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peb
08-12-2009, 12:10 PM
Well, a couple of weeks ago I wasn't treated so well around here for pointing out some of the exact same things this article points out.

http://www.salon.com/opinion/paglia/2009/08/12/town_halls/

Got to agree with this:

"But who would have thought that the sober, deliberative Barack Obama would have nothing to propose but vague and slippery promises -- or that he would so easily cede the leadership clout of the executive branch to a chaotic, rapacious, solipsistic Congress"

Sam F
08-12-2009, 12:24 PM
My local paper published a front page AP editorial pretending to be a news article that rebutted many of the concerns people have about Obamacare - what ever that ever-morphing "plan" may be. My take on it (shared by many) is that it's just more of the "Obama is a god!" MSM attitude that's an abdication of the news media's responsibility to the public.

peter radclyffe
08-12-2009, 01:22 PM
camille paglia is a national treasure

pcford
08-12-2009, 01:29 PM
My local paper published a front page AP editorial pretending to be a news article that rebutted many of the concerns people have about Obamacare - what ever that ever-morphing "plan" may be. My take on it (shared by many) is that it's just more of the "Obama is a god!" MSM attitude that's an abdication of the news media's responsibility to the public.

Yes! How dare he propose a system which will lower costs, allow more coverage, ensure better infant survival rates and in general, bring the US into a standard that resembles the rest of the civilized world.

Much better to pay health care executives outrageous salaries for amounts to a substandard system when compared to other countries.

High C
08-12-2009, 01:42 PM
This was posted on another thread and somebody immediately referred to Paglia as a right wing neocon nut, or something like that. :eek: :D

Classic!

Sam F
08-12-2009, 01:53 PM
Yes! How dare he propose a system which will lower costs, allow more coverage, ensure better infant survival rates and in general, bring the US into a standard that resembles the rest of the civilized world.

Much better to pay health care executives outrageous salaries for amounts to a substandard system when compared to other countries.

That's not what I said.
Nor am I a fan of insurance companies - far far from it.
I merely wondered how any editorial (aka a fake news story) could say anything definitive about a plan that does not yet exist.
Oh and excuse me for being concerned about unintended consequences and just a tad suspicious about the nobility and wisdom of Congress.

Peter Malcolm Jardine
08-12-2009, 02:05 PM
Sure, shoot the messenger SpamF... yet another example of your finely honed sense of logic:

I cannot, by design, decry a public health care system for everyone.. that would be unchristianlike..:D So, better to criticize the President for the blasphemy of his god-like popularity, and Congress, because how could a plan be good if the people are untrustworthy.

Congrats Spammy, another excellently crafted piece of tripe

Uncle Duke
08-12-2009, 02:24 PM
SamF:

My local paper published a front page AP editorial pretending to be a news article that rebutted many of the concerns people have about Obamacare

Link, please?

Tom Montgomery
08-12-2009, 02:32 PM
You're just gonna have to take his word for it. LOL! :D

Sam F
08-12-2009, 02:35 PM
Sure, shoot the messenger SpamF...

I have not done that. Perhaps you have:


...yet another example of your finely honed sense of logic:

Hows this logic?
1. My local paper published a front page AP editorial pretending to be a news article... That's Fact

2. that rebutted many of the concerns people have about Obamacare -... That's Fact

3. what ever that ever-morphing "plan" may be...
If you happen to know the final form of this plan please let the rest of the world know... If you can't do this, then statement # 3 is also fact.

4. My take on it (shared by many) is that it's just more of the "Obama is a god!" MSM attitude...
That's an opinion, but also a very well founded one. Do I need to quote any of the well documented and irrational adulation the MSM has bestowed on "The One"? How about Newsweek's Evan Thomas?: "I mean in a way Obama’s standing above the country, above – above the world, he’s sort of God."


5. that's an abdication of the news media's responsibility to the public...
Yeah that's more than opinion too. See point #s 3 & 4

OK so that's dealt with definitively. Do you have anything else?


I cannot, by design, decry a public health care system for everyone.. that would be unchristianlike..:D

Since when did I object to health care for everyone?


So, better to criticize the President for the blasphemy of his god-like popularity,

Huh? 50% and dropping fast isn't exactly something to brag about.


and Congress, because how could a plan be good if the people are untrustworthy.

Great question Peter. How could a plan be good if the people [creating it] are untrustworthy?


Spammy, another excellently crafted piece of tripe

Sorry Peter, but it looks like your case is somewhat lacking. ;)

Tom Montgomery
08-12-2009, 02:46 PM
What did I tell you? You're gonna have to take his word for it. And that's a Fact!

Sam F
08-12-2009, 02:50 PM
SamF:


Link, please?

Sorry, it's not here so I can't search on it... but so what?
The article "rebutted many of the concerns people have about Obamacare - what ever that ever-morphing "plan" may be..." This is not responsible journalism.
If you happen to know the final form of this plan, please let the rest of the world know... If you can't do this, then what I said is self-evidently true.

Tom Montgomery
08-12-2009, 02:51 PM
A likely story....

Uncle Duke
08-12-2009, 02:54 PM
Moi:

Link, please?SamF:

Sorry, it's not here so I can't search on it... but so what?Could you tell us what the name of the newspaper is? Maybe I could find it for you.
The point, by the way, is just that I'd like to read it.....

Sam F
08-12-2009, 02:59 PM
It it helps, the article stated unequivically that the bill's critics were wrong. That's not really a sensible thing to say...
Camile Paglia said:

Obama's aggressive endorsement of a healthcare plan that does not even exist yet, except in five competing, fluctuating drafts, makes Washington seem like Cloud Cuckoo Land.

The AP only re-enforced that point.


Moi:
SamF:
Could you tell us what the name of the newspaper is? Maybe I could find it for you.
The point, by the way, is just that I'd like to read it.....


Sure. The Daily News Record published in Harrisonburg VA... (yesterday's paper).
It's one of the two largest Valley newspapers - the other is the Northern Virginia Daily.
I get another one but that's strictly local with headlines like:
Pigs Basking in the Winter Sun
...with the photos to prove it! :D

John of Phoenix
08-12-2009, 03:06 PM
It's that "God-like" business. Very taboo. "None before me" and all that.
It's the very first commandment you know. That's the rub.

Keith Wilson
08-12-2009, 03:17 PM
It it helps, the article stated unequivocally that the bill's critics were wrong. That's not really a sensible thing to say...Even without a final bill, it is eminently sensible and entirely accurate to say that some (not all) of the criticism of the proposed health care reform is definitely wrong. Off-the-wall loony, in fact. "Death panels", anyone?

Uncle Duke
08-12-2009, 03:21 PM
I did a search on the Daily News Record site, but didn't see your article. Maybe they restrict what the search returns. Or something.
Search is here (http://www.dnronline.com/search.php?channelid=0&key=health+care&title=&author=&startDate=08%2F01%2F2009&endDate=08%2F12%2F2009&allDates=0).

coelacanth2
08-12-2009, 09:29 PM
Mr Jardine is happy with his healthcare in Canada. He will not be materially affected by what happens here (unless, as is often threatened, a large portion of our population quits the US in frustration and moves North:D. I'd feel sorry for our brothers up there, dealing with a bunch of our malcontents) While his opinions and examples are interesting, they have little bearing on what happens here, unless he should change his mind, naturalize here, and begin voting, something he has shown a reluctance to do.

George Roberts
08-13-2009, 01:35 AM
"Off-the-wall loony, in fact. "Death panels", anyone?"

I found out where that came from today.

It seems Mr. Obama made some comments about the wisdom of hip replacement for his grandmother. The hip replacement took place a couple weeks before she died.

While Mr. Obama said he would have paid for the hip replacement from his own pocket, he said something along the lines that perhaps an insurer should not pay so much for so little.

And at some point someone will say that enough is enough. And care will end. A "death panel?" Perhaps too much emotion is in that name.

Osborne Russell
08-13-2009, 08:13 AM
Good article, Peb.

A situtation of competing proposals, being constantly chopped up and re-configured, is the rule, not the exception. And what you wind up with is something not as coherent as one might wish.

But this involves a lot of money.

There was a wide spectrum of opinion on slavery, not just emancipate/not. There was voluntary re-patriation, forced re-patriation, civil equality, segregation, special status, etc. Of course the matter ended up being settled in about the worst possible way. But the good news is, a fundamental moral principle was identified -- by a catastrophic breakdown of politics. Is that what will happen here?

Government health care wouldn't be easy to implement even if the principle were agreed upon. And it's a lot of money.

Sam F
08-13-2009, 08:39 AM
I did a search on the Daily News Record site, but didn't see your article. Maybe they restrict what the search returns. Or something...

Something.. maybe... like not a very good website?

Ah but no matter, here's a quote:


Palin wrong; no ‘death panel’ in health care bill

BY RICARDO ALONSO-ZALDIVAR
ASSOCIATED PRESS
Published: August 11, 2009


WASHINGTON (AP)—Former Republican vice presidential candidate Sarah Palin says the health care overhaul bill would set up a “death panel.“ Federal bureaucrats would play God, ruling on whether ailing seniors are worth enough to society to deserve life-sustaining medical care. Palin and other critics are wrong...

Now there's not a thing wrong with saying that - in an editorial.
But remember this was a front page supposed-to-be-news article.
But then the article (in question-answer format) goes on to state:


Q: Would the health overhaul legislation change the way people now deal with making end-of-life decisions?

A: It very well could.

Hummm.....



Q: So why are some people upset?

Some social conservatives say stronger language is needed to protect seniors from being pressured into signing away their rights to medical treatment in a moment of depression or despair.

The National Right to Life Committee opposes the provision as written.

“I’m not aware of ‘death panels’ in the bill,“ said David O’Steen, executive director of the group. “I’m not aware of anything that says you will be hauled before a government bureaucrat. But we are concerned ... it doesn’t take a lot to push a vulnerable person - perhaps unwittingly - to give up their right to life-sustaining treatment."...

Again, all this is fine in an editorial.

Sam F
08-13-2009, 08:46 AM
...Off-the-wall loony, in fact. "Death panels", anyone?

Oh, that's hardly loony.*
If the State is footing the bill, inevitably, at some point, some committee is going to decide that the cost benefit ratio does not justify further treatment.
You can call it what you will, but it'll end up deciding who lives and who dies.





*OK, granted that's in the same category of... If one separates marriage from its procreative function, then homosexual marriage is the logical result... which as everyone knew in the 1960's & 70's was "off-the-wall loony", never going to happen, etc. :D :D

skuthorp
08-13-2009, 08:51 AM
"to give up their right to life-sustaining treatment."
From my reading on the forum there are 48 million(?) Americans who effectively don't have that right at the moment.

Tom Montgomery
08-13-2009, 09:09 AM
"Death panels" ain't loony! Obama's slippery slope is gonna git yer grandma, you betcha!
Now I'm frightened! I'm gonna have to go disrupt my next neighborhood town hall meeting.

Keith Wilson
08-13-2009, 09:10 AM
It's only wrong if the gummint does it.

skuthorp
08-13-2009, 09:13 AM
It's only wrong if the gummint does it.

Yep, if private industry does it it's called 'risk management'.

Keith Wilson
08-13-2009, 09:21 AM
Yep, if private industry does it it's called 'risk management'. But that's OK, because a corporation is required by law to maximize shareholder return above all other considerations, and that's a low of nature, the way God intended it to be.

Tom Montgomery
08-13-2009, 09:29 AM
Hey Sammy! Level with us. You made up that story about the AP article being in your local newspaper, didn't you? Be honest. Lying makes the baby Jesus cry.

Sam F
08-13-2009, 10:14 AM
It's only wrong if the gummint does it.

Heck no.
It's just a lot scarier if the gummint does it... among other things, it's 'cause there's no way to opt out and no other alternatives... other than emigration.

Tom Montgomery
08-13-2009, 10:16 AM
The offending artical appears nowhere on the Daily News Record website. It does appear on the Associated Press website. Admit it, Sammy... you are stretching the truth for dramatic effect, aren't you?

Here is the entire article:


FACT CHECK: No 'death panel' in health care bill

By RICARDO ALONSO-ZALDIVAR Associated Press Writer

Former Republican vice presidential candidate Sarah Palin says the health care overhaul bill would set up a "death panel." Federal bureaucrats would play God, ruling on whether ailing seniors are worth enough to society to deserve life-sustaining medical care. Palin and other critics are wrong.

Nothing in the legislation would carry out such a bleak vision. The provision that has caused the uproar would instead authorize Medicare to pay doctors for counseling patients about end-of-life care, if the patient wishes. Here are some questions and answers on the controversy:

Q: Does the health care legislation bill promote "mercy killing," or euthanasia?

A: No.

Q: Then what's all the fuss about?

A: A provision in the House bill written by Rep. Earl Blumenauer, D-Ore., would allow Medicare to pay doctors for voluntary counseling sessions that address end-of-life issues. The conversations between doctor and patient would include living wills, making a close relative or a trusted friend your health care proxy, learning about hospice as an option for the terminally ill, and information about pain medications for people suffering chronic discomfort.

The sessions would be covered every five years, more frequently if someone is gravely ill.

Q: Is anything required?

Monsignor Charles Fahey, 76, a Catholic priest who is chairman of the board of the National Council on Aging, a nonprofit service and advocacy group, says no.

"We have to make decisions that are deliberative about our health care at every moment," Fahey said. "What I have said is that if I cannot say another prayer, if I cannot give or get another hug, and if I cannot have another martini — then let me go."

Q: Does the bill advocate assisted suicide?

A: No. It would block funds for counseling that presents suicide or assisted suicide as an option.

Q: Who supports the provision?

A: The American Medical Association, the National Hospice and Palliative Care Organization and Consumers Union are among the groups supporting the provision. AARP, the seniors' lobby, is taking out print advertisements this week that label as false the claim that the legislation will empower the government to take over life-and-death decisions from individuals.

Q: Should the federal government be getting involved with living wills and end-of-life questions — decisions that are highly personal and really difficult?

A: It already is.

The government requires hospitals to ask adult patients if they have a living will, or "advance directive." If the patient doesn't have one, and wants one, the hospital has to provide assistance. The mandate on hospitals was instituted during a Republican administration, in 1992, under President George H.W. Bush.

Q: How does a living will work, and how is it different from a health care proxy?

A: A living will — also called an advance directive — spells out a patient's wishes if he or she becomes incapacitated. Often people say they don't want to be kept alive on breathing machines if their condition is terminal and irreversible.

A health care proxy empowers another person to make medical decisions should the patient become incapacitated.

There's also a power-of-attorney, which authorizes another person to make financial decisions for someone who is incapacitated.

Such legal documents have become standard estate-planning tools in the last twenty years.

Q: Would the health overhaul legislation change the way people now deal with making end-of-life decisions?

A: It very well could.

Supporters of the provision say the main consequence would be to formally bring doctors into a discussion that now takes place mainly among family members and lawyers.

"When you execute a legal document with your lawyer, it ends up in your files and in the lawyer's files," said John Rother, a senior policy and strategy adviser for AARP. "Unless the doctor is part of this discussion, it's unlikely that your wishes will be respected. The doctor will be the one involved in any decisions."

The American Medical Association says involving doctors is simple common sense.

"There has been a lot of misinformation about the advance care planning provisions in the bill," AMA President Dr. James Rohack said in a statement. "It's plain, old-fashioned medical care."

Q: So why are some people upset?

Some social conservatives say stronger language is needed to protect seniors from being pressured into signing away their rights to medical treatment in a moment of depression or despair.

The National Right to Life Committee opposes the provision as written.

"I'm not aware of 'death panels' in the bill," said David O'Steen, executive director of the group. "I'm not aware of anything that says you will be hauled before a government bureaucrat. But we are concerned ... it doesn't take a lot to push a vulnerable person — perhaps unwittingly — to give up their right to life-sustaining treatment."

Sam F
08-13-2009, 10:18 AM
...I don't recall anyone talking about insurance company 'death panels', however.

I think you've not been paying attention... for a very long time.

Tom Montgomery
08-13-2009, 10:23 AM
Sammy: It is not at all convincing when a notoriously loony, rightwing-nut, ID, theocrat tells us that some rightwing-nut talking point is not, in fact, loony. You wildly over-estimate your credibility here. To our amusement.

Osborne Russell
08-13-2009, 10:24 AM
This occurs every single day, by private insurors. They often impose limits on what they will or will not pay for, especially in end-of-life situations, where they will deny extraordinarily expensive treatments if the likelyhood of effectiveness is low. They have been doing this since the dawn of the concept of health insurance.

The government does essentially the same thing all the time. Raise the speed limit, people die. Cut the police budget, people die. Levee the delta, people die. A constant stream of cost/benefit decisions where X amount of money is judged to be worth more than a life, or thousands of lives. It's not individual, true.

I think the real deal with this scene is: so many Americans have been so tribal and paranoid so long -- you're with us or against us, the gloves come off when protecting "us" against "them", beware their secret workings -- that the idea of government health care produces the overpowering image of helplessness in the hands of a partisan enemy. IOW you're about to get a taste of your own medicine, as it were. Sooner or later someone in the system, even if not the Death Panel, is going to be one of "them" and then it's your ass.

They took over the schools, put in race mixing and homosexuality and took out the prayer, then you go to them with your bronchitis . . .

Sam F
08-13-2009, 10:29 AM
"I don't recall anyone talking about insurance company 'death panels', however."


If there is any one single issue to which I've given an extraordinary amount of attention, it's been the health care debate. As a news junkie, I've consumed every imaginable piece of information I've been able to find on the subject... and my personal family health situation makes my interest that much more acute.

But I imagine you're going to tell me that I don't know what I'm talking about.

You haven't heard the frequent accusations that insurance companies' policies kill patients from time to time?

Sam F
08-13-2009, 10:30 AM
For a medical analysis from a business perspective go to:
How American Health Care Killed My Father

http://www.theatlantic.com/doc/200909/health-care

We should thank the Atlantic magazine for making this available.

"Everyone I know has at least one personal story about how screwed up our health-care system is; before spending (another) $1trillion or so on reform, we need a much clearer understanding of the causes of the problems we all experience."

Tom Montgomery
08-13-2009, 10:30 AM
I think you've not been paying attention... for a very long time.

With apologies to downthecreek, isn't that what you call an "ad hominum attack?" Your hypocrisy is making the baby Jesus cry.

Keith Wilson
08-13-2009, 11:13 AM
To be strictly accurate, insurance companies can't deny treatment, all they can do is refuse to pay for it. It's effectively the same thing in many cases, but not all. Likewise, under any system that's been seriously proposed for the US, the government would do exactly the same. The only time the government would prohibit a treatment is when it's been shown to be harmful or ineffective, just as it does now.

