October 6th, 2009 by DrRich in Better Health Network, Health Policy, Opinion
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In his previous post, DrRich used a combination of history, logic, and sleight of hand to convince even his most conservative readers that healthcare is indeed a right.
To summarize that erudite posting: The BOSS rule says it’s a right, so it’s a right – as long as we’re talking about a civil (or legal) right, and not about a natural (or inalienable) right.
A civil right is granted, more or less arbitrarily, by a government or a society, to some group of individuals, usually to redress a past grievance, or to attempt to achieve equality in outcomes, or for some other form of social justice. Civil rights almost invariably require a second group of individuals to sacrifice something of their own in order to satisfy the civil rights granted to the first group. So the granting of civil rights (as opposed to natural rights) will often be seen by at least some as being inherently oppressive, but if used appropriately civil rights can be very good for the furtherance of a stable and civil society. (As DrRich has pointed out, even our Founders – the great purveyors of natural rights – explicitly understood the importance of well-designed civil rights.) Civil rights, at least ideally, advance the virtue of justice, just as their creators claim. Read more »
*This blog post was originally published at The Covert Rationing Blog*
September 28th, 2009 by DrRich in Better Health Network, Health Policy, Opinion
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Is healthcare a right?
DrRich has visited this question before, but it keeps being raised by readers of this blog, some of whom have decidedly settled views on the matter (either to the affirmative or to the negative), and who angrily accuse DrRich of having the wrong view (that is, either to the affirmative or to the negative). DrRich is sorry to have confused so many people regarding his stance on this important question.
So, is healthcare a right? Well, to paraphrase the last president who was widely held to be a paragon of nuanced speech (who, Lincolnesque, once noted that the truth of some assertion or other “depends on what the meaning of is is”), it depends on which meaning of “right” is right.
Read more »
*This blog post was originally published at The Covert Rationing Blog*
September 23rd, 2009 by DrRich in Better Health Network, Health Policy, Opinion
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In his last post, DrRich considered the differences between a system of healthcare rationing in which individual autonomy is honored, and one in which the good of the collective takes precedence. DrRich concluded that the former is more desirable than the latter, since the latter would amount to throwing aside the Great American Experiment. In response to this post, an astute reader calling him/herself Jupe wrote:
. . in the case of a limited supply of an effective vaccine during a deadly epidemic, it doesn’t weird me out to think of docs and nurses being prioritized over, say, me. Or a hypothetical situation of military leaders being prioritized in the event of bio warfare So it’s not that collectivism inherently offends me across the board.
In my mind there seems to be some sort of invisible line in there somewhere, but I can’t identify what it’s based on or exactly where it’s at, or why. I just know when it’s been crossed.
Jupe then continues, quoting Ezekiel Emanuel on setting rules for healthcare rationing. Emanuel says, “. . .Conversely, services provided to individuals who are irreversibly prevented from being or becoming participating citizens are not basic and should not be guaranteed. An obvious example is not guaranteeing health services to patients with dementia.”
Jupe continues:
[That] just screams “line WAY WAY WAY CROSSED! HOLY CRAP!” to me. I know (well, deeply suspect) there actually is a fundamental difference between “doctors, nurses and military first to be immunized in the event of a bio-warfare attack” and “no antibiotics for the feeble minded” but I can’t pinpoint it outside of “it just intuitively seems right/wrong”.
DrRich interprets Jupe’s question as follows: Why does it intuitively seem OK to ration healthcare in the manner described in the first instance, but not in manner described in the second?
The most obvious answer would be that in the former case there’s an emergency, and extraordinary times call for extraordinary measures. For instance, in times of a war that threatens our survival, most of us would agree that a military draft – perhaps the ultimate sacrifice of individual rights for the good of the collective – is appropriate. And Lincoln, who was fighting a war whose explicit purpose he defined as upholding the Great American Experiment (i.e., to see whether a nation “conceived in liberty and dedicated to the proposition that all men are created equal could long endure”) was himself quite willing to violate individual freedoms to achieve that goal. For instance, he was willing to suspend habeus corpus and jail newspaper editors for sedition. Read more »
*This blog post was originally published at The Covert Rationing Blog*
September 17th, 2009 by DrRich in Better Health Network, Opinion
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When DrRich left his medical practice nearly a decade ago, he spent much of the next few years as a consultant to certain companies that make implantable defibrillators.
