The title is excessively provactive – just trying to get your attention.
Gil Dupre - Louisiana Assoc of Health Plans
Yesterday a guest host Jim Nichols was in charge of the “Jim Engster Show” on our local National Public Radio station. (I do not enjoy the show very much. But I often listen to NPR and this show happens to come on about the time I am driving in morning.) The host was talking about the current healthcare reform debate with Gil Dupre(sp?) head of the Louisiana Association of Health Plans. I appreciated both what Gil Dupre and Jim Nichols had to say. Jim Nichols began his interview by commenting that “I think everyone supports the idea of health coverage for everyone. But there are still questions about cost and accessibility“. And Gil Dupre did a fine job I thought of commenting on the healthcare reform bill currently up in Congress. In a nutshell he said it contains several good and worthy changes. But much of it is not good. I appreciated the “Jim Engster Show” giving someone who actually works in the heathcare industry a chance to comment.
Listen to the show by following this link.
Where the show got seriously weird was when Jim Nichols started taking calls. I may or may not have voiced loud and inappropriate things at my radio. I have seldom heard such breathtaking idiocy.
The first caller said there are two main questions. First – whether healthcare is a privilege or a right. Second – his expressed concern that in the relationship between healthcare and insurance industries the patient does not have a voice. Dupre and Nichols handled the first question well. Dupre declined to answer what he defined as a “philosophical” question and said it does not matter whether one regards it as a privilege or a right – either way we still have the problems of cost and how to get coverage for the un- or underinsured.
For the record I would argue it is not a right. Although it is a good and worthy goal. (Keep in mind that I still agree with Gil Dupre – whether healthcare is a right or not matters less than some think.)
What does it mean to say something is a “right”? I have a right to free speech – does that mean American taxpayers should pay for my ability to say what I want? So if I want to say “I disagree with politician so-and-so” and want to say this on national television at a cost of hundreds of thousands of dollars – everyone must pay for me to do that?
In general (and I will come back to this) “rights” are things that I can do without restriction but also impose no obligation on others. On the Baptistlife discussion board in which I used to participate one person expressed this point exceptionally well:
First, health care is not a human right. A human right is something that can exist simultaneously among all people without imposing an obligation on someone else. The rights to life, liberty and the pursuit of happiness are such rights. Free speech, a free press, freedom of religion, freedom of assembly, the right of self-defense (2nd Amend.) and the right to file grievances against your government are all rights that we Americans have that impose no obligation on others.
Health care, on the other hand, cannot be classified as a human right under that definition. Health care may be needed as much as food, clothing and shelter, but it is not a right. One cannot have health care as a human right without imposing an obligation on others. A “right” to health care means that if I cannot afford medical services, then you are to be coerced through government force into providing it for me. What moral principle says that I have the “right” to insist you pay for something I cannot afford? Why should you have to sacrifice you right to enjoy the fruits of your labor in order to provide something for me? You may do so out of the goodness of your own heart, but should you be forced to do so?
However, like a basic education, we may define a societal right to health care and may set up a government program to administer it, but health care is not a human right. [emphasis added]
There is at least one important counterexample which is the “right to an attorney”. “If you cannot afford one an attorney will be provided for you” (at public expense). Perhaps our excellent friend above would classify that as a societal right (or a societal obligation under the United State Constitution).
Dupre also pointed out that huge steps have been taken to make sure the concerns of patients are addressed. Well answered sir!
Before I get to the truly annoying and chilling phone call let me address directly what Jim Nichols said about healthcare reform and economic competitiveness.
A lot of countries have gone to a more socialized or government-run health care. They seem to have contained costs. And have gotten something of an economic advantage over us. Some would say part of our problem competing in the global economy is our cost of health care in America.
I was sorely tempted to call in at that point – because it is not (necessarily or clearly) true that the cost of healthcare in America is a factor in how we compete effectively in the global economy. But I am not an economist – I merely read what economists of stature have to say.