Any system must have some limits on what it will pay for. Reasonable people may differ about where those limits should be. IMHO, we spend a lot of money uselessly at the very end of people's lives, and I have the paperwork in place to ensure that won't happen with me.

Sam F
08-13-2009, 11:46 AM
I don't recall anyone talking about insurance company 'death panels', however.

"You haven't heard the frequent accusations that insurance companies' policies kill patients from time to time?"



Sure I have.

Well that's settled then.

elf
08-13-2009, 11:53 AM
And while the hysterical are flaming the entire process, Atul Gawande is working slowing towards a better understanding of possible solutions:

http://www.nytimes.com/2009/08/13/opinion/13gawande.html?th=&emc=th&pagewanted=print

Sam F
08-13-2009, 11:55 AM
It's a very interesting article.. and the guy makes a number of salient points... but his arguments aren't without flaws.
There are darn few arguments that are flawless and even those few aren't necessarily convincing. ;)


However, I think his reasoning in a number of other areas is flawed. For one thing, the solution he proposes is far, far more radical than anything Obama has proposed...

Norman, being radical isn't a flaw - it's being radical.


...and would likely meet even more resistance from the health insurors and big pharma, than they are presently offering.

So?
That's not a flaw either, it's just what one would expect from those whose economic self-interest would be damaged.


Bear in mind that Obama has said that, in a perfect world, he'd prefer universal single-payer coverage...

That's not necessarily a feature of a perfect world.


Any health care plan that can be expected to pass has got to be similarly pragmatic; everyone will not be satisfied with every provision,...

I think that any healthcare plan ought to work.


but compromises are better than no reform at all.

Not necessarily. Just declaring that something is a "reform", no matter how noble one's intentions may be is no guarantee of anything - let alone being better.

Sam F
08-13-2009, 11:55 AM
In that vein...

The Limits of “Comprehensive” Health-care Reform
A wasteful insurance system; distorted incentives; a bias toward treatment; moral hazard; hidden costs and a lack of transparency; curbed competition; service to the wrong customer. These are the problems at the foundation of our health-care system, resulting in a slow rot and requiring more and more money just to keep the system from collapsing.

How would the health-care reform that’s now taking shape solve these core problems? The Obama administration and Congress are still working out the details, but it looks like this generation of “comprehensive” reform will not address the underlying issues, any more than previous efforts did. Instead it will put yet more patches on the walls of an edifice that is fundamentally unsound—and then build that edifice higher.

Sam F
08-13-2009, 11:58 AM
The root of the problem:

All of these initiatives have some theoretical appeal. And within the confines of the current system, all may do some good. But for the most part, they simply do not address the root causes of poor quality and runaway costs.

Consider information technology, for instance. Of course the health system could benefit from better use of IT. The Rand Corporation has estimated that the widespread use of electronic medical records would eventually yield annual savings of $81 billion, while also improving care and reducing preventable deaths, and the White House estimates that creating and spreading the technology would cost just $50 billion. But in what other industry would an investment with such a massive annual return not be funded by the industry itself? (And while $50 billion may sound like a big investment, it’s only about 2 percent of the health-care industry’s annual revenues.)

Technology is effective only when it’s properly applied. Since most physicians and health-care companies haven’t adopted electronic medical records on their own, what makes us think they will appropriately use all this new IT? Most of the benefits of the technology (record portability, a reduction in costly and dangerous clinical errors) would likely accrue to patients, not providers. In a consumer-facing industry, this alone would drive companies to make the investments to stay competitive. But of course, we patients aren’t the real customers; government funding of electronic records wouldn’t change that.

Sam F
08-13-2009, 12:02 PM
Nothing is settled. Especialy when you ignore the rest of the post.

Of course it's settled Norman. You in fact have heard of insurance companies policies killing people (i.e. death panel by another name)

The rest may well be of importance to you but it's a different question, isn't it?


You didn't answer the question: would you want any/all treatment to be provided, regardless of expectation of success, in end-of-life situations[?]

Nope. But so what? Who's asking for that anyway?

Sam F
08-13-2009, 12:03 PM
When you advocate radical ideas that have no chance of ever being accepted, that isn't radical... it's just stupid.

Since when do you consider Capitalism* radical?


*In this case, the application of free market principles to health care.

Tom Montgomery
08-13-2009, 12:40 PM
A simple phone call to the newsroom of the above paper verified that the article did indeed appear on the front page on the day specified. (The newspaper does not routinely post articles available on other sites.)

Ahhh.... well, as the anonymous SamF has pointed out in the past, we really can't trust the word of anonymous Internet posters. That is why reasonable people expect provocative claims ("Fact," he said) to be backed up by links or references. My apologies to anyone who may have been offended by my justifiable skepticism.

Sam F
08-13-2009, 01:28 PM
'Death panel' is hyperbole, intended to frighten people. I haven't heard of insurance companies 'killing' people... I've heard of insurance companies denying extraordinary and expensive care in circumstances where the likelyhood of successful outcome is highly doubtful... that isn't 'killing' people.

Cost benefit ratio - ever hear of it?
It's one of the primary ways the govt. uses to determine what it will and will not do.
So how does one define "successful outcome" in a way that saves the government's budget?
Sometimes successful outcome is the less expensive treatment (or no treatment) which may well result in death. Who decides? Some panel, that's who.
That's not even touching on "the right to die" which can save the most money of all.


No, it's precisely ON POINT. Either you object to the denial of any kind of medical care, regardless of expected outcome (and therefore are prepared to PAY for it), or you're not.

Sorry Norman that may have been your point but it wasn't mine.




The people who like to use the scare-word 'death panel'. They are asking for it, by implication. Anyone who accepts the notion that some levels of treatment, in hopeless situations, are inappropriate and too expensive, are, by definition, endorsing the idea that someone, or some institution, is going to have to judge these situations and may deny the benefit.

OK, so we're talking about death panels after all, eh?


Of course, in a capitalistic society (AND, even under Obama's proposal), those with sufficient assets can buy any damn care they want... under 'free market' principles.

You didn't answer, so I'll ask again:
Since when did you consider Capitalism to be radical?

Keith Wilson
08-13-2009, 01:35 PM
Sam: Let us say someone has a terminal disease. There is a very expensive treatment for which they personally do not have enough money to pay. Let us say that the treatment has a fairly small chance (5%? Pick a number.) of extending their life a fairly short time (Thee months? Six months? You pick.) Let us also say that the resources available are finite (money, hospital beds, doctors' time, etc.).

In a just society - which is what we're trying to achieve, isn't it? - how do we decide whether or not the person gets this particular treatment? Who makes the decision? What factors do they take into account?

Uncle Duke
08-13-2009, 01:40 PM
Nice article on "amenable mortality" here (http://blogs.consumerreports.org/health/2009/08/amenable-mortality-us-health-care-system-versus-other-countries-.html)...

Enter the concept of "amenable mortality." Invented years ago in the United States and used worldwide by researchers ever since, it’s basically a body count of people who die for want of "timely and effective health care."

Sam F
08-13-2009, 01:45 PM
Originally posted by Tom Montgomery:

post#32 The offending article appears nowhere on the Daily News Record website....you are stretching the truth for dramatic effect, aren't you?

post#34 ..a notoriously loony, right-wingnut. ID, theocrat...You

post#39 ...isn't that what you call an "ad hominum attack?"(sic) Your hypocrisy is making the baby Jesus cry. (addressed to Sam F)

A simple phone call to the newsroom of the above paper verified that the article did indeed appear on the front page on the day specified. (The newspaper does not routinely post articles available on other sites.)

You boys certainly do carry on.

Carry on. And play nice.

Me go back in cave now.

That's interesting Horace.
Since I don't see the posts of He-who-is-ignored, I'd have not noticed that... uh... performance.
While such conduct is not the reason He-is-ignored*, it is certainly a good confirmation of the prudence in doing so.

*He-who-is-ignored is ignored because he told me I couldn't put him on my ignore list.
Tellin' ol' Sam he can't do something is always a risky thing to do. :D

Sam F
08-13-2009, 01:54 PM
Sam: Let us say someone has a terminal disease. There is a very expensive treatment for which they personally do not have enough money to pay. Let us say that the treatment has a fairly small chance (5%? Pick a number.) of extending their life a fairly short time (Thee months? Six months? You pick.) Let us also say that the resources available are finite (money, hospital beds, doctors' time, etc.).

Nobody can deny that such circumstances exist. The question is: Who decides?



In a just society - which is what we're trying to achieve, isn't it?

What's justice got to do with it? Who committed what crime when someone gets a terminal illness? Nobody.
What you want is a perfect society which is a very different thing.
BTW, imperfections are not incompatible with freedom - while the impossible attempt at perfection is positively toxic to freedom.

Thomas Sowell has an interesting point along those lines at:
http://article.nationalreview.com/?q=NmVlODY0YzFiMzcxNzYwNGE2Nzg2ZTBhZTA2YTU0NjM=

Sam F
08-13-2009, 01:56 PM
You didn't answer, so I'll ask again:
Since when did you consider Capitalism to be radical?


Other people, and other threads, have vastly more intelligent and interesting discussions on the health care issue. I really don't care to discuss it with you.

Translation: "I won't answer."

Uncle Duke
08-13-2009, 01:59 PM
Since when did you consider Capitalism to be radical?
Here's a different question: why should we consider health-care to be a market driven commodity instead of a normal human need like clean water?

Sam F
08-13-2009, 02:04 PM
A bit more from Mr. Goldhill's Atlantic article:

Let’s say you’re a 22-year-old single employee at my company today, starting out at a $30,000 annual salary. Let’s assume you’ll get married in six years, support two children for 20 years, retire at 65, and die at 80. Now let’s make a crazy assumption: insurance premiums, Medicare taxes and premiums, and out-of-pocket costs will grow no faster than your earnings—say, 3 percent a year. By the end of your working days, your annual salary will be up to $107,000. And over your lifetime, you and your employer together will have paid $1.77 million for your family’s health care. $1.77 million! And that’s only after assuming the taming of costs! In recent years, health-care costs have actually grown 2 to 3 percent faster than the economy. If that continues, your 22-year-old self is looking at an additional $2 million or so in expenses over your lifetime—roughly $4 million in total.

Would you have guessed these numbers were so large? If not, you have good cause: only a quarter would be paid by you directly (and much of that after retirement). The rest would be spent by others on your behalf, deducted from your earnings before you received your paycheck. And that’s a big reason why our health-care system is so expensive.

$1.77 million.

Sam F
08-13-2009, 02:09 PM
Translation: you're a really unpleasant person to debate or discuss ANYTHING with.

My unpleasentness is quite beside the point. Look at what you don't object to. ;)

It's a real simple question Norman. Now the fact is you're stuck 'cause the answer doesn't exactly make your case. That's OK. Your refusal pretty much proves that.
Capitalism generally isn't considered radical and Mr. Goldhill's proposals are neither radical nor unachievable. It does not support the status quo however - perhaps you're more conservative than you let on Norman. ;)

Sam F
08-13-2009, 02:17 PM
Here's a different question: why should we consider health-care to be a market driven commodity instead of a normal human need like clean water?

Or food?


Insurance is probably the most complex, costly, and distortional method of financing any activity; that’s why it is otherwise used to fund only rare, unexpected, and large costs. Imagine sending your weekly grocery bill to an insurance clerk for review, and having the grocer reimbursed by the insurer to whom you’ve paid your share. An expensive and wasteful absurdity, no?

George Roberts
08-13-2009, 02:23 PM
Let’s say you’re a 22-year-old single employee at my company today, starting out at a $30,000 annual salary. Let’s assume you’ll get married in six years, support two children for 20 years, retire at 65, and die at 80. Now let’s make a crazy assumption: insurance premiums, Medicare taxes and premiums, and out-of-pocket costs will grow no faster than your earnings—say, 3 percent a year. By the end of your working days, your annual salary will be up to $107,000. And over your lifetime, you and your employer together will have paid $1.77 million for your family’s health care. $1.77 million! And that’s only after assuming the taming of costs!

Examples sure do get crazy. The obvious erroneous conclusion is that $1.77 million dollars is significant. Total wages were 4.7 million. Taxes must have been about 50%. So there is about $600K for 60 years of expenses. About $10K/year.

There must be something wrong with the example.

Sam F
08-13-2009, 03:19 PM
Examples sure do get crazy. The obvious erroneous conclusion is that $1.77 million dollars is significant. Total wages were 4.7 million. Taxes must have been about 50%. So there is about $600K for 60 years of expenses. About $10K/year.

There must be something wrong with the example.

Remember the conditions:
"By the end of your working days, your annual salary will be up to $107,000."
Now I don't know about you, but the end of my working days is quite unlikely to be at quite that salary. ;)
But take it at your $600K for someone at my underbelly of Capitalism employment level... That's still a bunch of money.

Sam F
08-13-2009, 03:24 PM
No, it's exactly the point. You're an extremely unpleasant person to debate with, and it's just not any fun, nor is it particularly enlightening.

That's quite subjective. I think arguing with you can by great fun.
Enlightening? No. But great fun. :D


It doesn't have to be this way...

It sure doesn't. For starters you could drop the personal stuff every time you've painted yourself in a corner.
It doesn't work.
It never has worked.
It never will work.
Read carefully and quit stereotyping. Deal with the matter at hand. Back down when you're mistaken. Try non-ideological thinking now and then. You might be amazed at the results.

George Roberts
08-13-2009, 03:31 PM
Remember the conditions:
"By the end of your working days, your annual salary will be up to $107,000."
Now I don't know about you, but the end of my working days is quite unlikely to be at quite that salary. ;)
But take it at your $600K for someone at my underbelly of Capitalism employment level... That's still a bunch of money.

I made up a spread sheet. The point is the assumptions in the example are just unreasonable.

Tom Montgomery
08-13-2009, 03:38 PM
That's interesting Horace.
Since I don't see the posts of He-who-is-ignored, I'd have not noticed that... uh... performance.
While such conduct is not the reason He-is-ignored*, it is certainly a good confirmation of the prudence in doing so.

*He-who-is-ignored is ignored because he told me I couldn't put him on my ignore list.



As I said, Horace. Loony.


Tellin' ol' Sam he can't do something is always a risky thing to do. :D

Is that right? You can't permanently remove me from your ignore list.

Captain Blight
08-13-2009, 03:57 PM
Oh, Norm. Normnormnorm. "Give unto Caesar that which is Caesar's; render unto God that which is His."

SINCE life belongs to God (whichever form you think she inhabits) and SINCE the medical profession is charged with prolonging life, THEN it follows that Sam will simultaneously decry the increase in taxes as belonging to Caesar, and thus not worthy to recieve His (samF's) blessing--AND insist that the patient's life be prolonged as long as possible, no matter the cost.

<<Pulls popcorn out of microwave and settles in>> This oughtta be good.

Keith Wilson
08-13-2009, 04:00 PM
Nobody can deny that such circumstances exist. The question is: Who decides?That is, if you'll look at my original post, precisely what I asked. You didn't answer the question.
What's justice got to do with it? Who committed what crime when someone gets a terminal illness? Nobody. What you want is a perfect society which is a very different thing. BTW, imperfections are not incompatible with freedom - while the impossible attempt at perfection is positively toxic to freedom.Please, argue with your imaginary utopian communist if you like, but leave me out of it. I said "a just society", not a perfect one, which I think we both recognize is not possible. The alternative would be an unjust society, which I think neither of us would favor.

So, once again, Sam: Let us say someone has a terminal disease for which there is a very expensive treatment. They don't have enough money to pay for it themselves. The treatment has a small chance (5%? Pick a number.) of extending their life a fairly short time (Three months? Six months? You pick.) Let us also say that the resources available are finite (money, hospital beds, doctors' time, etc.). As you say, such situations do indeed exist; it happens quite often, in fact.

So how do we decide whether or not the person gets this particular treatment? Somebody has to decide; who should make the decision? What factors do they take into account?

Captain Blight
08-13-2009, 04:13 PM
Oh, Keith. Keithkeithkieth. "Give unto Caesar that which is Caesar's; render unto God that which is His."

SINCE life belongs to God (whichever form you think she inhabits) and SINCE the medical profession is charged with prolonging life, THEN it follows that Sam will simultaneously decry the increase in taxes as belonging to Caesar, and thus not worthy to recieve His (samF's) blessing--AND insist that the patient's life be prolonged as long as possible, no matter the cost.

<<Pulls popcorn out of microwave and settles in>> This oughtta be good.I thought it bore repetition.

Sam F
08-13-2009, 04:32 PM
That is, if you'll look at my original post, precisely what I asked. You didn't answer the question. You said:
Sam: Let us say someone has a terminal disease. There is a very expensive treatment for which they personally do not have enough money to pay. Let us say that the treatment has a fairly small chance (5%? Pick a number.) of extending their life a fairly short time (Thee months? Six months? You pick.) Let us also say that the resources available are finite (money, hospital beds, doctors' time, etc.). No question there. It's just a scenario. Here's the question:
In a just society - which is what we're trying to achieve, isn't it? The answer is: No, that's not what you 're trying to achieve. You were supposed to figure that out from my response. How is it unjust to get a terminal disease? It isn't. It is imperfect. That's not going to go away with another government spending program or mandate.



- how do we decide whether or not the person gets this particular treatment? Who makes the decision? What factors do they take into account? That was answered with another question: Who decides?
I’d prefer that I decide, not a bureaucratic committee eager to make it through this year’s fiscal budget.


Please, argue with your imaginary utopian communist if you like,
Who said anything about communism?
But if you're not working for a Utopia what exactly are you advocating Keith?


I said "a just society", not a perfect one, which I think we both recognize is not possible. The alternative would be an unjust society, which I think neither of us would favor. You've only got choices between imperfections - I'd prefer to preserve freedom and put up with a few imperfections - you did read Sowell's article, didn't you?
So, once again, Sam: Let us say someone has a terminal disease for which there is a very expensive treatment. They don't have enough money to pay for it themselves. The treatment has a small chance (5%? Pick a number.) of extending their life a fairly short time (Three months? Six months? You pick.) Let us also say that the resources available are finite (money, hospital beds, doctors' time, etc.). As you say, such situations do indeed exist; it happens quite often, in fact. So how do we decide whether or not the person gets this particular treatment? Who makes the decision? What factors do they take into account?
They? That's exactly what I'm talking about. What impersonal "they" decides what happens, Keith? I’d prefer to have the freedom to do that for myself thank you.

