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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?

  • GeorgeSorwell
    Polimom--

    I wonder if public policy should be built around such a worldview?
  • mikkel
    Objectively speaking, her refusal to declare bankruptcy and start over was a net loss for society. She is highly educated and proved she could be successful, and just got blind sided...something that could happen to any of us for reasons in or out of our control. It was her personal values that prevented her from letting go and accepting a new beginning that put her on her life's path.

    I have a close friend whose father did the exact same thing (and my friend has similar personality traits which causes him to not take any risks because he's afraid of being unable to let go) and whose skill has been removed from the system.

    While I think that these are the wrong paths to take, I acknowledge that they are being true to themselves and that's their decision; but it is terrible social policy. The United States has had a strong embrace of entrepreneurship when compared to Europe precisely because we make it easier to start over after business failure -- if we had a stronger social support net to help people transitioning then it would allow millions more people to get more education or go for a crazy idea that might just work and produce something amazing.

    As it stands, a very particular set of personalities and personal circumstances are needed to start a business or dabble outside of job security, and I know many people with great ideas/drive that step back from them because it's too risky. "Responsibility" is too often equated with negative consequences and not enough with realization of social participation. I think that everyone has a responsibility to realize their potential -- in accord with their social values -- and society should have policies that best allow this.
  • D. E.Rodriguez
    Polimom:

    That is a very touching story.

    Your mother is quite a remarkable person, and a beautiful example of someone who embodies pride, independence, and a desire for self-reliance. And there are many other people in America just like her. That's one of the things that has made our country great.

    Thank you for sharing.

    Since you quoted me, forgive me for putting your short quote into context by showing my comments in their entirety below:


    Referring to another touching story by dr. e, I said:

    "I hear, read and see heartbreaking stories such as these--and worse--all too often.

    I have often said that I "have no dog in this fight," as my family and I have, and have always had, the best possible medical care our government can provide.

    But, call it stupidity, call it compassion--I don't care--I would want every American to have the same health care. And, call it stupidity or whatever, I am willing to pay a few more dollars in taxes to see this come about.

    I understand--albeit I find it morally questionable--that others who are fortunate to be in a financial position to have good medical care whenever they need it, would not want others to be as fortunate, for whatever reasons: they want to hold on to the money they worked so hard for; or they don't want bigger government, bigger deficits, or they don't want "socialism," etc., etc.

    That, I can understand---I may not approve of it, but, then again, it is not up to me to approve or disapprove.

    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..."

    Thanks again, Polimom, for your story and our best wishes to your Mom.

    Dorian
  • casualobserver
    Your "acquaintance" is the kind of person I respect and admire......she didn't go to the welfare lines, she didn't sit around the house and whine on a blog looking for insurance paid for by someone's else's hardwork. Her own hardwork, perseverance and determination and a pride in individualism........it will die when she and I die.
  • ordinarysparrow
    Polimon. . . i can honor your Mom making that personal choice. . .but could not honor myself for wanting a health care system for ALL others based on your Mom's personal choice. . .

    Polimon i ask this with a gentle voice. . .

    what would of it looked like to you if Mom had battled breast cancer. . . a serious heart disease that required hundreds of dollars in medicine each month. . .or been involved in a serious accident requiring months of rehabilitation?. . . severe back pain with no relief. . . what would it do to your heart to see your Mom suffering in uncontrollable pain or disease devouring the precious years of her life all to quickly? . . .Your Mom chose to take responsibility and that is admirable. . . but let there be choice. . .

    in my humble opinion. . . people should have the option to receive quality medical care . . .the issue in the health care debate is not the people and whether they should have access, but rather how can we overhaul and make smart a health care system that devours and grows fat like Jabba the Hut on the very people it is there to serve?. . .we are paying for emergency care and catastrophic care these days. . . for 50 or 60 bucks we could of bought Mom a pair of glasses that might of kept her from having a head on collision with a truck costing 500,000 or 600,000 to sustain her in a coma for too many years. . . .

    all for the lack of nail. . .sometimes being compassionate is our Nations greatest self-interest. . .
  • archangel
    Your mom is so lucky to have the support and help of her family... you and yours. That is great. Medicare is what has been her health insurance for the last 6 years? Was she able to get, or the family able to help her get, a supplemental as well?

