The Ideological Gulf (Back into the Breach)
It’s unfortunate that what I brought online yesterday was colored by some distracting background noise, and I very much regret that I allowed a defensive reaction to intrude on the larger point I was trying to make. Since that point got lost in the shouting and attacks (and with the acknowledgment that I may have some hitherto unrecognized masochistic pathology), I’m going to try again.
Let’s go all the way back to the original question from Dorian de Wind:
But what I don’t understand is the philosophy of those who don’t have insurance, don’t have health care, don’t have the financial resources–oftentimes have already bankrupted themselves and their families–who would badmouth and even reject a health care reform that, at the very least, would bring some much-needed medical care into their lives.
If it is self-reliance, pride, stoicism, independence, etc., etc. then I understand and salute them.
But, there must be more to it…”
Unlike yesterday, let’s stop right there.
There is obviously more to the opposition to health care reform for some people, but my point wasn’t about generalized opposition, or fear-mongering, or partisanship, or lies and distortions. The original question was about people who need help but are rejecting an expanded social program that would provide it.
Hard as it may be for some to believe, “self-reliance, pride, stoicism, independence, etc., etc.” are the bottom line for some folks. Really and truly.
It’s story time. (It’s kind of a long story. Sorry)
I know a woman who once had a moderately successful small business in Houston. By “moderately successful”, I mean that she was paying her bills on time, feeding and clothing herself, and putting a little bit away each month. As was fairly common here at the time, most of her large clients were oil and gas companies. Thus, when the economy crashed here in the mid-1980s, her business went with it.
In spite of an excellent education that included two masters degrees, she was unfortunately slow to read the tea leaves. Instead of folding up shop and moving on to another source of income immediately, she tried to hold on. She extended her credit card debt to stay afloat as she continued to maintain her inventory and market her services. As income continued to dry up, she went further under water — and there was absolutely nothing she could do about it. She was self-employed, meaning no unemployment benefits and no group medical insurance.
Unsurprisingly, when all was said and done by the end of that decade, she was underwater so far that the surface was no longer visible.
Needing an immediate income stream in a city that was bottomed-out economically, she took a job driving a taxi, and she continued that for the next 18 years — right up until recently when, at 71, it became too demanding for her.
It took nearly two decades, but she’s finally almost out of debt. In the intervening years, though, many things fell by the wayside. Her house deteriorated (as did the neighborhood it’s in). Her health is relatively good, but the lack of dental care set up some very painful difficulties. She has, however, managed to get a new pair of glasses — meaning she now has two uncracked lenses and both side temple attachments.
Her house is less dilapidated these days as well. Over the last five years-ish (after many arguments about it), her family has been replacing failed appliances and systems. She now has heat and an air-conditioner, for example (after nearly 10 years in Houston without one), and a refrigerator (that ice chest really didn’t hold much).
Now some folks might say that this woman was a prime candidate for bankruptcy. Legally, they’d be right. Yet approaching her on the topic was to invite an angry backlash. She had, she said, done this to herself, and she would get herself out of it.
For a very long time, she was part of the “working poor”, and if anyone could use public assistance, she could. Her social security is laughably too little, and she’s had to reverse mortgage her home to hold onto it… but she won’t take anything more than what she contributed toward for herself. The very thought of having external parties — strangers – contributing to her well-being still sends her right over the edge.
She’s neither ignorant nor racist, and while I often disagree vehemently with her politics, I have enormous respect for the honesty and consistency of her positions.
Therefore, when people suggest that there must be something more than just pride, or independence, or a desire for self-reliance, motivating someone who needs but does not want more governmental social programs, I have to disagree. There does not have to be more to it. However much it may seem to you, they’re not working against their self-interests; they’re staying true to their personal values.
I know this because I know this lady very very well. She’s my mother.
Now maybe she’s just an anomaly. Perhaps every other person in this country would have asked for public assistance in her situation.
