Politics & Media
Apr 24, 2012, 06:26AM

Equal Health Care Or No Health Care At All

With liberty and technocratic fixes for all.

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I'm sure everyone's got their own, but here's my story of being jerked around by America's oligarchy of insurance providers. My son was born at home, and our midwife recommended a pediatrician in the area who was willing to see newborns. We trotted off to her, and she was great—very low key, very competent. Best of all, she was at the University of Chicago hospitals, a five minute car-ride from our home in Hyde Park. We fully intended to continue seeing her until my son was a bit older and could go to his own doctor.

But then the inevitable happened. The University of Chicago decided it wasn't going to take our insurance anymore. So instead of going to the convenient five-minute-away doctor we loved, I'm traipsing my child halfway across the city to see a decent doctor, but certainly isn't the one I'd choose if I had my druthers.

Is this a tragedy?  Of course not.  Is it irritating?  Absolutely. Is it a good way to conduct our health care system? No. In general, health care outcomes are better when you stay with the same doctor over time so they can get to know you, and you want to be close to the doctor so you can get to them in an emergency. Randomly forcing people to switch doctors is nobody's idea of what a reasonable health care service should be doing. It's inefficient, expensive, and dumb. It's the sort of thing that makes you wonder why on earth anyone thinks our current health care system is a good idea.

Of course, nobody does actually think our health care system is a good idea—except perhaps for the insurance companies and their paid slaves in Washington. Still, this is in theory a democracy. Our health care system doesn't work. Presumably all the people who use the system realize it doesn't work; they're all being forced to switch doctors and/or not getting the medicine they need and/or being turned down for preexisting conditions just like I am.  So… what the hell? Why are we doing this to ourselves?

Eli Zaretsky's new book Why America Needs a Left offers an interesting explanation. His thesis is that the American left has traditionally been the force pushing for equality—and more than that, the force that has attempted to define progress in terms of equality. Zaretsky points out that the end of slavery could have meant a society based on racial equality, or it could have meant a reorganization of capital in which slavery was abolished but blacks remained second-class citizens. In the event, America chose to go with the second… but the left's struggle for the first eventually blossomed in the Civil Rights movement. Similarly, the Civil Rights movement could have meant a more egalitarian (and not incidentally, more peaceful) society—or it could have meant a meritocratic society in which women and minorities were able to compete in greater numbers alongside men upon the neoliberal field of global capital where everyone receives bonuses for stepping upon the faces of their peers.

Zaretsky argues that President Obama's 2008 campaign promised to take up the banner of the left and equality. The enthusiasm people felt for that campaign wasn't because Americans are idiots and dupes; it was because there's a hunger for a more just society. That hunger for a more just society is a political force to be reckoned with. Obama showed himself able to use it, at least for a time. He got elected, but unfortunately proved himself unworthy of the vision he had evoked. Instead, he reverted to type—a Chicago machine pol, interested mostly in looking competent and throwing bags of largesse at his donors, not necessarily in that order. Thus, his great vision for health care system is to make it more efficient and less expensive, and to make sure the insurance companies are happy.

Obama's plan is an improvement over what we've got, but it's not exactly an exciting improvement. As mentioned above, I'm happy to bitch and moan about my health care, but that's bitching and moaning; it's low-level irritation. Everybody would like the health care system to work better, but you don't get an effective political movement built on a desire to smooth out small scale, or even mid-scale, annoyances. The insurance companies care a lot more about keeping the system the way it is than I care about going across town for a doctor.

If you want change you can believe in, you have to offer change you can believe in. Tinkering around the edges to build a better mousetrap isn't going to do it; nor is cost-curbing. The issue with health care in this country isn't that I can't get exactly the doctor I want. The issue is that there are millions of people who can't get care; millions more who put off going to the doctor because they can't afford it; and millions more who live in fear that they will lose their job and be unable to get treatment for a loved one's preexisting conditions. The issue is that we have a system that says it's okay to let the sick slide away as long as the sick are poor. In short, we have a system that is unequal, unjust, and wrong.