    In our work, family is the FIRST social support system for those who have working families. If more had supportive families like yours for your mom, it would be so nice. I cared for and supported my parents who lived to be in their late 80s. And, many cannot, perhaps will not. It's hard to know how others lives are truly, from the inside that is. What old things interfere in family care. What ongoing fracases, exilings, etc.

    I'm self employed (45 years of self employment now), lived through five recessions including this one; oil bust hit us hard here in the Rockies also. Really hard. I can relate to your mom's frustrations then. But. People go on. One way or another. As many self-employed people, I have never in my lifetime had only one job. Usually three at a time. What it takes. No shine. Just life.

    Particularly for the self-employed, you have to educate yourself, as you have no oversight from a board or ceo or coo or cfo, and you make and break your own business. No one can decide for you. Only the sole proprietor knows when to cut the nuts. (THat is an old saying from the orchardlands, the nut cutter would decide when to harvest, when to let go fallow.)

    I know the rule that if a business starts hemmorhaging, (especially if you are raising children or have dependents) to shut it down asap unless one wants to see all their equity, sweat eq included, wash away. But, wait, that doesnt necessarily take into account indomitable human spirit... that most often keeps hoping for a turn around and hangs in and hangs in and hangs in as the waves come over the rails.

    Just my two cents? If there could only be a choice between two, I'd rather a person try to hang in and kick the heck out of the bushes for work, even though sinking more and more daily... than to see a person give a limp try to many things, and never put their full weight to it.

    Your mom sounds like she did fine for facing herself in the mirror each day. The choices are so personal.

    Then there are the people who have little and no choice because of choices they may have made decades ago, or becuase fate has dealt them a truly bad hand. Another subject for another time perhaps.

    Please tell your mom hi and tell her she has a feisty smart daughter.

    dr.e
  • D. E.Rodriguez
    Added:

    By the way, Polimom, your mother is one of those who I explicitly or implicitly saluted when I said:

    'If it is self-reliance, pride, stoicism, independence, etc., etc. then I understand and salute them."

    Just so there will be no misunderstanding.

    Dorian
  • CStanley
    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.

    Dorian, first, I think it's incorrect to state unequivocably that the currently debated health insurance reform plans will have that net positive effect for all such people. There are people who currently don't have health insurance because they don't feel they can afford it who would be mandated to get it under the current proposal, and some of them may find that their concept of not being able to afford it may differ from the way the govt defines it so they'll have to pay to get insured. In other cases, small business owners will similarly face increased costs due to the mandates or be fined if they don't comply.

    And second, you don't seem to believe that anyone might see a possible short term or individual gain from a proposed plan but also weigh that against long term cost or societal cost, and decide that it's still not worth it. Have you ever thought about it that way?

    You seem to be making a variation on the 'What's the matter with Kansas?' argument, that people are voting against their own interest and therefore you think something else must be in play. But perhaps you, and they, don't see their own interests in the same light.
  • Dorian, my friend -- I *did* see your salute. It was that very salute, in fact, that made the "but there must be more to it" so very confounding to me. I puzzled over it for quite a long time before asking that initial "why", because whether you intended it that way or not, that short little coda said it couldn't be.

    I really hope my response and thinking has come through more clearly this time. Yesterday's fire truly astounded me.
  • D. E.Rodriguez
    "Dorian, first, I think it's incorrect to state unequivocably that the currently debated health insurance reform plans will have that net positive effect for all such people."

