The private sector has known that people have been concerned about health care costs since the first years of the Clinton administration. The money they might have spent on innovation seems to have been spent instead on lobbyists intent on maintaining the status quo. So I’m not inclined to see a private enterprise solution as superior to a government one at this point.
[Note to folks near Catholic University:
Alasdair MacIntyre will speak there the afternoon of Sept. 25th. I don't have the particulars.]
“That my family has employer-provided health insurance, while his doesn’t, is about as clear an illustration of the inequity of the status quo as could be wished.”
Jim, hope this doesn’t sound smart-alecky here, but I don’t see, even a little bit, how your family situation is an illustration of the inequity of anything. Your brother chose to go into business for himself, with higher risks and rewards and you chose to be employed with an employer that offers health benefits. So what’s the problem? If his profits are higher than your salary, is that a clear illustration that of inequity, in the other direction?
And if, as a self-employed entrepreneur, the tax treatment of health insurance is significantly disadvantaged compared to that of larger employers, so that your brother not only pays a higher premium for insurance, but incurs a much higher effective tax burden that effectively cross subsidizes larger entities and you (and me and Mark), that’s just the political process at work. Nothing to see here. Move along. So long as we can clearly explain and account for the inequality, it’s all good.
Barbara, no need to get snarky on me. Remember, as the commenter of the day, I have certain rights and privileges that mere mortals such as your self do not have–don’t make me use them!
As it stands, I fully agree that there’s no reason employers should have a tax advantage when purchasing health insurance that’s not available to anyone else. I completely support that type of reform. But that’s not the inequity that’s being talked about in the health care debate–I only wish it were.
Mark, I can’t tell whether you’re honestly confused about this or what, but: the comment of the day was Jean’s. Not yours.
Now I’m hurt.
Hi, Mark, nope, not smart-alecky, but getting at an interesting thing (interesting to me, anyway – I commented on it somewhere else but nobody took me up on it. Ah, well, probably related to my propensity for saying in 800 words what could be said in 20 :-)).
Here’s the thing: implied in your free-market views is the notion that health insurance – and by further implication, health care – is just another commodity that willing buyers and sellers can come together in the marketplace to transact. Totally voluntary and optional. It’s no different than buying a washing machine or an iPod. Buy it if you want it; if you can’t afford it, get a better job, or look harder for a cheaper deal.
But the church says health care is more than a commodity. It’s a human right. The right analogy isn’t iPods but food. Food is something to which everyone has a right, just by virtue of being human. Certainly, we rely on the marketplace to get food to humgry people. But the marketplace isn’t perfectly efficient, because not all of the hungry people are able to get food. If I go without an iPod because I can’t afford it, nobody cares; but if I can’t afford to eat, you have a responsibility to feed me (to put it bluntly :-)). Heck, I can even steal it from you if I must, and it wouldn’t be a sin. Health care is another one of those its-all-of-our-business categories.
There’s more that could be said. I’m sure you’re right that my brother should have gone into business for himself with eyes wide open about health care. Suppose he didn’t, though. Do we deny him health care because he wasn’t very bright about that decision? He’s contributing to the good of his community by providing a necessary service at a fair price. The community would be worse off if he exited the market. Wouldn’t it be better for everyone if he could stay in business and be able to afford health care for his family?
Jim –
I think you’ve hit on a very Importany point when you say that your brother contributes to the common good by running a needed business. This , I think, is the basis for a claim to have a right to health care and food, etc., in hard times. I think that able-mnded and able bodied people who refuse to contribute in some way to society have in effect excluded thselves from that society and can
t can’t fairly make any claims on it. But those who do, like your brother, certailnly are owed help by the rest of us. The deadbeats (and some do exist) must then depend on the charity and the altruism of others.
No, I am certanly not saying that only bsiness people make contributions. Neither amvI saying that those who are currently out of a job or other function (like taking care of a helpless familyember,) or between jobs etc., have no claim. We are beings-in-ime and a life’s value extends over time and is not measured only by economic production. What is important is that who can contribute do contribute at least some of the time. (OK, so I’m Marxist in this respect.)
Mark said to Jim: Your brother chose to go into business for himself, with higher risks and rewards and you chose to be employed with an employer that offers health benefits. So what’s the problem?
Jean says: I think “chose” is the operative word there.
I, as the Official Commenter of the Day, wonder if Mark, as the Official Commentee of Same, would agree that the ability to “choose” between making a lot of money and self-insuring or going to work for an employer who offers health benefits is dwindling to zip.
Consider: I didn’t “choose” to work for an employer who doesn’t offer benefits. My employer stopped offering them to me by changing my contract. You betcha I’ve been looking around for somebody who WILL give me benefits, but I’ve got no offers to choose from due to high unemployment, my age, and other factors beyond my control.
