Posts Tagged ‘health care reform’

Too Much Broccoli

March 28, 2012

Leading up to the Supreme Court hearings on the Healthcare Reform Bill there was a lot of reference to broccoli:  “If the government can force you to buy health insurance, why can’t they force you to buy broccoli?”  OK, so that was the question of partisans and pundits.  When the issue reached the supreme court it would be pursued at a whole new level, right?  No, wrong!

Yesterday, more than one judge raised this naive question about the mandate that each citizen is responsible for securing insurance to cover their own health needs.  I could not believe that the judges themselves would pursue the broccoli question.  Let me explain.

While in college I learned the maxim: “To distinguish well is to teach well.”  (I think this maxim was attributed to Thomas Aquinas.)  I would expect not only educated citizens to be capable of distinguishing well, but also judges on the Supreme Court.

Let’s take a look at broccoli, a simple commodity available in the produce department of supermarkets.  Broccoli is just one vegetable among many through which certain food values can be acquired when it is eaten.   Since it is only one vegetable among many, I can make an unforced decision to buy it.   My decision can be determined by market factors: what is the demand for broccoli?  what is the price of broccoli? or, by a simple taste test: am I hungry for broccoli, do I like it?  When broccoli is on sale, I am inclined to buy it.  When the price is up I am more likely to buy lettuce, cabbage, or spinach.

Now let’s take a look at health insurance.  First, there should be no doubt that everyone at some point in their life will need healthcare.  This need while inevitable is unpredictable, and meeting this need is very expensive.  The need for healthcare can only be met by checking in with the health care system.  While there are some market factors that will govern my choice of which providers and services I will be using, there is no option as to whether I will or will not take advantage of one of these options  (unless I simply allow myself to become less and less healthy, and eventually, bring about my own death by carelessness.)  This is a first major distinction between health care and broccoli.  I have much less choice as to whether I will receive health care, and I do not know of any case in which the failure to eat broccoli by itself can lead to death, whereas the failure to receive timely health care can.

Second, when I receive healthcare, I will be billed for it.  But the bill will not simply be a function of the current market for the healthcare that I received.  The price will be affected by my need to make a contribution to the development and maintenance of a healthcare system through which I receive the particular healthcare that I need.  That contribution will be needed to cover the cost, for example,  of the education of doctors and nurses, the cost of facilities including hospitals, and the cost of very expensive diagnostic equipment and laboratories.  Even if I do not make use of these each time that I draw on healthcare services, I make some contribution to some portion of these costs.   The price will also be affected by another important variable–the growing number of persons who can not pay for healthcare, yet receive it, and do so at the expense of all of those who can pay for it.  This is another major difference between health care and broccoli.  When I buy broccoli, that is what I am basically paying for, or not paying for, depending upon the purchase price.  By the way, I know this price before I ever put the broccoli in my cart.  When I go in for healthcare, I am altogether clueless as to its ultimate cost.  That is still another difference.

Finally, because the bills for healthcare are large and unexpected, about the only way that anyone can manage the payment of these costs is through securing insurance.  That statement is just as true whether I have insurance or not.  If I have insurance, I hope to be able to manage the cost of my healthcare.  If I do not have insurance, I may not be able to pay my healthcare costs, or these costs may  bankrupt me, or both.

So given these distinctions, why are we talking about broccoli? In particular, why is broccoli being discussed at the supreme court?  Sadly, I fear it is the consequence of two things.  First, we can never discuss any issue these days without polarizing the issue within the frame of our current politics.  This leads to gross oversimplification of issues, as well as an excessive use of rhetoric.  Secondly, it is a reflection of our lack of humane and/or moral sensitivity.  We forget that there are millions of Americans who cannot afford healthcare, and who daily forgo its benefits, or receive it without the capacity to pay for it.  In either case, these Americans do not have access to the same health care that is received by those who are insured.  Rather they receive healthcare sporadically, and without regard to their overall state of health.

As the judges weigh the issues of  the healthcare reform bill and the mandate which it includes for personal responsibility for the purchase of health insurance, they would do well to remind themselves that there is on way to interpret the Constitution by considering only the words which it contains.  If they know very little about contemporary theories of language, they will still know that the meanings of words are not something which are attached to the very words.  The meaning of words depends upon their use in a much broader context, including the whole “system” of behavior of humankind.  Given the comprehensive context in which any text must be interpreted, the justices will do well to weigh carefully the consequences of their decision.  A question for all of us to consider is whether once they have weighed in with their decision they will still be worthy of being called “justices”, or whether they will simply be politicians holding a different title.

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Buying votes

December 23, 2009

Yesterday I heard an interview with Senator Grahm of South Carolina.  He had asked his state attorney general to look into the legality of the deal by which Senator Ben Nelson was persuaded to vote for cloture on the health care reform bill.   He along with others was appalled that the state of Nebraska will have its share of the increased Medicaid costs resulting from the Health Care Bill waived as a condition for Senator Nelson to vote for cloture.

Senator Graham is not the only person who has asserted that this arrangement does not pass the “smell test.”  Before I continue,  I should say that I do not believe this arrangement to be fair either.  Moreover, I believe it is never a positive development to bribe legislators to vote in one way or another, even though I am realistic enough to recognize that this kind of  thing goes on all the time.

What I do want to go on to say, however, is that in criticizing this arrangement it is important to consider what made it necessary.  The first consideration is that we no longer have majority rule in the Senate.  Almost anything that is presented needs to have the 60 votes to impose cloture on the debate.  In other words, every piece of substantive legislation on which there is any partisan differnce is subject to the requirement of a procedural vote of 60 members.  Under these conditions a legitimately elected majority is prevented from carrying out the mandates on which they were elected.

A second consideration which made Senator Nelson’s vote necessary was the refusal of the opposition party to engage in any constructive dialogue regarding the needs for health care reform and any good faith effort to develop legislation to provide that reform.  When under the leadership of Senator Baucus of the Finance Committee Republicans were given the opportunity to have a direct impact on the bill, those involved chose to use this opportunity to water down the bill, rather than to present positive proposals for reform.

A third consideration is the disingenuous participation of some Republicans and Democrats alike.  Chief among those involved was Senator Joe Lieberman.  Lieberman represents Connecticut, a state in which a large majority of the voters supported including a public option in the health care bill.  Lieberman, however, would have no part of it.  Why?  Because he also comes from a state in which the insurance industry has corporate headquarters, and because his pockets have been well-lined by corporate insurance contributions.  (Lieberman is, of course, an Independent, but Democrats were not exempt from being in a similar position.  Consider Evan Bayh of Indiana.)

So, yes, immediate deals made prior to the post-1:00 am vote early  Monday morning generated a might stench.  But those objecting to the smell must also acknowledge that the entire process was odiferous from its earliest beginnings, and there is plenty of blame to go around for that.  No one source of smell should be singled out either for investigation or criticism.