Tag Archives: Health care debate

WARNING: The Potential Side Effects of Discussing Health Care Reform may Include Elevated Blood Pressure, Early Onset Dementia, Constipation of the Brain and Excessive Paranoia.

No blog subject – no matter how controversial – brings a quicker, more passionate and vitriolic response than does one discussing health care reform. The good news is that any blog dealing with health care reform causes an immediate spike in web site visits, but the downside is that most responses end with something to the effect, “I will never read your #?& blog again!”

This reaction was epitomized following my recent blog “Health Care Reform: Complicated Problem – Simple Solution.” Frankly, I was neither surprised nor offended by the negative, passionate viewpoints of many who read the blog. (Hell! I am just happy so many people read the blog.) But I am disappointed that many of the respondents exhibited such a lack of independent, individual critical thinking and instead fell back on the tired old pabulum of disingenuous arguments dished out by the insurance industry and other special interest groups that have a financial stake in the current health care system. (I know this attitude may upset those respondents, but they are unlikely to read this anyway; so who cares?)

I sometimes wonder if real people are actually posting these comments since their carping exhibits certain mirror-like qualities, and – most telling – they ignore the specifics of what was actually written in the blog. You’d think these hasty missives were generated by a seditious Internet “bot” that uses “health care” as a keyword to post these comments. (Am I being paranoid here?)

Missing The Mark

For example, the central theme of my health care blog asked one, simple question:

Should basic health care be a right or
a privilege for all American citizens?

That seems like a simple, straightforward, yes-no, binary question. Either you believe that basic health care should be a right afforded to all citizens just as they are guaranteed free speech, the right to vote, a public education and “life, liberty and the pursuit of happiness.” Or, you believe that receiving basic health care is a privilege available only for those who can afford and find it. In other words, it’s akin to attending a private school, flying first-class or buying a more expensive new car.

Yet, as simple a choice as that may be, not one of the respondents made an effort to address or answer that question. I guess this means the question was too complicated for them, they didn’t have the courage to take a stand, or they have the mental capacity of a parrot that can repeat, but not understand, the specific words and phrases said to them over and over.

Look, I can respect –even if I don’t agree with — those who sincerely believe basic health care for American citizens is a privilege available only for those who can afford and find it and not a right for the rest of us. After all, one of the rights we all have is the right to disagree. But I disdain those who lack the guts to take a stance by directly answering the key question. I even have a modicum of respect for health insurance companies (and we all know “corporations are people”) that have made it abundantly clear by their actions, lobbying and political contributions, their stance that health care is a privilege and not a right. It may not be possible for these blog bashers to be forthright in their response to the most basic question in the health care debate, but we can examine the logic of the arguments they make opposing health care for all Americans. Most of these arguments center on what they view as the sanctity of “personal liberty” and “right of free-choice.”

The argument as espoused is that individuals – not the government – should be free to decide if they even want health coverage, what form it takes and where they can buy it. For them, it is a violation of their “personal liberty” for government to “mandate” that individuals must purchase some type of basic coverage. I have no problem giving people the freedom to make that choice. But if they do decide to forgo health coverage for themselves or their family, they should be willing to sign a waiver agreeing that if they ever do get sick, they are fully responsible for all costs of care. Because if they don’t, you know who will end up paying for their “freedom” to decide not to have health care coverage. But more importantly, the issue is not about those who have the resources to “self-insure” or can find private coverage; the concern is for those who lack the means to buy private insurance (at prices set by companies) and those who have the resources, but can’t find an insurance company willing to issue a policy. Shouldn’t there be some option – private or public – for these groups to have the “individual freedom” to have access to and acquire basic health care coverage (which at the present time is made up of almost 50 million Americans)?

The Mandate

The real hang-up for those who oppose health care reform is the idea of a “mandate” coming from government requiring the purchase of some type of health coverage. For them it is the litmus test in the battle between individual freedom and government oppression. It is their sincere belief that government has neither the moral authority or constitutional power to compel an individual to do what they don’t want to do or to buy what they don’t want to buy.

This, of course, is ludicrous logic, which if taken to its full course, leads to anarchy. The essence of any government is the power to mandate compliance with the rules of society. Without the power to mandate, any government ceases to exist and soon thereafter, so will organized society. Of course the power of any government must only come as a mandate from the governed and it must be balanced in a way to benefit all of society, sometimes even at the expense of unfettered individual liberty.