Sam F
08-13-2009, 04:36 PM
AND insist that the patient's life be prolonged as long as possible, no matter the cost... I thought it bore repetition.

Repeat it till you turn blue - but I've never said that nor have I ever thought that.

Keith Wilson
08-13-2009, 04:40 PM
That was answered with another question: Who decides?That was exactly what I asked you: Who should decide?

There is no injustice in getting sick; none of us get out of here alive. The question is about allocation of resources, which is a human decision, and which can be done in just or unjust ways . You will note in my scenario that the sick person doesn't have the money to pay for treatment himself; therefore someone else will have to decide if he'll get treated or not. Who should decide? What factors should be taken into account in making this decision?

Sam F
08-13-2009, 09:35 PM
That was exactly what I asked you: Who should decide?

Once again... I’d prefer to have the freedom to do that for myself thank you.


You will note in my scenario that the sick person doesn't have the money to pay for treatment himself; therefore someone else will have to decide if he'll get treated or not.

I don't have the money to buy a new car and nobody else has decided that for me. In your scenario, if I had to choose between dying sooner or putting my family deep in debt, I'd rather die sooner. I'm just not that important.
There's no point in worrying about how I don't have enough money to get "justice". I already face that every day... it won't be any different when I die.
On the other hand, if someone is fool enough to foot the bill... You know the old saying:
I wish I might, I wish I may... always buy and never pay. ;)

But I don't believe in Ponzi schemes now or ever.


Who should decide? What factors should be taken into account in making this decision?

Apparently you think that some bureaucratic committee (aka "Obamacare") will decide that for me.
No thanks. I'll do that like I do everything else - I'll decide for myself.
But in case you haven't read the Atlantic article (or Ms. Paglia's either) you might do that. Mr Goldhill is far more moderate than my personally rather Stoic position:

First, we should replace our current web of employer- and government-based insurance with a single program of catastrophic insurance open to all Americans—indeed, all Americans should be required to buy it—with fixed premiums based solely on age. This program would be best run as a single national pool, without underwriting for specific risk factors, and would ultimately replace Medicare, Medicaid, and private insurance. All Americans would be insured against catastrophic illness, throughout their lives...
How would we pay for most of our health care? The same way we pay for everything else—out of our income and savings. Medicare itself is, in a sense, a form of forced savings, as is commercial insurance. In place of these programs and the premiums we now contribute to them, and along with catastrophic insurance, the government should create a new form of health savings account—a vehicle that has existed, though in imperfect form, since 2003. Every American should be required to maintain an HSA, and contribute a minimum percentage of post-tax income, subject to a floor and a cap in total dollar contributions. The income percentage required should rise over a working life, as wages and wealth typically do.

All noncatastrophic care should eventually be funded out of HSAs. But account-holders should be allowed to withdraw money for any purpose, without penalty, once the funds exceed a ceiling established for each age, and at death any remaining money should be disbursed through inheritance. Our current methods of health-care funding create a “use it or lose it” imperative. This new approach would ensure that families put aside funds for future expenses, but would not force them to spend the funds only on health care.

What about care that falls through the cracks—major expenses (an appendectomy, sports injury, or birth) that might exceed the current balance of someone’s HSA but are not catastrophic? These should be funded the same way we pay for most expensive purchases that confer long-term benefits: with credit. Americans should be able to borrow against their future contributions to their HSA to cover major health needs; the government could lend directly, or provide guidelines for private lending. Catastrophic coverage should apply with no deductible for young people, but as people age and save, they should pay a steadily increasing deductible from their HSA, unless the HSA has been exhausted. As a result, much end-of-life care would be paid through savings.

That is neither radical nor unachievable. And it just might work.
From what I've seen of the current proposals, they won't work and have no chance to work because they don't address what fundamentally wrong with our health care "system". Oh and then there's that teeny detail about the government starting a massive new program when it's flat broke... not that anybody cares, huh? Apres nous le deluge!

Sam F
08-13-2009, 09:40 PM
Notice, Keith... he wants the right to decide for himself what medical treatment he'll receive.... by the way, he doesn't think that OTHER people should have the right to decide their medical treatment for themselves.... most notably, preganant women.

Remember Norman - if your pregnant you'll have a baby, not a blob of tissue.
But I forgot... unwanted land defenseless life counts for nothing with your sort.
Beware! Some day you too may be unwanted and unable to defend yourself.
Who'll decide what to do to you when that day comes?

Glen Longino
08-14-2009, 12:20 AM
Remember Norman - if your pregnant you'll have a baby, not a blob of tissue.
But I forgot... unwanted land defenseless life counts for nothing with your sort.
Beware! Some day you too may be unwanted and unable to defend yourself.
Who'll decide what to do to you when that day comes?

If you're pregnant you don't always have a baby, Sam. Don't forget that 20%+ of pregancies end in natural miscarriage.
I would think that a religious person must hold God responsible for those abortions and call God the Great Abortionist.
So, let's just leave abortions up to God and to women, okay?

Keith Wilson
08-14-2009, 07:26 AM
Ah - So according to Sam, if anyone doesn't have the money to pay for a particular medical treatment, anyone else would be a "fool" to pay for it, and that health care should be on a cash-and-carry basis, purely private, like buying an automobile. So the only person to decide anything would be the patient himself or his family, and the only necessary questions would be "Do I want it?" and "Can I pay for it?", and the patient in my hypothetical example would certianly not get the treatment.

Well, that's one way to do it.

And please, not another abortion thread, OK?

PeterSibley
08-14-2009, 07:39 AM
Ah - So according to Sam, if anyone doesn't have the money to pay for a particular medical treatment, anyone else would be a "fool" to pay for it, and that health care should be on a cash-and-carry basis, purely private, like buying an automobile. So the only person to decide anything would be the patient himself or his family, and the only necessary questions would be "Do I want it?" and "Can I pay for it?", and the patient in my hypothetical example would certianly not get the treatment.

Well, that's one way to do it.

And please, not another abortion thread, OK?

I suppose the automobile analogy could be extended to say that if you can't afford your own bit of road you shouldn't drive ...but then by a miracle of cooperation it was discovered that it is possible to share.Even a health system ,perhaps some form of non profit insurance scheme spread across the entire population ?? Impossible ...verging on Stalinism! :D

Australia's works very well ,more liberal than Canada's , you can go private if you choose or Medicare .You always go to the doctor of your choice .Rather good really .:)

Duncan Gibbs
08-14-2009, 07:48 AM
I find it all rather depressingly interesting: Watching the debate about the introduction of universal health care in the US is much like watching a debate about whether to use wheels or not, when EVERY other OECD country has been using wheels for quite some time now.

The whole "Death Panel" thang just sounds like more infantile reductionism from the reactionary element in the US that wants everything in black and white and can't comprehend the notion that life can be infinitely complex. We were watching the news reports of the town hall meetings where idiots (and that's a polite term for them) were standing up and crapping on about "becoming like Roosha," or that they objected that their taxes were going to fund abortions. I suppose they may feel somewhat differently if it were pointed out that MANY more lives of children would be saved from treatable conditions if they had equitable access to proper medical treatment. But such a conundrum really does lay well beyond the pale of thought doesn't it?!

The one that took the cake was a bunch of right royal fluck-knuckles yelling in unison "HEALTH CARE IS NOT A RIGHT!" Please... Someone!! Hand me Bren gun: I'll be a one man death panel and do the World a favour!! :D :rolleyes: ;)

TomF
08-14-2009, 08:21 AM
Curious, Sam.

I understand you to be saying that you wish to be responsible for your own health care decisions. That if you got an illness which was fatal if left untreated and hadn't the $ to pay for that care, your decisions are the ones which count. Whether the decision to not anticipate and sock away money on spec, or to take out insurance, or the decision to die.

Am I correct to think that you're advocating a similar personal responsibility for everyone else too?

If so, what's the rationale for the centuries-long radition of charitable medical missions?

Sam F
08-14-2009, 08:46 AM
Curious, Sam.

Equally curious... doesn't anybody read what I wrote... Say post # 82?


I understand you to be saying that you wish to be responsible for your own health care decisions. That if you got an illness which was fatal if left untreated and hadn't the $ to pay for that care, your decisions are the ones which count.

By framing your statement in that way I understand you to be saying that you wish not to be responsible for your own health care decisions. That if you got an illness which was fatal if left untreated and hadn't the $ to pay for that care, your decisions are not the ones which count.



Whether the decision to not anticipate and sock away money on spec, or to take out insurance, or the decision to die.

Facts Tom. Somebody has got to pay for my medical treatment.
Now, if you're willin' to pay for my healthcare - you're perfectly welcome to do it!
Just let me know the address where I can send the bills. ;)
But as I said, I'm not in favor of Ponzi schemes. They are, among other things, immoral.

Given the fact that customer-facing enterprises generally manage to reduce costs and increase quality (or they lose customers to competition) and given the fact that in almost all situations, hospitals do not work for their patients and instead work for an insurance company or some government program, it's no surprise that costs spiral out of control and quality often stinks and patients are treated like a side of beef. That's a DUH if ever there was one.


Am I correct to think that you're advocating a similar personal responsibility for everyone else too?

Unless one is advocating a life in a padded play pen and a refusal to grow up, then I guess so.


If so, what's the rationale for the centuries-long radition of charitable medical missions?

Get real Tom. Do you honestly think I object to charity?

Sam F
08-14-2009, 08:51 AM
I find it all rather depressingly interesting: Watching the debate about the introduction of universal health care in the US is much like watching a debate about whether to use wheels or not, when EVERY other OECD country has been using wheels for quite some time now.

Them's some expensive wheels:


Whatever their histories, nearly all developed countries are now struggling with rapidly rising health-care costs, including those with single-payer systems. From 2000 to 2005, per capita health-care spending in Canada grew by 33 percent, in France by 37 percent, in the U.K. by 47 percent—all comparable to the 40 percent growth experienced by the U.S. in that period. Cost control by way of bureaucratic price controls has its limits.

Anybody think that this is sustainable?

From 2000 to 2007, despite its market power, Medicare’s hospital and physician reimbursements per enrollee rose by 5.4 percent and 8.5 percent, respectively, per year. As currently structured, Medicare is a Ponzi scheme. The Medicare tax rate has been raised seven times since its enactment, and almost certainly will need to be raised again in the next decade. The Medicare tax contributions and premiums that today’s beneficiaries have paid into the system don’t come close to fully funding their care, which today’s workers subsidize. The subsidy is getting larger even as it becomes more difficult to maintain: next year there will be 3.7 working people for each Medicare beneficiary; if you’re in your mid-40s today, there will be only 2.4 workers to subsidize your care when you hit retirement age.

Sorry but this isn't as simple as "Healthcare is a right". Somebody has got to pay for it.

Art Read
08-14-2009, 08:54 AM
"The one that took the cake was a bunch of right royal fluck-knuckles yelling in unison "HEALTH CARE IS NOT A RIGHT!" Please... Someone!! Hand me Bren gun: I'll be a one man death panel and do the World a favour!!"

__________________________________________________ __________________________

A small quibble if you don't mind: I posted this here, (http://www.woodenboat.com/forum/showthread.php?t=100990&page=2) previously, but it bears repeating.

__________________________________________________ ___________________________


"Everybody has a "right" to every medical advance and technique that has ever been or ever will be discovered or devised? Suppose I develop a wonderful artificial eye next year. Does every blind man, everywhere, have a right to one even if I can't afford to make that many and no government has the political will to pay me to? Do I have a "right" to even mundane medical care if I was unwilling to support the infrastructure that provides it through either direct or indirect financial compensation or political participation?

A "right" is a very specific thing. It is something that no man and no government agency has the means to deprive you of. It is NOT a "good". I have the right of free speech. I don't have a "right" to my own printing press. I have the right to bear arms... I don't have the "right" to a gun... I have the right to be free from unreasonable search and seizure. I don't have a "right" to my own home. Please use your terms carefully."

__________________________________________________

I would only add that the big one, our right to Life, does NOT imply the "right" to the means necessary to support that life. (Food, clothing, shelter, etc.... Including "health care!"...) A just an compassionate society, however, will acknowledge the moral imperative to provide the least amongst them with the assistance necessary in order to survive and improve their situations. Exactly HOW that is to be done most effectively and with the least social cost is what "Politics" is all about.

Keith Wilson
08-14-2009, 08:59 AM
A "right" is a very specific thing. It is something that no man and no government agency has the means to deprive you of. Nope. It may be a semantic quibble, but people are, unfortunately, deprived of their legitimate rights all the time, and bad governments most certainly have the means to deprive people of their rights. By that definition, one has a right to nothing except one's own private thoughts, as long as one is alive.

And I take serious exception to the idea that "those with less money" is equivalent to "the least among us".

Art Read
08-14-2009, 09:13 AM
"...bad governments most certainly have the means to deprive people of their rights..."

__________________________________________________ ___________________

You're correct, Keith. It's called tyranny. I hope we can all agree that we should make every effort to avoid that situation. As Ben Franklin said after the Constitutional Convention, "We've given you a Republic, Ma'am... If you can keep it." When you make health care a "right" you are by definition using force to deprive me of my ability to provide for myself and and my loved ones in the manner which I deem best. You may tax me with proper representation in order to provide for the "general welfare", but when you declare my free will subservient to someone else's "needs", you have transformed me from a citizen into a servant.

__________________________________________________ _____________________


"Adn I take serious exception to the idea that "those with less money" is equivalent to "the least among us".

__________________________________________________ _____________________


Not just "less money". Less health, less power, less luck, less ability... Sorry if it strikes you as politically incorrect, but its a turn of phrase I've heard and read many times with no apparent derision implied.

Sam F
08-14-2009, 09:22 AM
Please use your terms carefully."
Gee Art - that's getting kinda radical doncha think? ;)


A just an compassionate society, however, will acknowledge the moral imperative to provide the least amongst them with the assistance necessary in order to survive and improve their situations. Exactly HOW that is to be done most effectively and with the least social cost is what "Politics" is all about.

Yep that about covers it.

Keith Wilson
08-14-2009, 09:42 AM
When you make health care a "right" you are by definition using force to deprive me of my ability to provide for myself and and my loved ones in the manner which I deem best.Excuse me? What sort of anarchist nonsense is this? When we make free speech a right we are using force to deprive you of the ability to make somebody else shut up. When we make the free exercise of religion a right, we are using force to deprive you of the ability to drive out those damned infidels. When we make liberty a right, we are depriving you of the ability to own slaves. So what? Every right that is defined, every single law that is enforced, for that matter, deprives you by force of the freedom to do as you wish. While reasonable people may argue about which rights are justified, and which laws should be passed, the general consensus is that there are some rights and some laws which are good. It is the price we pay for civilization.

And no reasonable person would argue that every other industrialized democracy is actually tyrannical because they have universal tax-supported health care.

Look, you may not think that heath care should be considered a public good, like the fire department or the public schools; that's fine. But spare us the absurd rhetoric about "tyranny" OK?

OTOH, I agree with this (slight editing):
A just and compassionate society, however, will acknowledge the moral imperative to provide everyone who needs it with assistance necessary in order to survive and improve their situations. Exactly HOW that is to be done most effectively and with the least social cost is what "Politics" is all about.This is precisely what the current debate is abut. The experience of every other wealthy country been that treating heath care as a public good is both much more equitable and much more efficient, and that it doesn't result in "tyranny" at all.

Sam F
08-14-2009, 09:54 AM
In the meantime... seeing the error of my ways for having the unmitigated gall to question the wisdom of "The One" and The Party. I've decided to turn myself in to the white house... Nor am I the only one. Go Flag yourself!

http://www.youtube.com/user/StevenCrowder

Tom Montgomery
08-14-2009, 10:03 AM
Once health care reform is signed into law, surrender yourself to your local death panel.

Art Read
08-14-2009, 10:07 AM
"Excuse me? What sort of anarchist nonsense is this?"

_______________________________________________

It makes perfect sense. By defining healthcare a "right", you imply public "ownership" of individual skills, time and capital. A society may, as you suggested on the other thread, decide to make universal health care a public "good" through representative legislation. But it may NOT demand my services, time or capital without my consent and/or compensation and remain "free". One's rights by definition end at the point of infringement upon another's.

downthecreek
08-14-2009, 10:15 AM
One small comment.

People keep on going on about "someone else deciding whether X, who can't pay for his or her own care, gets treated".

This is a red herring and is typical of the endless distortions to which these arguments are subject.

I know of no case in which someone "doesn't get treated" in any health care system with which I am familiar. The only exception is the American system, in which I know people (and I mean I know them or about them personally) "don't get treated" for conditions that need treatment. (Unless, perhaps, they are fortunate enough to do as one friend did and enter into a marriage of convenience in order to qualify for treatment of a complex long term disorder. This is certainly preferable to the lot of another friend who had to remain for many years in an abusive and miserable marriage because her husband relied on her for his insurance and also needed long term, complex treatment of the sort the ER most certainly cannot provide)

The situation in the NHS (and, I am sure, in Canada, Australia and certainly all across Europe) is that everyone who needs treatment gets it. What NICE decides is not whether people get treatment, but whether certain types of treatment can justifiably be provided on the NHS. In the vast majority of cases, the treatments involved are drugs that may (not will) just prolong the life of a terminally ill patient for a few more weeks or months.

Here's an example of the way in which this notion is distorted. There was a furore on another board recently about a news reported that NICE would deny people with back problems the benefit of cortisone injections. "Thousands will live in agony!!!!"

The fact is that NICE has looked at the evidence and concluded that these injections should be available to people who are likely to benefit from them and not simply as a hit or miss experiment for anyone with pain from an unknown cause. As a matter of interest, I compared the NICE guidelines for the management of back pain with those published on the website of the Mayo Clinic. They were quite extraordinarily similar!

My father died at the age of 89 from esophageal cancer. There was no hope of survival, but he was still treated in exactly the same way as patients attending the same clinic who were 10 or 20 years younger. My mother is 94 and receives the most assiduous treatment for a couple of medical conditions, both from her GP and from the consultant at the Teaching Hospital where she is an out-patient.

And, since we have been informed that the brilliant Stephen Hawking would have been left to die by the NHS if he lived in the UK (Give me strength! :D:D:D) here is the list of provisions made by the NHS for a friend of mine who did die (as almost 100% of sufferers do, no matter where they live) from motor neurone disease.

