On the way home I heard these 2 stories back to back and just had to shake my head. Are we surprised that different areas have different life expectancies when some neighborhood businesses have to have bathroom security due to drug addicts over dosing and/or dying in the stall?
NPR Bathrooms and Opioid Crises
CNN Life Expectancy Varies
And Neal at MP pointed me to this piece. And then we disagreed... Surprise !!!
Of course the irony is that I am Lutheran... Not Catholic...
NPR Bathrooms and Opioid Crises
CNN Life Expectancy Varies
And Neal at MP pointed me to this piece. And then we disagreed... Surprise !!!
"How to decide??? That is the question.
"Therefore, everybody should just take it easy, and the government must provide for them? No. Another moral principle is that everyone is responsible for his or her sustenance, but if something beyond his or her control gets in the way, either by personal misfortune or more general problems, such as emanating from in society, public authority cannot simply ignore anyone in need. "
Is our epidemic of single Parent homes that continues to propagate poor academic achievement and generational poverty a personal choice issue or a societal blight? I lean towards personal choice since birth control is readily available and one does not have to have poorly protected sex.
And if it is a social blight, did the war on poverty promote it by transferring the negative consequences of the actors involved to the shoulders of the tax payer?
By the way, please remember that the Good Samaritan is a story of personal charity. Not broad social welfare. I am a huge proponent of charitable giving." G2A
"Your tactic of shifting the argument transparent. Your basic contention was that taxation was immoral . "I must have missed the lessons regarding how the moral thing for individuals to do is to promote society forcefully taking $1 Trillion from certain citizens so that it can be given arbitrarily to other citizens."
I gave you the answer to that = a clear and direct writing by a Catholic publication on the morality and necessity of taxation for the support of the less fortunate members of society. Your reaction is nothing more than the defense of the cult of self-interest and money, not morality." Neal
"I disagree... I believe wholeheartedly that tax payers funds should be used to take care of the truly disabled. And that tax payer funds should be used to support people in their short term times of need, and to train them to escape dependency. This is what the piece supported. Please remember from your quote:
"Another moral principle is that everyone is responsible for his or her sustenance"
This seems to be the part that many people on the Left have forgotten. All citizens have the moral and societal responsibility to strive to learn, improve, live within their means, work, save and provide for their own sustenance. I believe in safety trampolines and you seem to believe in safety hammocks." G2A
Of course the irony is that I am Lutheran... Not Catholic...
58 comments:
It's interesting that when people are discussing health care, there is such an effort to change the subject to food.
--Hiram
To me they are both related to the common moral question.
"Another moral principle is that everyone is responsible for his or her sustenance, but if something beyond his or her control gets in the way, either by personal misfortune or more general problems, such as emanating from in society, public authority cannot simply ignore anyone in need."
If one dies due to lack of food, lack of healthcare or due to exposure to the elements makes little difference to the dead person.
We live in a society that provides free education and tons of support programs for the truly needy and disabled...
So the question is what should we do about people who are unwilling to strive to fulfill their part of the deal?
"everyone is responsible for his or her sustenance"
How do we differentiate?
Are we willing to give very basic food, healthcare and shelter? Or do we owe them top tier healthcare?
A. Hunger is a great motivator. Free food works the opposite.
B. Whenever my church hierarchy starts talking about taxes for "the poor," I send them a note like the following: "I heard you call for all good Christians to support increased taxes so that the poor could be helped. Unfortunately, in order to pay those taxes, I am going to have to substantially reduce my pledge to the church. I hope you understand. I also must ask something from you. I am going to need a Bible study, since it is my recollection that Jesus charged the Church with the care of the poor, not the government. You see how confused I am?"
We live in a society that provides free education and tons of support programs for the truly needy and disabled...
The society I happen to live in pays for education, pays a lot in fact. I can attest to that from a lot of personal experience.
--Hiram
The fact is, like it or not, we as a society are moving in the direction of saying that health care is a right. It has been politically unacceptable for quite some time to take the position that uninsured people can legally be denied care. Remember death panels and how passionately Republican campaigned against them. Why was that if not for the fact that they opposed denial of needed care?
I understand, believe me I do, that this view is not universally held. In the richest nation history as ever known, there are millions of people who would deny care to those who need it based on wealth. They argue, in effect, that investment bankers should receive health care because they are successful in a way that the guy who roofs your house and prevents you from getting wet is not. It is a defensible position, but as a political, moral and social matter, is finding less and less support. It is hardly ever articulated by anyone seeking public office, for some reason.
