Tuesday, June 21, 2005

Want to Read Something Gross?

I'm not the kind of person who goes around making political comments on other websites. I have two reasons. One is that politics enrages me and when I start to talk about it, it's hard for me to remain rational. The other is that I have a hard time believing that, beyond voting, there's much that I can do to change things directly. I can try to appeal to the better judgment of the people in power, but the whole system seems to me to be set up to keep the rich and powerful rich and powerful and the rest of us not. So, they're going to do what they're going to do, for better or for worse, and we're going to have to live with it. Our ways of making change have to be much more subversive. So, the state of Tennessee has this problem. We have this program called TennCare which provides health insurance to a good portion of Tennesseans and when I mean a good portion, I mean like one in four or one in three. It provides better coverage than any federal government program. And, so, as you can imagine, it is the main expense in the state's budget and it keeps getting more and more costly to the citizens of Tennessee. Something must be done. But what? I don't know. What's happening right now is that they're kicking a quarter of a million people off of TennCare and some enrollees who will loose their coverage have occupied the governor's office. What will come of it? I don't know that either. Probably not what the protestors want. But here's the thing, if most of these folks don't have TennCare, they won't have any insurance. And some of them will die. This, to me, means that this ought to be a very solemn decision. Whatever we have to do, this is a grave situation. There's nothing to indicate that this isn't weighing heavily on the governor's mind, but, if you'd like to read some really gross stuff, I recommend you head over to Pith in the Wind. Here you'll find such nuggets as:
So yeah, from an intellectual standpoint those people "kicked off" TennCare will either (a) find alternate forms of coverage; (b) pay for it out of their own pockets; or (c) forgo treatment, and, like all of us, eventually die. Too bad. So sad. But that's life. The cliche that there are no free lunches simply has now come home to roost for this population.
To laud a group's convictions when their whole purpose is to take value created by someone else rather than actually add any value is quite telling indeed. I think in nature we call them parasites.
Why are all the leftist activists (and, boy, this is a left wing bunch) not at work? I'll bet they are graduate students, TA's, gov'mint workers, you know the crowd, all on someone elses' dime. Lot of 21st avenue slackers, I would guess
I disagree with the premise that wealth redistribution is the solution for poverty, crime, and public health. It simply rewards indolent behavior at the expense of the producers thus contributing to a smaller economic pie upon which we all depend. Sure there are differences in income...but there were differences in behavior as well; and even our lowest earners enjoy a standard of living in the top 10% in the world. Would I be crying the blues if I was still living in my two bedroom trailer with two in diapers and scraping by on $900 a month? Well, maybe so; but that's what night school, student loans and a work history of busting your ass. I agree with a basic safety net but a quarter of the population on a Cadillac insurance plan that even the highest earners can afford-- one that includes no inducements not to over-consume and drive the costs through the roof for all of us? Guys, come back down to earth--your ivory tower is just an echo chamber for your flawed premises.
So, to sum up, the general argument by the conservatives over there seems to be "Well, tough shit if you die. You brought it on yourself by being poor."* I honestly don't understand what conception of government these folks have. I think I have a series of obligations to folks. Some obligations are stronger than others. I have deep and grave obligations to my family, deep obligations to my friends, important, but not as important obligations to my acquaintances and colleagues, and lesser, but still vital, obligations to my community and country and world, etc. My efforts or lack thereof to meet those obligations affects the health of the whole group and meeting those obligations or not has far reaching implications. One doesn't have to be a psychologist to see that my great grandmother's failure to meet her obligation to raise her family in a loving, non-fearful, non-violent environment still echoes down even to both of my nephews who don't have a stable home. This doesn't mean that my brother is off the hook. He has even greater obligations to those children and his inability to meet those obligations has far reaching consequences. But that doesn't mean that leaving the initial failure unaddressed doesn't have continuing consequences as well. And there are consequences for y'all too. I mean, think of poor Lavender Howse. I don't know what obligations to him were not met, but the failure of his family and his community to meet them means that he now has done something so terrible that he can never make it right and indebted himself to the family of that man in ways they'd rather he hadn't. His fate and the fate of his family is now tied to the fate of that family. His life or death now means something to people who preferred they never even knew him. It's the continuing insult after the initial crime. We're not a nation of individuals whose actions have no affect on others. We're groups of people tied to each other through things as important as love and thing as slight as proximity. Your actions affect me and mine affect you. One thing I hope the government would do is provide a means for us to meet our obligations to each other in ways we can't do alone. Does this mean that we can continue to provide health insurance to people who desperately need it? I don't know. Personally, I wish we could. To me, having watched enough people I love desperately die, if another few pennies every time I bought a can of pop would help, I'm all for it. But maybe we can't. If that's so, that's not something to gloat about. We created an obligation to those people when we said that we'd provide them health insurance in the first place and now we're going back on that. We're going to fail to meet our obligations to them. That's going to have consequences and the gloating going on about it, as if they've won the lottery of life and know it, and fuck everyone else not lucky enough, really sickens me. *The only reason I can figure that these types of conservatives are anti-abortion is that they resent that they're denied the chance to actually watch the "kids" die.