Most of his work was in research and development, and had next to nothing to do with defibrillators themselves, or any aspect of treating cardiac arrhythmias. Rather, DrRich was interested in developing physiologic sensors that could be deployed in implantable devices, and the algorithms that could use these sensors to predict and detect various developing medical conditions (so as to enable early intervention, and potentially prevent said medical conditions from becoming manifest). DrRich considered this work a) interesting, and b) representative of a business model that could potentially flourish within a healthcare system whose chief concern is reducing costs.
And whenever the captains of industry who signed his checks would ask him something about implantable defibrillators, usually seeking his opinion on a proposed subtle variation in some unbelievably complicated programming feature, DrRich’s reply was likely to be something like this: “Sir (or Madam) – I will be happy to study the question you pose to me, as I am working on your dime. But it greatly saddens me to see all this time, energy and talent wasted on adding yet more irrelevant features to a mature technology, in pursuit of a business model that is fundamentally broken.”
To which they would smile indulgently, hand DrRich the document describing the proposed changes, and schedule a meeting to discuss them.
The indulgent smile was in recognition of the fact that DrRich never made a secret of his disdain for the business model embraced by implantable defibrillator companies. The fact that these captains of industry put up with DrRich’s disapproval was a clear indicator that they considered it to be “quaint,” and apparently not worth taking seriously, and that the value DrRich provided in other arenas at least counterbalanced the annoyance of having him criticize their core business every chance he got.
DrRich’s disdain for the implantable defibrillator business model was based on two factors.
First, their business model relies on the artificially high prices the system will pay for their devices. DrRich has discussed this before. While these high prices are not directly the fault of the companies themselves (rather, they are fundamentally the fault of Medicare processes that distort and destroy natural market forces), these companies have now come to rely entirely on this artificial price structure, and have established all their business practices around this high-margin enterprise. The problem is that this high-price model absolutely precludes any reasonable penetration of this life-saving technology into the vast population of patients who might benefit from it. Also, because the price structure is not only artificial but arbitrary, a few simple changes in Medicare processes could abruptly destroy their business overnight.
Second, nobody is really interested in preventing sudden death. It’s difficult to sell any product when there’s no demand for that product, and there is no demand for sudden death prevention. In contrast, most other medical problems have a built-in constituency Read more »
*This blog post was originally published at The Covert Rationing Blog*
September 8th, 2009 by DrRich in Better Health Network, Health Policy, Opinion
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Because some of his recent posts seem to have confused many of his readers (why is he so strongly against proposed healthcare reforms when he supports so many of its goals?), DrRich will state once again, for the record, his political philosophy.
DrRich is a classical liberal. This means he deeply values the concepts that guided America’s Founders; individual autonomy, property rights, freedom from restraint, free markets and limited government. He is deeply committed to the Great American Experiment, which is, to determine whether a nation conceived in personal liberty and dedicated to the proposition that all people are created equal can long endure.
He believes that healthcare is very, very important, and indeed, has dedicated his career and most of his life to healthcare. But it is not the most important thing. For our generation to abandon the Great American Experiment for the sake of healthcare, or anything else for that matter, would be a perfidious act against our posterity, and indeed a crime against humanity.
DrRich is in favor of healthcare reform, and is glad that serious efforts to reform healthcare are at last taking place. He even finds much to like in the proposed reforms now percolating through Congress, such as, provisions for health insurance to be made available to most, if not all, of the people who cannot afford it today; the provision for health insurance to be made available to all the people who are blocked from insurance today because of their underlying illnesses; and the provision to prevent insurance companies (if any continue to exist in their present form) from canceling policies of their subscribers who get sick. These are all very good things.
But, as regular readers will know, DrRich has recently strongly criticized these proposed reforms, and hopes they will fail. This has angered and confused some of his readers, who know that he has favored universal healthcare, comparative effectiveness research, and other aspects of the reform plan now before Congress.
DrRich has turned against this reform plan not so much because of what’s in the reform bill itself. As DrRich has pointed out, the actual words of the reform bill are entirely open-ended. This is why proponents of one view or another can find in the bill what they wish to see (death panels vs. no death panels, continued availability of private insurance vs. a poison pill for private insurance, etc.), and it’s why their arguments take on the cast of debates among Biblical scholars over the true meaning of some cryptic Old Testament passage.
