Without getting into partisan politics it is instructive to consider the "lessons learned" by L- and C-minds from the horrid 1932-1972 Tuskegee experiment where hundreds of black men were told they were being treated for their syphilis when, in actuality, they were simply being observed as the disease progressed without any attempt at treatment.The issue has surfaced because Rev. Jeremiah Wright recently claimed “the government lied about inventing the HIV virus as a means of genocide against people of color.” He backed up his claim by saying the U.S. government “purposely infected African-American men with syphilis.” He also said: “Based on this Tuskegee experiment ... I believe our government is capable of doing anything.”
According to Jonah Goldberg, many present-day Americans, including some prominent conservative commentators, believe the Tuskegee experiment involved purposely infecting the experimental subjects with syphilis. Until I read the linked story, I also believed that.
As awful as the experiment was, it absolutely did not involve purposely infecting the men - they were recruited because they already had syphilis. As for the lack of treatment, at the initiation of the study, in 1932, penicillin was not available. Into the 1940's and '50's, it was not medically established that penicillin was a safe treatment for men in the latter stages of the disease. Thus, the un-ethical aspect of the Tuskegee experiment consisted of: 1) Lying to the subjects when telling them they were being treated for syphilis and 2) Not providing penicillin to those still alive when it was known to be an effective and safe treatment.
Lesson of Tuskegee for L-Minds:
According to Goldberg, "I’ve lost count of how many times I’ve heard guilt-ridden white liberals say ... 'Considering what we did at Tuskegee, who can blame them [black people] for being distrustful of government?' ...”
"Liberals like to invoke Tuskegee as if it’s solely an indictment of what other people did, proof that we need more progressive government."
Lesson of Tuskegee for C-Minds:
Goldberg adds: "as a conservative, I have no problem with distrusting government, nor can I fault the descendants of slaves or the victims of Jim Crow for distrusting government more than most. But why blacks remain the most reliable voters for the party of ever-expanding government power is something of a mystery. Indeed, it’s worth noting that the Tuskegee study, launched under the New Deal, was symptomatic of arrogant liberal government. The study ... emerged out of a liberal progressive public health movement concerned about the health and well-being of the African-American population.”
"... Tuskegee was in fact the poisoned fruit of progressive government."
OK, L- and C-minds on this Blog - what do YOU think?
Ira Glickstein
Ira asks us to consider two conclusions that one might draw from the Tuskegee breach of ethics.
ReplyDeleteL-Mind; "Liberals like to invoke Tuskegee as if it’s solely an indictment of what other people did, proof that we need more progressive government."
C-Mind; "... Tuskegee was in fact the poisoned fruit of progressive government."
I'm not so sure that I agree with those choices. I think that an L-mind would focus on the emotion of outrage that all must feel about what was done. An L-Mind would also be outraged that no one was punished and would applaud Pres. Clinton's apology and the monetary award given to the survivors and their families. An L-Mind might, in addition, consider that Rev. Jeremiah Wright is correct to conclude that this incident lends credence to his contention that the US government invented the AIDS virus to wipe out African Americans.
The C-Mind would experience the same emotions of outrage as the L-Mind, but would be more likely to judge the individual doctors and nurses based upon the medical ethics of the time and what they were trying to accomplish. That does not excuse the fact that the ethics of the time were badly flawed. In addition, the C-Mind would consider the fact that scholarly papers which described the study (see Wikipedia, Tuskegee Experiment) were published, indicating that there was no hidden genocidal agenda. There is so little similarity between Tuskegee and the accusation of a plot to use AIDS as an instrument of genicide that one must consider, that one must consider such a reference to be a dishonest rhetorical trick. As a C-Mind, I conclude that public health is a legitimate governmental role, but that bureaucracy often subverts transparency.
Lets get a little more up to date on this blog! Tuskegee was a single bizarre case inolving a few hundred adults in a different era.
ReplyDeleteHow do you C-minds feel about President Bush’s “experiment” refusing health support to a few million U.S. children on purely ideological grounds, even though a report shows U.S. has the second worst newborn death rate in modern world.
"All children, no matter where they are born, deserve a healthy start in life," (Melinda Gates, in the foreword to the report).