Greg Mankiw who is an economist at Harvard University – and is an insufferably rational and reasonable thinker who handles dyspeptic hacks like Paul Krugman with uncommon civility and grace – has addressed this on a few occasions:
A common argument, often made by ostensibly sophisticated commentators, is that the United States needs to reform its health care system to maintain its international competitiveness. Regardless of your views of health care reform, this particular argument is, to put it bluntly, nonsense. Long ago, Paul Krugman wrote a nice piece demolishing the whole concept of international competitiveness as a motive for national economic policy. More recently, the Congressional Budget Office has done a nice job explaining why the idea of international competitiveness as a reason for health care reform is fallacious.
Read the whole thing here. And I will stop writing “you do not have to register” after every quote.
Do note that even Paul Krugman argues against the “healthcare-competitiveness fallacy”. Note that we are not even addressing the questions of:
- whether socialized or government-run healthcare really contains costs
- whether socialized or government-run healthcare reduces quality and accessibility
- whether nations with socialized or government-run healthcare are truly economically competitive vis-a-vis the United States
- whether anyone really would prefer socialized or government-run healthcare
- whether anyone would want to work in the healthcare profession within a socialized or government-run system
Do not misunderstand me. I strongly support the idea of healthcare reform. Not just in terms of “containing costs”. But also in terms of helping all or most Americans receive adequate insurance coverage.
(Quick important point. People talk about “universal health care”. That is not really the issue. The issue is “universal health insurance” or “universal health coverage” yes? What we are debating is the extent to which you receive healthcare and do not have to pay for it out-of-pocket.* I am pretty sure that is what we really are talking about. I also think the current situation – where we depend upon our employers for health insurance coverage – is not a healthy one. It means too often Americans will not look for new/better jobs because they are afraid about losing/changing their health insurance coverage. I would like to think this is of concern to all or most political conservatives.)
Back to the “Jim Engster Show” yesterday morning.
The next caller was something else. Something about how we “couch our Christianity in America in terms of concern and compassion… not knocking [or did he say not for - hard to hear him at this point] free markets… should we lower the salaries commanded by people in this arena [healthcare and insurance industries]… compared to individuals who work and struggle to pay the bills. They live a comfortable lifestyle. How much more money do you need? If you can live comfortable in a nice home drive an automobile feed you family – how much more rich do you need to be? To me sir it all boils down to greed…”
Or envy. And the desire to control others. And make them do for us what we will not do for ourselves. But let us pass over that for the nonce.
It is difficult not to hear good old fashioned Communism in that call. Yeah I know it is unfashionable to throw out that word and others will dismiss you as a reactionary wingnut – but do think about it.
“I think you guys make enough money. I do not think you should make any more money past a certain point. I think I and/or the government should dictate what those salaries and reimbursements and so on should be”.
It is tempting to take that stance. And there are legitimate questions about how much profit is enough and at what point does the legitimate desire for profit turn into exploitation? But one has to wonder who this fellow is to determine what is enough – for people who do work thank you very much and often work harder than the working people who struggle to pay the bills. Did my dad make a high salary? Yup. And he worked at least 60-80 hours each week and traveled all the time.
How would you like to be a doctor and have the government say “you know – after all those years of med school and being up all night studying and working 100+ hours each week as a resident and all the rest… we do not think you should be well compensated for what you know and what you do”? My last primary care doctor transferred to working at the hospital because it meant for the first time in two years he might get some holiday time off with his family. He worked and sacrificed to get where he is. He works harder than I do. Darn right doctors should be well paid.
And let me note in passing that during his address to the American Medical Association the president rather strongly hinted that one way to contain costs is… that everybody gets paid less. And who will make that decision? And how will it be enforced? (Some offhand comment about “spreading the wealth around a little” comes to mind.)
I am not sure how much I should thank the “Jim Engster Show” for letting us know that Communism and craziness are alive and well in Baton Rouge. But my genuine appreciation to Jim Nichols for an intelligent discussion. And especially to Gil Dupre for how well he addressed the issues.