Or maybe she just embodies a personal worldview and value system that is hard for well-intended liberals to understand. I guess that’s only fair, since she struggles (unsuccessfully) to understand them — and that’s the ideological gulf to which I referred yesterday. It’s difficult to articulate, it’s easy to attack (by both sides)… and it encompasses far more than the current debates about health care.
I understand her, though. Even as I recognize — and even empathize with — someone who might choose a different path, I see exactly where she’s coming from.
Do you?
61 Responses to “The Ideological Gulf (Back into the Breach)”
Hemm, as hard as it may be for you to believe this, I don't debate for the sake of trying to win debates either. I'm not trying to score points on you, but when I read things that are logically incorrect I do have a drive to try to rebut and then if you show me why you think I've erred in my reasoning I'm willing to listen.
I did see that last response you gave and quoted above- but hadn't seen it before I wrote my comment here.
Basically though, where I believe you are in error with that example (which seems to be the point you've been stuck on all along in these discussions) is in comparing the cost of ONE visit to ER vs. PCP, and extrapolating as though this proves that universal coverage would lower costs since people who now go to ER would be able to go to PCPs.
But it's the sheer number of the visits in each case which would make that assumption false. If I can find any data, I'll come back and post it, but it belies belief that people who are uninsured currently end up in ERs even 33% as often for illnesses (not trauma, or true emergencies which can happen to the insured as well as uninsured) as they would end up in PCP offices or specialists to recieve routine care if they were insured. So even if your cost differential estimate is correct, that it's three times as costly to get care in ER as it is through a PCP, the overall costs still will not be lowered if everyone has insurance and the access that that buys them.
Whether or not you agree with that (which I realize depends on whether the data will support my assumptions about the frequency of visits), can you let me know if I've made the point clear, in terms of the cost implications for numerous routine care visits as compared to a much lesser number of ER visits?
Cs
I understand your point well. I would only say that my example was not to infer that this 3 to 1 cost ratio between emergency room and office visit was somehow the complete solution to our problem. I was contending that much of the existing system has built in inefficiencies that drive costs higher. Please read this example as an example of one of many needed ways to reduce cost and increase care.
There are a bunch of links out there about the effects on uninsured patients, and I include a one below. I do this not to prove any of my contentions, but to share a narrative of how no insurance effects people. for our purposes, some of these details show how late or no treatment results in eventual higher medical costs when they finally do seek medical care. If you find this link biased, let me know, that of course is not my intention.
http://www.nchc.org/facts/coverage.shtml
OK, and I get that you aren't necessarily insisting that the ER care is a higher overall cost than will be the cost of insuring everyone- but isn't that an important point to determine, since it makes all the difference in the world as to which approach we need to take to get real reform? If the goal of universal coverage actually drives up costs, then we have to figure out a way to not only pay for or reduce not only our current high costs, but also the new added ones.
I don't have a problem with those stats, in fact some of it seems to come from this source that I was about to link to. It's just that I'm not disputing the hardships on the working poor who are uninsured and end up with costly health problems. I agree that's a problem- but it doesn't logically follow then that if we provide publicly funded health insurance for them that the public costs will be less than they are now.
If we expand coverage and it's going to cost more, we need to know that upfront and figure out how to cover those increased costs- and at least admit that a reform plan which focuses on the universal coverage aspect is going to bend the cost curve upward instead of downward unless there are some other serious cost reducing measures included to offset the new entitlements.
Instead of trying to decipher that end number, let's list a couple more savings.
One you've mentioned before with which I concur, how about medical malpractice reform? I came across a lawyer site that listed won lucrative cases for people who showed up in emergency rooms. It didn't state so explicitly, but their stories had that ring of uninsured. How much is it worth to our discussion if reforms were made that lowered doctor's malpractice insurance costs. Add to that the lessening of extra CYA tests.