--Hiram
The reason why when the right possible right to health care is discussed, critics of that right try to shift the discussion to rights to other things, food, housing, a job, that sort of thing, is that they have a sense that they are losing the debate on health care. That's the point of deflection and slippery slope argument. They are used to change the terms of a debate one is losing.
--Hiram
Hiram,
I think you avoided my questions...
We live in a society that provides free education and tons of support programs for the truly needy and disabled...
So the question is what should we do about people who are unwilling to strive to fulfill their part of the deal?
"everyone is responsible for his or her sustenance"
How do we differentiate?
Are we willing to give very basic food, healthcare and shelter? Or do we owe them top tier healthcare?
OK, health care is a right. So is having my cotton picked. See the NOT difference?
You don't die if your cotton isn't picked. Good lord.
Moose
is what should we do about people who are unwilling to strive to fulfill their part of the deal?
Depends on what the deal is and what you mean by striving.
People who don't have insurance aren't living up to their end of the deal. They receive the benefit of the system without paying for it. So I guess the question is whether they should be asked to pay for it, or we should ask for others to pay for it. Largely, the Erpublican answer is the latter, that the costs should be passed along to rest of us. Democrats seem to differ. We apparently feel that those who benefit from health care should pay for it, at least in part.
--Hiram
Moose,
That was my first response also...
Especially when it comes from Jerry who is pretty Pro-Live / Anti-Choice...
Hiram,
Are you taking medicinal pot today? That last paragraph seems so backwards that there must be an excuse... We can send an ambulance if you hit your head or something... :-)
ACA and Medicaid are all about letting people use the system without them paying for it...
ACA and Medicaid are all about letting people use the system without them paying for it..
It's Affordable health care, not free health care. The point of uninsured is to pass on health care costs to the various other stakeholders: health care professionals, shareholders, taxpayers, and others.
What Republicans do is obfuscate who is paying for health care. Paulsen in his op ed piece this morning did it with a truly wonderful sentence in this morning's op ed, the one about preexisting conditions.
--Hiram
Hiram,
ACA was about redistributing the costs... Not about truly reducing the cost of healthcare in America.
From the MP Sam comments, yes we are still going.
""What is your rationale that others should be forced to pay for your healthcare bills?" -- You're putting words in my mouth. I never said that, no one is, nor do I expect it. I just want affordable health care. Something every other "first world" country has." Marc
"The simple reality is that ACA expanded Medicaid, provided subsidies, coverage until 26, pre-existing condition coverage and capped premiums for older people to 3 times... by transferring those costs to other citizens. (ie tax the wealthy, cutting FSA yearly amount, medical device tax, higher premiums for all, etc) It made some citizens pay for the care of others. It did little to attack the factors I listed above, that is why I asked about your rationale for supporting it." JTA
And ACA certainly was not about promoting that everyone be "responsible for his or her sustenance"...
Now I agree that in pre-ACA world much of the financial cost for healthcare was hidden in bankruptcies, medical facility write-offs, etc.
However the health care recipient bore many of the costs directly. (ie stress, bill collectors and some financial payment, etc) Being low income and not taking care of yourself was nasty.
Now ACA transferred much of the cost to the wealthy and all of us other insured. To me it is just another welfare program with no work requirement...
Wow. My point is that a "right" is something you can exercise without impinging on anybody else. If health care is a right, then any provider must give me all I want for free. In any other context that would be slavery, as it is here. Hiram is right that /somebody/ has to pay for health care. Where we collectively seem to have taken all 5 sides of this two-sided issue, the best solution is to make the patient responsible to the degree they can be, meaning that the costs for EVERYBODY will come down through competition and personal value-seeking. Inserting insurance companies-- at least of the "fee-for-service" kind-- interferes with that, and getting government involved, well...
One can claim that economists are often wrong, but their conclusions are based on solid science, math, and observation. Politicians base their conclusions on pure fantasy, too much of the time.
"You don't die if your cotton isn't picked. Good lord."-- Moose
And you don't die if you don't get a free tube of acne cream, either. Good Grief. At what point are we going to simply write off these folks crying in the streets about "we're all going to die from Trumpcare" as simple-minded idiots, raving lunatics, or evil parasites?
Jerry,
Now Think Progress is a pretty Liberal publication and they only estimate 17,000 additional people dying prematurely in the first year if Trumpcare passes. Where did you get the "we're all going to die from Trumpcare"...
Now the big question what is it worth in America to prevent 17,000 Fathers, Mothers, Daughters, Sons, etc from dying each year?
Jerry I think you are confused... I am pretty sure the responsibilities speak to that... (ie follow laws, pay taxes, etc) My point being that our democratic government decides what "Freedom to pursue “life, liberty, and the pursuit of happiness.” means and how to best support it.
