Health Care and Human Rights

November 19, 2009

Senate Democrats have just released their proposed health care reform bill. The good news: their proposal is estimated to cost $200 billion less than the bill proposed by House Democrats. The bad news: the cost will be $849 billion over ten years.

Of course, as was true with the House bill, the Senate bill actually projects a net reduction in the federal deficit over ten years, to the tune of about $130 billion. Much of the cost savings comes from projected cuts to Medicare reimbursement. Anyone who thinks that substantial reductions in fees paid to the providers of seniors' health care will actually take place may be interested in purchasing from me a toasted cheese sandwich that has an image of both Jesus and Harry Reid.

In principle, health care reform may be all well and good, but unless you're getting commissions on NINJA loans, you can't get something for nothing. We are already operating under huge budget deficits. Our national debt is approximately $12 trillion, and climbing rapidly. Huge chunks of that debt are owed to foreign governments, most notably China. If health care reform winds up costing us money -- and this is highly probable -- how are we to pay for it?

CFI has officially endorsed universal health care coverage -- of some sort. One reason for our endorsement is that sound scientific evidence establishes that when patients receive appropriate care in a timely manner, more serious and costly medical problems are often prevented. However, CFI studiously avoided endorsing any particular health care reform bill. Following our standard practice, CFI decided not to take a position on an issue where there is not only a wide divergence of views among humanists and skeptics, but these divergent views all can be considered reasonable.

But from my personal perspective, I believe both the current House and Senate proposals lack some necessary provisions. Tort reform, such as a cap on damages in malpractice cases and use of arbitration instead of litigation, could save billions. Everyone recognizes physicians order many unnecessary tests because of the fear of being sued. Price Waterhouse Cooper has estimated that $240 billion was spent on "defensive medicine" just last year.

Another change that should be required is an increase in taxes for most income groups, not just the super-rich. If health care reform is something we really want, we should be willing to pay for it -- instead of placing all the debt on the government's magic charge card, with the bills coming due when our children and grandchildren reach maturity. If we are not willing to pay an additional 2% or 3% in taxes to fund health care reform, then perhaps it's not that important to us.

Access to health care is often labeled a human right. I have some doubts about the use of "rights" claims in this context, but leave that point aside. In any event, there are other, arguably more fundamental, human rights, such as the right to free speech, the right of assembly, and the right to petition one's government. Moreover, humanists have been reminding themselves over the last few years that we have global moral obligations, that is our circle of ethical concern does not stop at our national borders but extends throughout the world. The direct implication of this view is that we should be working to advance basic human rights in all countries.

But running up our national debt limits our ability to do that. China is our largest lender. China is also run by a brutal, authoritarian government whose lack of respect for human rights was made manifest by the Tiananmen Square massacre of 1989. Some have criticized Obama for not pressing the Chinese hard enough on human rights during his recent visit. Actually, the wonder is that he raised the issue at all. A debtor does not typically march into a creditor's office and start hurling loud accusations -- not when that creditor can call in the debt at will. To influence the Chinese, we need leverage, and it's difficult to obtain leverage when one is in debt bondage.

With respect to one's own household, one has a moral responsibility to live within one's means, especially if one has dependents. That same responsibility extends to one's political household. We should not support policies that require us to make expenditures that can be funded only by increasing our debt. Fiscal responsibility is one aspect of moral responsibility.

Comments:

#1 Bob (Guest) on Thursday November 19, 2009 at 4:19pm

I think the point that people fail to see is, we’re already paying for it. The only way to avoid paying for it is to not provide care to people who can’t pay, and that’s medically unethical and morally repugnant. The reason this will reduce costs is because health care providers no longer have to account for people not paying their bills because everyone will have health insurance. The other place we’re going to see tremendous savings is in bankruptcy court. I don’t know what the current statistics are, but prior to the recent financial collapse the majority of bankruptcies were due to medical bills. So, combine just those two things and you get lower cost of care for everyone because we’re not paying for “freeloaders” anymore, and reduced cost of debt because of a lower rate of bankruptcy.

