Thursday, May 15, 2008

Health Care, Revisited, Ad Infinitum

Pretty Lady cannot allow dear jSin to continue moping, all the way down at the bottom of that last thread, so she will take advantage of his tantrum to stir up the issue once again:
PL here indicates that she has insurance but might drop it because of the amount it costs. While I obviously cannot speak for the entirety of her finances, she seems to speak of a reasonably active social life. If health insurance is such a priority, where is it prioritized in the budget? If it is not more important than eating out and socializing to her, why should her having it be important to me?
Before Pretty Lady takes serious umbrage at the vast set of assumptions contained in this inflammatory passage, she must hasten to reassure herself that this is merely a Rhetorical Device on jSin's, part, not an actual indictment of her habits. Because jSin is pointing out the very real danger that a society which prioritizes taking care of its own, can very easily morph into one which controls its own.

However, the mere juxtaposition of these two notions may serve to indicate, to every reasonably discriminating mind, that they are not synonymous. Not by a long shot. So simmer down.

First, then, Pretty Lady must deal with the rhetorical smears on her character by stating the following:

1) Her health insurance payment is $300 a month, which is higher by a factor of six than her monthly socializing budget. Pretty Lady was not kidding when she said she was thrifty. Health insurance companies as a whole do not run on the same principles of economy with which she runs her own life, and this is one of the reasons she views the industry with grave circumspection.

2) Before she had health insurance, she invested a substantial portion of her income in yoga class cards, bicycles, bicycle helmets, bicycle repairs, excellent footgear for all types of terrain, arch supports, and the very occasional massage. Additionally, she works a monthly shift at the co-operative grocery store, which insures that she can afford to buy and consume organic produce daily, without bankrupting herself. These investments rendered her, usually, healthy as a French draft horse.

3) Socializing, in New York City, is not merely a frivolous endeavor, but is in fact vital to one's economic viability. Thus, Pretty Lady's stingy socializing budget is not necessarily a long-term savings; she would perhaps be served better in the long run if she partied more than she does now. Because people, by and large, prefer to do business with people they know, particularly if that business is of a highly esoteric variety.

4) Furthermore, socializing has been proven to be vital to one's health, as well. So attempting to separate out the two budgets is a nonsensical exercise, right at the start.

(As an aside, it is a tragic commentary on the state of our society when it is assumed that a person who maintains a healthy social life is assumed to be spending a great deal of money. Whatever happened to good old-fashioned conversation, plus a walk in the park? Round it off with a good cup of coffee or a beer at a dive bar, and life holds few greater pleasures.)

So. Since jSin is relatively new to Pretty Lady's circle, he may not be aware that Pretty Lady has already proposed a Universal Healthcare Plan, which addresses both the economic and social concerns he raises in his comments:
Yes, she proposes that the government freely give its low-income citizens money, to spend upon their own health. Rather like EBT vouchers.

This, of course, violates all established precendents of Condescension, Patronization, and Punitive Reinforcement. It presupposes a dangerous Lack of Control, and irresponsibly opens up the system for instances of Flagrant Abuse by the least deserving among us. It amounts to a Robin Hood philosophy of robbing the rich to reward the poor.

Or does it?

The key of Pretty Lady's plan is that this subsidization will not be unlimited. Persons shopping for health care will be presented with the challenge of frugality; they will be forced to make their own decisions. They will try things and see if they work; if they don't work, and are expensive, they will try something else. Meanwhile, healthcare practitioners who charge exorbitant rates for nothing at all will be forced into another line of work.

Note, furthermore, that the government is not running this system. Note that Pretty Lady has said nothing at all about Medicaid, Medicare, or prescription-drug plans. The only 'insurance' plan which makes sense to her, as she has said in the past, is a universal catastrophic-coverage plan, payments to be subsidized below a certain income level.

