Wednesday, September 2, 2009


So, the national health care debate rages on - at this point having evolved to a bizarre, Felliniesque performance. On the one hand we find hoards of Grey Panthers disrupting our Town Hall meetings with blood curdling remonstrations against the horrors of Socialized Medicine - while at exactly the same moment accusing Libs of wanting to take a meat ax to their, er, socialized medicine. Visions of sinister intentions dance in their heads: of corpulent bureaucrats (direct from Satyricon) deciding to Gas Grammy so some ne'er-do-wells down on Peachtree Industrial can get faster treatment for their stab wounds. Have we reached, as some would have it, the Apocalypse? And where the heck is John Wayne when you really need him anyway?

Thank God that here within the cool, comforting confines of LRA&H the muffled explosions of supreme idiocy outside are only a passing nuisance. For this I suppose we owe a debt of gratitude to Professor de la Paz, whose tolerance for blind, ideological repartee is essentially non-existent. To work...

Yesterday I watched an interesting show on Frontline which posed some relevant questions about the nature and extent of public health care. This episode, "The Released" followed the lives of several mentally ill individuals as they transitioned through a never ending cycle of jail, half-way houses, treatment centers and the street. In a climactic moment, one psychologist attempted to reconcile government's current reliance on personal liberty and accountability with the reality that these individuals, frankly, aren't going to make it without constant professional treatment and supervision.

Which leads one to ask, assuming they were not mentally ill by choice, what "right" do men like these have to that treatment? To my mind, the answer of "none whatsoever", while technically advancing some presumed law of nature, still, in some ways not only short changes the counter efforts of men to obligate themselves to one another by fashioning compassionate institutions, but also leads to even more disturbing questions. To wit: how can we suppose we are inherently obliged to protect an embryo's "right" to life when no such right exists in nature either? We'll save that troubling extension of logic for another round.

The only genuinely worthwhile answer therefore is that men often establish among themselves a set of mutually beneficial rights and obligations precisely because they wish to overcome the arbitrary whims of nature. Now we are welcome to engage in meaningful debate as to when and how these obligations become a hindrance rather than a help. We ought at all times remember that societies must strike a balance between shared and personal responsibility. But the wholesale characterization of mutual responsibility, by codification, as slavery is merely to argue that blind nature is better at governing men then men are. And pointless. Back to Frontline...

The men featured in the segment were not special cases. They were representative of literally millions of individuals who drift between prison and the street. In prison, they take their medications and attain a level of rational behavior. Once discharged, they eventually make it back to the street, fail to take their medications, commit a crime and wind up back in prison where the cycle starts again. Can you fairly hold them accountable for this because they chose not to take their medicines? Hardly. In many cases it became obvious that their own mental illnesses (over which they had no control) figured into that decision. In other cases, well, when they finally got to the street these men were homeless. Under the circumstances the regular supply of medication to them was next to impossible.

Let's break this down. How do you deal with men like these? Clearly they represent a threat to society. Most of the crimes they committed which landed them back in prison were minor - but there remains the potential for sudden, extreme violence against otherwise innocent bystanders. So, do you just lock them up for good on the basis of the possibility they may commit worse crimes? I don't think you could get that one past even Judge Roy Bean.

So, if you can't just throw 'em in the hole and fergit about 'em, what are you going to do? Well it seems to me at some point the solution is going to involve the application of enlightened self interest - and there is where this specific problem starts to bleed into the larger context of health care generally. Society creates the responsibility of caring for these men (one hopes) firstly because they are our brothers, and American citizens. But secondly, because by keeping them well we add to our own safety.

And that's the conclusion I want to leave you with. It seems to me Steve that you are looking at this thing through the wrong end of the telescope. While you are concentrating on what is fair and what isn't, shouldn't you at the least be considering how affordable health care would benefit American society as a whole, and therefore your own circumstances? Forget, just for a minute, the damning pronouncements of "slavery" and consider how a drastic reduction in health care costs could provide American industries with an important advantage against foreign competition. I've already noted that if health care costs per capita was the same as that in France, this would literally plow an extra trillion dollars a year a year into the economy - and I've yet to hear a response to that. Moreover, if the projections from The Commonwealth Fund are even approximately correct, per family health insurance which cost $9,300.00 in 2003 is due to cost almost $24,000.00 in 2020 if things don't change. Do you think our kids can handle that kind of expense and still compete internationally?


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