Wednesday, June 24, 2009

Health Opponents Shown for What They Are

June 24, 2009, 7:45 a.m., 9:20 a.m.

Where Do They Get This Stuff?

Ever wonder where and how the opponents of universal-single-payer health care are able to come up with their outrageous assertions?

Here's a video that reveals the answer:

This video of a "Late Night Brainstorming Session" by what appears to be four ad agency executives for HAARM (Healthy Americans Against Reform of Medicine) is a work of parody by SEIU's Change That Works campaign. What's scary is how close it tracks what does seem to be the strategy of those who oppose meaningful health care for all Americans -- especially given the insertions into this video of actual video from opponents' talking points on television.

"John Barleykorn" has been a constructive critic of this blog since it began three years ago, a sort of "loyal opposition." His comments have often caused me to do a double-take on my own thinking.

And so it was with his recent comment added to my "Universal Single-Payer a Necessity Now," June 19:

John Barleykorn said...

How is a single payer system going to stop someone from eating a Big Mac everyday and getting heart disease?

What is the responsibility of the individual?
It raises a serious range of categories of questions (e.g., medical, economic, philosophical, administrative/managerial, political, theological/moral/ethical) that could support a very lengthy discussion -- or master's thesis.

If you're among those who haven't been following just how far the fast food epidemic has spread you will want to watch this report from the Onion News Network regarding a new innovation that simultaneously increases calorie intake while reducing the amount of exercise formerly associated with eating:

New Wearable Feedbags Let Americans Eat More, Move Less

To cut to the chase, and remove any question about my own position, I'm siding with one of my favorite theology doctors: "Let he who has no bad health habits cast the first bed pan."

If what I mean by that is ambiguous, let me try again.

I recall years ago reading about a British doctor who simply refused to treat patients' self-induced medical conditions -- the impact of smoking on a cough or bronchial condition, the consumption of excessive salt on elevated blood pressure or excessive animal fats on cholesterol levels. In effect, if the patient was unwilling to make any effort whatsoever to improve their condition by altering their own behavior, the doctor's sense of the most appropriate triage of his own time and talent was to spend them with the patients who would. (Of course, other doctors were available to serve those patients, so it is not a perfect analogy to leaving Americans with no option for receiving health care.)

It's theoretically consistent, I guess, to take the positions that (a) "I don't want the government controlling what people can smoke, drink and eat," (b) "so long as those engaging in risky health behaviors are willing personally to pay for the medical care they require I have no problem with their doing whatever they want," but (c) "I don't think I should have to pay any part, however small (in increased taxes or insurance premiums) of their medical bills."

We're talking here about issues of "paternalism." An example: some motorcyclists want to ride without helmets. Do we have a right to care about their safety? Do we have a right to pass laws mandating that they wear helmets? One can argue that the safety of all is a concern of all -- certainly with regard to children, but with adults as well. But a major issue, directly related to health care costs, is who should pay when a motorcycle accident results in a need for neurosurgery, or a lifetime of care for someone who's paralyzed -- at least in part as a result of their own action (refusal to wear a helmet)?

Similar analyses can be applied to smoking, excessive use of alcohol, quantity and quality of calories/nutrition, aerobic and weights exercise, stress, sleep, etc.

I guess my initial reaction to that approach is four-fold.

(1) To the extent we all benefit from an improvement in the health of all Americans (as we all benefit from providing a quality K-12 education -- which I'd urge ought now be K-16 -- to all Americans) that means all Americans. Providing health care only to those who don't need it is like a bank loan department that will only provide loans to customers who don't need them. Healthy students learn better. Healthy workers are more efficient on the job, and have fewer sick days.

(2) I guess I think there's a moral and ethical issue here as well; that at least some minimal level of health care needs be considered a basic human right, not a privilege provided only to those sufficiently affluent to pay for it.

(3) My initial guess is that the complexities of designing a universal single-payer health care delivery system would pale by comparison with the complexities of the procedures for (a) finding out the necessary basic data for every single American, and (b) the formulas for determining the relationship between self-induced conditions, by levels of seriousness, and the impact they should have on [1] charging for, or [2] denying, the medical services to treat the resulting conditions. For example, I would be healthier if I were to lose an additional 15 pounds and rode my bike an extra 5-10 miles a day. How could we calculate what my punishment should be for my failure to do that?