Good to see Howard posting again on this Blog. (He shared with me that he has been busy writing a paper for a new Biosemiotics journal and was kind enough to allow me to read and comment on his excellent paper. I hope he will try to boil this highly scientific work down to the level of this Blog and post it as a new Topic.)
ReplyDeleteHoward asks about "...President Bush’s 'experiment' refusing health support to a few million U.S. children on purely ideological grounds," and quotes Melinda Gates but gives no URL.
I Googled the Gates quote and found this CNN story with the Gates quote and the information the US scores poorly on infant mortality, but does not seem to mention Pres. Bush. Howard, please provide us with the link to the information you want us to comment on.
Ira Glickstein
Bush said the bill would have encouraged families to leave the private insurance market for the federally funded, state-run programs. http://www.cnn.com/2007/POLITICS/12/12/bush.schip/index.html
ReplyDeleteGiven the bad state of U.S. child health,
I was looking for C-mind arguments on health care policy. Should child health care and costs be a private responsibility, or should it be a government responsibility?
Thanks Howard for the link to this CNN story that does not mention either the Melinda Gates quote nor the US scores on infant mortality.
ReplyDeleteBefore I comment on the Bush veto of a $35 BILLION DOLLAR INCREASE in US funded health payments for children (he favors a mere FIVE BILLION DOLLAR INCREASE) let us focus on US infant mortality. According to the CNN story I linked to in my last comment, "...In industrialized nations deaths were most likely to result from babies being born too small or too early..." In particular, US-born African-American babies were twice as likely as other American babies to be low-birth weight.
According to U Virginia low birth weight is primarily due to premature births, teen mothers, multiple births, and "...Babies of mothers who are exposed to illicit drugs, alcohol, and cigarettes ..." (Such as crack babies?)
There may also be a racial factor because the worst ten countries are ALL in Black Africa.
Contrary to the tone of the CNN story, the US is tenth BEST out of 125 countries! All the countries with better infant mortality rates are in White northern Europe, Australia, and Canada.
The L/C issue here is the level of government responsibility. C-minds distrust government and believe decision making is best linked to those who are paying the bills and getting the benefits. The ideal situation is private health insurance paid for by employers out of the earned value produced by their workers. The next best is local government where officials have a sense it is their hard-earned community money being spent on their less-fortunate neighbors. The idea that state and federal government should have primary funding responsibility is as ridiculous as expecting the UN to administer world-wide health care!
As Milton Friedman wisely observed: When Mr. A spends Mr. B's money to benefit Mr. C, there is no limit to how much money will be wasted.
He also observed: "... nobody spends somebody else’s money as carefully as he spends his own. That’s a fundamental principle. All government spending is spending somebody else’s money."
Ira Glickstein
Milton Friedman’s statements have no relevance for my question. Insurance, by definition, is sharing the risks. In that case, Mr. A, B, and C are rationally pooling their own money for reducing their own risks. The only issue I was addressing is over the optimum size of the community the risk should be spread, and how effectively the risks are minimized.
ReplyDeleteYou simply assert as opinion that the smallest community (a single employer) is optimum, and that the largest community (the UN) is “ridiculous.” I see no evidence or logic in either of these extreme views, especially for children’s health. I see here some C-minded ideological bias. Children’s health necessarily involves very long-term risks to a potentially very large indeterminate community.
Incidentally, one of my ex-students employed by the Defense Dept. says his government health insurance is far better than any that is privately available (He has MS). This is consistent with what I have read about government health insurance for our elected representatives.
I forgot to add that I quoted Melinda Gates because neither the Gates Foundation nor the UN think reducing childhood health risks in the global community is “ridiculous.”
ReplyDeletehttp://www.gatesfoundation.org/GlobalHealth/Pri_Diseases/ChildHealth/
http://www.un.org/apps/news/story.asp?NewsID=26344&Cr=child&Cr1=health
This Topic has been a great illustration of the contrast between L- and C-minded argument.
ReplyDeleteIt began with the emotion-laden and fact-free claims by Rev. Jeremiah Wright that the US purposely infected black men with syphilis in the 1930's and recently invented HIV as a means of genocide against people of color.
Howard updated the argument with a claim that Pres. Bush refused health support for children on purely ideological grounds.
