30 May 2008

Colorado & healthcare reform

Colorado has an unreasonable number of healthcare activists with national prominence.

I'll begin with T.R. Reid, although he's a journalist, not an activist. His Frontline film and upcoming book are and will be important in the debate.

There's Nathan Wilkes, a young father and member of the board of Health Care for All Colorado who speaks nationally on the need for universal, effective, quality healthcare.

There's Donna Smith - who's now in Chicago, but has deep roots in Colorado. She appeared in Michael Moore's Sicko.

David Sirota, the pundit, is here. He's not exclusively about healthcare, but he speaks on the issue, and how it's central to a movement to strengthen the middle class.

Glen Pearson, MD, is former president of Physicians for a National Health Plan.

Rocky White, MD, also on HCAC's board, is running for the State House of Representatives, and is the editor of the reprint of Healthcare Meltdown, a book to read if you're wanting to learn more about the need for healthcare reform.

Elinor Christiansen, MD, was one of the original authors of the first draft of HR676, the single-payer legislation sponsored by Rep. John Conyers (D-MI) and Rep. Dennis Kucinich (D-OH).

In the center there's the 208 Commission, with many of its members being nationally known leaders in healthcare policy, Barb Yondorf in particular, who has co-authored several papers.

On the right, there are Paul Hsieh, MD, and Lin Zinser. The two have an article on "Moral Health Care vs. 'Universal Health Care'" at something called The Objective Standard.

There are a number of single-payer advocates who ignore stuff like this on the grounds that it's mean-spirited. Other activists love to get exercised over this kind of argument, ignoring the fact that most Americans see Zinser and Hsieh's position for what it is - not only mean-spirited but also extremist.

I guess I think it's good to understand where people are coming from, even if you know beforehand that you won't agree. To be a Social Darwinist and still feel good about yourself must require an extreme ability to think in the abstract. For instance, Z&h's first step in fixing what they now acknowledge to be an American healthcare crisis is to repeal EMTALA, the law that requires hospitals to treat people who show up injured or sick at their doors. They'd also eliminate Medicare, Medicaid, and all insurance regulations.

About EMTALA - While the need for the EMTALA law is new, brought about by the distortions of profit in what used to be religious institutions' mission of caring, the underlying value is centuries old - at least as old as Christianity and Judaism.

Z&H give a history of our current crisis, beginning with how Blue Cross/Blue Shield became non-profits, and thereby began to compete with other insurance companies on what Z&H consider an unfair playing field. They believe it became even more distorted after the WWII wage freezes took place, with their concurrent tax breaks for employers offering health insurance.

Z&H compare health insurance to homeowners' insurance, arguing that if homeowners' insurance covered lawn work, painting and remodeling, our homeowners' insurance rates would skyrocket. Especially if the government forced homeowners' insurance to cover poor homeowners...

The problem with that analogy is that homeownership is completely optional - as is, to a lesser extent, upkeep. Health isn't optional. A good portion of what happens to our health isn't choice-driven either. No one chooses their father's stroke proclivity, their mother's and sisters' breast cancer. No one chooses to grow up down river from a chemical plant, or for their mother's crappy prenatal care.

Z&H see Medicare as worse than charity, worse because, they write, people don't realize it's charity. We fools think we've been paying for it via our own taxes.

I'll stop. It's tedious reading someone else's rebuttals to something, and more instructive to do it yourself. The Libertarian notion is that if the healthcare market were simply freed from government meddling it would thrive. It's not a bad intellectual exercise to actually think through what the evidence is against that being true. May even come in handy one day - especially here in Colorado.

Even some of the up-and-coming Colorado politicians are taking notice.

It's too bad the newspapers are out of the loop. Katy Human at the Denver Post does a good job of covering health issues and stories, but the opinion pages have pretty much taken a pass. It would be a public service if they did a better job of covering the issue - with an emphasis on single-payer and modified single-payer, since it is the funding mechanism by which the rest of the world keeps their costs down and provides universal coverage - despite Z&H's ongoing success in ignoring that.


Paul Hsieh said...

Dear Kristin:

I recognize that we are on opposite sides of this issue, and I thank you for linking to the article written by Lin Zinser and myself. I would like to make a few comments in response.

First, neither Lin nor I are Libertarians. Nor are we conservatives (i.e., we are not supporters of the political "right"). However, we are staunch supporters of individual rights.

Second, because you have mentioned the ethical dimension, I want to highlight the fact that our opposition to "single payer" health care (or any kind of government-imposed "universal health care") is based primarily on moral grounds.

I've written a FAQ that covers this issue in more detail, which arose from a letter of mine which appeared in the New York Times a few weeks ago supporting a free market in health insurance, and the from the multiple questions and comments I've received in return.

If anyone wishes to read it, it can be found on our website at:

"FAQ on Free Market Health Insurance"


I cover the moral basis for a free market combined with voluntary charity, and the reasons that any system of "universal health care" is deeply immoral.

The questions covered in the FAQ are as follows:

Q1) In a free market for health insurance, should insurers be able to exclude someone based on a pre-existing condition?

Q2) Why should whether I live or die depend on whether an insurance company finds it too costly to pay for my care? Should my fate be determined by whether a corporation finds it profitable?

Q3) How would a free market guarantee that all Americans will have necessary health coverage?

Q4) What if someone has a bad disease through no fault of his own, can't afford the treatment, and no insurance company will cover him? Who will pay for his care?

Q5) Isn't the purpose of a government to promote the common welfare of all citizens?

Q6) Your position is very harsh and Darwinian. If you were dying of cancer and could not afford treatment, would you really say to yourself, "Oh well, this is my random bad luck, no one has an obligation to treat me and so I must die"?

Q7) Isn't it my social obligation to subsidize the health care of those who can't afford it?

Q8) I agree that health care is not a "right", but isn't it moral for the US government to raise taxes to improve the overall welfare of the nation? Universal health care (ideally administered through a free-market mechanism to the greatest extent possible) would be a good use of that power.

Finally, on a personal note, I am sorry to read about your husband's death. During my years of practice, I have reviewed hundreds of CAT scans of patients with both diverticulitis and appendicitis. Based on what you have written, it looks like your husband's death may have been the result of a misdiagnosis and/or delayed diagnosis, rather than due to a lack of access to a physician.

If this was a misdiagnosis, then this is a separate issue unrelated to issue of "single-payer". The issue of misdiagnosis and/or delayed diagnosis is extremely important, but it will also arise in *any* medical system, regardless of the economics of the insurance system.

Paul Hsieh, MD
Freedom and Individual Rights in Medicine

Paul Hsieh said...

Kristin: After I posted my original comment, I subsequently realized that Paul Hannum was your brother, not your husband. I sincerely apologize for that mistake. -- Paul Hsieh