#2 Keith (Guest) on Thursday November 19, 2009 at 4:47pm

Another thing that we should remember is that having an initial bill in place should make it easier to pass further incremental reform that would address some of the initial bill’s problems. However, passing no bill at all will simply leave us worse off than we are now.

Another point: I understand the idea that if people aren’t prepared to pay for a bill, that may mean they’re happy to do without health reform. However, the people who need health care the most are those who are least able to pay for it.

Conversely, most middle and upper class people who feel they already have a decent health plan, and who may not be fully aware of the magnitude of the health crisis, are likely to be far less worried about reform - and therefore less willing to pay - than they really should be. In other words, they are the proverbial frogs in slow-heated pots of water.

#3 SimonSays on Friday November 20, 2009 at 10:00am

I agree that government mandates to buy private insurance and other questionable “solutions” that arise from the current bill are expensive and futile. I also agree that raises taxes should not be anathema, especially when we’re talking about healthcare or education.

However…what Ron fails to mention is that Americans already spend almost twice the amount of money per capita on health care as any other rich industrialized nation on the planet, and yet we manage to exclude 45 million+ from the system and have considerably higher prices for prescription drugs.

The problem is not therefore that we aren’t allocating enough money to this sector of the economy. As a percentage of GDP, we’re actually allocating MORE than other western countries.

While there is undoubtedly tremendous waste in the system, I have serious doubts about the “defensive medicine” figure that PwC came up with, and I’m not the only one: http://www.justice.org/resources/Medical_Negligence_-_Defensive_Medicine.pdf

I think that if we are to eliminate the waste, we should ask why options that would SAVE money are not being considered. One example is Medicare, which has an overhead of around 3% (as opposed to around 20% for private insurers). Why is extending Medicare coverage to people below 65 off the table? Private insurers could compete to offer supplemental services, as they do for Medicare patients right now. I recommend taking a look at HR 676 for more details on this plan.

The government has huge purchasing clout if it chooses to utilize it. Why is centralized drug purchasing off the table (apart from the deal Obama made with Phrma)? Despite having a smaller group, the VA currently has cheaper drugs than Medicare because they are allowed to negotiate with the drug companies.

#4 SimonSays on Saturday November 21, 2009 at 9:02am

To add another point, I’m not convinced that defending human rights abroad is (or really ever was) an objective of US administrations. This is evidenced by the amount of human rights abusing regimes we actively support (or stop supporting when they go against our “national interests).

With regards to China, yes they may be our banker, but we’re also the biggest purchaser of their goods by far, so also not sure if this is the reason Obama (like previous presidents) tends to only pay lip service to human rights during visits there.

IMO, at least partly as likely the reason why Obama can’t condemn human rights violations in China is because our own house is not order. For just one example, read Glenn Greenwald’s article today talking about how Lithuania, a country that has had democracy for less that 20 years, is going to publicly investigate and prosecute the people behind the CIA secret prisons in their country: http://www.salon.com/opinion/greenwald/2009/11/21/accountability/index.html

#5 gray1 on Sunday November 22, 2009 at 2:50pm

Good write!

The realistic view is that this “healthcare” business is much more concerned with the further accumulation of federal power (over us!) than any sense of altruism. 

Louisiana Senator Landrieu’s price for her vote in favor of this boondoogle was some $100,000,000 in future taxpayer’s dollars to spread around to her friends “back home”. 

What did your guys get?  Do we have a “winner” yet?
Hint - it isn’t us.

#6 wayne (Guest) on Sunday December 13, 2009 at 6:23pm

Why must poor working class persons suffer from lack of health care while they pay, with their taxes, for the health care insurance needs for the wealthy members of Congress. If we can’t afford to provide health insurance for the poor and working class poor, we can’t afford to provide free health care for the wealthiest of our citizens.  Also, what kind of society do we have when a major priority of the U.S. government is not caring for the health of our citizens while it provides for numerous, often absurd, ear marks tagged onto bills for increased spending for war and other bills. 
  It is time to change our spending priorities from that of taxing the poor for the benefit of the wealthy to that of providing adequate health care insurance to those of the working class who are currently pawns to be sacrificed for the welfare of the wealthy.

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