Blogger the Professor said...

Way to go Aunt B!
Health care is a basic human right. Freedom of speech and assemply matter lots - really they do. But what is it all worth is you're not alive? This country is soooo wealthy that we think it legitimate to have arguments about just how wealthy we get to be. When people die from bug bites, or any disease that is preventable and treatable, I don't see how we can call our systems of (corporate sponsored) government anything but barbaric.

6/21/2005 10:45:00 AM  
Anonymous Anonymous said...

Sorry, but health care is not a basic human right. It may be an ideal that we strive for, but that's as far as it goes. The basic human rights are those enshrined in the Declaration of Independence - life, liberty and the pursuit of happiness, as reflected in the Bill of Rights. Nowhere in these rights is there enshrined the right to health care. We have a right to these things without government intrusion into our homes and persons. There may be an obligation on the part of the government to make some level of health care available on the part of all its citizens, but that is an obligation that is the result of the political will of the governed, codified in whatever statutes TN has passed to create the program in question. This is not a reflection of our inalienable rights as persons.

I agree with Aunt B (doesn't happen much, I know) there is some level of committment to the least among us that government should strive for, but we must recognize that there are only so many dollars in the system. I am sure (ok, not sure, but at least hopeful) that the decision to remove people from the roles was a hard one to make, but all allocations make someone unhappy and deprive some. For every dollar that goes into healthcare there is a dollar that does not go to hiring police or paying teachers or any number of other valuable or frivolous program our governments support.

Further, the idea of universal health care provided by the government has its problems. Just ask the Canadians who wait years for surgery.


6/21/2005 11:45:00 AM  
Blogger Taketoshi said...

LE, I'm not sure why your first recourse in determining what constitutes a basic human right has to be to the Declaration of Independence and the Bill of Rights. Granted, these are the rights we're currently (ideally, anyway) guaranteed by our own system of government, and it's those documents that make the claim that these are our basic inalienable rights (note that they're not basic human rights but rather those rights which can't be infringed upon, especially by the government). It seems natural to me to want to think of the government of the U.S. to be the pinnacle of human achievment in terms of self-determination of a populace (I might not agree, but in our social climate it seems natural), but it's definitely too limited to me to see its policies as somehow congruent with a kind of ill-defined "natural law" of humanity. To claim that health care isn't a basic human right because it's not in the DoI and the BoR not only pins you to the position of being a rather narrow dogmatist, it also completely misses the point of the professor's argument which seemed to be to open a dialogue on what our current priorities say about us.

6/21/2005 12:12:00 PM  
Blogger the Professor said...

thanks taketoshi, I couldn't have said it better - that the LE and I are arguing about two different things. I clearly moved away from Aunt B's comments about the details of TN and he wanted us to move back to the specific government. Of course I know that there are tradeoffs, and of course I know that there are lots of people who know better than me how to run the country. But, we do need a more thorough going reconsideration of priorities

6/21/2005 12:24:00 PM  
Blogger the Professor said...