The real problem in the health care debate is that the power brokers and special interests that oppose health care for all Americans have consciously corrupted the intent and objective of the “health care mandate” by tying it to the emotional issue of “individual freedom,” as opposed to what is best for society in general. People are being led to believe that they are being “mandated” to do something they don’t want to do and therefore their individual rights are being violated. But, that is not the case.

The “mandate” is simple and far less nefarious than people are led to believe. It starts with the assumption that everyone – rich, poor, old and young – need and want basic health care coverage. Then it says you have two options: You can either be covered by programs offered by the government or required to be provided by your employer or you have the freedom to purchase any private plan you desire and can find. However, for the overall protection and benefit of society, you are “mandated” to pick one of the options. And the reason why is patently (and fiscally) clear: If you don’t pick either option and get sick, then society will be stuck paying for the cost of your freedom to decide not to have health care coverage.

Unfortunately, the success of those opposed to health care reform to link the emotional issues of “individual freedom” and “mandates” together in a way that makes them seem in conflict, when in this case they are actually complementary, has led to some deeply irrational and kooky arguments.

An example of just how kooky things can get is one response to the previous blog on health care. It earns the first prize in the category of convoluted thinking. Here is the argument, reproduced as submitted:

“do people have the right to drive a car or is it a privilege. everyone needs transportation. must we then mandate that we buy everyone a car. As long as your asking someone else to pay your bills through a mandate it’s wrong. health care without some restrictions would drive the price out of site for all private companies and individuals. That’s what obamacare will do for everyone, but health care will be worse for most except the very rich.”

Beside proving that he slept through his (mandated) middle school English class, give the writer credit for one thing: In one tortured, convoluted paragraph he is able to cover the entire waterfront of the health care debate even though his logic went out with the tide.

The person is correct when he writes that everyone needs transportation, but he seems to be oblivious of the fact that cities, states and the federal government spend billions of dollars to provide “public transportation,” that is available for those who exercise their freedom not to buy a car or cannot afford either car or bicycle. Of course, we are all “mandated” to pay for this with our taxes, even if we don’t use public transportation, or sleep through English.

It is hard to tell, but his paragraph seems to suggest that “individual freedom” for anyone who needs transportation is defined by their ability to find it on their own or do without. While it is a big leap from figuring out how to get to work to figuring out to how to obtain and pay for basic health care, his logic seems to be leading us to believe that “individual freedom” for those who need health care coverage but can’t afford or find it – is to do without. The writer clearly believes it is wrong “asking someone else to pay your bills through a mandate.” Which leads me to wonder if he has ever received benefits under Medicare, which, if he has, means that others have helped pay his bills? (Lest we forget, Medicare is a mandated government program requiring all to contribute to and participate; which, unlike Obamacare, offers no “individual freedom” to opt out and secure private coverage. Even if one can afford and find it.)

This person argues elsewhere that, “health care without some restrictions would drive the price out of site…” (sic) I could not agree more, but no one – specifically not Obamacare – is asking for health care without restrictions; just that everyone have a right to receive “basic” health care. This gentleman may have forgotten that one of the main Republican attacks against Obamacare was that there were restrictions on coverage. Does he not recall the infamous brouhaha raised by the Republicans over the Obamacare “Death Panel” that would supposedly restrict and control benefits?

In one final killer dagger to the heart of health care reform this guy nails it when he declares that under the mandate of Obamacare, “health care will be worse for most except the very rich.” What is worse than no coverage at all? And isn’t that the real problem now, that health care really only works for the very rich?

As long as we have gone this far, let’s address one final issue that is central to the health care debate. Many are genuinely concerned with the propriety (if not legality) of “mandating” individuals to “pay” for benefits received by others or to receive benefits “paid for” by others. One respondent put it succinctly: “Do I have the right to force someone else to pay for my health care? If so, then that person no longer has the right to their liberty. One cannot have BOTH the right of liberty AND the right to health care. I prefer freedom.” This person is obviously sincere, but once again, the reality and logic of her comments are faulty.

It is the fundamental nature of any insurance program – public or private – that the benefits received by one are paid for by others. For example, if you buy a $250,000 fire insurance policy on your home, you will never come close to ever paying $250,000 in premiums, but if your home burns down, you will receive a check for $250,000. Where does the extra amount come from? Do you think the insurance company just gratuitously ponies up $250,000 of their own money? Of course not; your benefits are paid for by all others who also have a fire insurance policy with that company. Likewise, if another person’s home burns down, a portion of the premiums you have paid will go to pay the benefit they receive. Is this wrong? No, it is how insurance works.