Regular and frequent hospital admissions for monitoring, help with breathing and surgey to allow feeding via the stomach
Regular admissions to the Intensive Therapy Unit when major breathing and other problems arose
Admission to a hospice for one week out every four over a period of two years (relief for husband)
Transport to and from hospital and hospice when car travel became impossible
Regular home visits from a specialist anaesthesiologist to monitor breathing and deal with problems
Regular home visits (weekly, sometimes more) from her GP
Overnight nursing in her own home for six nights out of every seven when she was at home over a period of 2 years (relief for husband)
Four visits daily (sometimes more) seven days per week from community nurses
Thrice weekly visits (sometimes more) from community Physiotherapist
Frequent and regular visits from Speech Therapist
Frequent and regular visits from Occupational Therapist
Visits from an IT specialist to keep her using her computer as long as possible
Trained "sitters" on two afternoons per week (relief for husband)
Provision of equipment - hospital bed, special mattress, wheelchair, special keyboard, communicator, respirator, 12 volt converter to allow respirator use in car, stand and equipment for feeding, equipment for regular clearing of chest, all other medical equipment as required.
All disposables (dressings, pads, gloves etc. as required)
All drugs and nutriments.

There are many legitimate arguments to be made in this debate. Bureaucrats deciding who gets treatment is not one of them.


Messages In This Thread

Tom Montgomery
08-14-2009, 10:15 AM
So Art, I take it that since Social Security, Medicare and Medicaid were enacted none of us in the USA have been free?

Uncle Duke
08-14-2009, 10:16 AM
By defining healthcare a "right", you imply public "ownership" of individual skills, time and capital.
If I'm understanding your point that is only true if a situation where, for example, you are forbidden to be a doctor unless you only treat the public covered by the health care plan and only at rates set by the state. I don't think that this is true in Canada, UK or Australia - you still have the right to have private practice if you want.

Art Read
08-14-2009, 10:27 AM
"So Art, I take it that since Social Security, Medicare and Medicaid were enacted none of us in the USA have been free?"

________________________________________________

As I just said:

________________________________________________

"A society may, as you suggested on the other thread, decide to make universal health care a public "good" through representative legislation."

_________________________________________________

Please drop the straw man. That obviously applies to Medicaid, Medicare, Social Security, Highway taxes, or even "turkeys in every pot", if thats what the elected representatives of the the people legislate. Should they misjudge or ignore the the public's will with such legislation, they do so at their political peril.

Keith Wilson
08-14-2009, 10:27 AM
But it may NOT demand my services, time or capital without my consent and/or compensation and remain "free". Art, normally you make a lot of sense, although I don't often agree with you, but this is just ridiculous. By that definition any society that collects any taxes for any reason is not free. We collectively consent to taxes since we vote for those who decide on them, but individually it doesn't make a damn bit of difference if you consent or not. Every penny you pay to the government is extracted by threat of force; if you don't pay, an armed representative of the government will eventually come and either confiscate your property or lock you up. Exactly the same argument could (and was) used against public water supplies, or fire departments, or public schools, or Medicare. Taxation, i.e. taking your money by threat of force to provide these things "implies public ownership of individual skills, time and capital." Well, yes, some of your property is owed to the government. That's the price you pay for civilization.

Now we may disagree about what things should be in the private sphere and which should be in the public, but in any functional state there will always be some public goods provided through taxation. The argument that any expansion of the public sphere is tyranny is simply silly in a nation where total tax receipts are some 28-29% of GDP, and have been roughly that for 35 years.

Art Read
08-14-2009, 10:35 AM
"If I'm understanding your point that is only true if a situation where, for example, you are forbidden to be a doctor unless you only treat the public covered by the health care plan and only at rates set by the state."

________________________________________________

Not at all. I am simply rejecting the notion that health care can somehow be "declared" a "right" just because we wish it were so. Perhaps this would be clearer. Is health a "right"? Wishing it so won't make it true any more than wishing medical care was a "right" either. The same with happiness, respect and purpose. We have a right to pursue and/or earn them, but no "right" to posses them.

downthecreek
08-14-2009, 10:38 AM
It makes perfect sense. By defining healthcare a "right", you imply public "ownership" of individual skills, time and capital. A society may, as you suggested on the other thread, decide to make universal health care a public "good" through representative legislation. But it may NOT demand my services, time or capital without my consent and/or compensation and remain "free". One's rights by definition end at the point of infringement upon another's.Another red herring.

Legislation confers rights and imposes duties. People, acting through their democratically elected representatives, can and do agree to grant the right to health care that is free at the point of need to all who qualify and impose upon themselves the obligation to pay for such care and make it available.

Strangely enough, health care providers agree to provide. Nobody compels them to do so and nobody's rights are being infringed. Occasionally there are difficulties about making provision (for example in remote rural areas) and then the authorities have to get their fingers out and make it happen - which usually means offering extra incentives to attract the providers. Arcane arguments about rights are all very fine and dandy, but health care provided as a public good can and does work in practice.

Also strangely enough, many of the people working in these systems do so, not least, because they believe in them!

I'm afraid that governments can and do demand your capital, if not your time, to pay for all sorts of common "goods", many of which you may not meet with your approval. That's democracy for you. I presume some of your taxes are going to pay for public education, for example. But I don't expect anyone is trying to force you to become a teacher in the public school system, are they?

Kaa
08-14-2009, 10:41 AM
A note: rights do not exist by themselves. They always come as one half of the pair -- the other half being duty. Each right of someone's is someone else's duty.

For example, the right to free speech as formulated in the US Constitution is equivalent to the duty of the government not to make specific laws. The right to a trial by a jury of one's peers is equivalent to the duty of the justice system to provide such a jury.

If you want to meaningfully declare health care a right, you need to specify who gets the duty to provide it.

Kaa

TomF
08-14-2009, 10:43 AM
Creeky,

I must say, I'm appreciating your comments today. Carry on.

t

Art Read
08-14-2009, 10:47 AM
"By that definition any society that collects any taxes for any reason is not free."

_________________________________________________

Please read what I wrote carefully, Keith. I did NOT say that society has no ability to coerce it's citizens into providing for the common welfare. Exactly the opposite. As long as it is legislated by a representational government. What I object STRONGLY to is the idea that any individual, group or class has an endowed "Right" to any other individual, group or classes' skill, time or capital without benefit of REPRESENTATION in a participatory government of laws. I would think that would disturb any politically liberal individualist.

_________________________________________________

"But it may NOT demand my services, time or capital without my consent and/or compensation and remain "free".

_________________________________________________

In your example of taxes, my "consent" above is empowered by by my participation in said representative democracy. Jeeze, I thought this was pretty basic stuff?

Keith Wilson
08-14-2009, 10:47 AM
"Rights" are are something people have decided to incorporate into political systems. The concept of "rights" has changed as people's ideas change Free speech has not been considered a "right" in most countries at most times. The concept of lese majeste is only recently extinct. Freedom to practice any religion, or none, was once an extremely radical idea. The idea that government's only legitimate source of authority is the consent of the governed? Horrors; what abut the legitimate God-given power of the king? If we abolish property qualifications for voting, the poor uneducated rabble will just take over! Allowing women to vote is a quite recent innovation. We had to fight a very nasty war over ending slavery. The idea that one has the right to be be treated equally by the law whatever one's skin color was bitterly opposed during living memory.

My point is that political rights are what we decide they should be, that they change over time, and that there is no fundamental reason that expanding them is a bad idea. In any given case , it may be a bad idea, but not universally.
What I object STRONGLY to is the idea that any individual, group or class has an endowed "Right" to any other individual, group or classes' skill, time or capital without benefit of REPRESENTATION in a participatory government of laws.I agree with this. How could I not? What does it have to do with tax-funded health care?

Art Read
08-14-2009, 10:59 AM
"I agree with this. How could I not? What does it have to do with tax-funded health care?"

_______________________________________________


From Mr. Gibbs (and others) previous posts here: "Health care is a RIGHT!"

What's next? "Shelter is a RIGHT!" "Shoes are a RIGHT!" "Transportation is a RIGHT!" Where do we draw THAT line? None of the examples you cited require the denial of another's rights in order to endow them. Unless one considers infringing on others rights a right in and of itself?

Keith Wilson
08-14-2009, 11:01 AM
Has anyone take away your right to representation? Is anyone suggesting it? Sorry, but I really don't understand.

downthecreek
08-14-2009, 11:03 AM
If you want to meaningfully declare health care a right, you need to specify who gets the duty to provide it.

Kaa

Why is everyone making such a meal of this? The duty to provide lies with the the body that grants the right - the elected government. Nothing unusual about that.

The right to health care does not imply a duty imposed upon individual providers, but on the authorities to whom the enactment of the legislation is delegated by the government. It is up to that authority to run a system in which individual providers in sufficient numbers and with sufficient skills will agree to work. Part of that agreement is the provision of health care to all who qualify. No-one is being coerced. The said authority is, of course, accountable, via the government, to the electors, for the management of the system. In every country I know with such a system, woe would certainly betide any government that tried to do away with it.

Of course there will be tensions and frictions within the system - any system. The simple fact is that it can work and does work.

Tom F - thanks :)

Kaa
08-14-2009, 11:11 AM
Why is everyone making such a meal of this? The duty to provide lies with the the body that grants the right - the elected government. Nothing unusual about that.

Consider the implications. If health care is a right and the government has the duty to provide it (to *provide*, not just set up a system to pay for it), then interesting consequences develop.

Kaa

Keith Wilson
08-14-2009, 11:16 AM
This may possibly be merely a semantic dispute. No, health care is not a "right" like free speech that we should write into the Constitution. I think it is something that should be a public good, paid through taxation, like the fire department. People do sometimes use the word "right" very loosely; that's probably what happened.

Art Read
08-14-2009, 11:17 AM
"Has anyone take away your right to representation? Is anyone suggesting it? Sorry, but I really don't understand."

That is not my objection, Keith. We will all witness our representative government at work with the debate over how we will arrange our affairs regarding the fairest, most efficient and highest quality health care infrastructure for this country. I doubt any of us will be completely satisfied. But it will be a decision reached based upon a system of laws. Not an angry mob yelling "Don't touch my money!" on one hand, and an equally loud mob yelling "Free Health Care is a RIGHT!" on the other.

Do you see why I insist on verbal precision with this issue now?

Art Read
08-14-2009, 11:25 AM
"No, health care is not a "right" like free speech that we should write into the Constitution. I think it is something that should be a public good, paid through taxation, like the fire department."

__________________________________________________ _

See? I knew you'd agree with me about the right definition of "Right"... Right?:D

(We'll just have to agree to disagree about the best way to manage, finance and regulate Health Care for now...)

downthecreek
08-14-2009, 11:27 AM
Consider the implications. If health care is a right and the government has the duty to provide it (to *provide*, not just set up a system to pay for it), then interesting consequences develop.
Kaa

Fascinating, I'm sure, but, again, why such a meal? Perhaps all this speculation is interesting if you only have experience of the American system. You work in the abstract and I work in the concrete. Universal health care coverage is real, commonplace and effective. It can be achieved by several different routes and using several different types of system, each with its own strengths and weaknesses.

As I didn't say, or imply, that the only role of the government is to set up a system to pay for it, I shall leave you to expound on that point. However, I think you need to distinguish between the duty to ensure that care is available and the duty to provide care. They are not the same.

Keith Wilson
08-14-2009, 11:31 AM
Oh, right, now I see what you meant. :D

Just for information, what would you think of a single-payer system (maybe with an option to buy fancier care or shorter waits)? It's an option that seems to have a surprising amount of support here from all political sides.. Taiwan made the transition recently (http://en.wikipedia.org/wiki/Healthcare_in_Taiwan) and it seems to have worked quite well.

Duncan Gibbs
08-14-2009, 11:31 AM
In every country I know with such a system, woe would certainly betide any government that tried to do away with it.

As such, in Australia, where I live, universal health care is considered a right. One more of life's little grey areas: Just because someone doesn't consider something a right doesn't mean for one second there isn't someone else who does. As far as breaking the bank goes, our economy is out-performing the US economy in just about every way and we've had universal health care since the early seventies. So that particular argument is moot to say the best of it.

Kaa
08-14-2009, 11:35 AM
Universal health care coverage is real, commonplace and effective. It can be achieved by several different routes and using several different types of system, each with its own strengths and weaknesses.

True. But please pay attention to Keith's distinction between a right and a public good.

Take roads, for example. They are provided by government for the benefit of all. But there is no "right" to have a road. I cannot claim a right and force a government to do its duty and pave a road down to my house in the middle of nowhere.

In the same way a society may decide that it's good (efficient/fair/rational/moral/etc.) to provide some degree of health care to all comers irrespective of their ability to pay. That's fine -- but that does not make health care a right.

Kaa

downthecreek
08-14-2009, 11:59 AM
True. But please pay attention to Keith's distinction between a right and a public good.

Kaa

Oh, for heaven's sake! Maybe you should pay attention to what I have already posted about "rights". Anyone can assert what is or is not a "right". Maybe it's only what is written in your constitution, or our Human Rights Act or whatever. Well, for practical purposes governments can and do grant rights and, when they do, take upon themselves the concomitant duties.

As a citizen of the United Kingdom, I have a legal, enforceable right to health care from the NHS and I can hold my elected representatives to account if that right is not upheld and fulfilled.

The NHS Constitution is available on the net for anyone who may wish to read it.

Your clever little arguments and nice distinctions may be quite fascinating to you, but to me they are just so much chaff! :D

downthecreek
08-14-2009, 12:00 PM
Arrrggghhh... I think nearly EVERYONE in the last 20 posts is getting it wrong.



Some of us are not Americans, you know :rolleyes:

Art Read
08-14-2009, 12:07 PM
"Oh, right, now I see what you meant."

____________________________________________

And it only took us two pages! LJB5 and Jamie could take lessons from us... :D

And, Norman... EXACTLY "right"! Where were you two pages ago?

______________________________________________

"Just for information, what would you think of a single-payer system (maybe with an option to buy fancier care or shorter waits)?"

_______________________________________________

Off the top of my mind, Keith, I don't have an absolute "philisophical" objection to the concept. More of a "practical" skepticism. Single payer conjures up images of monolithic control to me. The specter of unlimited fraud, abuse and institutional incompetence also worries me. But then again, the efficiencies of standardization and economy of scale are tempting. I will read the article you linked and get back to you.

Kaa
08-14-2009, 12:07 PM
As a citizen of the United Kingdom, I have a legal, enforceable right to health care from the NHS and I can hold my elected representatives to account if that right is not upheld and fulfilled.

A government can, of course, make health care an enforceable right.

We'll see how that experiment works out for you.


Your clever little arguments and nice distinctions may be quite fascinating to you, but to me they are just so much chaff! :D

You are entirely free to ignore them altogether. I would urge you not to spend you valuable time on chaff :D

Kaa

Art Read
08-14-2009, 12:11 PM
"Your clever little arguments and nice distinctions may be quite fascinating to you, but to me they are just so much chaff!"

_____________________________________________

Perhaps this attitude goes a long way to explaining just why we felt the need to "rid" ourselves of your country so long ago... (You know? The "original" Tea Party and all that!) :p

downthecreek
08-14-2009, 12:13 PM
A government can, of course, make health care an enforceable right.
We'll see how that experiment works out for you.
Kaa

Experiment??

The National Health Service was established by Act of Parliament in 1948. :rolleyes:

downthecreek
08-14-2009, 12:17 PM
"Your clever little arguments and nice distinctions may be quite fascinating to you, but to me they are just so much chaff!"

_____________________________________________

Perhaps this sentiment goes a long way to explaining just why we felt the need to "rid" ourselves of your country so long ago... :p

Oh, my! We ARE a clever fellow, aren't we? :D

But fatuous....... :(

Kaa
08-14-2009, 12:18 PM
Experiment??

The National Health Service was established by Act of Parliament in 1948. :rolleyes:

Still being distracted by chaff?

The NHS may date back to 1948, but that "legal, enforceable right to health care" that you mentioned does not. How old is the NHS Constitution..?

Kaa

Tom Montgomery
08-14-2009, 12:18 PM
Creeky: How does it feel to be enslaved by socialism? Do you long for freedom?

downthecreek
08-14-2009, 12:18 PM
My apologies, to you. You always do a remarkable job of comprehending what goes on in the US... far better than any of us are capable of understanding the politics of the U.K.:)

Thank you. That is a generous compliment and I appreciate it. :)

Keith Wilson
08-14-2009, 12:20 PM
In practice, there isn't much difference between a "right" established by law - the "right" to collect Social Security, for example, and a "right" in the Constitution - the right to vote, say. The former is much easier to change, of course, but the latter do change, and no doubt will again. Women couldn't vote until 1920. Most African-Americans in the South couldn't vote until the 1950s at least, although this was mostly against the letter of the law.

downthecreek
08-14-2009, 12:20 PM
Creeky: How does it feel to be enslaved by socialism? Do you long for freedom?

Oh, I do! I do! Every time I visit my wonderful GP I yearn to give him lots and lots of money - but the rotter simply refuses to grant me my right to do so. I feel SOOOOO oppressed by it all..... ;)

downthecreek
08-14-2009, 12:24 PM
Still being distracted by chaff?

The NHS may date back to 1948, but that "legal, enforceable right to health care" that you mentioned does not. How old is the NHS Constitution..?

Kaa

The constitution is new. It simply sums up and pulls together rights that have existed since the beginning and some that have been added along the way.

You don't know (in a very real sense) what you are talking about.

Kaa
08-14-2009, 12:28 PM
You don't know (in a very real sense) what you are talking about.

So tell me. Since when do British subjects have a legal enforceable right to health care -- meaning one can go to court and force, say, a hospital or a GP to provide health care when it/he doesn't want to?

Kaa

TomF
08-14-2009, 12:48 PM
Y'know, Kaa,

In the British parliamentary tradition, much of our constitution is unwritten. As true in Canada and much of the rest of the Commonwealth as in the UK.

It is probably impossible to say with precision when the "right" to health care became an enforceable right in Britain.

JimD
08-14-2009, 01:09 PM
Interestingly, Israel has no constitution at all.

Yeah, but they have the Torah, providing divine right to the promised land.

Tom Montgomery
08-14-2009, 01:14 PM
So tell me. Since when do British subjects have a legal enforceable right to health care -- meaning one can go to court and force, say, a hospital or a GP to provide health care when it/he doesn't want to?

Kaa

On the right to emergency care:

American Independence and the Right to Emergency Care

Robert Baker, PhD*
Department of Philosophy, Union College and Center for Bioethics, University of Pennsylvania

JAMA. 1999;281:859-860.