And, what I guess I meant to intend, in terms of the DoI, is that health is a condition for the possiblity of the pursuit of happiness. The balance of freedom for me to (individually) seek happiness and the social conditions that make it possible to seek and maybe find it are really quite complex and I have not yet figured out how to navigate them. But, we already pay the gov't to provide all kinds of services that (almost) no one challenges. Why is health care so controversal?

And, saying that gov't sponsored universal health care is not a guarantee of it being fairly provided with good quality is not actually an argument against it being a right. That means that there needs to be a discussion, by those informed and competent professionals, on how to best provide what we can.

6/21/2005 12:33:00 PM  
Anonymous Anonymous said...

I am not sure why you would accuse me of being a "rather narrow dogmatist" for referring to America's founding documents in a discussion of what the government created and bound by those documents should or should not do. If we cannot look to these sources for guidance, what can we consult? (note I said guidance and not slavish devotion to).

If I was unclear, I apologize. Health care is not a "right", not because it is not enshrined with the bill of rights or declaration of independence, but because it is not inkeeping with what a "right" actually is. The word "right" has a particular meaning in America and in American jurisprudence - a "right" is not created by government, society, the individual. A "right" is internal to us as individuals. Health care is not such a "right", it is an entitlement - that does not mean the gov't shouldn't take steps to provide health care.

I think we should have more open discussion of our priorities as a society. I think we should look more critically at our entitlement programs to ensure that the finite resources available are put to the best possible uses. But this is not a discussion of rights, this is a discussion of social policy. There is a difference.


6/21/2005 12:57:00 PM  
Blogger melusina said...

Well, I think if you are quoting the Declaration of Independence, one of those rights being life, and life cannot be lived in today's America without healthcare insurance, then health care insurance becomes a right, even by your logic.

In an involving society, as America has become, you can't only focus on the basic document as your guide to the rights of the individual. Obviously, the government of the U.S. doesn't think about founding documents that much, or we wouldn't be discussing the Patriot Act so much.

The thing with health care is that the costs in America are way too overwhelming for even middle class America to afford if they become seriously ill. Hell, I'm not even sure a rich person could afford a seriously devastating and costly illness without insurance. And just because someone is rich, doesn't mean they can get health care insurance. You can have all the money in the world, but if you have a pre-existing condition and are trying to get insurance for yourself, they won't cover you.

I was on TennCare before I got married and came to Greece. Now I am enjoying the European right to health care insurance. Ironically, the costs of healthcare in Greece are so low that we *could* afford it without insurance. My husband and his family are all doctors, and they are astounded by the costs of healthcare in America. So am I, when I see the comparison.

Anyway, Aunt B made a really good post, which is the main point of my comment.

6/21/2005 01:34:00 PM  
Blogger Yankee T said...

Sing it, Aunt B! Great post.

6/21/2005 01:44:00 PM  
Blogger The Corporate Shill said...

First, I am truly fascinated by class issues related to health benefits / insurance -- that is a subject worthy of another post.

Second, I can't speak nearly as intelligently as most of you, but I gotta agree with the spouse (I'm not citing the DoI though) -- health care is no more a basic human right than food or housing. It’s a necessity and god knows when I need it, I like having it – but a right? Nope. Sorry.

So let’s get the dialogue started! We want it all in this country (e.g. the stock price if Pfizer to go up) but we don't want to make any sacrifices (that Pfizer must remain profitable and, to do so, it might have to lay people off now and then). But we have a weird relationship to healthcare and money. Doctors provide services. And they deserve to be compensated for that service. Whether that's a bushel of corn, a pig or cash doesn't matter. And me? I am a consumer who wants to pay for and receive that service. Americans do not like talking about the economic reality behind health care because we're uncomfortable about the idea that people profit from people being sick and hurt. Until we ask some really hard questions about the current system and figure out what it will take to fix them -- this is all pointless rhetoric. The current system cannot help everybody. At some point, some people will lose.