Consider Social Security. We are all “mandated” to buy into the program and pay “premiums” during our working years, so that we can begin to receive benefits at retirement. It only takes a few years of receiving Social Security payments for them to exceed the amount of taxes we have contributed. Does that mean the payments stop? Of course not, they continue for as long as you live. So who pays for these benefits? They are paid for by others who are still working and contributing to the plan; just as you did when you were working. Is this wrong? No, it is how insurance works. With universal benefit programs such as Social Security it is necessary for financial soundness to “mandate” that all participate. (The financial problems with Social Security are not the fault of the soundness of the plan, but because our friendly politicians have “borrowed” money out of Social Security to pay for other things.)

If it is determined that basic health care is a right for all citizens, then to work effectively and to be on a sound financial basis it must be structured like any other insurance program. As such, others will pay much of the benefits you receive in the program and some of your payments into the plan will be used to pay benefits for others. As with any universal benefit plan, all must be “mandated” to participate in order for it to be financially sound. But, unless you never go to a doctor or get sick, the benefits you receive will always exceed the amount you have contributed and those benefits will be paid for by all the other participants.

Give me Liberty or . . .?

The final part of the respondent’s comments argued that the concept of a “right” and “liberty” are mutually exclusive. That you can’t have both and you must pick between the two. This is faulty logic. We all have a “right” to a basic public education; does this mean that we lose our “liberty” to go to a private school? We have a “right” to police protection; does that mean we lose our “liberty” to hire a security service? We have a “right” to free speech; does that mean we lose our “liberty” when the government “mandates” that we can’t yell “FIRE!” in a crowded theater? When women were given the “right” to vote; did that mean that men lost their “liberty?” (Well maybe, but that is for another discussion.)

The beauty of this country and the government we have selected is that as “rights” have been recognized and made available to all, it has expanded “liberty” for all. All American citizens deserve the right to receive basic health care; if for no other reason than it is the right thing to do.

And the Moral of the Story …

This all leads us back to the fundamental question at hand: Should every American citizen have the right to receive basic health care? If the answer is “no,” then we are done. We are saying that we are satisfied with the current system that allows private insurance companies to ration health care with the objective of making a profit. We are satisfied with a system that excludes 50 million Americans from any coverage and provides inadequate, prohibitively expensive coverage to millions more. If the answer is “yes,” that basic health care should be a fundamental right of all Americans, then we have a lot to do. But the debate will switch from emotional and irrational arguments about the problem to finding ways to solve the problem. And we have always been better as a society when we have sought to work together to expand the rights of others in a way that expands freedom and liberty for all.


Health Care Reform: Complicated Problem – Simple Solution

Politicians should be sued for malpractice when it comes to resolving health care issues in America

The question of access to, and the scope of, health care in America has been a long-term, intractable dispute. At the core of the debate, contributing to the elusiveness of a solution are two, sometimes contradictory, philosophies. One is the long-term American societal acceptance of the Judeo-Christian belief in the “sanctity of life.” This philosophy mandates that a paramount duty of society and its government is to do everything that can be done to protect, preserve and extend life. (This is why the question of “when life begins” is such a critical issue in the “right to choose” versus the “right to life” debate.) Also in the mix of the health care brouhaha are the traditional American concepts (myths) of “rugged individualism,” self-reliance, freedom of choice, free markets, and fear of the incursion of government into the private lives of individuals.

All these elements have been intermingled to produce a caldron filled with emotional, passionate, confusing, sometimes deceptive debate over the form and scope of access to health care in America, and that has frustrated practically everyone. The only group that seems satisfied with the current state of health care in America is the health insurance industry that remains free to “cherry-pick” from among the masses selecting not only who can receive coverage, but what type is received and at what price. As a result, health care is rationed and almost 50 million American citizens are left with no health care coverage – even if they can afford it – and millions more have only limited benefits.

Curing the ills of the health care system in America will never be accomplished unless the superficiality of these emotional terms is overcome and the debate is reduced to a simple question: Is access to basic health care for all American citizens a “right” or a “privilege?” Only when this hotly debated question is resolved will a clear path emerge to determine the future structure and form of health care in America.

Better Late than Never

Most major industrial countries have already answered this question and have overwhelmingly concluded that basic health care is a “right” not a “privilege.” In fact, the United States is the only country of the top 46 industrialized nations not to view basic health care as a right. And it’s highly unlikely that the citizens of the U.S., as opposed to its leaders, believe in such an isolationist view.