    I don't think that I have stated anything "unequivocally" about the health care reform plans. Just that I think and hope that it will be better for all those who have inadequate or no health care.

    "And second, you don't seem to believe that anyone might see a possible short term or individual gain from a proposed plan but also weigh that against long term cost or societal cost, and decide that it's still not worth it. Have you ever thought about it that way?"

    Acctually, I have , and stated so in:

    "...they don't want bigger government, bigger deficits, or they don't want "socialism," etc., etc."

    I believe that what you refer to as "the long term cost or societal cost" are included in there.

    Finally, as to "What's the matter with Kansas," and Polimom's "but there must be more to it," I will come back to that, after I think deeply about it and select my words carefully so that theyr will not be (once again?) misunderstood or mischaracterized.

    Thanks for your comments

    Dorian
  • Polimom,
    Leaving aside your mother, there are people that oppose slightly more nationalized health care on racial grounds, there are those who oppose it because they are misinformed, and then there are some who have genuinely well informed, if wrongheaded, beliefs.

    Maybe someone can fund a poll to really figure out how many people fall into each category.
  • D. E.Rodriguez
    "I really hope my response and thinking has come through more clearly this time. Yesterday's fire truly astounded me."

    It has, Polimom, thank you. It is now I, and perhaps others, who have to try to work hard on making our thinking and responses come out more clearly. (See my comments above)

    Dorian
  • ordinarysparrow -- "i can honor your Mom making that personal choice. . .but could not honor myself for wanting a health care system for ALL others based on your Mom's personal choice. . ."

    sparrow, allowing her to take this path without trying to force a different outcome was unbelievably hard to do. Pain, suffering, and poverty call to us all.
  • Thanks, dr.e. Indomitable is exactly the right word. LOL!

    "Please tell your mom hi and tell her she has a feisty smart daughter. "

    Ummm.... maybe not. She'd not be happy that I used her story for a political point, I don't think.
  • Mikkel: "Objectively speaking, her refusal to declare bankruptcy and start over was a net loss for society."

    I could hardly agree more. OTOH, had she done so, she'd not have been able to face herself.

    At the end of the day, is it not the individual spirit we're trying to preserve?
  • CStanley
    Dorian, thank you for the response. What I meant by 'stating unequivocably' was the part I quoted from you:
    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.


    I'm sorry if you feel that I mischaracterized that, but to me that said that the currently proposed plan would definitely have that positive effect on their access to medical care.
  • mikkel
    "At the end of the day, is it not the individual spirit we're trying to preserve?"

    No, public policy should be about trying to find the insanely difficult balances that will allow the most social "progress"...which I think actually changes nearly constantly based on tons of factors.

    Individual spirit is a large determinant of that (which is why communism and other centralized economic systems will never ever work, I mean the concept of progress is even different) but IMO it is a means to an ends. In other societies they don't value individual spirit nearly to the same degree, and in fact on many levels they would be unhappy if things were changed to value that as much as us.

    Personally I like how much individual flexibility we have; in fact I want much much more. It's completely fine that she chose the path she did (although if I had met her I'd try to argue logically that a different path was more responsible in my view, but if she didn't agree then c'est la vie) but in my experience a ton of other people's individual spirits bristle at the existential cost of failure that our society commonly hands down.
  • roro80
    "She'd not be happy that I used her story for a political point"

    I hope she would feel proud. I think it's important to bring people back into politics, instead of always discussing these issues from some supposed unbiased "objective" point of view where everything is an intellectual excersize. When it comes down to the real-life effects on real-life people of the political issues our government and population choose to address, we do need to think about the range of human experience, and your mother's story adds to that range. Emotional is not the opposite of rational.
  • D. E.Rodriguez
    CStanley:

    "I'm sorry if you feel that I mischaracterized that, but to me that said that the currently proposed plan would definitely have that positive effect on their access to medical care"

    What I actually said is " a health care reform that, at the very least, would bring some much-needed medical care into their lives,. and I stand by that

    Thanks
  • irina
    So I assume she'd refused Medicare and Social Security? To be true to her values?
  • irina -- you do understand how those systems work, yes?