The universality of this plan, moreover, is key; this obviates any need for layers and layers of bureaucracy, put into place for the sole purpose of denying coverage to people in need. Once denial is no longer an option, the wit and wisdom of plan-managers will have nowhere to go but toward the efficient managing of resources for absolutely everybody.
As a healer herself, Pretty Lady has long noted that healing is best facilitated by the person in need of it. It cannot be imposed, it may only be accepted. Furthermore, people in general are not particularly motivated by fear of gruesome and painful demise; the Denial aspect of the human mentality kicks in, and the more you show them pictures of diseased lungs, the more they reach for a cigarette to calm themselves down.

Thus, attempting to control people's self-destructive habits is a non-starter; encouraging themselves to take good care of themselves by subsidizing massage therapy, yoga, organic produce and regular checkups might be infinitely more effective.

(Don't worry, Pretty Lady is not so delusional as to actually think that centuries of ingrained Puritanism will be overcome in her lifetime. She can only dream.)

In conclusion, let Pretty Lady remind the hard-core Libertarian contingent of her readership that human beings, as a group, are intimately and integrally connected. This is a fundamental and inescapable truth. One cannot propose a template for Human Liberty while simultaneously disclaiming any interest in the health and well-being of others; this is akin to attempting to launch a foot-powered airplane. Freedom for the individual depends upon consideration of the whole. And as Pretty Lady has demonstrated above, it is eminently possible to consider those less fortunate than oneself, without controlling them.


jSinSaTx said...

Ouch... moping? tantrum? I thought it was reasonably lucid and even toned.

Hardcore libertarian? Perhaps you missed my entire post on just one of the issues libertarians need to address...

I read your plan... obviously you lay it out as an idea with few supporting details (in which of course we would find the devils). I was not aware that you had it... I still think most of the comments in my past postings apply... a) Government actions in the past have done more than a little to foster this nightmare b) Everyone wants a subsidy c) Where is all the money current Western Civilization needs to maintain its programs going to come from.

It is C that I will look at in this particular post. While Obama and Paul are correct that we are wasting a fortune in military adventures all over the world... the idea that if we stop money will fall from the heaven like manna seems overblown. This reminds me of Bush the Elders 'Peace Dividend'... what dividend? Exactly.

We as a society are broke at every level... SS and Medicare alone will drive us into a financial ruin (ok... this is a bit mopey). And what is the idea for solving that problem? I doubt PL runs up significant medical expenses. I am sure with her full participation in the hippy routines available (truly an endearing quality) that she is not frequent at her local hospital. However, most medical care expenditures occur in the last 6 months of life. Short of avoiding the last 6 months of life, how does one avoid those expenses? As we have already committed to funding them to the largest voting block, and soon to be largest population block, in this country... again, where does the money come from?

One should hardly assume that I am an emotional poster. This represents the one way I can have a conversation with you at all. I abhor using emoticons... but if I need to throw smiley faces in here then I suppose I will... jSin hearts PL :)

jSinSaTx said...

As government has risen so has the requirement that we justify so many of our actions to it... even for EBT you have to provide family data, income etc. The idea of a client has long been established (and very documented from at least the Roman Republic times). You owe who you take from and the person you take from owns you. With each successive program and generation of a program it will become more invasive. Give one circus and the next one has to be bigger... Medicare is a perfect example of this... predicted to cost <100B by this time it costs way beyond... still not enough for our seasoned citizens... now cover medicine... which is predicted to cost 800B? What is the likelihood it runs less than 4T.

I do not believe that people are not interconnected... I do not believe we do not have obligations to others... if I was to trail out my personal efforts it would seem simply self promotion... but government is not society... government is not what interconnects us... government is force... sometimes force is necessary (how libertarian does that make me sound?) but must all associations, all charity, all civil interactions be driven by it?

jSinSaTx said...

Hmm let me throw in a :) hah hah (<--- see I thought it was funny) :) (I really did... not being sarcastic)

I honestly do appreciate your lengthy and thoughtful replies... I have found that people who think on things as a population are about as dead as conversation...

Pretty Lady said...

most medical care expenditures occur in the last 6 months of life. Short of avoiding the last 6 months of life, how does one avoid those expenses?