To find out, ask yourself this question: As an American citizen who is guaranteed the right to “life, liberty and the pursuit of happiness” by the Declaration of Independence, do you believe that includes the “right” to receive basic health care to protect, preserve and extend your life? Or do you believe that the guarantee of “life” applies only so long as you (and your family) don’t get sick? Do you honestly believe that your “right to life” stops at the front door of a hospital and that basic health care is really a “privilege” that should only be available to those who can find and afford it?

When you cast the health care issue in any other way, the debate creates a number of incongruities. For example, many thinking adults earnestly resist the idea that basic health care is a right that should be guaranteed by the government. They shudder at the thought of government incursion into something as personal as their health. They also fear the loss of freedom to choose who provides the care and what type of treatment. Yet, for some reason these same people seem to believe that a private insurance company – one that can reject, cancel or limit their care and charge the premiums they decide, all in the name of making greater profits — will, for some altruistic reason, care more about them than the government. It is also telling that many people who passionately argue that any unborn child has a “right to life,” and yet are, paradoxically, unwilling to guarantee that this same child has a “right” to health care once they are born.

It is my belief that if Americans are presented with this clear choice between health care being a “right” or a “privilege,” the vast majority would come down on the side of what is right. Just as basic education has been considered a right for every child, even for the poorest child from a broken home, since the 1850s. Just as every American believes they have a right to personal safety and security from police and fire protection. What American was not raised with the belief that they have a right to “life, liberty and the pursuit of happiness?” If we have a right to “life,” would that not include health care to protect and extend that right? If we look to government to protect our life and preserve our liberty, why should the government not be charged with assuring (although not necessarily providing) that every American citizen has access to basic health care?

If you sincerely believe that finding, securing and receiving basic health care is not a right, but is rather the responsibility of the individual, then you will be satisfied with the existing system of “privilege,” because that is how it works. However, if you are one who believes the “right to life” includes the right to have that life protected, preserved and extended, you will recognize the need for a different approach to structure and accessibility of health care.

If we can agree that access to basic health care is a right and not a privilege, then finding a solution to provide and protect that right, while respecting the individual’s desire for freedom of choice, is actually quite simple. Probably the closest parallel for this is the system of public education. Every child born in America is entitled to a publicly-funded education, paid for by local, state and federal taxes or grants. Through high school there are no fees to the child, but if they want to go further – on to public college –then a series of co-pays come into play.

All during this process the family has the privilege – if they have the desire and resources – to seek alternatives to the public system. They are free to send their children to private schools, retain tutors, or home-school their offspring, just so long as they could afford it and meet the minimum standards of a public education. If the student is not using the public system, sometimes vouchers are even offered to help offset the cost of private education. This system has provided the “right” to a basic education, while maintaining the “privilege” for the individual to go beyond that system, so long as they had the resources to do so.

Providing the right to basic health care could follow a similar approach. The existing Medicare system (with Medicaid folded in) could be expanded to provide basic health care for all citizens from “cradle to grave.” These services could be provided by expanding the existing Medicare payroll and employer taxes. (Employer expenditures would be reduced because there would be no need to provide employee group health care benefits.) Cost of the program could be reduced by implementing a “needs based” system of increasing co-pays for services provided, based upon the income or the net worth of the individual covered.

All during this process the individual would have the privilege – if they have the desire and the resources – to seek alternatives to the public health care system. They could purchase private insurance that would cover co-pays. They could seek additional services or specialist care that go far beyond those provided by the basic program. Those who decline to participate in the public program could be issued vouchers for the purchase of private insurance plans; just so long as they met the minimum requirements of the public plan.

This outline of a reformed health care system that would offer access as a “right” for all American citizens is too brief to be perfect. It raises more questions than it answers, but the objective here is simply to suggest that if, as a society, we decide that basic health care is a right and not a privilege, then resources can be shifted from focusing on the problem to finding a solution.

And the moral of the story …

The question of access to and the scope of health care in America has created a cornucopia of confusion, consternation and conflict, all because of the failure to ask the most basic question: Should health care for all American citizens be a “right” or a “privilege?” The problem is that special interests, moneyed powers and weak, self-serving political leaders have a vested interest in not focusing on the simple issue to be resolved. Unless and until that happens, a simple problem will continue to be complicated. This is not right and we have a right to demand a change.


Health Care Legislation: A Sign of Failed Leadership

Health Care Bill Passes But The Administration’s “My Way or the Highway” Approach Offers Some Solid Evidence of How NOT to be a Leader

If you were confused, angered and bored by the shenanigans revolving around the final stages of the health care reform debate, even to the point that you have tuned it out, you are not alone. But whether you favored or opposed the current health care reform legislation, I hope you didn’t miss this golden opportunity to study real life examples of both good and bad leadership.