    She'd been paying into ss all her working life. I tried to point that out in the post, maybe i wasn't clear enough. However, I'm absolutely sure that she'd happily decline it if somebody would kindly return to her the $ she put in.

    Also -- We'd have covered her on our medical policy if we could, but our system is set up in such a way that she cannot get coverage at her age -- because she's eligible for medicare.

    Because both of these took away her own choices in the matter, you'll perhaps understand why i see your question as a possible strawman.
  • D. E.Rodriguez
    I promised to explain better what I meant by "but there must be more to it," after listing many possible reasons for the current opposition to the health care reform. Some of the reasons I listed were, rightly or wrongly:

    "...that others who are fortunate to be in a financial position to have good medical care whenever they need it, would not want others to be as fortunate, for whatever reasons: they want to hold on to the money they worked so hard for; or they don't want bigger government, bigger deficits, or they don't want "socialism," etc., etc".

    I said that I didn't understand 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.

    And I quickly followed that up by saying,

    "If it is self-reliance, pride, stoicism, independence, etc., etc. then I understand and salute them."

    Polimom has just shared a story where her mom falls under this category, and I have saluted her (again)

    Then I said:

    "But, there must be more to it..."

    Now let me try to explain why I think that there must be more to the opposition to health care reform than the factors listed above.

    And these are all opinions, which I am sure many will disagree with---and which is perfectly fine.

    First, I believe that many are opposing the President's health care reform plan strictly for political reasons, because they want this President to fail..

    As a matter of fact, some prominent Republicans have flat come out and said so.

    Rush Limbaugh's desire for the economy to fail because he wants Obama to fail is the earliest and most virulent expression of this phenomenon.

    He soon followed that up with this: "There's one thing we gotta stop is health care. I'm serious, now. If they get that, then that's the tipping point."

    Sen. Jim DeMint (R-SC) explained why he hopes that health reform fails: "If we're able to stop Obama on this it will be his Waterloo. It will break him."

    Talking about defeating the health care plan, Sen. Jim Inhofe (R-OK) bluntly said that defeating Obama's health care agenda is "going to be a huge gain for those of us who want to turn this thing over in the 2010 election." and later, "We are plotting the demise on a week by week basis of where Bill Clinton was in 1993 and where Obama is today and his demise ratio is greater than Clinton's was in 1993."

    And I could go on and on.

    I believe that there are some Americans who desperately need better and cheaper health care, but they oppose the President's health care plan because they are afraid--they have been made afraid. They have been told that there will be death panels, euthanasia; that Obama will pull the plug on seniors, etc.

    I believe that there are some Americans who can't afford their present health care, but who oppose Obama's health plan for moral and religious reasons...because they have been told that Obama's health plan will pay for abortions.

    I believe that there are some Americans who can not pay their present health and prescription bills, but who oppose the president's plan because they have been told that illegal immigrants will receive free health care.

    I believe that--and you can disagree with it--there are some people who are so ideologically opposed to this president or who , yes, hate him so much, or mistrust him so much that they are willing to forego the benefits that an improved health care plan could bring them, because it is "Obamacare."

    This is some of the "there must be more to it." There probably are other reasons. Some good reasons, some not so good.

    I know that many will vehemently disagree with some or all of it. That's fine. It's an opinion, and Polimom and others have asked that I elaborate. So there it is.