(4) By bringing all Americans into the system it substantially increases the opportunities for proactive, preventative counseling and programs for behavior modification of those who would benefit by it.

So what can we do to respond to John Barleykorn's concern?

I haven't thought this one through. But I note that there has been a concerted effort to reduce tobacco use, especially by the "replacement smokers" (replacing those killed by tobacco) in their teens. There has been an increase in the percentage of drivers/passengers using seat belts -- as well as added safety features in cars, such as air bags. My sense is that there's been an increase in the use of bicycle and motorcycle helmets. There has been some effort to at least list and publicize the calories and ingredients of "fast food" places, e.g., Subway. And even McDonalds introduced salads years ago. And my sense is that there is fairly widespread agreement, certainly within the "public health" profession (and beyond) on the value of such efforts to motivate healthier behaviors.

Obviously, such programs won't cut our health care costs as decisively as what may be Barleykorn's suggestion that we simply drop them from the rolls (or Jonathan Swift's suggestion that we just eat them). But it's considerably less draconian.

# # #


John Barleykorn said...

I saw Senator Harkin wrote an Op/Ed regarding this on Yahoo today.

Wellness is great and all, and I think everyone agrees with the concept. I just find it tough to believe that people will respond to that without some sort of stick to go with any carrot. Only individual underwriting can do this, and that can be from a government or private plan.

I think that the uninsured are a totally secondary issue in this debate. The public is going to compare any solution to the plan they have now, and if it is going to cost them more, they wont go for it.

sajohnson said...

Some random thoughts:

Very funny video clips -- ya gotta love The Onion!

1) If we intend to cover everyone, and charge the same premium no matter what their chosen personal habits are, then isn't that an argument for:

* Eliminating all 'sin taxes' that are purported to cover the additional cost of drinking and smoking?
* Eliminating any fines or penalties for not wearing a motorcycle or bicycle helmet?

Why 'punish' people with one hand but not the other?

2) As a practical matter, it would be essentially impossible (not to mention unconstitutional/illegal) to monitor the habits of private individuals that might impact their health. Still, there is something very wrong with forcing people to pay for the bad choices of others. Covering non-preventable illness and disease is one thing, but what about the person with cancer of the mouth who keeps chewing tobacco, or the quadruple bypass patient who continues to eat sausage and bacon and cheeseburgers every day?

What about women like the "Octamom" who had in vitro fertilization and carried eight (8) babies to term when she already had six (6) children? The Earth is incredibly overpopulated. Why should we be forced to pay for a) all of the medical expenses associated with low birth weight octuplets (millions of dollars), and b) the cost of raising fourteen (14!) children?!

I like the idea of charging those who choose to ride without a helmet higher motorcycle insurance premiums. Or collecting a tax on tobacco that is to be used exclusively to cover tobacco related illnesses and smoking prevention/cessation.

That said, I would suggest that we should at least be consistent. If we intend to cover everyone equally without any regard whatsoever to their personal habits and lifestyle, then we should legalize all drugs, eliminate all laws regarding helmet use, repeal all sin taxes, etc.

Or -- tax _all_ risky behavior and activities -- skydiving, hang gliding, contact sports, cliff diving, water skiing, snow skiing, rock climbing, scuba diving, any form of racing, smoking, non-prescription drug use, driving a car, riding a motorcycle (particularly without a helmet), eating salty/greasy fast food, etc. Force parents to pay for their own children.

The system we have now seems schizophrenic.

Take health insurance premiums. Why is there typically such a small difference between 'single' and 'family' coverage? Why does a married couple not pay exactly double what a single person pays? Why doesn't a family of six pay six times the single person rate? We seem to be subsidizing the increase in our population. This is 2009 -- not 1909 or 1809. We need fewer humans, not more. If people want to have multiple children that's currently their right but they should pay for them. As it is, my wife and I have no children (by choice) yet we pay the same insurance premium as a couple with 6 or 8 or 10 kids. How is that fair?

We've now come to the end of this segment of "Random Thoughts".


John Barleykorn said...

It's because a lot of the cost is in administration. One employee, be they single or family has a certain amount of administration at the base level so each individual you add is not going to be as much.

I have a family plan with multiple kids. We pay for them through the deductibles and co-insurance.