Here's something else -- programs like TennCare that provide “better coverage than any federal government program" (Aunt B – I’m curious, why does that matter?) are built on an unbelievably flawed system. That is why they cannot provide the services they promise and why they continue to fail. I'm sorry to see them fail -- but to anybody who spends anytime working in health care it’s no surprise. We need to change the entire system -- and not with bullshit smoke and mirror train wrecks like the Medicare drug benefit or just cutting people from the programs. People are so invested in the current system they can’t see outside of it and until we take a long-term view, we are doomed to repeat this cycle.

Pith in the Wind does have some gross statements on there but one of the reasons the system is flawed is because too many groups are trying to profit from a limited amount of value. And I’m not blaming the insurance industry alone – hospitals and doctors and patients and health care companies and lawyers and employers shoulder some of the blame as well.

Ultimately, I don’t know how you fix it. I don’t know how you shake the foundations of an industry with such ingrained problems. I don’t know how you make the hard decisions about when to “deny” care (it’s a bad word but I mean deciding that a heart transplant on a 95 year old is probably not a good use of limited resources and so you “deny” care). How does a society learn to let people go and stop administering drugs because they’ll extend life another 2 months but will cost the taxpayers hundreds of thousands of dollars. How do decide if those two months are worth it? To the 44 yr old father of three who is dying of prostate cancer, hell yeah it’s worth it. But if you could keep everybody currently enrolled in TennCare on the program for another 3 years for what it would costs to keep Joe alive another 2 months – who decides which is the best value for society?

There are lots of huge ideas swirling in these comments. I think it will get worse before it gets better. But I don’t think lamenting the slow demise of TennCare and saying that we have a responsibility to help the poor is enough. We do need a discussion on social priorities – but in a country where we think we can wage war without casualties, elect a jackass and not suffer the consequences, collect a paycheck while spending most of the day surfing the Internet -- we might be too soft right now to handle that.

6/21/2005 02:06:00 PM  
Blogger the Professor said...

But I don't need Pfzier to be profitable. I don't want to argue for that. I do not support a pseudo free market system - because it requires that we do not, as a society, make decisions about how to govern ourselves that will work toward protecting everyone's life. I do think that housing and food are rights as well. I do not think that it is the government's job to give them to everyone, but they cannot make it impossible for some to get. I think it is our job to form a government that makes it possible for everyone to meet their basic rights, and to hope for more than just scraping by. I need the basic necessities of life to be within my reach.
We are definitely operating with very different notions of rights. I am sorry for making the problem worse by talking about rights in at least two different ways when I should just stick to the one I mean most.

6/21/2005 04:02:00 PM  
Blogger The Corporate Shill said...

To your earlier point about the gov't providing all sorts of services -- look at the spectacular job the gov't has done running the Amtrak, Medicare and HUD. They'd mess it up more than it already is.

As for Pfizer, we do need our companies to be profitable -- just not at the expense of people or the environment -- or they cannot continue providing the goods and services we need (I know, I know -- I'm the freakin' Shill! Somebody tell my in-laws I'm not really a communist!) And that goes for healthcare companies as well -- and we really struggle with that in America because that means that sometimes things are expensive and we can't fund everything. But we cannot send everything with a pricetag to the government (and in the same breath gripe about paying our taxes -- not that you were -- I'm generalizing!)

I'm intrigued by the idea that we are "operating with very different notions of rights." If we agree that something is a right -- it does mean that gov't gives it to everybody (not really though, if it's a right, then I've got it and the gov't can't interfere with that for anybody -- it's not a matter of GIVING). I have the right to freedom of speech and religion but, much as I might wish for it, I do not have the right to a 3-bedroom Cape Cod in a nice neighborhood for under $200,000.

I think we frequently confuse rights with opportunities and privileges, and in doing so, we make it very hard to get anything done. While we've been arguing about all this, we lost our chance to devise any solutions.

6/21/2005 05:20:00 PM  
Blogger The Corporate Shill said...

Aunt B -- are you delighted or appalled? Will you spend the rest of your week defending one set of friends to the other? All I wanted was to escape to TCP and enjoy the banter. Sigh.