True leadership is the ability to inform, inspire and motivate followers to adopt the leader’s goals as their own and work to see them achieved.

True leadership always revolves around the idea of achievement; the attainment of a goal. Leadership is about doing, not, not doing. The reality is that it is far easier to be against something without offering constructive dialogue for improvement, but that is not leadership. That’s anti-leadership.

Although it’s a bit I risky to use a political process such as health care as a case study in leadership, it is real life, and it offers plenty of lessons. Part of the problem is that much of the health care debate is about politics, not necessarily the right thing to do. The Republicans – their pockets lined with millions from the insurance industry – and clearly only targeting the next election, are not interested in doing anything other than preventing anything from being done.

The Republicans would be in a much more credible leadership position if they had acknowledged that the health care system in America has failed to provide all Americans with the right to basic health care coverage, and then offered positive and constructive solutions. The fact that they have not is evidence of obstructionism, not leadership.

No matter how strong or how much in the right a leader might be, the chance for success is nil if half the people he is attempting to lead are actively and aggressively acting to sabotage his efforts. Can you imagine how successful a CEO would be if half the people in his company were dedicated to seeing his efforts fail?

It’s no surprise, then, that President Obama has exhibited both strong and weak examples of leadership. He receives high marks for his focus and consistency. He has expressed the vision of what he believes is the right thing to do and has consistently stuck to it. In the ferocity and intransigence of the opposition many weaker leaders would have backed off long ago and moved on. It would have been easy for Obama to use the economy, terrorism and the war in Afghanistan as excuses to bail out knowing he “fought a good fight” on health care. And he could blame the Republicans for blocking reform – and move on. But, to his credit he has not.

However, some weak leadership techniques on the part of Obama exacerbated his challenges for success and, in fact, played into the hands of the Republicans. As I have written in previous blogs, Obama failed to simplify his vision in terms that everyone could understand, and few could disagree with. Instead of positioning his vision as an effort to assure that every American had the right to basic health care coverage, Obama spoke in the broad concepts of “health care reform.” This failure to clearly and effectively define his vision in clear, simple terms opened the floodgates for those opposed to basic health care for all Americans to raise any number of issues, no matter how specious they may be.

In addition, President Obama failed to maintain control over the debate regarding his vision. A strong leader always sets the terms of the debate and forces those opposed to be on the defensive. By not taking the lead in developing the specific steps needed to achieve his vision (Obama allowed the House of Representatives to develop the plan) he put the structure and fate of his vision in the hands of others; a sure sign of leadership weakness.

Effective and strong leaders will always empower others to implement their vision, but they will never allow others to define their vision.

When Obama began to see his vision for health care reform going down to defeat he undertook to initiate tactics that are a sure sign of failed leadership. It was an attitude of “the end justifies the means” and it is “my way or the highway.” A confident, strong leader – no matter how committed they are that their vision is the right thing to do – will always hew to the belief that doing the right things is the only way to achieve the right thing.

Obama allowed those pushing the reform through Congress to use (at least attempt to use) tactics and tricks not befitting a strong leader. One could certainly argue that those opposed to reform have been less than ethical in their attacks, but that does give license for the leader to stoop to the same tactics. To do so, even if they are successful, damages the credibility, respect and long term power of the leader. Anytime a leader is required to use his power to adopt a “my way or the highway” style of leadership he should recognize that he has failed as a leader.

No matter what the end result may be in the health care debate, one thing is clear, the experience is a great study in leadership or the lack thereof.

And the Moral of the Story . . .

The practice of real leadership is much like being a good salesperson.

The salesperson’s job is to identify his prospects’ need, demonstrate that his product is a solution to the need and then motivate the prospect to buy the product to solve the need.

The leader must be able to offer a clear vision of what needs to be done, demonstrate that his plan will solve the need and then motivate others to “buy in” to his vision and solution.

Just as the salesperson will fail to make a sale if he does not identify the need, offer a product that solves it, and closes the deal, the leader who fails to accomplish any of these points will fail as a leader.

Even the most accomplished salesperson does not always make the sale, but if he remains true to the principles of effective salesmanship he will make more sales than he loses. Even the most effective and strongest leader does not always achieve all his objectives, but if he remains committed to the true principles of leadership, he will succeed more than he fails.

Still, even though the historic health care reform bill has passed, one cannot help but feel that the Hobsonian choice of “take it or leave it,” and “my way or the highway” was not the way a true leader should have achieved it.