What I think is ridiculous is for the UN to administer health care for the whole world. Or for the federal government to tax and run health care for the whole country from Washington, DC.
I definitely do NOT think Melinda Gates is ridiculous when she states that all newborns deserve a healthy start in life. What we disagree on is how that noble goal is best achieved in a practical sense in the real world.
Low birth weight is the primary cause of newborn death in industrialized countries like the US.
What causes low birth weight? Primarily risky behaviors such as: 1) multiple births now often due to fertility treatments, 2) teenage pregnancy, 3) abuse of alcohol, cigarettes and illicit drugs.
What health-care policy is best?
I believe it is putting the costs as close as possible to those INDIVIDUALS making the risky decisions -and- making the INDIVIDUALS receiving the health care sensitive to the costs so the available resources are spent most effectively.
L-minds seem to miss the point that ALL costs are borne by INDIVIDUALS. Government programs are paid for taxes paid by INDIVIDUALS. When corporations are taxed, or put under government mandate, the costs are passed on to the employees of that corporation, their stockholders, and their customers - all INDIVIDUALS.
When possible, people should pay the costs of their own health care, particularly when their health issues are due to their own risky choices (alcohol, tobacco, illicit drugs, teen preganancy, ...)
Of course, not all health problems are due to personal behaviors. At some point, some of us will be hit with a devastating disease where costs are too great for a family and must be shared by an insurance program covering multiple people and companies. I am in favor of insurance programs that assess the risks and allocate costs accordingly, the idea being we each have a relatively small risk of a devastating loss, so if we each pay a fair share of the risk there will be money available to cover those who happen to get hit.
Howard rejects Milton Friedman's wisdom as irrelevant. Friedman is not opposed to insurance that pools the money and shares the risks between Mr. A and B and C and so on. What he warns about is when Mr. A (a politician or government bureaucrat) spends Mr. B's (hard-earned taxpayer) money to benefit Mr. C (a welfare recipient).
When personal care decisions are made in Washington, DC, by civil servants using taxpayer money, there is no limit to how much will be wasted and how little will actually go to deserving victims.
We have "the best government money can buy" - the money of big corporations and big labor and other special interests. High paid lawyers write laws to benefit special interests and politicians pass these laws to curry votes. Dollars journey up to Washington and return as pennies to localities.
Ira Glickstein
I agree with Ira that "this topic has been a great illustration of the contrast between L- and C-minded argument."
ReplyDeleteIra has written an essay blaming most health problems of children on what he sees as the consequences of immoral behavior, drugs, and race. I would say that is consistent with typical C-minded “hard-nosed” realism that punishes evil-doers and visits the sins of parents on their children.
My “bleeding heart” L-mind was focused on blameless childhood diseases like birth defects, and cancers. Leukemia is, in fact, the leading cause of death for children under the age of 20.
Ira does admit that such blameless risks exist. He says, “Of course, not all health problems are due to personal behaviors. At some point, some of us will be hit with a devastating disease where costs are too great for a family and must be shared by an insurance program.”
The only issue I raised was how large a community should share such insurance risks.
Ira’s says the ideal size community is the single employer and its employees. I don’t know why he believes this other than his C-mind ideology. We know this does not work, because only the largest corporations can afford to run their own health plans with the employees paying a large portion, and their coverage is usually inadequate for catastrophic diseases. Health insurance companies must enroll a much larger population to cover risks, and they are notorious for excluding specific costly conditions, and denying individual claims over inadvertent mistakes in contracts.
Most insurance systems are usually multi-statewide, like my own NYS Blue Cross. Of course now Medicare covers my major health costs, and it is better than Blue Cross. Almost all independent analyses show that Medicare is more cost-effective than any private insurance plan. Also, contrary to Ira’s scare tactic claim, my individual health care decisions are NOT “made in Washington, DC, by civil servants using taxpayer money”
So, until I hear some reliable evidence to the contrary, I stand by my assertions that child health care in the US is worse than most countries with similar standards of living, and that government employee health plans are better than any private plans.
Howard got almost everything I believe correct.
ReplyDeleteOne point where I apparently was not clear was on the preferred size of the insurance risk pool. I do NOT believe it should be restricted to one single employer and its employees. I agree with Howard that the risks should be shared more widely, such as Blue Cross and other large medical insurers. Such insurers have economy of scale benefits, can effectively negotiate for drugs and medical services rates, and have a profit incentive to streamline medical care to the extent possible.