Moreover, Raber didn’t “choose” to be self-employed. It was more or less thrust on him when the remodeling biz started tanking three years ago, and his employer let everybody go who was making the most money, i.e., the most experienced and skilled carpenters.
Here is additional information in terms of what Jean Raber is stating and those who see it another way.
Geography plays a signficant and huge part in whether you have insurance or not in the US:
http://news.yahoo.com/s/ap/20090924/ap_on_re_us/us_census_health_insurance;_ylt=Aj4U9MAw2mQczubblvnYOles0NUE;_ylu=X3oDMTNjczgxY2NlBGFzc2V0A2FwLzIwMDkwOTI0L3VzX2NlbnN1c19oZWFsdGhfaW5zdXJhbmNlBGNwb3MDNgRwb3MDMwRwdANob21lX2Nva2UEc2VjA3luX2hlYWRsaW5lX2xpc3QEc2xrA2dlb2dyYXBoeW1haw–
Highlights: Census data released this week shows a vast geographic inequality in the uninsured that has been shaped by an area’s state laws, population makeup and jobs. Residents in pockets of the Northeast and upper Midwest are many times more likely to have health insurance than residents of vast swaths of the Southwest.
The reasons for the geographic disparities boil down to state policies, types of jobs and demographics.
Eligibility for Medicaid, the federal health program for poor families managed by states, varies between states: Some are more generous than others. In Massachusetts’ case, lawmakers mandated that virtually everyone in the state be insured or face steadily increasing fines, dropping the percentage of uninsured to 4.1 percent.
An Associated Press statistical analysis showed that a county’s percentage of residents without health insurance was influenced by its percentage of Hispanics; the percentage of residents ages 20 to 24 and 60 to 64; and the percentage of residents working in farming, fishing, hunting, mining, construction, real estate, support positions such as secretary or janitor and hotel and food service workers.
Salaries matter too, as well as the presence of government and union jobs.
While more than 90 percent of the nation’s highest-wage earners had access to health insurance, that was true for little more than a quarter of the nation’s lowest wage-earners. Just under three-quarters of the nation’s workers had access to health insurance, but the access rate jumped to 88 percent for government workers, according to the Bureau of Labor Statistics.
Add into this discussion the fact that some states and its citizens basically have few choices for insurance coverage e.g. Dakota’s – 90% of all insured via BCBS. Few other options.
Sorry, this colors the discussion – doesn’t mean that single payor, public option, etc. is the only answer but it does add complexity to simplistic answers and responses and makes an option such as state or group purchasing co-ops even more difficult.
Jim makes a good point “Here’s the thing: implied in your free-market views is the notion that health insurance – and by further implication, health care – is just another commodity that willing buyers and sellers can come together in the marketplace to transact.”
—————
It is worth noting that health care is not the same as health or medical insurance. Health insurance is how we usually pay for health care.
Some models have a group of people who periodically pay into a pool. Then, as needed and as allowed under the group policy, those individuals draw money from this common pool to pay for their health care requirements.
Some models have a group of people who for many years regularly pay into a government plan like Medicare. Then as they reach 65 years of age, they become eligible to pull money from that common pool to pay for their health care requirements.
Some models like Medicaid consist of a group of people too poor to pay for anything, and so wealthier members of society fund a pool of money from which, according to both need and to the rules that govern such a program, qualified participants may draw to pay for their health care requirements.
The Church maintains health care is a right, but does not speculate as to which particular form of health insurance (i.e., payment plan) is best for a particular country. I am not certain, but it does seem that while the Church says we must provide basic health care for all as needed, how to pay for that health care is left as a prudential decision, very much in the secular realm.
Hi, Ken, you’re right that the church (wisely) doesn’t insist on one particular form of societal arrangement to deliver and fund health care. I wouldn’t say it belongs to the “secular” realm, although I think we’re on the same page. It belongs to the realm of *politics* to determine these things, and politics is one of the great works to which the laity are called. (I’m quibbling about the word “secular” because, if we really believe that the kingdom of God has already been inaugurated, we shouldn’t settle for secular; faithfilled Christians should be going out into the marketplace and into the halls of government to transform these institutions).
I find these theoretical discussions interesting and helpful, but in the case of free market delivery of health care, we don’t have to stay at the level of the theoretical; we have the empirical evidence of the 20th century United States to consider the successes and shortcomings of the market in delivering this human right to the humans who need it. As with food and housing, the market seems to work fine for many of us, but it has also failed many of us. We have Medicare and Medicaid now because the market failed people in need. And we still have all of these other populations, like contract workers, small business employees and undocumented immigrants who work hard but can’t afford to pay for their health care. (I was going to say “earn a living wage”, but if they can’t afford health care, is it truly a living wage?)
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