Asserting a "right" is a powerful statement in American political rhetoric. In this country, medicine has recognized patients' rights for over 150 years.1 As early as 1886 there was a proposal to "draw up . . . a Bill of Rights which shall secure patients from any injustice from the votaries of science."2 But it was not until almost a century later, in 1972, that the House of Delegates of the American Hospital Association (AHA) first formulated an official "Patients' Bill of Rights."3

If US patients are so well endowed with rights, why has a Patients' Bill of Rights been promoted by the President and debated in Congress? Observers from nations that provide universal health insurance for their citizens might reasonably presume that the additional "right" sought was the right to health care. But it was not a general right to health care that was created in the Patients' Bill of Rights by an executive order of the President in February 1998,4 nor is it a general right to health care that is being endorsed by several prominent advocacy groups. The right being established is the right of access to emergency health care.5

This country's frontier heritage is one of independence rather than interdependence. Communal assistance is acceptable in the United States during emergencies so as to assist individuals to reassert their independence. It is this extraordinary value that US citizens place on independence that leads them to insist on a right to emergency health care: a form of health care that enables them to reassert their independence.

The Right to Emergency Care

The 1716 New York Midwives Oath, the earliest formulation of medical ethics in the United States, unequivocally states a midwife's obligation "to help any woman in labor, whether she be poor or rich . . . in time of necessity."6 A similar sentiment was expressed a half century later in the constitution of the first permanent US medical society, which stipulated that physicians must "always most readily and cheerfully assist gratis . . . the distressed poor."7 Medical professionals in colonial American society considered themselves obligated to provide care to those in "distress," or in "time of necessity," irrespective of a patient's ability to pay.

The foundational document of US medical ethics, the Code of Ethics adopted by the American Medical Association at its founding meeting in 1847, reinforces this obligation. It stipulates that the first and preeminent duty of a physician is to "come when called," that is, to attend to patients during an acute illness or an emergency. In the prologue to the Code duties and rights are held to be correlative. This implies that patients have a correlative right to be attended to in emergencies—even "when pestilence prevails," for physicians also have a "duty to face the danger, and to continue their labors for the alleviation of suffering, even at the jeopardy of their own lives."8

The moral tradition formalized in these earlier codes of medical ethics continues to this day: like their 18th-century counterparts, emergency department nurses and physicians still see everyone "in time of need," regardless of the patient's ability to pay. A patient's right to emergency care is thus the most enduring right in US medical ethics.

The Challenge by Managed Care

Managed care practices challenge the fundamental right to be seen by a doctor or nurse "in time of need." Evidence of this was apparent in the cases cited in Congress to support the Patients' Bill of Rights. For example, a father, 45 years of age, has a myocardial infarction requiring emergency surgery unavailable in his local hospital. Yet his health maintenance organization (HMO) declines to approve out-of-town treatment. Eventually they relent, but the man dies while awaiting surgery. A mother, 55 years of age, discovers large bruises on her body while vacationing in Hawaii. Hawaiian emergency department doctors diagnose aplastic anemia and recommend immediate treatment. Her HMO insists that she return home for assessment. They decline payment for a "medivac." Nine days later she dies, succumbing, in her weakened condition, to a fungal infection transmitted by the air recirculated on a commercial jet. In both cases managed care organizations refused to treat emergencies as emergencies, attempting instead to substitute ordinary care for emergency care; that is, they refused to recognized the patient's right to emergency care.

These tales of death and delay were paraded before Congress to assert the need to protect patients' rights to acute and emergency care, to appropriate care, and to continuity of care. The Patients' Bill of Rights reasserts patients' legal right to emergency treatment without prior authorization and defines "emergency" as "a medical condition manifesting itself by acute symptoms of sufficient severity . . . that a prudent layperson, who possesses an average knowledge of health and medicine," would believe it needs immediate treatment.9

Tom Montgomery
08-14-2009, 01:15 PM
Continued...

The Position Taken by Managed Care

How did managed care organizations place themselves in the unenviable position of challenging patients' rights? The answer involves ethics and law. Legally, the Federal Insurance Retirement Income Security Act of 1972 exempts managed care organizations from lawsuits under state malpractice laws. Therefore, unlike doctors and nurses, managed care administrators cannot easily be sued for denying patients' care, not even in cases as outrageous as those presented to Congress.

Ethically, the issue is more complex. Medical ethics in the United States has traditionally been conceptualized in terms of physicians' duties and patients' rights. Managed care administrators, however, tend to conceptualize their obligations in terms of either stakeholder analysis or the utilitarian ethic that predominates in public health medicine.

Stakeholder analysis is a common form of business ethics that was developed as a theoretical framework to extend the concept of managerial responsibility beyond the boardroom, so that it encompassed communities, employees, and customers, as well as shareholders.10 When applied in the context of managing medical care, stakeholder analysis inadvertently, but inescapably, demotes patients from the position of primacy they enjoy in traditional medical ethics. In a stakeholder analysis patients' interests become just one among many that must be balanced against those of (1) the managed care organization, which must retain its competitiveness in the market, (2) employers and other third-party payers, who have an interest in containing their costs, and (3) society at large, which seeks to minimize the number of uninsured by containing the cost of employer-financed health insurance. Additionally, in for-profit managed care organizations, (4) shareholders are stakeholders with a right to a reasonable return on their investment.

Traditional Medical Ethics Subverted

By 1990, when managed care emerged as the dominant form of employer-financed health care in the United States,11 employees found themselves unknowingly subject to ethical norms that had not been customary in the clinical practice of medicine. The examples paraded by the Democrats are cases in point. From the perspective of traditional medical ethics, these "horror stories" demonstrate the moral callousness of managed care. From the perspective of a stakeholder or by a utilitarian analysis, however, these cases, although unfortunate, are neither unfair nor unethical. Managers who accept the ethos of managed care will feel morally bound (either to multiple stakeholders and/or to maximize the greatest good) to manage health resources efficiently. Efficient resource utilization requires enforcing rules that may have unfortunate consequences for some individuals—such as those cited in Congress.

If the above analysis is correct, then what is at issue in the debate over patients' rights is the very core of US medical ethics in the 21st century. From the Hippocratic oath to the bioethics revolution, the patient has traditionally been the central focus of medical ethics. Managed care organizations, however, operate from within ethical frameworks that countenance practices that erode the centrality of patients' needs. The historic shift to managed care has thus generated a parallel moral paradigm shift that fundamentally challenges medical ethics and the patient-physician relationship, as they have traditionally been understood.

The question before us is whether we should sustain traditional medical ethics or adopt the new ethic of medicine implicitly embraced by managed care organizations. Those who believe that the individual patient and the patient-physician relationship is properly the focus of medicine and of medical ethics will need to find a mechanism that can successfully embed the values of traditional medical ethics within the ethos of managed care medicine. The idea of patients' rights provides a well-tested mechanism for accomplishing this. Rights act as a "side constraint" on political and economic calculation as well as moral reasoning.12 Rights can stay the calculations of the utilitarian and stakeholder calculus, reasserting the centrality of the patient-physician relationship even within the larger framework of stakeholder and utilitarian ethics.

If one believes in the centrality of the patient-physician relationship, one ought to favor the creation of a framework of patients' rights for individuals enrolled in managed care. Thus, health care professionals should champion the idea of patients' rights in their professional organizations and in political fora as well. For almost 2millennia, patients and physicians have been well served by an ethic that focused on the needs of the individual. It would be tragic if this ethic were inadvertently jettisoned in the shift from fee-for-service medicine to managed care.*

REFERENCES

1. Baker R, Caplan A, Emanuel LL, Latham SR. Crisis, ethics, and the American Medical Association: 1847 and 1997. JAMA. 1997;278:163-164. FREE FULL TEXT

2. Withington CF. The Relation of Hospitals to Medical Education. Boston, Mass: Cupples Upham & Co; 1886.

3. American Hospital Association. A patient's bill of rights. In: Reich WT, ed. The Encyclopedia of Bioethics. New York, NY: The Free Press; 1978.

4. Kim EK. Clinton orders patient bill of rights in federal health care. Associated Press. February 20, 1998.

5. Other rights to be protected by the Patients' Bill of Rights can be found at: US House of Representatives. HR 3605: Patients' Bill of Rights Act of 1998. Available at: http://thomas.loc.gov/cgi-bin/bdquery/z?d105:h.r.03605. Accessed March 15, 1998.

6. Davis NS. History of Medicine, With the Code of Medical Ethics. Chicago, Ill: Cleveland Press; 1903.

7. New Jersey Medical Society. Instruments of Association of the New Jersey Medical Society. New Brunswick: New Jersey Medical Society; 1766.

8. American Medical Association. Code of ethics. In: Baker R, ed. The Codification of Medical Morality: Historical and Philosophical Studies of the Formalization of Medical Morality in the Eighteenth and Nineteenth Centuries. Dordrecht, the Netherlands: Kluwer Academic Publishers; 1995:75, 86.

9. Patients Before Profits: The Patient's Bill of Rights. Available at: http://www.senate.gov/dpc/ patients_rights/index.html#patients. Accessed January 14, 1999.

10. Goodpaster KE, Nash LL. Policies and Persons: A Casebook in Business Ethics. 3rd ed. Hightstown, NJ: McGraw-Hill; 1997.

11. Bodenheimer T, Grumbach K. Understanding Health Policy: A Clinical Approach. 2nd ed. Stamford, Conn: Appleton & Lange; 1998.

12. Nozick R. Anarchy, State, and Utopia. New York, NY: Basic Books; 1974.

http://jama.ama-assn.org/cgi/content/full/281/9/859

downthecreek
08-14-2009, 02:06 PM
It is probably impossible to say with precision when the "right" to health care became an enforceable right in Britain.

Correct. The National Health Service has been evolving for 61 years. It would be surprising if that were not the case. However, if Kaa wishes to research this point (because I have no interest in doing so for him) than I suggest he starts with the National Health Service Act 1946, which was first implemented in 1948, and takes it from there. There are plenty of good histories of the service available if he is interested.

The case of the GP is a good illustration of the difference between "make available" and "provide". No GP is forced to have anyone "on his (or her) list" and all have the right to remove someone from the list if they choose. However, the Primary Care Trusts that commission care and oversee primary health care services have a duty to ensure that everyone has access to GP services. And they do. There are strong incentives to provide care, not to refuse it.

Hospitals can only refuse care if, for example, a patient repeatedly and violently attacks staff. I believe American hospitals have a similar obligation? They, of course, will render a bill, though.

Kaa
08-14-2009, 02:28 PM
Y'know, Kaa,

In the British parliamentary tradition, much of our constitution is unwritten. As true in Canada and much of the rest of the Commonwealth as in the UK.

Ain't no such thing as "unwritten constitution". You're referring to common law which is a bit of a different thing.


It is probably impossible to say with precision when the "right" to health care became an enforceable right in Britain.

Well, it seems that a general right to health care became enumerated in the NHS Constitution. Unfortunately for downthecreek's line of argument, that happened only this year, 2009.

Before that you have to look to common law, so a relevant question might be -- when was the first lawsuit successfully prosecuted against NHS (or the government) for failing in their duty to provide health care?

Kaa

Kaa
08-14-2009, 02:34 PM
On the right to emergency care:

That mostly talks about ethics and I'm talking about legalities, legal rights.

I think in the US some form of right to emergency care exists -- that is, a hospital cannot turn away an emergency patient for non-medical reasons (e.g. inability to pay).

Kaa

Kaa
08-14-2009, 02:38 PM
However, if Kaa wishes to research this point (because I have no interest in doing so for him)...

Research? I thought you knew. So, it turns out you don't know, and can't be bothered to figure it out, either... :D

Kaa

downthecreek
08-14-2009, 02:46 PM
Well, it seems that a general right to health care became enumerated in the NHS Constitution. Unfortunately for downthecreek's line of argument, that happened only this year, 2009.

Rubbish. If you want the answers, do as I suggest. I'm afraid my lack on interest in playing your game does not constitute evidence that you are right. If you want to know the answer, do the work.


Before that you have to look to common law, so a relevant question might be -- when was the first lawsuit successfully prosecuted against NHS (or the government) for failing in their duty to provide health care?
KaaSuch cases are not common, because the NHS does, in fact, provide universal health care. But they exist and records can, no doubt, be located on the internet if you are interested. Which, of course, you are not. :D

There is, in fact, an interesting case in progress at the moment concerning health care provision to a remote rural community. Hasn't got to court yet, but it might. One thing that is not in dispute is the fact that the people involved are entitled to health care and the PCT has a duty to provide it.

Sorry, Kaa, but you really don't know what you are talking about (that much is obvious) and I really can't be bothered to play the internet link game with you. I have grown very bored with that.

downthecreek
08-14-2009, 02:50 PM
Research? I thought you knew. So, it turns out you don't know, and can't be bothered to figure it out, either... :D

Kaa

I do know. But I'm not going to waste my time turning up lots of links to show you at precisely which point each aspect of health care was enshrined in law. After all, what you think about it really doesn't matter to me :)

downthecreek
08-14-2009, 02:52 PM
Ain't no such thing as "unwritten constitution". You're referring to common law which is a bit of a different thing.


Americans never could comprehend the concept of the unwritten constitution. :)

Kaa
08-14-2009, 02:54 PM
Rubbish. If you want the answers, do as I suggest. I'm afraid my lack on interest in playing your game does not constitute evidence that you are right.

Of course, your lack of interest does not constitute evidence that you're right, either :D


Such cases are not common, because the NHS does, in fact, provide universal health care. But they exist and records can, no doubt, be located on the internet if you are interested. Which, of course, you are not. :D

Let's recall that you have made affirmative statements about having an enforceable legal right to health care. When I pressed for details of these rights, you lost interest and started suggesting that I research the topic. I happen to have no particular interest in determining whether your perceptions are correct -- but you, who sets them out as "facts", might.


Sorry, Kaa, but you really don't know what you are talking about (that much is obvious) and I really can't be bothered to play the internet link game with you. I have grown very bored with that.

LOL. You seem to have difficulties in tearing yourself away from my chaff. I have urged you several posts ago not to waste you valuable time with it -- perhaps it's time for you to take my advice? :D

Kaa

downthecreek
08-14-2009, 03:12 PM
LOL. You seem to have difficulties in tearing yourself away from my chaff. I have urged you several posts ago not to waste you valuable time with it -- perhaps it's time for you to take my advice? :D

Kaa

Your "chaff", if you recall, is your preoccupation with "rights" and "common good". For practical purposes, this is irrelevant to the situation in the UK and most European countries.

If you are interested in the question you have asked and want to have a look at the 1946 NHS act and subsequent legislation, be my guest. You might learn something. If not, fine by me. Somehow, I've grown weary of "discussions" that are actually nothing more than ego battles.

Uncle Duke
08-14-2009, 03:23 PM
"discussions" that are actually nothing more than ego battles. Another case of "counting coup"? :D

Kaa
08-14-2009, 03:23 PM
Your "chaff", if you recall, is your preoccupation with "rights" and "common good". For practical purposes, this is irrelevant to the situation in the UK and most European countries.

If that is so, why did the NHS Constitution feel the need to become quite explicit about legal rights?


Somehow, I've grown weary of "discussions" that are actually nothing more than ego battles.

That was more an exchange of snippiness than an ego battle :-) Perhaps if you weren't so adamant about the unworthiness of my posts, the discussion might have turned out to be more civilized?

Kaa

Osborne Russell
08-14-2009, 04:00 PM
The thing about rights is kind of tweaked. There are rights to property and liberty, which may include many things, but health care isn't one of them. Neither is education. Property and liberty are that which you cannot be deprived of without due process of law.

So what? There's no right to highways either but there's millions of miles of them. No one deprived of any rights. The only real question is: does the American Constitution permit socialized medicine? Of course.

Is it a good idea? Different question. But let's be clear, no one's rights to anything are involved, directly. Just like highways.

Duncan Gibbs
08-14-2009, 06:03 PM
What a truly idiotic debate... I mean to have it at all!

I know not of ONE Australian who would give up the Medicare system (this country is where you got the name for your 'system') in favour of minimal care in the form of the emergency room and hefty insurance premiums or having their insurance tied to their employment status. No system is going to be perfect and ours has room for much improvement. But the US doesn't have a 'system,' it has the market place. And those who cannot afford to pay simply go under.

Our system has a ranking of procedures and treatments with life saving or life prolonging ones up the top and elective or optional procedures and treatment down the bottom. Certain items are covered by private insurance only such as cosmetic surgery (face lifts, boob jobs and the like). Death panels my arse!

TomF
08-14-2009, 08:11 PM
Ain't no such thing as "unwritten constitution". You're referring to common law which is a bit of a different thing. No, it's simply true that you don't have an unwritten constitution.

The British constitution remains primarily unwritten, and the written bits are spread across any number of Acts. The Canadian Constitution includes the British North America Act (1867) and the Constitution Act (1982), but retains substantial bits as unwritten.

This has both enabled our Constitutions to be re-interpreted over time to keep pace with societal change, and kept constitutional lawyers and courts in business for generations.

We had a rather substantial change revealed in our Constitution last December, when our Governor General was asked to prorogue Parliament, and not allow a minority government to fall via a vote in the House.

Many Constitutional experts believe that despite the apparent choice she had, really that was an illusion. That a Governor General does not retain the power to act contrary to the request of a sitting Prime Minister, though this power was never questioned in the past. The loss of power was an implicit constitutional amendment.

Kaa
08-14-2009, 10:01 PM
No, it's simply true that you don't have an unwritten constitution.

The British constitution remains primarily unwritten, and the written bits are spread across any number of Acts. The Canadian Constitution includes the British North America Act (1867) and the Constitution Act (1982), but retains substantial bits as unwritten.

Any particular reason you like to refer to this collection of written and unwritten bits as "constitution"?

Kaa

Sam F
08-15-2009, 08:49 AM
What a truly idiotic debate... I mean to have it at all!

Nah. Those of us in the US are going to be stuck with whatever happens and that's kinda important you know.


I know not of ONE Australian who would give up the Medicare system (this country is where you got the name for your 'system') in favour of minimal care in the form of the emergency room and hefty insurance premiums or having their insurance tied to their employment status.

Which means what to us?
Look, if you Australians have a great system, which AFAIK it's pretty good, then the best you could do is point out what works about it and advocate that for everyone else.
Why hide your light under a basket?
But as far as I can tell the various proposals being considered are not the Australian model.



No system is going to be perfect and ours has room for much improvement. But the US doesn't have a 'system,'

That's quite correct. It's not a system it's a sort of amorphous blob - a combination of for-profit, government funded and charity.


...it has the market place. And those who cannot afford to pay simply go under.

That is not true.


Death panels my arse!