Employees of large and small employers, and those self-employed, should obtain their insurance from one of these large insurers.
Rates should be based on the risks involved, including age and health history, which should be averaged for employees of the same employer or affinity group that negotiates for coverage. [Some will object to consideration of risk issues. However, considering car insurance, I don't think I, living in a very safe area, should pay the same for glass breakage as someone living in downtown Brooklyn where breaking car windows is a sport, and insurance fraud is rampant. The same idea should be adapted to risk issues affecting health, such as history of smoking and other risk factors, including medical costs in a given locality.]
Also, I do not blame the children for the sins of their parents, nor do I blame people for most of the diseases they happen to get. As Howard points out, unnecesarily pejoratively IMHO, I "admit such blameless risks exist".
What I do believe is that the FIRST payers should be those who choose risky or non-risky behaviors. Most of us have chosen relatively non-risky behaviors and should not be penalized for the few who abuse themselves and their children. Private insurance plans are the most economical and most effective for us.
The government should step in only when parents cannot afford to pay the costs of insurance for their children or where citizens are handicapped or struck by devastating diseases that are beyond their ability to cover, even with private insurance. That is called "WELFARE". No one who is gainfully employed at any legal job, no matter how "lowly", should have poorer medical care than anyone on welfare.
Ira Glickstein
I agree with Ira, “No one who is gainfully employed at any legal job, no matter how "lowly", should have poorer medical care than anyone on welfare.”
ReplyDeleteI would ask, conversely, should an employer no matter how highly paid, say, 100 times what his employees are paid, have better medical care than any of his employees?
Howard asks: "...should an employer ... have better medical care than any of his employees?"
ReplyDeleteOf course, YES, if he or she can afford it.
We need a health care net below which no-one in the US should be allowed to fall, but absolutely no ceiling for those who can afford, with their own money, to pay for it. It is THEIR money and if they want to spend it on a boob job or plastic surgery or staying alive for 200 years, that is THEIR choice.
Should those of us in the US have better health care than those in poor countries? Of course, YES!
Should those of use who can afford it live in excellent retirement facilities as you and I do? Of course, YES!
What are you getting at?
Ira Glickstein
Ira responded to my short question as a true C-mind with a simple black and white answer. To Ira health care ethics is simply anything money can buy, along with a compassionate conservative’s minimal safety net for the poor. He sounds exasperated that my question implies some other answer. He asks, “What are you getting at?”
ReplyDeleteMy L-mind was getting at the old ethical question that physicians and medical ethics departments in hospitals and medical schools are still struggling with. The question is: To what degree should the quality of an individual’s health care depend on what he can afford to pay for it? This is not a Mickey Mouse question.
Ira’s high regard for “whatever money can buy” is certainly a common view among conservatives, but it has problems with health care, especially with children, that are obvious to those who seriously study the question. There are about thirty million working Americans without insurance who can’t afford comprehensive health care, many more with inadequate care, while the wealthy receive extraordinary high quality care without regard to cost. Whatever your ethics, this disparity presents serious practical problem in the delivery and distribution of limited health resources. Every hospital in the country faces this problem.
The United States health care system is unique among those of other developed countries. Health care is not a legal right in the United States, but mostly an inefficient, unregulated collection of partial employee benefit plans. Many experts consider the US health care a shambles that is not only cost ineffective, but ethically corrupt.
How would Ira decide what his safety net would cover? Maybe yearly checkups, X-rays, two MRIs, treatment for one cancer, one heart surgery, two pregnancies, two joint replacements, and a bucket full of prescription pills. All this for only for $500/month! For another $200/month we’ll throw in a year in an Alzheimer’s unit. There is already a going black market in organ donors. Using money-based ethics, blood and organ transplants would be auctioned off to the highest bidder.
Your view of medical ethics fits well with "WWJD?" - "What Would Jesus Do?"
ReplyDeleteWWJD ethics are reflected in your quote from Melinda Gates: "All children, no matter where they are born, deserve a healthy start in life..." [Emphasis added]
What a noble goal and it even makes me feel good to think about it.