Obama was never willing to make that case, though. Instead, we are supposed to believe that we should focus on balancing our budget rather than caring for our neighbors; on propitiating current stakeholders rather than on helping those in need. Obama presented himself as a technocrat, not a leader, and then he seemed surprised when his grand scheme gets snagged on technocratic details like church funding for birth control or the commerce clause.

Of course, just framing health care as an issue of equality wouldn't necessarily mean that you could pass health care. Maybe what Obama got was the best deal possible from Congress. But as Zaretsky says, how you present these things matters, and what ideals you're pursuing matter as well. There is a not unimaginable world where universal government health care was seen as a way to help people who lost their jobs in the recession, or where the Occupy movement was centered specifically on health care for all, rather than on a nebulous dislike of Wall Street. That's not the world we've got though, in part because the President we have wasn't interested in leading us there. So I'm still dragging my son cross-town to the doctor, and a lot of my fellow citizens are still getting sick and dying needlessly, to no small degree because our leaders insist on pretending that you can fix the first without ever thinking about the second.  

  • There is equal health care for all. It is based on expense. If one is willing/able to pay for it, it doesn't matter what race or religion they are. This is called equality. Why should someone who is unable or unwilling to pay the same amount as I do get the same level of health care? How is that equality rather than favoring the unwilling/unable?

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  • Texan, you seem confused about the meaning of equality. Equality doesn't mean you are sorted out by whether or not you happen to be rich or poor. It means people are treated equally on the basis of their being people, not on the basis of their income. Poverty is not a moral failing; people who can't afford to have their children's asthma treated don't deserve to have their kids die anymore than rich people deserve to have their kids die. If you believe that that's true, you believe in equality. If you believe the poor kid should die (or "shouldn't get care", if you prefer), then you may believe in the market, or the prosperity gospel, but you don't believe in equality. Simple as that.

  • True. Getting sick is not a choice, it happens to everyone eventually. Market gospel allows people to indulge their selfishness and take full advantage of their capacity to be distracted. It's an industrial principle applied to people, no wonder it's inhumane and cruel.

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  • Noah, I was talking about equal opportunity. As for equality in health care, you do a nice job of ducking the issue with the asthma example. My question to you is how is it equal if I have to pay for my kids medical treatment but another does not? Why should an unproductive member of our society get a liver transplant for free when productive members pay for it? Making some pay and others not is just not equal. Simple as that.

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  • My question for you is how is it equal for some people to get medical care when they're dying and others to be denied it? You're not talking about equality of opportunity; you're talking about being humane to people with money and not to those without. That's not equality; that's the market. They're not the same thing, and jumping up and down and insisting that they are isn't going to make them so.//Personally, I think we should raise our taxes by a lot, cut defense spending by even more, and have a single payer system where the society provides care to everyone, just like they do in most civilized countries. But again, to get there you have to be willing to think of the issue as one of equality and view it from the perspective of the less well off, rather than seeing basic decency as an infringement of your right to get the most bang for your buck.

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  • Noah, once again you dodge the question because you can't defend it. Equality exisits on many levels and economic is certainly one of those metrics. This is why the equality argument is a loser. The compassion argument is a loser too since it is used as a bludgeon on any who disagree with one's perspective. The best argument is for a base line care afforded all at a lower expense to all. As for my organ donation scenario, how should the limited resource be expended if not by money?

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  • I'm not dodging the question. You want to redefine equality as value for money, and or empty it out because you don't want to pay more taxes or have society focus on people who aren't getting a fair shake. That's your priority, but if you're telling me it should be mine...sorry. Not interested in playing.

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  • I'm not redefining equality! I'm taking a more global and factual approach. Anyone can claim inequality on one metric or another. Why you refuse to acknowledge that economic equality is a factor of overall equality is beyond me. It is not my priority either, just a point I'm making about the losing aspects of the equality argument in health care. As for dodging my question, what is the "equal" way of distributing a limited resource like organs? You have yet to answer, which is in itself a dodge. You see, once dealing with real life supplies versus demands, equality does not exist and therefore becomes a moot arguement in health care.