So far as I've heard nobody has claimed anything of the sort from Australia.
Now, such a thing would never have been considered as likely in the US either and it's probably true that no proposal that may pass in the US will explicitly have that provision. But anybody who trusts our politicians and bureaucrats (i.e. the agencies who actually interpret the rules and implement them) to abide by any law in it's most pro-life intepretation is just crazy - or stupid.

Keith Wilson
08-15-2009, 10:50 AM
But anybody who trusts our politicians and bureaucrats (i.e. the agencies who actually interpret the rules and implement them) to abide by any law in it's most pro-life intepretation is just crazy - or stupid.Probably true, and a very good thing too, since the "most-life interpretation" is quite an extreme position, held by only a small fraction of the population.

Sam F
08-15-2009, 05:21 PM
Probably true, and a very good thing too, since the "most-life interpretation" is quite an extreme position, held by only a small fraction of the population.


"most-life"? Must be rare. Never heard of it.

George Roberts
08-15-2009, 06:57 PM
"So far as I've heard nobody has claimed anything of the sort from Australia."

Some Google searching finds this description of part of the Australian Medicare system:

"The Medical Services Advisory Committee (http://www.msac.gov.au/)advises the Minister for Health and Ageing on the strength of evidence on new medical technologies and procedures in terms of their safety, effectiveness and cost effectiveness, and under what circumstances funding by the Medicare benefits should be supported."

It seems that Australia also makes decisions as to what treatments are covered for end of life care. Some people like to call the panel that makes that decision a "death panel." I don't like the name, but it appears to be apt.

Uncle Duke
08-15-2009, 07:25 PM
It seems that Australia also makes decisions as to what treatments are covered for end of life care. Some people like to call the panel that makes that decision a "death panel." I don't like the name, but it appears to be apt.

What's wrong with "artificial extension of life at any cost panel"? Too wordy?
:D

Keith Wilson
08-15-2009, 08:51 PM
Oops; typo. Fixed it.

George Roberts
08-16-2009, 01:36 AM
What's wrong with "artificial extension of life at any cost panel"? Too wordy?
:D

I like it. :)

It is often said that a funeral is for the benefit of the living. My mother-in-law and no longer recognizes anyone. I can see how hard it has become for her 4 children, their spouses, and various other relatives. I am beginning to see the wisdom in "death panels." "Death panels" could remove a burden from those who have to go on living.

Duncan Gibbs
08-16-2009, 06:07 AM
"So far as I've heard nobody has claimed anything of the sort from Australia."

Some Google searching finds this description of part of the Australian Medicare system:

"The Medical Services Advisory Committee (http://www.msac.gov.au/)advises the Minister for Health and Ageing on the strength of evidence on new medical technologies and procedures in terms of their safety, effectiveness and cost effectiveness, and under what circumstances funding by the Medicare benefits should be supported."

It seems that Australia also makes decisions as to what treatments are covered for end of life care. Some people like to call the panel that makes that decision a "death panel." I don't like the name, but it appears to be apt.

What utter piddle!

I can hear the cry of the medical hawker now: FRONTAL LOBOTOMIES!! GET 'EM HERE NOW! ROLL UP! ROLL UP! ROLL UP!!:rolleyes:

The roll of the MSAC is to review what techniques and technologies are to receive public funding. This does not, for one second, mean certain items not funded are not available through private cover. But it also means that such an unfunded item usually is experimental (in which case it is undertaken by a university, medical institution or hospital, or has a much better alternative, rated on the combined basis of is safety, efficacy and cost effectiveness. Note the order in which those words appeared folks. ;)

There is NO panel that determines the fate of individual patients as that would be THE most STUPID and RIDICULOUS and INHUMANE notion. ANY government that attempted to institute such a system here would not last a term in office.

Like I said, that fact you guys are even HAVING this debate is idiotic.

You've copied our name 'Medicare,' now copy our system.

PeterSibley
08-16-2009, 07:07 AM
Well we can rely on George Roberts to come up with complete crap ..it's his job description .

Andrew Craig-Bennett
08-16-2009, 08:01 AM
Any particular reason you like to refer to this collection of written and unwritten bits as "constitution"?

Kaa

I had avoided this thread, but what's good enough for Downthecreek is good enough for me...here goes.

We call the British constitution the British constition because that is what it is. Some countries have a written document setting out how the national institutions are supposed to work, and others do not. In all cases, the constitution can be distinguished from other laws, be they statutes or precedents.

"Constitutional law" is taught to English law students and is a compulsory paper. Handing in a blank sheet will not get you qualified.

The difference between written and unwritten constitutions is more apparent that real, because a written consitution requires interpretation. The sum of the correct interpretations is the real Constitution and that would take rather a longer document than the actual written text.

The right to treatment on the NHS started as the ability to be treated on the NHS - there are abundant descriptions of people turning up in doctors' waiting rooms with horrifying ailments, which were perfectly treatable by 1948 medicine, on the day that the 1946 Act came into force, because until that day they had been unable to obtain treatment. It seems rather clear that from that day on they were entitled to treatment, free at the point of need.

downthecreek
08-16-2009, 12:02 PM
The right to treatment on the NHS started as the ability to be treated on the NHS - there are abundant descriptions of people turning up in doctors' waiting rooms with horrifying ailments, which were perfectly treatable by 1948 medicine, on the day that the 1946 Act came into force, because until that day they had been unable to obtain treatment. It seems rather clear that from that day on they were entitled to treatment, free at the point of need.

Thanks, Andrew. There has, of course, been a long succession of subsequent Acts of Parliament during the last 60 years that have specified and codified particular rights and these were finally pulled together and summarised in one document in the Constitution. There have also been a fair number lawsuits. However,since the right of qualified people to be treated is NOT in dispute, they usually relate to a specific and limited range of treatments - most commonly drug treatments not currently authorised by NICE.

This is not a question of opinion, but of fact. I don't care to waste my time responding to fatuous challenges to produce "proof", the object of which is patently not to verify, to explore or to learn, but to "win" at all costs.

I have often noticed how difficult it seems to be for some Americans (not all, of course, by a long chalk) to think outside an all-American box when it comes to grasping ways of doing things other than their own.

Duncan Gibbs
08-16-2009, 04:11 PM
Let us consider this statement:


I don't care to waste my time responding to fatuous challenges to produce "proof", the object of which is patently not to verify, to explore or to learn, but to "win" at all costs.

I have often noticed how difficult it seems to be for some Americans (not all, of course, by a long chalk) to think outside an all-American box when it comes to grasping ways of doing things other than their own.

...in the light of this statement:


Look, if you Australians have a great system, which AFAIK it's pretty good, then the best you could do is point out what works about it and advocate that for everyone else.
Why hide your light under a basket?
But as far as I can tell the various proposals being considered are not the Australian model.
Logic would say that the various proposals being considered are probably a combination of various aspects from universal health care systems from around the World. But, you're absolutely right Sam: Ours IS pretty good and you could do a lot worse than copy the Australian system straight up. As far as my "light under a basket," Sammy baby, its been shining brightly atop the hill for as long as I've posted on this topic on this board: Our system is FREE TO ALL. If any costs are incurred by the patient, they are minimal: Usually less than $25 to cover what is called the "gap" in GP's consultation costs. Major surgery or hospitalisation, however, costs $0.00. For those whose income is derived from welfare payments is or is below a certain threshold there are now costs are all treatments covered by the system are free.


But anybody who trusts our politicians and bureaucrats (i.e. the agencies who actually interpret the rules and implement them) to abide by any law in it's most pro-life intepretation is just crazy - or stupid.

So you would DENY universal health care to, say, children with leukaemia, or mothers who choose to give birth to down-syndrome kids because of their right to life views, or to people and their kids with serious illnesses and injuries who DON'T have private or employer funded health cover, on the basis that abortions may be funded by such a system?

Hmmmm... What to do? What to do?... Everyone else's needs or abortions??

Uncle Duke
08-16-2009, 04:20 PM
SamF:

But anybody who trusts our politicians and bureaucrats (i.e. the agencies who actually interpret the rules and implement them) to abide by any law in it's most pro-life intepretation is just crazy - or stupid.
Duncan:

Everyone else's needs or abortions??
We need to remember, of course, that all current versions under study state that no federal funds can be used for abortion. Sure - there will be some accounting issues there, but not insurmountable. So, trying to derail universal health care over the abortion issue is, uhm, ... idiotic? disingenuous?
Neither, actually. It is an attempt to legislate abortion rights using health care - another front for the "kill abortion rights" campaigners, who cannot see any issue without seeing abortion issues. What they want is for the plans offered under the bills to specifically say that no abortions will be performed, even if legal.

Kaa
08-16-2009, 08:59 PM
In all cases, the constitution can be distinguished from other laws, be they statutes or precedents.

That's interesting. Do tell, how does that distinguishing work?

Kaa

Kaa
08-16-2009, 09:00 PM
I don't care to waste my time responding to fatuous challenges to produce "proof", the object of which is patently not to verify, to explore or to learn, but to "win" at all costs.

Ah, chaff. Here we go again :D

You seem to have spent a fair amount of time in this thread expounding on your not caring to waste your time... :D


I have often noticed how difficult it seems to be for some Americans (not all, of course, by a long chalk) to think outside an all-American box when it comes to grasping ways of doing things other than their own.

LOL.

Kaa

Andrew Craig-Bennett
08-17-2009, 02:18 AM
That's interesting. Do tell, how does that distinguishing work?

Kaa

The constitution is concerned with how the country is governed, silly.:D

The Road Traffic Acts are to do with how I may use the public highway, the Theft Act is to do with theft and the Bill of Rights stipulates some liberties of citizens.

The Bill of Rights is part of the constitution; the other two are not.

That wasn't hard, was it?

downthecreek
08-17-2009, 04:22 AM
Nice little piece by Paul Krugman in today's NYT (Yes, I know the NYT is the devil's own daily to some :D)

http://www.nytimes.com/2009/08/17/opinion/17krugman.html?_r=1&th&emc=th

Keith Wilson
08-17-2009, 09:48 AM
Well there we are; Mr. Krugman said what I've been saying for a long time now. That's way too reasonable for the current debate.

George Roberts
08-17-2009, 10:02 AM
I read Mr. Krugman's article. He leaves out some interesting facts.

He praises the French system. Doctors there earn $50-100K. Not in line with what health care professionals here deserve.

He praises the Swiss system. He says Massachusetts follows that system. I believe Tennessee does also. Neither system is moving in the direction that "following" the Swiss would imply.

He praises the VA (which follows the British system) and Medicare. Lots of complaints about both of those systems which is why neither is being expanded to cover all of us.

Certainly Mr. Krugman is reasonable. But reasonable in the sense that he writes a column to sell papers. Like everyone his comments are half truths that on examination turn out to be lies.

---

This weekend's news seems to be that the old now realize that their Medicare coverage will cover less and cost more under any of the proposed plans. The old are now moving toward the opposition of reform.

TomF
08-17-2009, 10:55 AM
I read Mr. Krugman's article. He leaves out some interesting facts.

He praises the French system. Doctors there earn $50-100K. Not in line with what health care professionals here deserve.Not in line with what American docs are paid, certainly. But even so, French GPs have about 1.5X the disposable income of the average French worker ... and as a sector they're the highest paid professional group in French society. http://www.worldsalaries.org/france.shtml

It's true that US GPs are far better paid, both in real and relative terms. The average American GP has about 3X the disposable income of the average American, and 2X the income of many other professionals (e.g. Engineers, University Professors, Airline pilots etc.). http://www.worldsalaries.org/usa.shtml. But that's a bit of an anomaly.

In fact, George, many many other industrialized countries have a much flatter disparity curve between physicians and other professionals - though GPs are typically top of the heap. Does this undervalue their GPs, or recognize the value of other professionals? Does the US get it "right," or is the American situation skewed by something ...?


He praises the VA (which follows the British system) and Medicare. Lots of complaints about both of those systems which is why neither is being expanded to cover all of us.Every system has lots of complaints. I suspect that the non-expansion of the VA or Medicare systems has more to do with the US' conditioned distrust of government than of actual poor outcomes. Witness, as Krugman points out, how vehemently the Town Hallers argue not to touch their Medicare benefits ... and the fact that the VA is one of 2 health outfits in the US (the other's Kaiser-Permanente) that regularly comes up on administrative best practices lists.

Certainly Mr. Krugman is reasonable. But reasonable in the sense that he writes a column to sell papers. Like everyone his comments are half truths that on examination turn out to be lies.Krugman's not lying any more than you are in reporting French GP incomes.

What he is doing is indicating that health systems, like any other system, reflects the cultures and beliefs of the polities in which they operate. The US polity, he argues, is probably more likely to welcome a Swiss model than others ... and that's why Obama seems to be presenting it.

As Krugman notes, this will be less financially efficient than what you've got, but more in keeping with Americans' values and belief systems.

downthecreek
08-17-2009, 11:38 AM
Not in line with what American docs are paid, certainly. But even so, French GPs have about 1.5X the disposable income of the average French worker ... and as a sector they're the highest paid professional group in French society.

British GPs are very well paid. So much so that we have quite a few doctors coming in from other parts of the EU. Can't quote figures because they are so variable, but most will be earning a good deal more than the Prime Minister. Senior specialists (consultants) also make plenty of dosh, although middle ranking hospital doctors in training for senior positions don't do so well.

They work hard for it.... :)

We have family in France. Health care there is very good indeed. I had an american friend who was thinking of visiting France with her father, who needed oxygen. She was stressing about this and said to me "well, I suppose they could manage something simple like oxygen..."!!!!! THis of the top rated health care system in the world when the WHO did their rankings and also one of the most sophisticated. I dunno!

Sam F
08-17-2009, 11:45 AM
…Logic would say that the various proposals being considered are probably a combination of various aspects from universal health care systems from around the World.

I don’t think that's logic. There is no necessary reason why any particular proposal would look like any other – there being more than on way to skin a cat.


… But, you're absolutely right Sam: Ours IS pretty good and you could do a lot worse than copy the Australian system straight up. As far as my "light under a basket," Sammy baby, its been shining brightly atop the hill for as long as I've posted on this topic on this board

Some heat yes, but very little light. …As far as I can tell the various proposals being considered are not the Australian model. Would you care to compare and contrast the Australian vs the US proposals? That would be a big help.


I’m sorry to say that this was no help:

… Our system is FREE TO ALL…

Oh? So the Australians have perfected the Free Lunch?
Excuse me if I exercise a healthy doubt about that.
May I remind you that the US govt. is beyond broke?
Somebody has got to pay for this expansion of government spending. It may be many things, but never free.


… So you would DENY universal health care to, say…

Did I say that? Did anybody say that?


… on the basis that abortions may be funded by such a system? Hmmmm... What to do? What to do?... Everyone else's needs or abortions??

Humm… But Uncle says:

… We need to remember, of course, that all current versions under study state that no federal funds can be used for abortion.

Izzat so?
“Pages 769-777 contain a section (Section 1714) on “State Eligibility Option for Family Planning Services.”

What do you suppose that’ll be interpreted to mean, eh?
Here's a clue from the 2006 Democratic Party's platform under the heading "Choice"

The Democratic Party also strongly supports access to comprehensive affordable family planning services...
Let’s see… “family planning services” in the Democratic Party's own platform means access to abortion.


… So, trying to derail universal health care over the abortion issue is, uhm, ... idiotic? disingenuous?

Humm… abortion “rights” are a plank of the Democratic Party’s platform.

Because we believe in the privacy and equality of women, we stand proudly for a woman’s right to choose, consistent with Roe v. Wade, and regardless of her ability to pay. (2004 version)
and

The Democratic Party strongly and unequivocally supports Roe v. Wade and a woman’s right to choose a safe and legal abortion, regardless of the ability to pay, and we oppose any and all efforts to weaken or undermine that right. (2006 version)

So where would anyone ever get the idea that the Democrats "oppose any and all efforts to weaken or undermine" abortion?
Search me!
The procedure is legal. Can anyone seriously believe that the people appointed by the Democratic administration and approved by the Democratic Congress will then deny publically funded* abortions in this or any healthcare bill the Democrats construct?
Not in this, or any other possible Universe they won’t.
Anybody who trusts our politicians and bureaucrats (i.e. the agencies who actually interpret the rules and implement them) to abide by any law in its most pro-life interpretation is just crazy - or stupid.


*regardless of the ability to pay- Duh!

Keith Wilson
08-17-2009, 11:53 AM
Somebody has got to pay for this expansion of government spending. It may be many things, but never free.Of course not. However, the US currently has by far the world's most expensive health care system, both in absolute terms and as a percentage of GDP, where we pay 1.8x the OECD average. The cost problem is not with a reformed system, but with the current one. We simply can't afford it anymore.

Sam F
08-17-2009, 11:55 AM
Of course not. However, the US currently has by far the world's most expensive health care system, both in absolute terms and as a percentage of GDP, where we pay 1.8x the OECD average. The cost problem is not with a reformed system, but with the current one. We simply can't afford it anymore.

So?
Who's says it doesn't need reform?
I mean other than the insurance companies (for painfully obvious reasons) there are very few who think that reform isn't needed.

Sam F
08-17-2009, 12:06 PM
Or in other words the US Healthcare system looks like this:
http://thereifixedit.com/wp-content/uploads/2009/07/tifi-airconditioned.jpg

Ugly, jury-rigged and inefficient, but it sort of works.
What we don't want is "reform" that works like this:

http://thereifixedit.com/wp-content/uploads/2009/08/jgordonac.jpg

Keith Wilson
08-17-2009, 12:22 PM
I see the problem; not enough duct tape! :D
Ugly, jury-rigged and inefficient, but it sort of works. It does, for some of the people some of the time. For others it doesn't work at all.

Yes, it certainly would be possible to screw it up worse than it already is; human ingenuity is boundless. But my point it that it is possible to provide a level of care comparable to what were doing now, but for everybody, not just those with good insurance, for considerably less than we're paying now. It's being done in some twenty countries as we argue.

Tom Montgomery
08-17-2009, 12:22 PM
Can anyone seriously believe that the people appointed by the Democratic administration and approved by the Democratic Congress will then deny publically funded abortions in this or any healthcare bill the Democrats construct?
Not in this, or any other possible Universe they won’t.
Well, this liberal Democrat has no problem whatsoever with abortion not being a reimbursable procedure under healthcare reform. In fact, I would urge my representatives in D.C. to see to it that abortion not be a covered procedure. It is enough that the procedure is legal and available. It should be paid for out of pocket.

Keith Wilson
08-17-2009, 12:27 PM
If that's what it takes to pass good heath care reform, I'd gladly put up with abortion not being covered. It's not what I'd choose, but if that's what's standing in the way, it's certainly worth compromising on that point.

