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Community, rationing, and Health Care

Does the fear of "death panels" show one of the inherent problems with nationalizing health care (further) in the US? As several commentators have noted, medicine, like any other scarce good, must be rationed. The question is how, by whom, and for what reasons? Is it good to have a single, open, republic-wide discussion of such things? Will there ever be anythig like consensus about such things? Do we really want a frank and open, nationwide discussion of when not to pay for a hip replacement, or a heart bypass?

Progressives, with their faith in technocracy, are often content with the idea that experts can, across a large system, make reasonable calculations about such things. If a 85-year-old has a 20% chance of benefittig from a liver transplant, then give the new liver to someone else, etc. Is it better to have a system like the one we currently have, where there is some chance involved? In that chance, there is, I suspect, more room for individuals to make measured calculations of risk and reward for themselves. There is also less blunt discussion of when it is time for our parents, grandparents, etc., to stop fighting for life. I'm not sure I want to live in a society where such decisions are made by a rule, created by expert ethicists (partly because I don't think that people with PhDs in ethics are, in fact, better at making such rules). But if there is a single payer for health care, there must be such rules. How else can the government make such decisions?

To reiterate a favorite point, the US is not a small republc. In a republic of a few thousand, it might be possible to have a real, and legitimate community consensus about such things, and also to allow some play in the system. In a large republic, of thousands of communities, that's simply not possible. People get reduced to atoms in a health care system that coveres a republic of 300 million.

Categories > Health Care

Discussions - 4 Comments

Very well put. Mega-dittoes.

Oh, Richard.

Progressives, with their faith in technocracy, are often content with the idea that experts can, across a large system, make reasonable calculations about such things.

What kind of stupid assertion is that? Their faith in technocracy? As if Reagan REALLY got rid of the Department of Education . . . Come on, now. What is No Child Left Behind? Or any poll? Or the military? Or homeland security? Or immigration? You don't think that any administration would hire statisticians and "experts" to deal with this stuff? Turn off the Fox News, quit reading "National Review", and wake up. Sheesh.

Is it better to have a system like the one we currently have, where there is some chance involved?

Chance? Do you mean money? Or do you mean the "experts" at current health insurance companies (those "private sector" ones) who already determine risk? Do you know how many people are turned down for different procedures (or even for a particular plan) because of their medical conditions? Rather than have a government "expert" do it - a person appointed by an elected official or committee, who can be influenced by policy enacted by legislatures - you would prefer a corporate "expert" who determines such risk in a cost-effective model. I'm sure that the free-market approach to health care has treated you well, Mr. Adams. In the abstract, I'm sure it also makes for some pleasant fiction.

Please, please, please, understand something: there is no one advocating for a single-payer health system who Obama takes seriously. I wish this was not the case. For you, this is wonderful. It means that there will be plenty of corporate options for the rich and the government wary. You can choose to pay an profit-driven expert ethicist instead of a policy-driven one.

I guess to sum this up: I'm sure the government option will have rules. But there are already tons of rules, many of which are created to screw people out of their insurance and help a particular corporation turn a profit. Either you really have no idea how the health care industry really works, or you're pretending that those companies don't already evaluate potential policy holders according to risk-profit models or deny citizens with great credit because of particular illnesses or scour through medical histories in order to kick someone off their policy because they didn't fill out the paperwork right.

But keep scaring people, Mr. Adams. Because the government take-over is coming. Socialism is on the way. Private insurers won't be able to compete with the government (just like FedEx, UPS, private schools, NYC taxi cabs, etc.). And it's going to be single-payer!!!! Even though everyone counseling Obama about this and offering advice doesn't want that! He'll still get it through Congress!!! Are we Russia (the democracy) or something?!?!?

Matt, don't dismiss the idea that the public option is a strategy for destroying the private market in health insurance by offering lower premiums at the front end and then rationing the resulting artificial scarcities when the private market is smashed and there are no affordable private alternatives for the working and middle-classes. Private insurance companies might continue to exist, but with smaller risk pools (and no doubt tight federal regualation), private insurance costs will be even less affordable than now. You are right that private sector care would remain available, though at a high price, for the wealthy - which is why Congress would not vote to subject itself and its dependents to the mercies of whatever public option program exists. You are right that it would not be true single-payer. We would not all be in the same boat. It would have the effect of creating all the drawbacks of a single-payer system for the working and middle-classes, but not the wealthy.

How are we going to pay for it? Where do you get people who act out policy and don't look to make a profit?, government worker finds ways to profit. Where do you find policy makers not after profits? I am not a fan of our healthcare system at all but thinking that simply turning the keys over to the government is going to improve things and make it affordable is the stuff of LSD inspired commune ranting. Why not just get of currency? Just have a society where like some guy is the doctor and another guy makes shoes or whatnot and when your sick you just go to the doctor. People are sicker today than in the previous generation. Lets get some clear answers on that problem before anything else is done. I would like to know why cancer deaths went from one in sixty to one in two. Free healthcare is the cruelest of jokes in a society of corporate eugenics packing vaccines and colas full of poison.

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