    Please feel free to critique, condemn it, whatever, but please don't accuse me of saying that all Republicans feel this way. I have been very careful to say that I believe that there are "some Americans" who feel this way. If I can be proven wrong, I will be the first one to express my pleasure at that.
  • CStanley
    Thanks for expanding on it, Dorian. For me, the confusion in what you originally wrote came about because you placed the "there must be more to it" in close proximity to your thoughts about people who reject the public option plan even though they might personally benefit from it or need the reforms that it intends to bring. In my reading of that, it was as though you were saying that there had to be more to it than their belief in self reliance- for those particular people, that is, that that belief couldn't possibly explain their rejection of the plan. If I understand you better now, the 'there must be more to it' bit was about other groups of people, not those particular ones?

    Maybe you can see why I thought you were making the "what's the matter with Kansas?" argument...because I thought you were saying that the self reliant types were befuddled and voting against their own interests.
  • D. E.Rodriguez
    CStanley:

    I see where some people were confused and upset by what you call "the close proximity" of the two statements

    I hope I have explained it better now. But I will understand if I still get some criticism.

    Thanks

    Dorian
  • Dorian, thank you for the comprehensive explanation. I see what you were after now, though obviously I, too, put the closing line with its preceding paragraph.

    I agree absolutely that there are people who are opposing a government run option -- even though they might not have health care and can't get it for whatever reason -- due to any, or even several, of the various reasons you cite.

    I particularly agree that some of the Republican leadership is attacking and opposing on purely partisan grounds. Your examples make it pretty darned clear. As we unfortunately all know, the holy grail of political power has twisted no small number of our "leadership" across the board.

    That said -- I found that articulating what I wanted to describe extremely difficult. And I'm a communicator! How much harder must it be for somebody who hasn't tried to look that deeply, or isn't quite as articulate. Are they the majority? Or do large percentages of them fall to one of the examples you give? I dunno. I don't think there *is* a way to know (short of somebody coming right out and blurting some other reason).

    I do know, though, that the easy answer is only right sometimes, and Occam's Razor doesn't apply well to complex social issues.

    Thanks again. I really do appreciate your having taken the time to re-approach the entire question.
  • Added -- during the dialogue at the Chronicle on yesterday's post (I cross-posted that one), this comment came in:

    I don't have a job.
    I don't have insurance.
    I'm trying but the market isn't hiring.

    And I'm against the insurance reform.
    Why?
    First, my degree is in finance. I've looked at the numbers as best I can and don't see how they can do anything but long range harm to the U.S. It's NOT a no cost option.

    Second, I want a good country for my kids and grandkids. The idea of them being saddled with this incredible debt is abhorrent. The idea that the feds would have even more control over their lives is abhorrent.

    Finally, I know the federal government can't do anything efficiently. It's been proven too many times. I know some reps are simply voting a party line and some are in the pocket of lobbyists (and that describes both sides.) I think it is impossible for anything reasonable and workable to come out of this.

    Sorry. No racism in the whole argument. I'll try harder next time.


    It hasn't come up in the last couple of threads (other than CStanley, I think), but worries about the size of the national debt are very real, but they're being underestimated rather a lot.
  • HemmD
    "It hasn't come up in the last couple of threads (other than CStanley, I think), but worries about the size of the national debt are very real, but they're being underestimated rather a lot."

    I would ask what the prospects of the public debt will be if we do nothing for health reform?
    In other words, those who are concerned about the national debt never seem to evaluate the equally dire economic future of our personal finances as health costs go up and coverage is lessened.
  • D. E.Rodriguez
    Polimom:

    First, thanks for your kind words in another comment.

    On this one, I think the comment at the Chronicle, perfectly fits into one of the "categories" I mentioned:

    "or they don't want bigger government, bigger deficits..."

    And I do admit that a lot of people do sincerely worry about these issues.

    How nice it would be if America could focus the debate on such legitimate issues instead of on the misrepresentations about death panels, free abortions, illegal immigrants getting access to our health care system, etc., etc...

    Dorian
  • Jim_Satterfield
    "Finally, I know the federal government can't do anything efficiently."

