Friday, May 27, 2016

This Is America

I was speaking today with three women in their 30's and 40's in those minutes around a table before a meeting starts.  Health insurance provided by employers versus that purchased at high cost was the subject at hand, as all three have husbands who are self-employed or at private companies, which offer plans inferior to state of NH plans.  Also, siblings who make much less and purchase health insurance on the exchanges were referenced with some tut-tutting. They have already ratcheted up in their minds to expecting that everyone should not only have health insurance, but really good health insurance that doesn't cost very much. 

There are side issues here, such as the implied Old Contract for civil servants We will pay you low wages but give you great benefits: Cadillac health insurance, increasing vacation time, slight but regular raises, job protection - which has crumbled over time in the race between unions, agencies, and legislatures to game the system; the procedures people now expect to be covered that many of us would consider optional; the different starting points of "what we provide is governed by what we deem to be fair" vs "this is governed by what we have in cash-on-hand." All valuable things to discuss, but really, I'm not an expert here and there are other sites which offer a better discussion product.

What struck me was a single phrase offered with some vehemence about coverage: "This is America!" As near as I can guess, knowing her, knowing how human services people think, is that this meant America is a wealthy country.  It is only civilised that everyone within our borders should have health insurance taken care of without impoverishing themselves. We are good and generous people. There were no comparisons to Europe, no accusations against the rich - perhaps those are implied underneath, but they weren't stated.  There is a type of liberal, perhaps the most common type, that shrinks back from conflict and making others feel bad.  They admire those politicians that are more strident and forceful, but they seem to have no awareness that the inevitable result of what they state in positive terms, even if it is undeniably fair and just, is going to be expensive.  It does not register that it is they who will pay.

I said nothing, but it occurred to me that the phrase "This is America!" could have many different meanings, even opposite meanings, from the lips of others. This is how we talk past each other, and must define our terms.  Liberty, American values, Christian, generous, moral - we don't mean the same things when we say them.


Edith Hook said...

I think private sector people are more realistic than your acquaintances. I am sure I am stereotyping, but it is my observation that more liberal people are less aware of the concept of diminishing returns or the cost benefit analysis of going after the higher hanging fruit when the low hanging fruit is gone. Anecdotal, I know.
I wish the US had adopted the Australian model, which, to my mind, is more practical and down to earth and more modern than the UK and Canada.
I often hear that the US has the GREATEST Healthcare in the world, but that is just a clich√©, it is NOT true by every measure. I think it is true that America has the most advanced, pushing the envelope, healthcare in the world, but the delivery system and affordability is an issue. It has increasingly gotten out of reach for many, and doesn’t translate into improved health or mortality statistics, across the population as a whole. This becomes evident, when compared across demographic cohorts of the first world, even given the hurdle of comparing apples to oranges (as in infant mortality and still births).

Edith Hook said...

With all due respect to the real, advanced medical treatments that have developed over the last 40-50 years, they aren't the whole story. The REAL advances …longevity and quality of life were as much a consequence of childhood VACCINES, potable water, central heating and building codes, adequate nutrition, occupational safety, safer roads, cars, and car seats, and a changing of the workplace as people migrated off the farm and out of manufacturing (more dangerous than an office or retail store).

Edith Hook said...

This is just my opinion, but I think the impetus for subsidized healthcare is the contraction of middle class jobs, and as more and more Americans fall out of the Middle Class, the more attractive this looks to them. Before the emergence of “real medicine”, not just caretaking, but medicine that pushed back against or stabilized chronic, debilitating or terminal disease, socio-economic status didn’t matter that much, there were few effective, life prolonging long term options. It didn’t matter how wealthy you were. It is not always about dead beats or free riders. If the middle class was thriving, healthcare wouldn’t be that great an issue. We won’t get anywhere if we don’t acknowledge that many people have good reason to be afraid of being wiped out by a medical catastrophe.

Edith Hook said...

One last thing.
I have rarely encountered anyone who mentions the following:
It’s way past time to come to terms with the reality that demand for medicine... creates...more demand for medicine, It's a paradox, I know. If this isn't part of the conversation, it is beyond me how anyone can find solutions.
The Rising Cost of Healthcare, just scratching the surface here.
1 An explosion of new and effective drugs and treatments that didn't……… exist 60 years ago.
Many of these drugs/ treatments aren't one offs but are prescribed for decades or for
2. Demographics: The population has almost doubled over the last 60 years with a disproportionate increase in the percentage of 50+ year olds. Increasing longevity means the diseases of old age are more prevalent and more older people need treatment, NOT for just a FEW golden years but for golden DECADES. In the past, many people did not live long enough to get the diseases associated with age: Alzheimer's, Parkinson's, glaucoma, osteoarthritis (knee replacement)............In the past people didn't recover long term from strokes and heart attacks. And if they did, long term care was hospice like.
3. Survivors: In some ways, medical costs are a victim of medical success stories. Newborns, who would have died 30 years ago, survive severe problems and extreme prematurity. The trade off is that many are left with lifelong complications and side effects requiring a life time of expensive care and treatment. A similar paradigm occurs with many cancer patients or HIV patients. Don't leave out accident victims; think of wheel chairs and prosthetics and the costs of surviving a severe brain injury and I haven't brought up transplants and medivac. There are many people, with conditions that would have been terminal or debilitating in the past, who live happy, productive lives thanks to treatments and drugs that keep their symptoms at bay: kidney disease, Krohn's, MS............ Weigh that against the cost to society of nonproductive people.
4. I have read reports that American healthcare relies a great deal more on disposability of medical products than other countries, in the battle against the spread of infection. This has cost trade offs too.

I'm not saying that there aren't other drivers, like paper shuffling and reporting, waste, fraud, tort and patent law, government interference, and no doubt they add a percentage to the costs.......but to ignore the real cost drivers mentioned above gives an incomplete picture. I, myself, experienced the price gouging, after I was rear ended by an uninsured motorist.

herfsi said...

i like to reply, "well, this WAS america." :)

Sam L. said...

The diminishing of the middle class is, I have read, because many of them are moving to upper classes. I am not convinced of that. I do see the Left disliking-to-hating the middle class, and working to diminish their numbers.

james said...

He links to another of his posts about how bad things actually are for a large fraction of people.

Edith Hook said...

Sam Your point is well taken and I have read many contradictory claims. What I look at is the comparison of employment between say a General Motors, in its hey day, and a Facebook or Google. Sure the hi-tech companies produce a lot of great jobs, just not in the volume necessary for the great mass of people, not to mention they often import employees.

jaed said...

It does not register that it is they who will pay.

These aren't always the people who pay. The people who are "paying" for Obamacare's devastation of the individual insurance market, for example, are primarily the people who buy insurance on that market, and now are left with poor-quality plans that cost an arm and a leg. Particularly people who are neither well-off enough to afford medical care, considering the bite taken out of their budget by the expensive new plans, nor badly-off enough to get a subsidy large enough to make a difference.

Consider, by way of another example, the closing of flophouses, boarding houses, SRO hotels, and so on - largely because "it's not decent for people to live that way!" feelings on the part of people who considered themselves compassionate. People who fifty years ago would have been able to at least afford a crummy room with a door that locks for the night now sleep on the street or in a dangerous shelter facility.

Harming other people to make yourself feel more righteous is no act of compassion. No, not even if you steadfastly refuse to think about the harm.