Sunday, August 9, 2009

Starting Points


Before go any further, congratulations on facing up to cancer with
courage, dignity and faith - for five full years now. You've earned
the right to talk about health care from a perspective which no
one would care to gain voluntarily, and you are an inspiration.

I've always believed that government, properly constituted, has
the natural responsibility of providing certain services for the
governed, national defense being an obvious example. One principle
in establishing the nature of these responsibilities is that there are
some activities which private citizens, either in groups or
individually, cannot be expected to perform in the fair and
comprehensive ways which government can.

But just because, theoretically, government can do a better
job with certain responsibilities, should it? I've mentioned
to you before that I find much of the protests going on
against health care reform to be both obnoxious and idiotic.
Yet at the heart of these protests is a genuinely valid concern.
Liberals like myself are not inclined to recognize
this concern because we are loathe to lend overall credibility
to a movement which embraces all sorts of social views and
opinions which we find to be particularly offensive. But since
you and I have agreed to an open and honest dialogue, it
would be uncivil of me not to deal with this concern.

You can take all the blather about government controlling
"who lives or dies", roll it in a ball and drop it off a cliff for
all I care. As far as I can tell, government participation in
health care reform, as it is currently formulated, is not going
to lead to that sort of Orwellian future. The real concern
here, and worth considering, is to what extent will government
reduce the capacity of free enterprise to improve health
care through healthy competition and innovation? Let's take
auto insurance for example.

No one questions the ethics of insurance companies when
they charge higher rates for bad drivers and lower rates for
good drivers. We all recognize that this method encourages
good driving. Speaking for myself, I would be deeply offended
if State Farm decided to equalize rates and charge me the same
as some jackass in training for the next demolition derby.

I smoke - you don't. Is it fair, on this basis alone, that I should
pay the same for life insurance as you do? When it comes to
health, like automobile driving, some people make good
choices and some people make bad ones. Is it fair then, that
government should step into health care and expect
those who make good choices to subsidize the cost of caring
for those who make bad ones? I hardly think so.

At the heart of the opposition to health care reform is the
very nature of personal responsibility. Now I admit I do
get a little ticked off whenever I have to listen to all the
hogwash about certain groups of disadvantaged citizens
being universally referred to as deadbeats and social parasites.
This sort of stupid bigotry undermines the possibility
of rational debate and I will not stand for it.

However there is nothing wrong with encouraging personal
responsibility. In one way or another, as a group, Americans
are going to have to pay the entire cost of universal health
care. I see no reason to humiliate, through a system of odious
penalties, those who lack the ability to pay their fair
share. But why not offer them some honest and honorable
means to do so?

To summarize, before getting down to basic aims: America
spends at least twice as much per capita on health care as
any other industrialized nation, and yet by no objective
measure do we outperform these other countries. It follows
that we have the resources to provide universal health care,
but the system we have is not particularly good at distributing
them. Conservatives make the valid point that government
subsidies generally discourage personal responsibility.
These then are my starting points.

I propose our system of universal health care should be held to the
following standards:

1. Provide a reasonable level of health care for every American citizen.
2. Develop a health maintenance program with built in incentives to
encourage healthy lifestyles.
3. Allow for private options.
4. Protect all citizens from the high cost of catastrophic illness or accidents.
5. Reform the health industry "from the ground up" to increase the
number and and quality of health care professionals.
6. Engineer a universal system of electronic patient record keeping.
7. Engineer an accessible system of computer based diagnostics.
8. Review and reform tort law with the following goals:
A: No citizen is denied legal remedy for injuries from malpractice.
B: Lawyers who pursue cases deemed to be frivolous are liable for
censure, penalties and court costs.
C: Allow for actual damages but restrict "punitive" damages.
D: Criminalize certain acts of malpractice and negligence which are
presently the subject of civil suits only.
9. Provide universal access to low cost, generic medicines.
10. Allow the federal government to shop - and bargain for -
the lowest cost prescription treatments.
11. The cost of elective treatments, i.e., cosmetic surgery, will be
paid entirely by private citizens.


P.S.: Rather than addressing your post willy-nilly, I wanted
to start of by organizing myself this way - largely because
the subject is so difficult for me. In future posts I'll comment
on some of the points you made...

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