6/21/2005 05:26:00 PM  
Blogger the Professor said...

I think there is a distinction between positive and negative rights and I working with a very broad notion of very positive rights. My last post was rushed and I regretted it, but was too far awy from the computer to remove it in time once I found a better way to make my point - an analogy.

I think that health care should be more like education and security (police, fire, military) than like jobs. That is how the gov't helps ensure we are "free" tp pursue our rights as stated in those legal documents. Public schools, the army, local police stations ... all operate not as for-profit industries but as public service industries paid for by tax revenue. Hospitals and other health care agencies (I am all for greater preventative care as well - much cheaper too) should as well. And, there is a minimum standard we all receive. Some get more - some people pay for private schools, some have home security systems and OnStar. Some doctors and hospitals could work this way - as long as all of us get something.

I know, the easy answer is that it's already not fair. the police don't respond to shootings in black public housing complexes and some schools are seriously underfunded. But I am not sure that failure to meet your own stated expectations is evidence that the expectations are wrong. We have to actually do what we say we are going to.

I hope Aunt B doesn't choose sides. I am having fun too.

6/21/2005 06:24:00 PM  
Blogger Aunt B said...

Sorry, I would have posted earlier, but I was so shocked to find the LE and I in agreement on something I had to hide under my desk all afternoon fearing the end of the world had arrived.

Anyway, are you kidding? I'm delighted and honored that I have such smart friends who can talk about this stuff and wrestle with it and pick apart each other's ideas without picking at each other. Wow.

Melusina, your comments remind me of something that's been bugging me for a long time--that is, I think, tangentially related to this matter. There was a video a few months ago by one of those Lilith Fair women that was basically just an accounting of all the money that could have gone into making the video but instead went to buying cows for a village in Africa or pencils for a school in southeast Asia or whatever.

And the video really grossed me out on two levels. On the one hand it is so disgusting that so little--$50 for a cow that will give milk to a whole village or something--can make such a big difference and that we, who have so much, don't even give that much. But the other thing that pissed me off is that, god damn it, I can't buy a cow for $50. I can't supply my nephew with things he needs for school for $1.50.

And why the fuck not?

Why do I have to pay so much for what others pay so little for? Why do pills made in Ireland cost so much more here than they do in Canada? Why is a cow $50 in Africa and $5,000 here? Why am I getting dicked over just because I live in the U.S.?

I mean, we keep hearing how the cost of prescription drugs is so high because each drug must help pay for all research and development. Fair enough, but why am I, as a U.S. citizen paying more than a Canadian? Why aren't the Canadians helping to foot the R&D bill?

To that end, if open global markets will mean that we all pay $250 for a cow, sign me up.

But I think what it means is that we'll all pay $5,000.

Prof, I've been thinking about your idea of making all healthcare into a public service and I have to say that it seems okay on the surface, except that public servents are some of the worst paying gigs. How can you ask someone with hundreds of thousands of dollars of student loans to take a job that pays what public servants make?

Still, for all the disagreement, I think there's a lot of common ground--we all agree that there is a problem and that it's enormous and that fixing it is going to take more than just doing some patchwork and calling it good.

Ha, yes, I'm celebrating a lack of acrimony, even though we've failed to come to any solutions.

Ah, well, I said right up front that I don't know what we should do about this, and I still don't.

6/21/2005 08:26:00 PM  
Blogger The Corporate Shill said...

"To that end, if open global markets will mean that we all pay $250 for a cow, sign me up.

But I think what it means is that we'll all pay $5,000."

So true. And utterly depressing to think about. Some people and corporations can't be trusted!

LE and I talked more about rights last night and got into human rights, civil rights, contractual rights etc. The usual Tuesday night dinner at our house, tonight's topic: tort reform! Like you Aunt B, I love that I'm surrounded by really smart people.

I can explain why the Canadians aren't helping foot the bill... I'll send that to you in an e-mail and you can start a whole new post.

6/22/2005 07:42:00 AM  

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