I am pleased Bill and Melinda Gates are putting their money in that direction, God bless them. (Also some of ours - we own Microsoft stock, stuck at $30 for the past five years.)
If this is to be more than "feel good" hyperbole, we would have to divert billions of US taxpayer dollars to raise the level of child healthcare WORLDWIDE to our level. And then all US child healthcare to the highest level enjoyed by those who can afford to pay for it.
What would happen to global overpopulation if that goal was achieved? You don't have to answer that question because, as we all know, it ain't gonna happen.
A better question though is "WWDD?" - "What Would Darwin Do?" (Not Darwin the man, but Darwinian evolution.)
Despite the heights reached by human religion and philosophy and language and science and technology - we are still animals competing with each other and other societies and species for resources that will always be limited. WWJD warms the cockles of of our hearts, but WWDD rules in the real world.
In earlier postings you have written about adaptation. As you know that occurs when variants compete for limited resources. By natural selection, those more "fit" (better adapted to the environment they happen to be in) will, on average, have higher survival and reproduction rates.
Some, including me, believe this applies to variants of human social systems. Monitary resources, while not a perfect measure, are a good approximation, on average, of the "fitness" of individuals and families and communities, particularly in a society like ours where social mobility is a reality. (I say this as the grandchild of immigrants from Europe who came here with nothing, and the son of a letter carrier. Like many others, by working hard in school and in my profession, I achieved an above-average income.)
It seems harsh, and it is, but common resources, mostly funded by those with above average incomes, should be spent where, on average, the returns to society will be greatest.
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Howard wrote: "Many experts consider the US health care a shambles that is not only cost ineffective, but ethically corrupt." My personal experiences as a consumer of US healthcare services are quite the opposite. IMHO, "many experts" are well paid by special interests to get populist politicos elected and enrich selected business interests that could not compete otherwise.
Howard wrote: "There is already a going black market in organ donors. Using money-based ethics, blood and organ transplants would be auctioned off to the highest bidder." I fully suppport the laws against such black markets. The perpetrators should be jailed and anyone caught with a black market organ should be forced to give it back.
Ira Glickstein
Unfortunately, most liberals will reject Ira’s realism simply as an emotional response. Some of his points are very well stated but often ignored, usually resulting in a big waste of money. For example, the idea of wealthy nations raising worldwide standards of living to their level is clearly a “bleeding heart” pipe dream. On the other hand, raising awareness of birth control methods might help.
ReplyDeleteHowever, as a rational evolutionist I have to point out that Ira’s concept of evolution as a competitive fitness struggle is a misleading half-truth. The origin of life is the origin of a system of molecules COOPERATING so as to replicate. Ira knows a lot of theory and practice about systems. A system is characterized by a cooperative relation between its elements, resulting in the system’s function. All of evolution is a balance of competition between, and cooperation within, replicating or persisting systems. That is also what political theory is about. DARWINIAN COMPETITION IS ALWAYS BETWEEN COOPERATIVE SYSTEMS.
The basic political and moral issues that conservatives and liberals should argue about are (1) the optimum size of the cooperative systems that are in competition with each other, (2) the type of authority that achieves and maintains the system cooperation, and (3) the amount of individual freedom that is allowed within each cooperative system so that it can adapt without risking extinction. These are all tightly coupled questions. Biological evolution has discovered innumerable answers to these questions, but many more have become extinct than have survived.
What started my original post on child health was provoked by Bush’s veto of SCHIP funds. The veto was justified on purely dogmatic ideological grounds (“a step towards government health care”). It should be obvious that child health is far more important for the future of any society than keeping us old folks alive, which is where the most money goes.
Consequently, I asked if there is any reason beyond the ideological dogma of “non-government health care” for children. I asked, “Should child health care and costs be a private responsibility, or should it be a government responsibility?”
Ira answered with what I see as dogma, “C-minds distrust government and believe decision making is best linked to those who are paying the bills and getting the benefits.” I don’t see how his answer applies to children who are not responsible for their parent’s bad decisions or their inability to pay the bills.