Rather, DrRich’s objection to this healthcare reform is based on the context in which it is being advanced. And in recent months he has come to see the context as this: a broad dismantling (whether inadvertent or not) of the Great American Experiment.
This dismantling probably began earlier than the fall of 2008 when DrRich first noticed it. But last fall was when our Congress (the peoples’ representatives) first began the wholesale abandonment of their duties and of the Constitution, with their passage of TARP. TARP took $700 billion and presented it to the Secretary of the Treasury to spend as he saw fit, thus creating, arguably, the second most powerful government official in U.S., and certainly the most powerful unelected one, in a manner never conceived under our Constitution. This was followed by the government’s moves to begin consuming Fannie Mae, Freddy Mac, AIG, numerous banks and investment houses, and the auto manufacturers. And all of this was begun under a Republican administration.
While the Obama administration did not start any of this, they took the ball and ran with it, and to a degree that would have seemed impossible (to DrRich, at least) a year ago. They completed the acquisition of the car companies and other private and quasi-private institutions into the federal portfolio. They added yet another $800 or $900 billion onto the federal debt with the Stimulus Bill, and in the process our flaccid Congresspersons once again acceded to the idea that when the executive branch cries “crisis,” it is perfectly acceptable to pass a 1000+ page law into existence without even making a pretense of discovering what is in it.
Then there is the disturbing gathering of power by the executive branch. This includes commandeering control of the upcoming census by the White House, and just this past weekend, bringing the interrogation of foreign (and presumably domestic) terror suspects under White House control. (Under what circumstances do you suppose a Congressional Intelligence Committee would ever launch an investigation of the White House’s interrogation practices?) Perhaps more disturbingly are the 30+ unelected “czars” the President has named so far, individuals with potentially very big (but undefined) powers that at least threaten to impinge on the functions of Constitutionally legitimate government agencies and branches. These czars are not approved, or even vetted, by Congress (our representatives) – and at least some of them look to DrRich like very scary people, whose avowed political philosophies are collectivist, anti-capitalist, and dismissive of the Constitution.
So when the healthcare reform process began, yet again, with the presentation of a 1000+ page bill and the exhortation to pass it immediately – don’t bother reading it – on account of the dire crisis confronting our healthcare system, DrRich had seen enough. When that “pass-it-quick-it’s-an-emergency” strategy failed for once, and people began reading the monstrosity and reacting to it (as the Constitution provides that they may), and when in response our leaders accused them of being fascists, terrorists, mobsters, and other disturbing things, DrRich had seen enough. When DrRich read big parts of the reform bill himself, and realized that it is an intentionally ambiguous document whose effect will be to turn over the re-shaping of our entire healthcare system to appointed functionaries, czars, and other unelected bureaucrats, DrRich had seen enough.
DrRich has never been a conspiracy buff. He has always believed that sustaining for any length of time a conspiracy any more extensive than, say, cheating at bridge, would be impossible. He has always considered the right-wing nut-jobs who think the opposition secretly wants to convert the United States to a Marxist utopia to be, well, nut-jobs. But if the governmental activities we’ve seen over the past six months are not a concerted effort to end, once and for all, the Great American Experiment, then they are at least an inadvertent effort to do so. DrRich wants this to stop.
Reforming healthcare is important, very important. But reforming healthcare is not worth abandoning the foundational precepts of the most exceptional country the world has ever seen.
We can reform our healthcare system effectively and equitably, in a way that specifically preserves and strengthens those foundational American precepts. (DrRich has described how elsewhere.) At one time DrRich thought current reforms could possibly be turned into a first step in that direction. Now, thanks to the context in which these reform proposals are being advanced, he sees present efforts at healthcare reform as an irreversible step in the opposite direction, and possibly a final step from which we are unlikely to ever recover.
First we must decide what kind of society we are to be – and that’s the real “discussion” we’re having now – and then, and only then, can we decide how we are to reform our healthcare system.
And this is why DrRich will make his paltry efforts to try to stop it.
*This blog post was originally published at The Covert Rationing Blog*