    That one sentence renders the rest of his post into something that is simply not deserving of any respect. I've dealt with private insurance, Social Security and Medicare (When my mother was in a nursing home and when she was diagnosed with a terminal illness. Nowhere have I seen any evidence that the private sector has ever done a better job than the government. Also, I have to note that after our recent difficulties his degree in finance does not reassure me of his ability to accurately analyze anything.
  • Don Quijote
    It hasn't come up in the last couple of threads (other than CStanley, I think), but worries about the size of the national debt are very real, but they're being underestimated rather a lot.


    Amusing how this wasn't a worry when Bush was giving away the store to his supporters and starting two pointless wars.
  • How nice it is to read a thread where two views are reconciled.

    Looking back on it, it appears the problem with the phrase "there must be more too it" may have been a misunderstanding on whether the phrase applied to everyone who opposes the plan against their apparent self-interest, or just some people. If Dorian meant that some have legitimate concerns, but such concerns wouldn't add up to the amount of opposition we are seeing, and therefore there must be more that is contributing to the opposition, then that is a completely valid position. The degree to with the "more" is contributing to "it" is debatable, but I'll leave that alone so as not to spoil our reconciliatory moment here.:)

    I originally read it as Polimon did, but I can see how I could have misinterpreted that.

    But even if that's not what Dorian originally meant, I'm in favor of allowing people to have a second chance to explain (and sometimes even modify) their positions after being challenged. If we didn't allow that, and instead held people to their original statements as if written in stone, there would be little point in debating these issues, right? Not that I'm saying Dorian is doing this in this case, but just to make the general point: there is no weakness in admitting an error and correcting it.
  • ordinarysparrow
    ("sparrow, allowing her to take this path without trying to force a different outcome was unbelievably hard to do. Pain, suffering, and poverty call to us all.")

    thought you might enjoy the quote below, as you stated. . .it is true. . ." pain,suffering and (all kinds of) poverty call to us all.". . .i agree. . .the greatest of minds have said the same. . ." to live is to know suffering." and "all life is suffering.". . .and perhaps as true as that one is. . . there is also something in the heart of humankind that desires to soothe it . .

    "I feel gratitude to the Buddha for pointing out that what we struggle against all our lives can be acknowledged as ordinary experience. Life does continually go up and down. People and situations are unpredictable and so is everything else. Everybody knows the pain of getting what we don't want: saints, sinners, winners, losers. I feel gratitude that someone saw the truth and pointed out that we don't suffer this kind of pain because of our personal inability to get things right." Pema Chodron

    Pema Chodron
  • "Amusing how this wasn't a worry when Bush was giving away the store to his supporters and starting two pointless wars."

    Don Quijote, I don't know how you can say that. Many MANY people have had worries throughout.
  • CStanley
    Amusing how this wasn't a worry when Bush was giving away the store to his supporters and starting two pointless wars.

    It was, but last fall's economic meltdown and the Dem's doubling down on deficit spending has made it even more of a concern. In any case, you're wrong to assume that everyone who worries about the debt now was not worried about it then.

    I would ask what the prospects of the public debt will be if we do nothing for health reform?
    In other words, those who are concerned about the national debt never seem to evaluate the equally dire economic future of our personal finances as health costs go up and coverage is lessened.

    Again, Hemm, please reconsider those statements. Those of us who have been arguing here from the conservative viewpoint have most certainly NOT fallen into the category you mention. In fact, we are the ones who are asking the proponents of the current reform plans to consider costs first- and we've presented arguments for other types of reform which would actually have much more likelihood of addressing the real cost issues with our healthcare system.
  • **smiling at ordinary sparrow**

    A gentle soul. A kind soul.

    and perhaps as true as that one is. . . there is also something in the heart of humankind that desires to soothe it . .

    There's truth to this. Though I have met a few people who seem truly hardened to the suffering of others, they've been extremely few and far between in my lifetime -- and none of those were in any way political. Merely empty.