Ira says, “The government should step in only when parents cannot afford to pay the costs of insurance for their children.” Well, that is exactly why SCHIP was created! The State Child Health Insurance Plan was bipartisan, sponsored by Ted Kennedy and Orrin Hatch. Hatch’s view was that, "Children are being terribly hurt and perhaps scarred for the rest of their lives" and that "as a nation, as a society, we have a moral responsibility" to provide coverage (see Wiki). Yet despite SCHIP the number of uninsured children in the US continues to rise. An October 2007 study found that about 69 percent of newly uninsured children were in families whose incomes were 200 percent higher than the federal poverty level. That is why SCHIP needs more funds Where do conservatives think child support should come from?
As a further C-mind opinion, Ira adds, “The idea that state and federal government should have primary funding responsibility is as ridiculous as expecting the UN to administer world-wide health care!”
Whether or not that is “ridiculous” should not be decided by ideological dogma, but on reasoned answers to the three evolutionary issues that I stated above. In fact, the UN, as well as almost all the developed nations, and hundreds of foundations, like Gates, see worldwide child health care, including birth control (except for Bush) is an important responsibility.
Sorry for the delay in replying but we were traveling up to Andover to visit our grand-daughters and their parents.
ReplyDeleteHoward and I agree on the basics of systems as well as evolution.
I could not have said it better: "DARWINIAN COMPETITION IS ALWAYS BETWEEN COOPERATIVE SYSTEMS."
Let's you and me and those who share genes and/or memes with us COOPERATE with each other to better COMPETE with those who share different genes and/or memes. I agree COOPERATION is as important as COMPETITION.
Paraphrasing Howard, L- and C-minds argue political/moral issues: (1) optimum size of cooperative systems, (2) how to encourage cooperation, and (3) amount of individual freedom - all tightly coupled questions. Our differences are in the details!
When Pres. Bush vetoed a major increase in SCHIP (and agreed to a reduced INCREASE) he said it represented "a step towards government health care" which Howard interpreted as "ideological dogma" and I interpreted as prudent concern for limiting waste of taxpayer money.
This reminds me of something I learned in a 2-week IBM marketing school: Say our product uses stainless steel screws and our competition does not. An engineer would simply give the FACTS "stainless steel screws" and ASSUME the customer would understand the benefits. A good marketeer would add the ADVANTAGE "don't rust" and also the BENEFIT "will save you (the customer) money over the long run."
Pres. Bush was simply giving the FACTS the proposed increase was "a step towards government health care" and should have added the ADVANTAGE of his veto "private insurance paid for by consumers is generally more efficient than bloated government administration which should be limited to a safety net under children whose parents cannot afford insurance" and the BENEFIT "better health care for all at lower costs."
Howard notes that the number of uninsured children has increased since SCHIP was introduced and over 2/3rds of newly uninsured children had parents with income double the poverty level. Well, duh, those parents are not stupid - why should they voluntarily pay for insurance when the government is giving the medical services away for free?
Ira Glickstein
Ira is irritated by Gore’s “facts” that are unsupported by evidence, but has no problem stating his own “facts” that are unsupported by evidence. I called Ira’s thinking “ideological” because it is thinking based on dogma rather than on evidence.
ReplyDeleteIra stated, “Bush was simply giving the FACTS: private insurance paid for by consumers is generally more efficient than bloated government administration which should be limited to a safety net under children whose parents cannot afford insurance" and the BENEFIT "better health care for all at lower costs."
This is dogma, not evidence. Improving health care cost-effectiveness is a major research area for both Medicare and private health systems. Thousands of comparative studies have been done. There are no simple or obvious “facts” about what systems are best. As I said in a previous post, my own experience, as well as my friends who have government health insurance is that it is clearly superior to any private plan, both in cost and coverage.
When ideologies are involved, there is bound to be useless controversy over facts, but at least I though Ira knew the difference.
Evidence from a 2001 survey demonstrated that Medicare beneficiaries are generally more satisfied with their health care than are persons under age sixty-five who are covered by private insurance. Medicare beneficiaries report fewer problems getting access to care, greater confidence about their access, and fewer instances of financial hardship as a result of medical bills.
http://content.healthaffairs.org/cgi/reprint/hlthaff.w2.311v1.pdf
Another study attributes Medicare’s ability to equal—and using its measures, to actually exceed—the private sector in controlling the rate of health spending growth to Medicare’s ability to price aggressively for the services it covers.
http://healthaff.highwire.org/cgi/content/abstract/22/2/230
Of course you can find other opinions if you go to conservative think tanks. In any case, Ira’s claim that private care is “more efficient” and government health is “bloated” remains pure ideological fancy until he presents some evidence.