Uncle Duke
08-17-2009, 12:46 PM
Moi:

We need to remember, of course, that all current versions under study state that no federal funds can be used for abortionSamF:

Izzat so?
“Pages 769-777 contain a section (Section 1714) on “State Eligibility Option for Family Planning Services.” What do you suppose that’ll be interpreted to mean, eh? Here's a clue from the 2006 Democratic Party's platform under the heading "Choice"... <blah, blah, blah>The question, Sam, as you know, is not what the election year platform of the Democratic Party is - it is what the elected representatives are putting into (or taking out of) the proposed health care plans. In terms of abortion, here is what is really on the table:
From here (http://www.nydailynews.com/news/politics/2009/08/05/2009-08-05_abortion_funding_debate_rages_in_president_obam as_health_care.html):

A compromise approved by a House committee last week attempted to balance questions of federal funding, personal choice and the conscience rights of clinicians. It would allow the public plan to cover abortion but without using federal funds, only dollars from beneficiary premiums.
Likewise, private plans in the new insurance exchange could opt to cover abortion, but no federal subsidies would be used to pay for the procedure.The Capps amendment (http://www.politifact.com/truth-o-meter/statements/2009/aug/07/john-boehner/boehner-says-democrats-health-care-plan-would-lead/) is quite specific:

A compromise plan offered by Rep. Lois Capps, D-Calif., which passed the House Energy and Commerce Committee, seeks to alleviate many of the concerns expressed by abortion opponents — particularly the issue of tax dollars being used to subsidize abortions — while specifically making abortion coverage available in both the public plan and in private plans participating in the exchange.

* Abortion coverage would not be part of the required minimum benefits package. In other words, insurers would not be required to offer, or be prohibited from offering, abortion services in order to participate in the exchange.

* The public plan could include abortion coverage, but the cost of the additional coverage could not be paid through public subsidies (tax dollars), only through the premiums paid by the insured. And with private plans in the exchange, again, federal subsidies could not be used for abortion coverage.

* Public funding would only be permitted for abortions allowed under the Hyde Amendment — in cases of rape, incest or when the mother's life is in danger.

* At least one plan in every region must offer full abortion coverage; and one must not.

* Any insurance plan participating in the exchange cannot discriminate against hospitals or other health care facilities (such as Catholic hospitals) that are unwilling to provide abortions.

* The plan will not pre-empt any state laws regarding abortion, such as parental notification laws.

TomF
08-17-2009, 01:00 PM
I…As far as I can tell the various proposals being considered are not the Australian model. Would you care to compare and contrast the Australian vs the US proposals? That would be a big help. It's been done, with so much repetition that it's now quite tedious.

The Commonwealth Fund is a highly regarded leader in this kind of comparison; here's one example: http://www.commonwealthfund.org/~/media/Files/Publications/Chartbook/2007/May/Multinational%20Comparisons%20of%20Health%20System s%20Data%20%202006/Cylus_multinationalcomparisonshltsysdata2006_chart book_972%20pdf.pdf

If it's just the impact of those systems you'd like to measure, there's a recent OECD 2009 report, released last month. While you'd need to buy the overall report and its findings, country by country summary information is excerpted at the link below. FWIW, the US still isn't performing terribly well. http://www.oecd.org/document/46/0,3343,en_2649_34631_34971438_1_1_1_1,00.html

Sam F
08-17-2009, 01:33 PM
It's been done, with so much repetition that it's now quite tedious...

Not by Mr. Gibbs Tom.

Sam F
08-17-2009, 01:35 PM
...The Commonwealth Fund is a highly regarded leader in this kind of comparison; here's one example:


That's amazing! The Commonwealth Fund document dates from 2007.
How did they know what would be proposed in 2009?

Sam F
08-17-2009, 01:37 PM
...FWIW, the US still isn't performing terribly well...

Wow! I'd never have guessed it.

Maybe... just maybe, you're stereotyping my position be assuming that I support the status quo?

TomF
08-17-2009, 01:50 PM
That's amazing! The Commonwealth Fund document dates from 2007.
How did they know what would be proposed in 2009?The Commonwealth Fund document does date from 2007; you'd asked about comparisons between the AUS and US health care systems ... neither's changed markedly since 2007. That's one of the most recent reports that takes a comprehensive view. :)

The Fund's also published a number of more recent issue specific comparisons involving both the US and AUS on the Commonwealth Fund website. Not knowing your particular interests, I won't link them for you. ;)

Some interesting reading, though.

TomF
08-17-2009, 01:51 PM
Wow! I'd never have guessed it.

Maybe... just maybe, you're stereotyping my position be assuming that I support the status quo?I'm making no such judgment, Sam. Just tried to point you towards solid, internationally respected comparisons of leading industrial countries' health systems.

Sam F
08-17-2009, 01:56 PM
The Commonwealth Fund document does date from 2007; you'd asked about comparisons between the AUS and US health care systems ... neither's changed markedly since 2007.

No, I did not. I said: "But as far as I can tell the various proposals being considered are not the Australian model."

Andrew Craig-Bennett
08-17-2009, 02:00 PM
British GPs are very well paid. So much so that we have quite a few doctors coming in from other parts of the EU. Can't quote figures because they are so variable, but most will be earning a good deal more than the Prime Minister. Senior specialists (consultants) also make plenty of dosh, although middle ranking hospital doctors in training for senior positions don't do so well.

They work hard for it.... :)

We have family in France. Health care there is very good indeed. I had an american friend who was thinking of visiting France with her father, who needed oxygen. She was stressing about this and said to me "well, I suppose they could manage something simple like oxygen..."!!!!! THis of the top rated health care system in the world when the WHO did their rankings and also one of the most sophisticated. I dunno!

The average earnings of British GP's last year were £125,000 - some earned twice that.

http://www.telegraph.co.uk/news/newstopics/politics/3884528/NHS-hospital-doctor-earning-almost-300000-a-year.html

This graph from the British Medical Journal shows the figures for GPs for 2003-4, before the NHS issued its new contract, which increased GP's earnings by an average of 23% - I respectfully remind American readers that the numbers are Sterling:

http://www.bmj.com/content/vol334/issue7587/images/medium/docspayfeb03.f1.gif

TomF
08-17-2009, 02:14 PM
No, I did not. I said: "But as far as I can tell the various proposals being considered are not the Australian model."Mea culpa. I read into that ... assuming that since Duncan's been talking the AUS system up, you might be interested in seeing why.

I assume the reason you're not considering replicating the AUS system is the same preventing you from replicating that of the UK, France, Canada, New Zealand etc.. It is grounded in a universal, single-payer, tax-funded model. To make health insurance reform even potentially saleable in the US, looks like you need private insurance firms to retain pride-of-place, rather than move them gently into a secondary role. This ensures that your costs will continue to be higher than necessary to sustain a profit margin - as is true with Switzerland.

It's an ideological commitment that's rather unique even within US; in other sectors, you're quite content to see the Government have a leading though not exclusive role (education, infrastructure, social services etc.).

Though it's fine to operate both private and public (i.e. tax funded) universities, transposing the same practices into Health is communism.

George Roberts
08-17-2009, 02:31 PM
Quote:
Originally Posted by George Roberts http://www.woodenboat.com/forum/images/buttons/viewpost.gif (http://www.woodenboat.com/forum/showthread.php?p=2290053#post2290053)
I read Mr. Krugman's article. He leaves out some interesting facts.

He praises the French system. Doctors there earn $50-100K. Not in line with what health care professionals here deserve.

Quote of a response:

"Not in line with what American docs are paid, certainly. But even so, French GPs have about 1.5X the disposable income of the average French worker ... and as a sector they're the highest paid professional group in French society. http://www.worldsalaries.org/france.shtml

It's true that US GPs are far better paid, both in real and relative terms. The average American GP has about 3X the disposable income of the average American, and 2X the income of many other professionals (e.g. Engineers, University Professors, Airline pilots etc.). http://www.worldsalaries.org/usa.shtml. But that's a bit of an anomaly.

In fact, George, many many other industrialized countries have a much flatter disparity curve between physicians and other professionals - though GPs are typically top of the heap. Does this undervalue their GPs, or recognize the value of other professionals? Does the US get it "right," or is the American situation skewed by something ...?

---

My reply to the above:

I suppose that we will have to restructure the pay of all professionals so that doctors are near the top of the pay scale. Seems fair enough. I am sure some government board will start to set pay. The current pay czar would never have time to handle the entire population.

And with pay being set by the government I guess tax revenues will go down.(I assume in part the way we get health care cost reduction is to reduce pay of the providers.)

Free enterprise is difficult, messy, and seldom fair. But it is a system we seem to value - until we want more and then ...

Uncle Duke
08-17-2009, 02:37 PM
TomF:

It's an ideological commitment that's rather unique even within US; in other sectors, you're quite content to see the Government have a leading though not exclusive role (education, infrastructure, social services etc.).
Quite correct - the questions was raised earlier:

why should we consider health-care to be a market driven commodity instead of a normal human need like clean water?
And the respondent suggested that would like buying food through insurance and submitting your weekly food bills to a committee for payment. The key stumbling block is exactly that - that there is not enough public/political will to define health-care as a 'public good', and that almost any argument will be used to divert attention from that discussion.
Change is scary.

TomF
08-17-2009, 02:45 PM
You will obviously do what you wish, George.

FWIW though, implicitly any service which is contracted by government includes a pay structure. If government sets aside $5M to build a stretch of road, whether they do it directly with Department of Transportation staff and equipment or through a sub-contractor, the wage bill is limited by the public funds allocated.

What is difficult to understand is why you folks are so headed-up about "small government" and controlling "boondoggle" costs, but are so unwilling to put even notional caps on health spending. You put them there for everything else that's publicly funded - highways, universities, forest services, policing, etc. Why is it so desperately much more important to have unlimited laissez-faire for health care professionals, but not for the armed forces or police? Is one group more worthy than the other?

TomF
08-17-2009, 02:54 PM
...And the respondent suggested that would like buying food through insurance and submitting your weekly food bills to a committee for payment. ...And of course, it's nothing like that.

It's like sending your child to a K-12 school, and paying for their education through taxes. If you don't like the public school system, you can opt for a private one ... that's probably got to meet some curriculum standards too.

In fact, the biggest difference you'll find from the K-12 public school analogy is that physicians' associations are far more effective at maintaining education and work performance standards of their members than most teachers unions.

More effective in their collective bargaining too ... as they negotiate with government over their fees. ;)

Uncle Duke
08-17-2009, 03:24 PM
why should we consider health-care to be a market driven commodity instead of a normal human need like clean water?
...And the respondent suggested that would like buying food through insurance and submitting your weekly food bills to a committee for payment. ..TomF:

And of course, it's nothing like that. Quite right - that analogy is specious at best. If he had really wanted to use the food analogy he might have said that universal health care, as a public good, would be analogous to everybody getting a half cup of rice each day from the government, but being able to go to the store and get better food if he/she wanted and could afford to.
But that analogy would have defeated his purpose - which was to avoid discussion what constituted a 'public good' - wouldn't it?:D

Keith Wilson
08-17-2009, 03:58 PM
Interesting question. As a society, we decide that certain things should be public goods, provided to all and funded through taxes - public schools, fire departments, police protection, roads, harbor facilities, national parks, the FDA, etc. Some things are partially public and partially private, with tax-funded assistance for some people or some instances - food, with food stamps; housing, with Section 8; arts and entertainment, with the NEA; heath care with Medicare, Medicaid, the VA. Other things are purely private; they are produced mostly for profit and people buy them if they wish with their own money.

Other wealthy countries consider health care a public good, to be provided for all out of tax dollars. Most of them also allow people to buy it out of their own pocket if they wish. They provide health care to all their citizens at a substantially lower cost than the US does.

Other than the fact that some people are making a lot of money off the current arrangement and want to continue to do so, is there any rational reason why health care in the US should not be considered a public good?

P.I. Stazzer-Newt
08-17-2009, 04:25 PM
....
Other than the fact that some people are making a lot of money off the current arrangement and want to continue to do so, is there any rational reason why health care in the US should not be considered a public good?

It will cost some people more in increased taxes than they currently need to spend on insurance - who these people are is left as an exercise for the interested..

Duncan Gibbs
08-17-2009, 04:34 PM
Like I keep saying this "debate" is truly idiotic.

Sam, I'm not going to even attempt to 'prove' to you how good the AUS system is. If you don't get the notion of universal health care now, I doubt you ever will.

I feel incredibly lucky to have been born and live in Australia and receive the level of health care I do, and I feel very sorry for those who miss out on decent health care in the USA.

Sam F
08-17-2009, 07:43 PM
Mea culpa. I read into that ... assuming that since Duncan's been talking the AUS system up, you might be interested in seeing why.

Well, Duncan doesn't seem to get it either (see post just above*). Sure looks like stereotyping to me.


To make health insurance reform even potentially saleable in the US, looks like you need private insurance firms to retain pride-of-place, rather than move them gently into a secondary role. This ensures that your costs will continue to be higher than necessary to sustain a profit margin - as is true with Switzerland.

I don't recall saying much of much positive about insurance companies - ever.
Perhaps you didn't read the article I posted and quoted.


It's an ideological commitment that's rather unique even within US;
I wouldn't know. I don't have an ideology.



in other sectors, you're quite content to see the Government have a leading though not exclusive role (education, infrastructure, social services etc.).

The article I quoted happens to do just that.


*"If you don't get the notion of universal health care now, I doubt you ever will."
Did anyone object to everybody getting health care? Does anybody, anywhere, do that?

Tom Montgomery
08-17-2009, 07:48 PM
Like I keep saying this "debate" is truly idiotic.

I feel incredibly lucky to have been born and live in Australia and receive the level of health care I do, and I feel very sorry for those who miss out on decent health care in the USA.

But we are free unlike you poor wretches enslaved by socialism.

Glen Longino
08-17-2009, 08:30 PM
"I wouldn't know. I don't have an ideology." Sam F

Uhh....cough....sputter....spew....ahem...choke... .wheeeeze....pee my britches....somebody get me a casket....wheeeeeeze....I'm losing it here...anybody got a respirator?
If you ever do get an ideology, Sam, please let me be one of the first to know, okay?:D

Uncle Duke
08-17-2009, 08:51 PM
If you ever do get an ideology, Sam, please let me be one of the first to know, okay?
Heck, many here would settle for " If you ever get an idea which you want to actually state as personal belief and stand behind...":D:D:D

Duncan Gibbs
08-17-2009, 09:40 PM
But we are free unlike you poor wretches enslaved by socialism.

Hell! I'm a corporate lacky, typing on computer owner by a listed company (during my lunch break of course). Of course we all have to start the day by quoting from Das Kapital! :rolleyes::D;)

skuthorp
08-18-2009, 02:55 AM
But we are free unlike you poor wretches enslaved by socialism.

Hah!, what a laugh! If it's not droll satire, this remark deserves nothing but ridicule. If it is LOL.

downthecreek
08-18-2009, 04:38 AM
Hah!, what a laugh! If it's not droll satire, this remark deserves nothing but ridicule. If it is LOL.

Considering the source, I think LOL is in order ;)

TomF
08-18-2009, 07:07 AM
Considering the source, I think LOL is in order ;)oh yeah.

Tom Montgomery
08-18-2009, 07:09 AM
Yep. It was droll satire. ;)

But the town hall disrrupters seem to be convinced that it is the truth. And the GOP is pandering to their ignorance.

Andrew Craig-Bennett
08-18-2009, 07:12 AM
http://www.salon.com/comics/tomo/2009/08/18/tomo/story.jpg

Tom Montgomery
08-18-2009, 07:13 AM
"I wouldn't know. I don't have an ideology." Sam F

Uhh....cough....sputter....spew....ahem...choke... .wheeeeze....pee my britches....somebody get me a casket....wheeeeeeze....I'm losing it here...anybody got a respirator?
If you ever do get an ideology, Sam, please let me be one of the first to know, okay?:D

He also sez he is no conservative. :rolleyes:

Sam F
08-18-2009, 08:33 AM
"I wouldn't know. I don't have an ideology." Sam F

Uhh...

Apoplexy isn't called for Glen. Just a dictionary ought to suffice:

1. the body of doctrine, myth, belief, etc., that guides an individual, social movement, institution, class, or large group.
2. such a body of doctrine, myth, etc., with reference to some political and social plan, as that of fascism, along with the devices for putting it into operation.
As such, ideologies are substitutes for religion.
As you should already know, I don't need no stinking ideology. ;)


If you ever do get an ideology, Sam, please let me be one of the first to know, okay?

I promise I will Glen. But it ain't gonna happen.

TomF
08-18-2009, 08:38 AM
As such, ideologies are substitutes for religion.
As you should already know, I don't need no stinking ideology. ;)You've recovered then? Time to change that sig line ...:)

Keith Wilson
08-18-2009, 08:40 AM
According to the dictionary entry Sam guoted, "religion" and "ideology" are interchangeable under certain circumstances. The following describes Roman Catholicism quite accurately.
1. the body of doctrine, myth, belief, etc., that guides an individual, social movement, institution, class, or large group.

Sam F
08-18-2009, 08:42 AM
What leads me to suspect the influence of La La Land in all this "discussion" (other than persistent stereotyping) is that the question:
"Since the Feedrail government is broke, who is going to pay for all this?" remains unresolved.

Sam F
08-18-2009, 08:43 AM
According to the dictionary entry Sam guoted, "religion" and "ideology" are interchangeable under certain circumstances. The following describes Roman Catholicism quite accurately.

Sure. Isn't that what I've said many times?: Ideologies function like religions.
But are you going to class your Liberal ideology as a religion?
Not likely! :D

Tom Montgomery
08-18-2009, 08:44 AM
ideologies are substitutes for religion.
As you should already know, I don't need no stinking ideology.

In your case, it is a distinction without a difference.

Uncle Duke
08-18-2009, 10:46 AM
Ideologies function like religions.
But are you going to class your Liberal ideology as a religion?
Not likely!
Industrial robots function like human workers. Are you going to class robots as human?
Not likely!
Your logic is broken (again) Sam - you apparently don't care that "like" does not equal "is".

Sam F
08-18-2009, 10:56 AM
Industrial robots function like human workers. Are you going to class robots as human?

No.
Does anybody, anywhere, do that?


Your logic is broken (again) Sam - you apparently don't care that "like" does not equal "is".

Apparently you aren't getting it. I didn't say that ideologies are religions.
Ideologies are substitutes for religion.
Naturally, since I have a religion, I have no need for an ideology.

Sam F
08-18-2009, 10:57 AM
You've recovered then? Time to change that sig line ...