    However, I also think that the nature of a large society's efforts to 'soothe' suffering is rather too far removed, making the entire argument too impersonal and abstract. Taxing and then redistributing to others, often with unclear benefit to them, is also unsatisfying to that human desire to help. (yet another subject which I could easily launch a discussion of its own, i think...)
  • GeorgeSorwell
    Polimom--

    With all due respect to you, I think that Medicare has soothed a lot of human suffering.
  • GeorgeSorwell
    I would ask what the prospects of the public debt will be if we do nothing for health reform?
    In other words, those who are concerned about the national debt never seem to evaluate the equally dire economic future of our personal finances as health costs go up and coverage is lessened.


    I have to agree with HemmD about this.

    Also, I don't think Republicans were very serious about the national debt during the Bush years.
  • CStanley
    GS- that Medicare expansion is probably the best data point to support your point about the GOP being irresponsible. They clearly decided to imitate what most conservative voters oppose about the Dem party (the idea of expanding entitlements in order to buy blocks of voters.)

    In case you missed it though, we had elections in 2006 and 2008 where conservative VOTERS expressed their displeasure with the fiscal irresponsibility (among other things.) As is often the case, party leaders weren't abiding by the wishes of their constituents and they paid the price for it.
  • GeorgeSorwell
    CStanley--

    As easy as that, the largest entitlement program since the 1960's is dismissed as a "data point".

    There's also funding of the Iraq War.

    Don't forget that Republican party leaders like John Boehner and Eric Castor voted for the Medicare Part D bill. They're still in office. They're still in leadership positions. So I don't see how anyone can claim Republicans paid any price for their fiscal irresponsibility. And I don't see how anyone can claim that "conservative VOTERS" got what they wanted in the elections of 2006 and 2008.
  • Don Quijote
    Polimom,

    Very easily...

    Historical Debt Outstanding - Annual 2000 - 2008


    September 2000 - $ 5,674,178,209,886.86
    September 2008 - $10,024,724,896,912.49

    I remember the millions of Conservatives marching down the streets protesting... Oh sorry those were Liberals and they were protesting Bush's rush to war...
  • DQ -- It may be that I'm being overly sensitive here, but since I've come under fire about my "conservatism" in the last couple of threads (and I authored this one), I'm hearing your broad brush statements about conservatives and liberals as aimed at me. So excuse me, please, if I'm misunderstanding you.

    Having said that -- I think you may be confusing fiscal conservatives with Republicans, or perhaps partisans. You further seem to be forgetting that, for all the millions protesting, the majority of the country supported the escalation / redirection into Iraq. Whether everyone had all the correct information at the time is, as we know, highly questionable. But skating right past all the history surrounding those years to lump everyone into groups is, imho, both unfair and far too overly simplified.

    For myself -- I was screeching at the top of my lungs (often literally) as we geared up for Iraq, though it had less to do at the time with $$ and more to do with my understanding of the middle east and my realized fears about Bush's foreign policy team's ideology. (Can you say PNAC?) Yes, the war expenses are an enormous part of our current problems with expanding government programs generally -- a component that is not receiving much attention, I agree. You are, however, incorrect with the generalizations.
  • Don Quijote
    Polimom,

    "Despite the best that has been done by everyone . . . the war situation has developed not necessarily to our advantage." Hirohito
  • HemmD
    I suppose my original point has been lost in the rhetoric to defining the sub sets in political philosophy around here. 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?

    We now pay for the uninsured, but we just don't put it in any column when calculating the cost. It's similar to running a war without showing it in the budget as GWB did. When Obama accounted for the cost of conflict in a fiscal manner, many hammered his budget as being expansive. Where the "government expansion" meme is great rhetoric, it sure doesn't address the reality we all face.
  • HemmD
    I don't seem to be the only one who sees this a the problem:

    http://www.healthcarefinancenews.com/news/gao-h...
  • CStanley
    We now pay for the uninsured, but we just don't put it in any column when calculating the cost.