I read your link to the Commonwealth Fund study, here in clickable form.
ReplyDeleteThe first problem, common to virtually all surveys, is "self-selection" by respondants. Some 46% of those contacted did not participate in the survey. While this is reportedly pretty good for surveys of this type, one is entitled to wonder if the self-excluded 46% might represent a different set of opinions than the 56% who participated.
Respondants who received their medical insurance benefits from a combination of Medicare and private sources were included in the Medicare category. Thus, the Medicare category benefits from those of us who supplement Medicare with private plans that give us benefits not available to Medicare-only recipients.
The Medicare category is divided into two groups, those 65 and older and those under 65 and on Medicare due to a disability.
As Howard reported, Medicare 65 and over were more satisfied (66% "very good" or "excellent") than Private Insurance (54% "very good" or "excellent").
However, these are two different age cohorts and it may be that those of us over 65 are easier to satisfy than the younger generation. This conjecture seems to be supported when comparing Medicare under 65 (39% "very good" or "excellent") with those in the under 65 age with Private Insurance (54% "very good" or "excellent"). By that measure, the non-elderly are more satisfied with Private Insurance than Medicare. Of course, the non-elderly Medicare are disabled which is likely to affect their attitude towards health care.
The Commonwealth Fund website advocates "universal coverage" so it is no surprise they would fund a study that favored Medicare. It also bothers me they do not compare the satisfaction of Medicare-only with Medicare PLUS Private vs Private-only. They obviously have the data but did not include it in their report at all.
Ira Glickstein
I’m happy to see you looked at the little evidence I presented; but understand that I am not arguing the validity of these studies, because I have read many more of them and it is clear that more research is needed to improve both government and private health care.
ReplyDeleteI was responding to your unsupported assertions about government. Are you still claiming as a FACT that “private insurance paid for by consumers is generally more efficient than bloated government administration,” and that the BENEFIT of private health is "better health care for all at lower costs”? If so, then further arguments are useless.
If you are willing to doubt your “facts” then I would like to hear your opinion of the arguments for SCHIP. These arguments have nothing to do with your opinions of bad parents, how parents care for their children’s health, or why they choose to pay, or not pay, for health care. The arguments are based on national interest, cost-effectiveness and ethics.
The national interest in child health is obvious. Children are our nation’s future, and therefore it is a legitimate government concern. The cost-effectiveness argument is simple. Early preventative care is far less costly to the taxpayer (or anybody else) than later remedial care. Preventative care can be assured only if it is a requirement like education. The ethical principle is also simple. All children should have the same access to, and quality of, health care. As is the case for education, this equality principle can be approximated only if it is established by law.
Everyone I have read (except you and Bush) thinks SCHIP is a good beginning and needs more funds. Like education, it is administered by the states. It has bipartisan support in congress, it is supported by the AMA, by all the editorials I have read, and as far I can see, by everyone else, except for ideologues who simply repeat a mantra: “government health care is socialism.”
Howard, you inadvertently misquoted me in your May 16th 4:56 pm posting.
ReplyDeleteI did NOT claim it was an accepted FACT that private insurance is more efficient and so on.
Please read my statement again, here it is verbatim from my posting:
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Pres. Bush was simply giving the FACTS the proposed increase was "a step towards government health care" and should have added the ADVANTAGE of his veto "private insurance paid for by consumers is generally more efficient than bloated government administration which should be limited to a safety net under children whose parents cannot afford insurance" and the BENEFIT "better health care for all at lower costs."
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All I claim as FACT is that massive SCHIP expansion is, as Bush said "a step towards government health care" Both proponents of government health care and opponents should agree that is a fact. In fact, that is why proponents of national health care favor massive expansion of SCHIP and opponents favor a more modest increase.
The remainder of my statement is what I said in the previous paragraph "A good marketeer would add the ADVANTAGE ... and also the BENEFIT ..." The ADVANTAGE/BENEFIT is opinion the marketeer wants the audience to draw from the FACT. Your posting makes it appear I am stating these as established facts rather than what I consider to be well-founded opinions.