You use slow medicine.

"Grounded in research at the Dartmouth Medical School, slow medicine encourages physicians to put on the brakes when considering care that may have high risks and limited rewards for the elderly, and it educates patients and families how to push back against emergency room trips and hospitalizations designed for those with treatable illnesses, not the inevitable erosion of advanced age."

Be clear, this is NOT about euthanasia, or about giving up on people before their time. It is simply a recognition that heroic treatment at all costs can cross the line into death with terrible indignity, and gratuitous torture. Incorporating a bit of grace into our last months of life is not only cost-effective, but life-enhancing, IMHO.

Pretty Lady said...

Ouch... moping? tantrum?

Teasing hyperbole is one of Pretty Lady's signature characteristics. You need not emulate them, if they don't suit you. ;-)

jSinSaTx said...

If you are receiving your care on someone else's dime then this seems to be the logical future... if you are Bill Gates and want to flush 1B for another hour of breathing then so be it I suppose. I do think we work harder than most countries to stave off death... both at the beginning and ends of life. That comes with a price... both in dignity and dollars.

Well... I am glad to be the simple recipient of teasing. That I can take in good humor. I am more glad to be able to refrain from colon shift 0.

Desert Cat said...

Grounded in research at the Dartmouth Medical School, slow medicine encourages physicians to put on the brakes when considering care that may have high risks and limited rewards for the elderly

I would remain adamant that such decisions do not come from physicians but rather their patients, after being duly educated in the relative risks/rewards of a given therapy. At present my father is dying of leukemia, of a type (AML)that has a very low percentage of successful treatment at his age. Rather than either a) dive right in with painful and quality-of-life demolishing treatments with low chance of success, or b) deciding for him that they're not worth it, the doctor explained the situation to my dad and let him decide. He chose to take the path of a potentially shorter but higher quality life at the end. His only treatment now is to receive red blood cell transfusions to replace those his body is no longer producing. Eventually he runs out of donor matches and then the game's up. Maybe he has a year.

But that darn well better be the decision of the one dying, and not some cost-conscious bureaucrat. I would fight that tooth and nail.

Pretty Lady said...

DC, of course it must be the decision of the one dying; that's what 'death with dignity' is all about. And I have great respect for your dad's decision.

jSinSaTx said...

On a thread diverting note...

The Illinois senator also chided McCain and Bush for "saying no to America's farmers and ranchers, no to energy independence, no to the environment, and no to millions of hungry people."

How is this any different than anything else you here from other politicians?
While I have not read the bill... I find it hard to believe that opposition to it means you hate the American farmer and you want people to be hungry...

jSinSaTx said...

Now to rejoin the thread already in progress... the end result of government seems to involve it deciding who lives and who dies... who has value and who does not... that is a constant theme of almost all styles... they all just entail different answers or different methods of arriving at that point. If the government is paying for it (which means the application of force to those with the means to make them pay for services for those who do not) then the decision making process will divert to the person processing the funds. That does seem to be a legacy of W. Europe and not always to the betterment of those who are determined to be ready for 'carousel'...

jSinSaTx said...

Wow... I meant hear... not here... somebody needs to get a speak and spell... or hooked on phonics...

Chris Rywalt said...

I just want to say, PL, that your final paragraph here is fantastic. It took me years of being a cranky libertarian conservative P.J. O'Rourke reader before I realized the error of my ways, and your statement clearly outlines that error. Namely that without other people, we are not ourselves people.

Scientists have found that human beings, isolated from contact with other humans, rapidly deteriorate mentally and physically. Usually an isolated person will start to hallucinate in less than two weeks; full-blown psychosis sets in shortly after. (A person in an isolation tank, separated from sensory contact with the entire world, will start to hallucinate in about an hour.) In short: Any person's conception of themselves and the world around them is based on communication with other people. You don't exist unless other people exist.

Thus the idea of "pure" libertarianism is insane. What other people do is not entirely their business; it's yours, too. We're all too tangled up in each other for it to be otherwise.

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