Citizen Rights and Responsibilities
Responsibilities
•Support and defend the Constitution.
•Stay informed of the issues affecting your community.
•Participate in the democratic process.
•Respect and obey federal, state, and local laws.
•Respect the rights, beliefs, and opinions of others.
•Participate in your local community.
•Pay income and other taxes honestly, and on time, to federal, state, and local authorities.
•Serve on a jury when called upon.
•Defend the country if the need should arise.
Rights
•Freedom to express yourself.
•Freedom to worship as you wish.
•Right to a prompt, fair trial by jury.
•Right to vote in elections for public officials
•Right to apply for federal employment requiring U.S. citizenship.
•Right to run for elected office.
•Freedom to pursue “life, liberty, and the pursuit of happiness.”
access to health care is about much more than how many people will die each year due to lack of insurance. It is also about the quality of life/health of people affected by their access or lack of access to healthcare.
Laurie,
Good point.
ACA was about redistributing the costs... Not about truly reducing the cost of healthcare in America.
Obama, to get the ACA, did not get the cost reductions he would have liked. It was a tradeoff he had to make. We would have done more, but we had to bring on board interests that benefit from higher health care costs to get the deal done.
" You're putting words in my mouth. I never said that, no one is, nor do I expect it. I just want affordable health care."
Affordable health care means insurance. Hardly anyone can meaningfully pay for health care without it.
--Hiram
Here's an interesting thought: Not ONE SINGLE person will ever die for lack of health insurance. They may die from lack of health CARE, but that's a totally different thing, isn't it? Neither Obamacare nor the AHCA is going to change that.
Jerry,
Though you are theoretically correct...
The reality is that people will not get healthcare unless someone pays the provider. (be it private insurance, government, patient, or the charity of someone...)
And since these folks do not have the money to pay cash... Insurance / government are the next most reliable methods to ensure consistent thorough care. Though charity sounds wonderful, the reality is that there are not enough dollars and it is inconsistent.
So in this case insurance does = consistent thorough care...
"My point is that a "right" is something you can exercise without impinging on anybody else."
So a fetus does not have a right to life. Very good.
Moose
..
Here's an interesting thought: Not ONE SINGLE person will ever die for lack of health insurance.
This is a Republican view that baffles me at least to some extent. They don't see a link between the thing, and how it's paid for. I mean, one can assume that position, but what's the point? What is gained by looking at things that way? There is simply no point to having money unless it is to buy things. The two are totally intertwined. Generally, failing to link things like revenues and expenditures presents major governance problems for Republicans.
If people aren't hurt by an inability to pay for health care, it's because somebody is providing without adequate compensation, which is indeed something that happens a lot.
--Hiram
"So a fetus does not have a right to life. Very good."-- Moose
Moose, you've not had the benefit of our past conversations on this subject. My view is that the courts have settled the /legal/ (aka "rights") end of this issue. That at the point of viability, the woman has taken an implicit contract with the other human being involved (capable of life outside the womb) to bring that person to term. This means the woman may terminate before that point, which offends pro-life people greatly, but not after. And it very nicely coincides with Roe v. Wade.
"The reality is that people will not get healthcare unless someone pays the provider. (be it private insurance, government, patient, or the charity of someone...)"
That is the sort of blinkered thinking, advanced by politicians, that got us into this mess. They deny the existence of charity hospitals, free clinics, doctors who "overlook" billing, mandated "free" emergency room care, written off bad debt, and no doubt other things that existed before politicians convinced us that we could have "free stuff" because "somebody else" would pay for it, and because providers HAD to be paid what government told them they had to get paid. Of course, the notion of health care as a "right" turns that on its head, because if we say that, then providers do NOT have to be paid, and I'm not sure many people will go to 7 years of schooling to earn nothing.
Either way, government interference in this marketplace denies all morality and human decency.
"Affordable health care means insurance. Hardly anyone can meaningfully pay for health care without it." --Hiram
Sorry, but that's the politician talking. You are the one that says /somebody/ has to pay for health care. So how is it possible for the insurance company to pay out more for everybody than what everybody pays in premiums? Politics is not the art of the possible, it's the art of making people think the impossible is possible.
Jerry,
I think you are the outer fringe on this one... The thought that charity and wishful thinking can effectively provide consistent and quality healthcare to the low income folks.
Now I think they can handle acute concerns pretty well... But if we want Americans to be healthier we need a system that supports ongoing wellness efforts and long term care for chronic conditions.
Moose,
Excellent point. I wish folks were more consistent and less extreme. (ie black and white) There is a lot of gray in real life.