You say in your 9:45 pm comment: "Everyone I have read (except you and Bush) thinks SCHIP is a good beginning and needs more funds." NOPE! Both Bush and I support SCHIP as well as INCREASED SCHIP funding. Our only disagreement with proponents of national health care is the size of the INCREASE required.
Please have a look at Myth/Fact: Five Key Myths About President Bush's Support for SCHIP Reauthorization for his official position that SUPPORTS a 20% INCREASE in SCHIP funding, amounting to a non-trivial $5 BILLION DOLLARS, a 20% INCREASE. (The bill he vetoed would have increased it by up to ten times as much.)
What he (and I :^) oppose is the bill's increase of $35 to $50 BILLION DOLLARS which "Turns a program meant to help poor children into one that covers children in some households with incomes of up to $83,000 a year."
I DO AGREE with part of what you wrote, namely: "The national interest in child health is obvious. Children are our nation’s future, and therefore it is a legitimate government concern. The cost-effectiveness argument is simple. Early preventative care is far less costly to the taxpayer (or anybody else) than later remedial care."
Yes, we need to encourage early preventative care and that will save money in the long run. However, we have traditionally left child care decisions to the family and intervened only in cases of clear abuse.
Some examples, (1) We have an epidemic of childhood obesity. We could save money in the long run if the government set child weight limits and fined parents or put their obese children in foster homes. (2) Richard Dawkins believes indoctrinating children in traditional religion is "abuse". (3) My religious friends think belief in Jesus will save their children from an eternity in hell, so not to teach them would be abusive. (4) We recently took children away from their apparently loving mothers in the FLDS (Mormon) compound.
Each of these case has to do with improving child welfare and saving public money in the long run. I assume you, as I do, would oppose taking children away in the first three examples. On balance I think the fourth case is so serious we had to act, but it is a step down the "slippery slope".
Ira Glickstein
Ira, I apologize for misreading your comment. So we do not differ on “facts,” but only on your “well founded opinion” that private health care is "better health care for all at lower costs." than government health care. I have stated evidence for my opposing opinion that I think is also well-founded; so I think we should not expect to resolve our remaining differences which are probably not as far apart as we make them sound.
ReplyDeleteMay I suggest a new topic: How can we think about the optimum size of a cooperating society that must survive competition from other societies? I think your hierarchy theory of spans may be relevant here (which you might summarize for us). I’m wondering if an optimum size of a cooperative society might be limited by the number of levels over which effective cooperation can be maintained.
Also, have you thought about “competitive” reorganization within a cooperative hierarchy? Democracies are the prime example of adaptive change from the bottom levels up, if they are working right. One of the problems with military hierarchies is that they do not easily adapt from the bottom up. I guess businesses are more like military organization than democracies. Is this topic worth discussing, or is it too abstract?
Howard: I agree - let's "agree to disagree" on the few nits and lice that separate us and celebrate the wide areas of agreement!
ReplyDeleteI'll agree to work on a new Topic for the Blog relating my "Optimal Span" theory if you'll agree to do the same for your "Biosemiotics". It will be quite a challenge to make these subjects accessible and of interest to a general audience but I think it will be worth the effort.
If you agree let us coordinate via email.
Ira Glickstein
Hi Ira and Howard,
ReplyDeleteAs I read your challenging comments to each other, I concur with the way you suggested that it is time to call an honorable truce. You both have presented your “well thought out comments”, and have given your bloggers a great deal to think about!
I am especially pleased to hear that your comments over the “Tuskegee Experiment” will possibly produce two new topics, one on “Optimal Span” and the other on “Biosemiotics.” These are new topics for me. Ahh! I have already started to read about these potentially new topics in (From Wikipedia) in anticipation of your email agreement. Yes, it will be quite a challenge to make these topics understandable to the general audience. I am confident that each of you will be able to hit the mark because, Ira and Howard, you both have a very accessible style in writing…
With respect as always, Deardra
I'll be happy to talk about biosemiotics, but we have guests this week so there will be a delay.
ReplyDeleteIra's hierarchy span theory and biosemiotics are both aspects of what is popularly called complexity theory. Why does life get more and more complicated, and why do we still find certain patterns of complexity?