One of my favorites is importing drugs from canada. many drugs made in the US, exported to canada, still cost 50% less than what you and I currently pay. No, it may not include all drugs, but who cares, 50% less is a good thing. I brought this up in discussions because both Republicans and blue dogs have gone out of their way to block this saings.. Add that as another savings we currently don't employ.
I hope you see where I'm going here. Drip, drip, drip, and we fill the bucket.
HemmD: “If “reform costs too much” is more than a debating point, would someone believing that please demonstrate a solution that doesn't cause debt worry and solves the problems we now face?”
The comment sections of many threads on this blog are replete with various conservative and moderate alternatives. For one example, what about the Wyden-Bennett proposal?
HemmD: “One of my favorites is importing drugs from canada. many drugs made in the US, exported to canada, still cost 50% less than what you and I currently pay. “
I don't have the number on the top of my head, but I'm reasonably sure that the profit margin of drug companies is way less than 50%. Therefore assuming your number is correct, if the US implemented the same cost controls as Canada, there would be no more drug industry, at least not one that has the resources to invest in new drug development.
See my comment o this issue in a previous thread: http://themoderatevoice.com/40661/obamas-health…
Hemm- I'm all for an approach that will look for numerous sources of cost savings and increased efficiencies. Like adelinesdad, I'm not so sure I can endorse the prescription drug part.
I don't know that the drug industry or R&D would dry up completely, but it very well could be stifled- or, more likely, I think, a slowing of innovation along with a gradual increase across the board in the drug prices of the export/import products would result. I can't imagine it would take long before the pharmaceutical companies realize that the downward pressure on domestically used drugs from the reimportation from Canada would mean that they need to cover those lost revenues by raising the prices on the Canadian products.
I say that as someone who really does believe that patented drug prices are outrageously high- we see it in our family where we're currently using three prescriptions that are astronomically priced, and even our copayments are $50 a month each. We recently used COBRA for one month (which is a story unto itself- the process to enroll takes longer than the one month period for which we needed coverage, so we had to self pay for the meds and then get reimbursed later) and I realize that a lot of people aren't in the position to even temporarily cover those kinds of costs out of pocket (one prescription was $700 and we had to fill the whole 30 days worth because it's controlled and the pharmacy can't fill part of it and then fill the rest later- and then another couple of scripts we were able to fill partially to the tune of $120 each for a week's worth of meds.)
I see all sides here though. The meds are, in my view, necessary, and I'm thankful that they are available at all. I know this makes us high end consumers of healthcare, getting more out of our insurance policy than we're currently paying in (probably not true over our lifetimes though.) And I know a bit of what goes into the drug research and FDA approval process, so I find it hard to begrudge the profit taking that is necessary to incentivize the investment that went toward creating these products. I do wish it could all be more affordable, but I'm enough of a realist to know that there are no free magical ponies.
As an aside on the prescription drugs question: I've read that it costs nearly $1 billion (yes, with a B) to bring a new drug to FDA approval.
I find it very hard to believe that those costs can't be trimmed. I'm absolutely positive that the pharmaceutical companies are passing that along to the consumers.
Oh, I'm positive the costs get passed along too. As for trimming, though, I don't know. There's waste and inefficiency in every process, I'm sure, but there're also a lot of legitimate reasons (not the least of which are the safety concerns which I wouldn't want weakened, and real evidence for efficacy as well) for the costs being so high. I imagine that the $1B figure might be rolling in the costs for other drugs that don't make it to market? I'm not sure how they calculate that- but the point is it would be great if every potential drug they test worked well and safely, but no one knows ahead of time which ones will pass the test, so there are a lot of expenses for failed drugs that have to be recouped with the proceeds from the successful ones.
Safety, yes. Efficacy? Dunno that the FedGov's in its proper role there.
Oh, I don't know. I think it falls under that category of necessary information for consumers which they'd be unable to determine without some government regulation.
And really, even if it wasn't the FDA setting the guidelines for proof of efficacy, the medical professionals (at least ethical ones) would do so, so the companies would still have to spend the money on the research.
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