"That at the point of viability, the woman has taken an implicit contract with the other human being involved (capable of life outside the womb) to bring that person to term."
And Republicans continue to try to change laws to force women to carry a pregnancy through to viability, thereby advancing the 'right' of life of 'someone' who cannot, by your definition, have said right.
Moose
So how is it possible for the insurance company to pay out more for everybody than what everybody pays in premiums?
Insurance works that way. To some extent insurance companies make a bit of money through investments. But the fact is health insurance is a very difficult form of insurance which is why so few companies are in the business. That has an impact on the competition model. Health insurance companies just don't have a lot of competition with each other.
--Hiram
"I think you are the outer fringe on this one... The thought that charity and wishful thinking can effectively provide consistent and quality healthcare to the low income folks."
If so, I am in good company. Basic economic theory that includes the charitable nature of people would seem to readily support the former, and the politicians have convinced most of us of the latter. Of course, all of the alternatives to health CARE that do not involve government robbing from one to pay for another are pooh-poohed, as if people are not competent to manage their own care, or cooperate with one another to provide it. Have you heard of "medi-share" plans?
I have seen little indication that charitable institutions are willing to take on a huge portion of America's health care costs. Charities are in fact used by the government to route expenditures for health care, Planned Parenthood being one prominent example.
--Hiram
To get us back on topic...
CNN Life Expectancy
WP Life Expectancy
KFF Life Expectancy by Race by State
IP Life Expectancy by Country
So some folks in our country live as long as most of the "best countries" in the world, and then we have some who's life span is similar to various third world countries. Thoughts?
By the way, the range is from 86.8 (higher than Japan, Singapore, etc) down to 66.1(similar to Burma, Yemen, Pakistan)
Apples to oranges. Find another country with our level of crime, obesity, diversity in genetics, etc.. If you are arguing that universal health insurance prevents over-eating, murders and suicides, I think you're pushing a very long string.
Well I do agree that Universal healthcare would not solve the problem on it's own. Then again with all the tests and pharmaceuticals out there... It may achieve a lot.
Also, if the system is set up to reward healthy people with a financial incentive... It may help...
But we are also back to the old question...
G2A Why are poor people poor?
WP Why are poor people poor?
AGJ Poverty
And look at these shocking overdose caused death stats...
Something is very wrong with our society...
"Also, if the system is set up to reward healthy people with a financial incentive... It may help..."
"Something is very wrong with our society..."
You are correct; something is wrong when thinking like that first sentence becomes widespread in our society. "If the system is set up" means that /somebody/ other than the individual citizens are deciding what health care each of us receives. And that means that government decides what care you will receive according your "value to society," and what you will eat, a mandatory health club membership, not allowed to have a gun in the house, and however far they choose to go with that ultimate control.
And think about "reward healthy people with a financial incentive." Is that not EXACTLY what the free market does now? You seem overly concerned with a few people making a few bad decisions. Your solution seems to be to let government make all the decisions for everybody.
What good is a long life expectancy if you are not allowed to live it as you see fit?
I keep thinking that you think you live in the old time Wild West...
And I guess I disagree that our system does an adequate job of promoting healthy living.
Otherwise half the people in the USA would not be fat, addicted and/or smoking.
Feel free to disagree, but until very recently, "our system" allowed people to choose being fat, addicted and smoking. Now if you really want to force people to live the way you think they should, then you urge passage of some government controls, like Obamacare or UHC or single payer. No thanks.
Feel free to disagree, but until very recently, "our system" allowed people to choose being fat, addicted and smoking.
The major, even dominating factor in health care costs, is that people get older. And getting old is, for the most part, not a choice. Now the waters on that point are pretty clear, but if the policy outcome you seek is to shift money and resources from health care to tax cuts, your main alternative is to find a way of muddying them. So let's find a lot of time searching out other factors that raise health care costs and try to make the argument about them. Let's try to let a very small tail wag a very large dog while passing out the puppy chow to wealthy campaign donors, all of whom have their health care costs paid by their shareholders. No matter how much they weigh.
--Hiram
I will disagree. There are "preventable" health care costs, and "unpreventable" costs, like the natural aging and "wearing out" of body parts. Those preventable costs are choices, and people should pay for their own choices, or insure against them with their insurance costing more. It's a very simple, free-market, economic incentive system. Have you not heard people say things like, "I know it shortens my life, but I want to enjoy this"? What do you want to do, lock them up and feed them a vegetarian diet? We know they will live longer, and it's for their own good, right? And if "we" are paying their health care, they have to live by our rules, right?
No rules, just strong financial incentives like my company put in place.