    Hemm, I spent the better part of a day (yesterday I believe it was) discussing this point with you, explaining that we don't in fact pay as much currently for reimbursing care for the uninsured as we will pay to insure all of them-- and in addition, the current plans will only insure a portion of the uninsured so we'll still have some of those ER costs to cover.

    You either ignored everything I said or didn't understand the point. Getting to universal coverage is not a cost saving mechanism or even revenue neutral- it costs money. Again I'll suggest that you look at how things are working out in MA.
  • HemmD
    CS

    "Hemm, I spent the better part of a day (yesterday I believe it was) discussing this point with you, explaining that we don't in fact pay as much currently for reimbursing care for the uninsured as we will pay to insure all of them-- and in addition, the current plans will only insure a portion of the uninsured so we'll still have some of those ER costs to cover."

    So, on first blush, the uninsured are a drag on the system unless they're not....

    I sure wish you'd re-read that of other comment thread. Your response to me yesterday came at the very end of a thread of 130+ comments where I was one of the first responders. Your response above implies that I know you think you've addressed my points, but when was the last time you thought you lost a debate :)

    I will just restate the fact that a solution must be found to the current costs we all pay now "off the books:" My example quoted below is an example of how we can begin to accomplish that critical requirement.

    " Let's take a simple example of my present insurance. A regular doctor's office visit requires a $25 co-pay on my part. For an emergency room visit, my part is $75. Now either emergency room visits cost three times as much or the insurance company merely charges me three times more simply to lower their exposure.
    Thus, either we could provide three times the number of doctor/patient interviews by providing office visits or else the current pricing structure is arbitrarily designed to maximize profit. As I said, we already pay for these uninsured visits, so if the pricing structure is profit driven, it confirms that reducing costs can be accomplished by removing private incentives.

    At no point did I say my proposal would solve all aspects of the uninsured health care costs. I merely pointed to the fact that the way we do things now is totally inefficient and costs you and me money. I'm the first person for lowering everybody's cost. I thought that was the point being discussed.

    As hard as it may be to believe, I'm not trying to win a debate, I'm trying to find any way possible to give care to everybody at the lowest price possible. My example demonstrates an inherent inefficiency in the present system.
  • CStanley
    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.

    What is driving me to keep pressing this point is that I really believe that proponents of universal coverage are working under the incorrect assumption that this will lower overall costs, when I feel convinced that it will have the opposite effect. Since you and I apparently agree that costs are currently unsustainable, surely you can see that it is important to determine what the true outcome of expanding coverage will be. If we decide that the goal of universal coverage is important for moral reasons, we're going to have to get even more serious about finding other measures to cover that additional cost.

    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?
  • HemmD
    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
  • CStanley
    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.

    And BTW- to illustrate why I think it's important to get the record corrected about whether expanding coverage is a net savings, neutral, or a net increase in costs...here's an excerpt from a comment in another thread:
    Unless I am missing something, co-ops would do little to solve the problem of millions of people being uninsured, would it? Unless you did something like offer to let people pay on a sliding scale according to income (which I don't think has been proposed), we'd still have people driving up costs by ignoring preventative care they can't afford and then ending up in the ER when they get really sick. I know the standard conservative response is - I don't want to pay for these people, but....you already are paying, so what difference does it make whether the payment is to the insurance companies (higher premiums) or to the government (taxes)?


    I see/hear this over and over from those who support single payer and/or public option- that expanding coverage for all will either cost the same as what we pay now or it will save money because of the 'efficiency' of preventative care. If that is a main selling point for a lot of liberals, then it's important to know if they are right or if my side of the debate is more correct on that point.
  • HemmD
    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?

    Edit: I should also point out that it was Obama that made it a must that reform should not add to the deficit, so clearly it is not just a right-wing talking point.

    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...
  • CStanley
    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.
  • CStanley
    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.
  • CStanley
    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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