Comments on Health Care Organizational Ethics: American Values and Health Reform (2): Liberty

Hi John - I agree with you that to be relevant fo...

2009-10-19T21:46:27.612-04:00

Hi John -

I agree with you that to be relevant for making policy, practical consequences have to be derived from the values discussed in the Hastings project. But the Hastings project had a different aim - namely, to explicate values that were invoked in health reform discussion in order to show the range of implications the values have. My "assignment" was "responsibility." Often it is invoked to condemn those who are "irresponsible," and taking responsibility for ourselves is a crucial part of a sensible approach to health. But historially responsibility also referred to a responsible, caring community, which suggests that our call for responsibility has a communitarian as well as an individualistic meaning.

Great to hear about the blog you are starting. Welcome to the world of blogging! I look forward to reading your thoughts over time.

Best

Jim

Dear all - I'm sorry for the delay in responding....

2009-08-29T15:26:34.550-04:00

Dear all -

I'm sorry for the delay in responding. I actually wrote this post before heading off to Europe for 2 1/2 weeks and just got back yesterday.

Anonymous - I agree with your hunch that many Americans favor a system of multiple insurers because the multiplicity gives a sense of security through the possibility of changing insurers. In "Exit, Voice, and Loyalty" Albert Hirschman describes the alternative strategies of trying to exert influence within an organization as opposed to bailing out. My preference for health care is maximum use of "voice," since give-and-take, whether between patient and doctor or enrollee and insurer provide a better opportunity for mutual learning and quality improvement.

Re the degree of public fear of "Obamacare," I agree with L.A. Neumann that in large degree these fears are being fomented by clever, devious strategies and misinformation. This isn't surprising given the huge amounts of money at stake in any changes from the status quo.

I share Onlique Estafan's view that looking for savings in Medicare fees is a bad idea if it is done as it has been done in the past - blunt ratcheting down across the board. Some fees should go up substantially (primary care). Some should come way down (many specialty procedures). With regard to overall cost I continue to believe that there is enough money in the system now if we spent it more wisely. I've written about that topic in a number of posts.

Ashley - great that you've now been introduced to the Hastings Center. The Center shares your commitment to civilized debate and the expectation that one come to the process with "clear ideas and reasoned arguments." Unfortunately the salvos that boil down to what L.A. Neumann called "killing grandmas" is disinformation, not argument.

Thanks for your comments!

Best

Jim

Excellent post, and thanks for pointing me to the ...

2009-08-25T10:03:39.301-04:00

Excellent post, and thanks for pointing me to the work at the Hastings Center. I also appreciate that you are willing to take on the health care protesters not as "anti-American" but within the context of American dissent (that greatest of our historical values).

Reasonable people can disagree on health care and reform but they must come to the debate with clear ideas and reasoned arguments.

President Obama has repeatedly said that a health ...

2009-08-19T05:35:34.923-04:00

President Obama has repeatedly said that a health care overhaul "will be paid for" and that he won't sign a bill that isn't deficit-neutral. But neither the House bill nor the Senate HELP Committee bill meets that criteria. According to the nonpartisan Congressional Budget Office and Joint Committee on Taxation, the House bill as introduced would add a net $239 billion over 10 years to the deficit, while the HELP Committee bill racks up more, $597 billion over 10 years.

Obama has also said he has "identified two-thirds of those costs to be paid for by tax dollars that are already being spent right now." But "identified" is the operative word. These savings are estimates and whether around $650 billion (about two-thirds of the cost of health care over 10 years) can be saved remains to be seen. Most of the money would come from Medicare, but cuts in payments to insurers and practitioners aren't popular measures that move easily through Congress.

There are two problems with health care reform as ...

2009-08-17T19:40:47.990-04:00

There are two problems with health care reform as it is being formulated: that opposition has been allowed to mislead the public on what the bill will do; and Obama's administration has given them credence. The bill allows for plenty of choice. No one will lose their current care. No grandmas will be killed. Anonymous above says that both sides are disruptive. Only one "side" is showing up at town halls with guns, Nazi slogans, and monkey signs. There is more at work here, as the writer notes, than simple opposition to reform. You are wrong to conclude that a majority of the population opposes this reform; they are simply misinformed, misguided, and egged-on by the medical corporations and power-hungry Republicans. Once again, erroneous nostalgia and corporate monopoly are keeping this country in the dark. Liberty indeed.

Perhaps it is not that opponents of government hea...

2009-08-17T12:42:17.300-04:00

Perhaps it is not that opponents of government health care are unable to see alternatives, but rather that they see alternatives not being considered by Congress.

Discounting orchestrated disruptive protests on both sides, I see nothing monolithic about the substantial number of what appear to be ordinary citizens very worried that they will lose access to the care they currently have. Congressional leadership is ignoring other possibilities in their rush to control. The public sees this and has given Congress a failing grade.

I doubt that this group of citizens, which now represents a significant majority according to several of the more reliable national polls, has much more in common than that they dislike what Congress is proposing. If one opened up all the possible choices, I expect that they would gravitate in smaller groups toward several different solutions.

We know that prioritization will occur. The only question is how. I think many members of the public would be more comfortable knowing that, if they disagree with the methods of their insurer, they could leave and purchase coverage from a competitor.