I can choose to live poorly but it will cost me an additional $250 /month on my family coverage.
Now $3,000 /yr might encourage many people to pass on seconds or delay lighting up...
Of course that leaves us with what can be done to motivate those folks on free healthcare...
And will Conservatives like you be okay with penalizing fat smokers with higher premiums???
There are all sorts of different ways to allocate costs. But first, bear in mind the more ways you divide up the insurance pool, the more expensive it will be. There are two basic reasons for that. First, the infrastructure used to divide up the pool must be paid for. Somebody must be hired to decide what pool each individual is to be placed. The second reason is the smaller the pool, the higher the risk, and increases in risk must be paid for. And given the fact that the most expensive costs are paid for anyway in ways that are both real, and difficult to track, what have we gained by making the system both more expensive and more complicated?
But the real tradeoff is the more critical one. Why don't we have unviversal coverage? After all, everyone is for it. Even Congressman Paulsen is for it. The reason is that in our consensus based political system, we have never been able to agree on what it should be. In order to meet the demands of our politics, any universal health care system must be constructed in a way that would support that consensus. A choice to set various groups in our society against each is a choice not to have universal health care, contrary to what everyone says they want.
I supported Obamacare not because I thought it was the best system possible. It is very far from that. I supported Obamacare because it was capable of getting passed. And it is the irony of Obamacare that the quality of generating a consensus which was founded on making huge concessions to the Republican Party, is also what makes it virtually impossible to meaningfully repeal.
--Hiram
"what have we gained by making the system both more expensive and more complicated?"
You seem to have a lot of limiting beliefs going on here. The reality is that if applying the correct costs to the correct people drives them to make better life style decisions, we may improve things in many ways:
- people will maintain a healthier weight
- people will keep their triglycerides, cholesterols, blood pressure and sugars under control
- people may work harder to stop smoking
- all of which would reduce the country's healthcare bill by more than was invested, and people will live healthier and longer lives.
As for your aging is the cause silliness...
Costs of Obesity
CDC Obesity and Over weight
CDC Map
Just look at those numbers... Many states with 30+% OBESITY, we aren't even talking just a little over weight.
Harvard Obesity and Health
The reality is that if applying the correct costs to the correct people drives them to make better life style decisions, we may improve things in many ways:
Well, for one thing, that there is such a thing as "correct" costs couldn't be further from what I believe in this or any other context.
There are lots of incentives for living healthier live styles. It's just that people don't. For some reason, we don't deny or increase the cost of health insurance to people who live unhealthy life styles who get their health insurance through work. No one seems to have a problem with healthy people subsidizing unhealthy people in that context.
--Hiram
That is why government should not be deciding what the "correct" cost is in every context. It is why the free market must be allowed to work. If one must pay the doctor directly, then one who has the less healthful lifestyle has the greater cost, and thus the unhealthy lifestyle is discouraged. Similarly, if your insurance plan offers lower premiums if you lose weight, stop smoking, etc., and you refuse, you pay the higher price. Why should this be problematic, since it puts the costs exactly where they belong, and offers a direct economic incentive to good health, which has its own rewards?
Hiram,
Wrong. For your review
And another
Are you saying employers deny health insurance to workers who don't have healthy lifestyles? Do the bosses go around weighing people these days?
--Hiram
No, they give people with healthy lifestyles a big premium reduction.
The "bosses" are not involved.
Once a year we choose to have blood drawn by a Third Party to hopefully qualify for the lower premiums. We are then scored based on Blood Pressure, Triglycerides, Cholesterol, Tobacco, and Glucose...
And if one's score is too high, but are under the regular care of a Doctor... The Doctor can submit an exception request if there are complicating factors. (ie illness, etc)
All the company knows is if we qualified or not...
I think it would be great if all programs did this !!!
So long as people have insurance through their employer's "group" plan, that's probably a good idea. A better idea would be to divorce insurance from employment so that health insurance was "portable" and much of the "pre-existing condition" problem was eliminated. Then the insurance company would be offering the incentives, as if healthy living weren't enough.
I am fine divorcing health insurance from employment, but those tentacles are pretty deep.
As for pre-existing conditions, I just think that would expose more people to the problem. No one is giving incentives to sell a cancer patient a policy at a reasonable price...
If healthy living was enough we would not our country would not be full of over weight and obese people.
No, most of the "pre-existing condition" problem arises because people lose their insurance when they lose their job, and have to go buy a new policy.
And if healthy living was always rewarded not only with good health but with lower health care premiums, our general health might improve. On the other hand, most of us don't know what our health care costs because we have third-party payers picking up the tab. When it's the government that's the third party we really don't care.
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