Nope.
Nobody ever fully recovers from Atheism.

Uncle Duke
08-18-2009, 11:00 AM
SamF:

Ideologies are substitutes for religion.
Naturally, since I have a religion, I have no need for an ideology.
That is, of course, your personal opinion. A larger group might say that religions are a type of ideology, or an example of ideology.
But if you believe that religion supercedes ideology, well, that must simply be a part of your ideology. Fair enough. Incorrect, but fair enough.

TomF
08-18-2009, 11:02 AM
Nope.
Nobody ever fully recovers from Atheism.Childhood experiences can certainly cause people to over-react and lash out when triggered. As they say, the emotional reaction's appropriate to the original event, but not to the current event.

I'll try to cut you some more slack.

t

Sam F
08-18-2009, 11:08 AM
SamF:

That is, of course, your personal opinion. A larger group might say that religions are a type of ideology, or an example of ideology.

A group might well say that (or anything else), but that would involve a serious anachronism.
Religion predates ideology by many many centuries.
So how can the antecedent be a subset of the descendant? I don't think it's possible.


ideology
1796, "science of ideas," originally "philosophy of the mind which derives knowledge from the senses" (as opposed to metaphysics), from Fr. idéologie "study or science of ideas," coined by Fr. philosopher Destutt de Tracy (1754-1836) from idéo- "of ideas," from Gk. idea (see idea) + -logy. Meaning "systematic set of ideas, doctrines" first recorded 1909. Ideologue first recorded 1815, in ref. to the Fr. Revolutionaries.
"Ideology ... is usually taken to mean, a prescriptive doctrine that is not supported by rational argument." [D.D. Raphael, "Problems of Political Philosophy," 1970]


But if you believe that religion supercedes ideology, well, that must simply be a part of your ideology. Fair enough. Incorrect, but fair enough.

I believe no such thing - though your "argument" is classic ideological thinking.
Since the term ideology in the sense it's used here is only 100 years old, it's extremely unlikely that religion could possibly be a subset of ideology - if anything it's quite the opposite.

Tom Montgomery
08-18-2009, 11:11 AM
You've really got your teeth into that bone. Now SHAKE IT, SAMMY!

Sam F
08-18-2009, 11:13 AM
Childhood experiences can certainly cause people to over-react and lash out when triggered.

Nah. The evidence is... that what makes y'all squirm is I know the Liberal/Atheist position from the inside out. Knowing where all the bodies are buried and not minding a bit revealing them in all their decomposed glory is just part of my heritage.


As they say, the emotional reaction's appropriate to the original event, but not to the current event.
:D About the only emotion you're likely to see from me is hilarity.


I'll try to cut you some more slack.

t :D :D That's be the day!

Sam F
08-18-2009, 11:13 AM
"Since the Feedrail government is broke, who is going to pay for all this?" remains unresolved.

Uncle Duke
08-18-2009, 11:16 AM
Darlin' Sammy. You really need to be more careful. "ideology" as a concept certainly pre-dates the use of that exact word, in the same way that "religion" as a concept pre-dates the use of the exact word. From the same site which you used above:

religion
c.1200, "state of life bound by monastic vows," also "conduct indicating a belief in a divine power," from Anglo-Fr. religiun (11c.), from O.Fr. religion "religious community," from L. religionem (nom. religio) "respect for what is sacred, reverence for the gods," in L.L. "monastic life" (5c.); according to Cicero, derived from relegare "go through again, read again," from re- "again" + legere "read" (see lecture (http://www.etymonline.com/index.php?term=lecture)). However, popular etymology among the later ancients (and many modern writers) connects it with religare "to bind fast" (see rely (http://www.etymonline.com/index.php?term=rely)), via notion of "place an obligation on," or "bond between humans and gods." Another possible origin is religiens "careful," opposite of negligens. Meaning "particular system of faith" is recorded from c.1300.
"To hold, therefore, that there is no difference in matters of religion between forms that are unlike each other, and even contrary to each other, most clearly leads in the end to the rejection of all religion in both theory and practice. And this is the same thing as atheism, however it may differ from it in name." [Pope Leo XIII, Immortale Dei, 1885]Modern sense of "recognition of, obedience to, and worship of a higher, unseen power" is from 1535. Religious is first recorded c.1225. Transfered sense of "scrupulous, exact" is recorded from 1599.
By your logic, there was no "religion" before 1200 AD. Even you don't believe that, do you?

Sam F
08-18-2009, 11:18 AM
...By your logic, there was no "religion" before 1200 AD. Even you don't believe that, do you?

Do tell?
Where did you get that idea?

Tom Montgomery
08-18-2009, 11:18 AM
"Since the Feedrail government is broke, who is going to pay for all this?" remains unresolved.Government being broke never stopped Ronald Reagan or Dubya from submitting budgets that recommended spending more than projected income. Why is this a concern of the right today?

Sam F
08-18-2009, 11:25 AM
"Since the Feedrail government is broke, who is going to pay for all this?" remains unresolved.

Tom Montgomery
08-18-2009, 11:52 AM
"Feedrail government"

That's cute. So where would you prefer to live?

Uncle Duke
08-18-2009, 11:58 AM
SamF:

Where did you get that idea? Well, you sweet young thing, I got it from you! :D
Maybe you remember your post #232 where you stated:

Religion predates ideology by many many centuries.
So how can the antecedent be a subset of the descendant?... and then offered your version of "proof" by showing that the word "ideology" was first spotted in English in 1796.
I merely noted that, using that logic, that the word "religion" was not spotted in English until 1200 (using, I think, the exact same site as you did).
If your logic says "ideology did not exist until 1796 because that exact word was not in print, in English, before that date", the the same logic must apply to "religion", and you have to agree that religion did not exist before 1200.
Unless, of course, you want to use 2 different kinds of logic depending on the word itself. If so, please say so....

Keith Wilson
08-18-2009, 12:05 PM
Religion predates ideology by many many centuries.
So how can the antecedent be a subset of the descendant? Eh? When a word, or even the idea which it represents, originated has nothing at all to do with whether one concept is a subset of another.

Uncle Duke
08-18-2009, 12:21 PM
As a change of pace, here is a Joe Scarborough interview with Anthony Wiener (D-NY) about public vs. private health-care. Great fun when Wiener absolutely stumps Scarborough with the question about "what do insurance companies bring to the table".....
Long but very worth it.
Video here (http://www.msnbc.msn.com/id/3036789/32459067#32459067).

Tom Montgomery
08-18-2009, 12:34 PM
Poor logic-impaired SammyF. Pwnd once again. I almost feel sorry for him. It's time for one of his fanboys to show up and give him an "attaboy!"

TomF
08-18-2009, 12:37 PM
As a prof of mine used to say, "ideology is how the other guy thinks."

Uncle Duke
08-18-2009, 12:47 PM
It's time for one of his fanboys to show up and give him an "attaboy!"I think that he can handle that himself - he is not the kind of person who needs, or wants, the support of others. Self praise is sufficient.
But in case I'm wrong: "ATTABOY, SAM!" :D

Sam F
08-18-2009, 01:22 PM
Eh? When a word, or even the idea which it represents, originated has nothing at all to do with whether one concept is a subset of another.
Maybe. Maybe not. It depends on the concept, doesn’t it?
But novel ideas do occur. Indeed the whole modern project depends on a belief in their existence. For an obvious example, take the concept of “over kill”.
It doesn’t appear anywhere in pre-20th Century documents. This new concept was a response to the unprecedented killing potential of nuclear* bombs. Did people kill before the mid-20th Century? Yes they did. They even attempted genocide, but nobody ever thought of over kill, where one does enough damage to kill everything over and over and over.
So unless you believe that there is truly nothing new – which would be contrary to the facts (as just demonstrated) - then in the history of ideas some novel concepts do in fact grow out of their antecedents.
So believe it or not, sometimes a specific word's coinage coincides with the idea's actual novelty, I demonstrated the creation of the term ideology and the earliest published date of its use (in the sense used here). As it happens, I know of no pre-modern ideologies. Now if you're able to demonstrate an ideology in that sense (i.e. a secular substitute “religion”), say in ancient Egypt, then I suggest you do so. Otherwise these objections are just ineffective quibbling. ;)

*Nuclear is another novel example… it doesn’t appear in the atomic sense in any pre-20th Century dictionary.

Keith Wilson
08-18-2009, 01:33 PM
Oh why not; a little pedantry is fun sometimes.
So believe it or not, sometimes a specific word's coinage coincides with the idea's actual novelty,Certainly it can. However, that tells us nothing at all about whether the older idea is a subset of the newer. It's quite possible to invent a larger category, a novel way of relating existing things. Thus the relatively recent idea of "ideology" can includes the older idea of religion, as well as newer inventions such as Marxism. What I took exception to was this statement, which doesn't really make much sense.
So how can the antecedent be a subset of the descendant?

Uncle Duke
08-18-2009, 02:21 PM
Now if you're able to demonstrate an ideology in that sense (i.e. a secular substitute “religion”), say in ancient Egypt, then I suggest you do so. Otherwise these objections are just ineffective quibbling
Your definition of 'ideology' includes this, right?

"philosophy of the mind which derives knowledge from the senses"

Stoicism would be one.

Sam F
08-18-2009, 03:09 PM
Oh why not; a little pedantry is fun sometimes.Certainly it can. However, that tells us nothing at all about whether the older idea is a subset of the newer. It's quite possible to invent a larger category, a novel way of relating existing things... Thus the relatively recent idea of "ideology" can includes the older idea of religion, as well as newer inventions such as Marxism.

Sure you can " invent a larger category, a novel way of relating existing things". And it would still be an anachronism to anyone who lived before the concept existed. Unless you claim to reverse the arrow of time. Caution! I really don't think you want to do that.
Evidence please. Demonstrate a pre-modern Ideology.
I suggested ancient Egypt, but Babylon will do as well.

Sam F
08-18-2009, 03:10 PM
As a prof of mine used to say, "ideology is how the other guy thinks."

That's rather unreflective. Not all ideologues think like that. In fact, it's not at all unusual to speak of competing ideologies.

Even Uncle doesn't do that:

...That is, of course, your personal opinion. A larger group might say that religions are a type of ideology, or an example of ideology.

Sam F
08-18-2009, 03:12 PM
Maybe SamF ought to look up the definition of the word 'pedantic'....

...but, then again, he'd find some way to argue that he isn't.


No problem for me Norman. If ya'll don like pedantic discussions then stop.
How's about this?
"Since the Feedrail government is broke, who is going to pay for all this?" remains unresolved.

Uncle Duke
08-18-2009, 03:13 PM
Darlin' Sammy:

Demonstrate a pre-modern Ideology.
I suggested ancient Egypt, but Babylon will do as well.
Greece work for you? Stoicism.

TomF
08-18-2009, 03:14 PM
No problem for me Norman. If ya'll don like pedantic discussions then stop.
How's about this?
"Since the Feedrail government is broke, who is going to pay for all this?" remains unresolved.The same people who pay for it now, but are getting lousy or patchy value. The same people who pay for it in every other state with a health care system.

Uncle Duke
08-18-2009, 03:14 PM
"Since the Feedrail government is broke, who is going to pay for all this?" remains unresolved.
How about this one for you: prove that the Federal Government is broke.
Difficulty: acknowledge the fact that it can issue money as needed.

Sam F
08-18-2009, 03:15 PM
Darlin' Sammy:

Greece work for you? Stoicism.

Nope. "Stoicism was a school of Hellenistic philosophy founded in Athens by Zeno of Citium in the early 3rd century BC."
Try again.

Sam F
08-18-2009, 03:15 PM
How about this one for you: prove that the Federal Government is broke.

That's easily the funniest thing I've seen in ages!!! :D :D :D :D

TomF
08-18-2009, 03:16 PM
Nope. "Stoicism was a school of Hellenistic philosophy founded in Athens by Zeno of Citium in the early 3rd century BC."
Try again.distinguish between a "philosophy" (system of though that you like) and an "ideology" (system of thought that you don't like), OK?

Sam F
08-18-2009, 03:17 PM
The same people who pay for it now, but are getting lousy or patchy value. The same people who pay for it in every other state with a health care system.

Uh... I'm kinda aware of that - though I hear in Australia it's "FREE"!
So you mean taxes will go up?
Right?
BTW, isn't this relevant to your "lying" thread? ;)

Kaa
08-18-2009, 03:18 PM
How about this one for you: prove that the Federal Government is broke.
Difficulty: acknowledge the fact that it can issue money as needed.

As a matter of fact, it can not.

It's the Federal Reserve that issues money and the Federal Reserve is NOT the Federal Government by design.

When the Federal Government wants money, it borrows it by issuing debt obligations, commonly known as Treasurys. If people stop buying them, the Federal Government will run out of money.

Kaa

Sam F
08-18-2009, 03:19 PM
distinguish between a "philosophy" (system of though[t] that you like) and an "ideology" (system of thought that you don't like), OK?

Heck no. Who said that the defining characteristic of ideology is that I don't like it?
Really Tom, you need to get out of the personalization of everything.

TomF
08-18-2009, 03:24 PM
Heck no. Who said that the defining characteristic of ideology is that I don't like it?
Really Tom, you need to get out of the personalization of everything.Don't just say you disagree, distinguish between a philosophy and an ideology for me then.

The terms frequently are used fairly interchangeably to describe frameworks of thinking ... from disagreeing points of view. Not unlike "terrorists" and "freedom fighters."

Sam F
08-18-2009, 03:25 PM
...When the Federal Government wants money, it borrows it by issuing debt obligations, commonly known as Treasurys. If people stop buying them, the Federal Government will run out of money.

Kaa

Yes, technically the US govt isn't broke by that definition. It's in debt up to it's scalp, but not "broke" since apparently the Chinese are still willing to purchase our debt for the moment.
Though apparently at the price of US Treasury Secretary Tim Geithner being laughed at... but that was just in good fun. Right?

Sam F
08-18-2009, 03:27 PM
Don't just say you disagree,

Who's doing that?

If you're sloppy enough you can not...
distinguish between a philosophy and an ideology...

Show me a pre-modern ideology Tom. Unless you like anachronism, it's not possible.
Or do you too want to reverse the arrow of time and put effect before its cause?

Kaa
08-18-2009, 03:30 PM
Yes, technically the US govt isn't broke by that definition. It's in debt up to it's scalp, but not "broke" since apparently the Chinese are still willing to purchase our debt for the moment.
Though apparently at the price of US Treasury Secretary Tim Geithner being laughed at... but that was just in good fun. Right?

That was a content-free post :D

Kaa

TomF
08-18-2009, 03:30 PM
Uh... I'm kinda aware of that - though I hear in Australia it's "FREE"!
So you mean taxes will go up?
Right?
BTW, isn't this relevant to your "lying" thread? ;)Free at point of access, is the usual term. Meaning it's tax-funded.

Obama's said he could fund his health care proposal out of budget savings - and it's a claim I heard supported by the accounting firm talking head interviewed by CNN on the issue. That does remain to be seen, I agree - but it's not just Obamaspeak. The accounting firm though Obama was being very, er, conservative. ;)

But Sam, if the US is already overspending by up to 40% on health care, the real story should be that better organized care should leave money in your jeans, not take more out. If they have to compete with a comprehensive Public model, you'll pay less to the Insurance Companies and receive more. And overall out-of-pocket costs for citizens will go down.

As many conservatives will tell you, that's the beauty of actual market competition. It drives down costs, and drives up quality.

TomF
08-18-2009, 03:38 PM
Who's doing that?

If you're sloppy enough you can not...

Show me a pre-modern ideology Tom. Unless you like anachronism, it's not possible.
Or do you too want to reverse the arrow of time and put effect before its cause?Hold it, Sam. Duke suggested Stoicism, which you rejected because it was a "philosophy" instead of an "ideology." I think he did pretty well though, and that Stoicism may be a decent candidate. As you disagreed with him, my post asked you to
distinguish between a "philosophy" (system of thought that you like) and an "ideology" (system of thought that you don't like), OK?to which you gave this meaty and informative response.
Heck no. Who said that the defining characteristic of ideology is that I don't like it?
Really Tom, you need to get out of the personalization of everything.Want to try again, and distinguish between an ideology and a philosophy?

Duncan Gibbs
08-18-2009, 04:41 PM
"Since the Feedrail government is broke, who is going to pay for all this?" remains unresolved.

Well if you guys bypass the HMOs and go straight to a flat levy system your costs WILL be reduced, since you WON'T be paying for private profit of large corporations from the public purse. Our system costs less than your current 'system' by all accounts, on a per capita basis.

Keith Wilson
08-18-2009, 04:47 PM
Demonstrate a pre-modern Ideology.
Ideology
1. the body of doctrine, myth, belief, etc., that guides an individual, social movement, institution, class, or large group. By the definition of ideology you posted, Roman Catholicism is an ideology (as well as a religion) although, of course, one called it that until the word "ideology" was invented. Other examples would be the ideology of the Roman Empire (including the idea of citizenship, the divinity of the Emperor, etc.) and the Confucian ideology that characterized Imperial China, all of which fit the definition above.

Q.E.D.

Uncle Duke
08-18-2009, 06:34 PM
Stoicism may be a decent candidate.
Indeed. Especially since it not only described a "philosophy" (school of thought) but also (1) mandated a system of behavior by which you would be judged and (2) mandated "talking points" whereby you could "prove" that your system/method was superior.
How is this not an ideology?
Sammy, any comment, you lovely thing?

SamSam
08-18-2009, 07:00 PM
.... but nobody ever thought of over kill, where one does enough damage to kill everything over and over and over.
So unless you believe that there is truly nothing new – which would be contrary to the facts (as just demonstrated) - then in the history of ideas some novel concepts do in fact grow out of their antecedents.

It was called beating a dead horse.

I wonder how someone like you was described before the word bull**** came into use?

Sam F
08-19-2009, 07:55 AM
Let's see if I understand the "controversy"...
I said religion and ideology weren't the same thing. The serve similar functions - like baskets and wheelbarrows but they definitely aren't the same.
The objection is that I'm wrong and they are the same thing.

Do I have that right?

Sam F
08-19-2009, 07:57 AM
It was called beating a dead horse.

OK! So say the US or Russia or China or Britain or France nukes some small town with some megatonage bomb - we'll call it beating a dead horse?
I don't think so!

Try again.

Sam F
08-19-2009, 07:58 AM
By the definition of ideology you posted, Roman Catholicism is an ideology (as well as a religion) although, of course, one called it that until the word "ideology" was invented.

So why was the word "ideology" invented if there was already a perfectly good word, "religion", that fit?
Explain please.