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  • Economic equality means resources are distributed equally. It doesn't mean that you have a god given right to more stuff because you have more money. Organs are distributed on the basis of need and access, is my understanding. They aren't distributed on the basis of who has more money, precisely because people feel that would be unacceptably unfair. And they're right! The fact that your example contradicts your central point speaks volumes, it seems to me.

  • First of all Noah, if you are going to make up your own definitions we are not going to get anywhere. Economic equality is not defined as the equal distribution of resources. Look it up. 2. Organ transplants are done the way you say with one important factor missing. All pay. No insurance, no money, no organ. Are you suggesting, as you do in the article, that those without insurance and money are equally entitled to the rare commodity of organs? If so, how is it fair. 3. I agree with you that children in need of asthma medicine should get it. This would be covered under my baseline insurance discussed earlier. What I don't agree with is the prolonging of deadbeats lives for the sake of prolonging them. If someone gets cancer and can afford treatments, they should get them. If they can't, I agree that they should be treated for comfort but not treated with expensive remedies that have less than certain recovery rates. Prolonging ones life comes at a cost. One can eat better, pay for better treatments, excersize etc. Only one of these categories cost money. Thus making financial cost only one aspect of the equation yet you give this one aspect all the power in your pseudo-morality, or so it seems to me.

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  • Economic equality refers to two things 1. everyone is paid the same amount and make their own choices on how to allocate the money amongst many resources. eg person A buys a bigger house and no health insurance whereas person B buys a smaller house and health insurance. 2. Everyone is charged the same amount for resources regrdless of need/desire

  • "Economic equality is not defined as the equal distribution of resources. Look it up." // TEXAN, could you say where you looked up the term? Because the sense in which Noah is using "economic equality" is the way I've always seen the phrase used. A quick Google of the term produces examples that back up Noah's use.

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  • I used Bing and the first 3/5 sights defined it as my definition that everyone gets an equal amount of "money" (I excluded Wikipedia because it should not be considered an accurate source. Just look at what happened with conservatives and "forward"). The way Noah and apparantly you use it only exists in fiction and theory. No rational person that I've read ever suggests that everyone getting equal resources can, has or ever will exist in a modern city let alone country. Regardless, it was a nice diversion down semantics lane but I'm sure if snark is put aside, my original point was made and understood. If one person has to pay and another does not, in what universe is this equal?

  • Are you suggesting, as you do in the article, that those without insurance and money are equally entitled to the rare commodity of organs? If so, how is it fair.

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  • Oh for pity's sake...yes, I"m suggesging that those without insurance and money are equally entitled, because I'm suggesting that the lives of people with more money are not more valuable than the lives of people with less. Which makes me a crazy communist, I know.

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  • Thanks Noah. Now that we have agreed that there is no equal way to distribute limited resources like healthcare, how do you suggest we distribute said resources? A random lottery seems wasteful to me. How about basing it on merit? If you are a viable organ donor, you get a higher place on the list. If you served the country, you get points for a higher placement, if you are willing to pay a premium, you get points for a higher placement etc. If you pay more than 20% in taxes etc.

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  • The current organ donation system is set up by need and by closeness to the donor, I believe. I don't see any reason why you couldn't keep to that and just drop out the money. Which is what would happen if we had single payer. And basing it on merit is not equal. You're life isn't more valuable if you've been in the army or if you have more money. The fetishization of merit is certainly where Obama and neoliberalism is coming from. But it's a stupid way to approach healthcare. I think eugenics proved that if it proved anything.

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  • We already covered the fact that it is not equal the way you suggest doing it. Not sure what you have against money or merit. Eugenics has nothing to do with this. Eugenics was about dna, What I am proposing has nothing to do with inclusion or exclusion based on dna. As for merit, if there is a limited resource, what better way for a society to help itself than do distribute it based on merit? If someone is willing to pay for their surgery and that of one other individual, surely that would be a decent system, no?

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  • Not being snarky, just asking a question.

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