Stupid People and Health Care

Ezra Klein compares his views on Medicare to those of a conservative and finds that, while they have similar views on the problem, they differ greatly on the solutions:

What always fascinates when I read right-wing critiques of American health care is how similar our diagnoses are, but how diametrically opposed our treatments would be. For the right, more consumer risk is required in order to encourage wise treatment decisions on behalf of patients. That means, of course, that those who make poor decisions, or simply get really ill, face financial ruin. That seems crazed and cruel to me. While I do think the left needs to take financial incentives more seriously than it does, I’d favor having many more carrots than sticks, and I’d want to separate out poor decisions and behaviors from simple bad luck. HSAs and all the rest punish the illogically stricken as surely — or more surely — than they do the stupid. And I’m not even ready to punish the stupid. So much as I think it inadvisable that half of those with HSAs haven’t deposited a cent, I’ve no interest in abandoning them to the consequences of that oversight.

Ezra has it right, but to that I would add that, when it comes to health care, there are a lot of “stupid” people. Stupid is really the wrong word here because I’m speaking of the attitudes of most people, regardless of intelligence. The average person (and even some of my collegues, but that’s a topic for another day) lack sufficient knowledge to make decisions with regards to chronic and preventative care.

Most people might know to go to see a doctor if they are seriously ill (assuming they aren’t among the growing number who cannot afford it). Far fewer understand the importance of treating problems like elevations in blood pressure, blood sugar, or cholesterol when they have no symptoms. It is far more economical, both for the patient and society, to treat hypertension and diabetes early and aggressively than it is to pay for coronary artery bypass surgery, amputations of limbs, renal dialysis, and long term care following a stroke.

We cannot force people to make wise decisions, but at least we can make the system one which encourages patients to do the right thing. Health savings accounts, accompanied by high deductible insurance policies, lead to people putting off routine and preventative care. Patients are much more likely to seek needed medical care when it does not come out of their own pockets, but do not like to spend either thier own money or money in their HSA. There are many possible ways to make health care more affordable, but in the long run HSA’s are a poor method.

Leadership or Pandering? Kerry or Warner?

During the 2004 campaign, John Kerry called for an elimination of the Bush tax reductions for those making over $200,000 per year in order to reduce the deficit and pay for his proposals. The Des Moines Register quotes John Warner as opposing this position:

“I think the Kerry campaign missed something,” Warner, who is weighing a 2008 presidential campaign, told about 50 local business leaders.

“Even though the Bush tax cuts only applied to the top 2 percent of Americans, what I think the Kerry campaign missed was that the other 98 percent of Americans still aspired to get to the point in their life where they could qualify for the tax cuts.”

From a pure political point of view, Warner is right. The candidate who promises the most for free will always have an advantage. Republicans have done great with this strategy. Warner is also right that even those who are not affected by the tax cuts hope to one day earn enough where this impacts them.

If we want a candidate in 2008 who will say anything to get elected, nominate John Warner, not John Kerry. My previous post on the increase in number of uninsured shows why we need a leader who does not pander in this matter. If we are going to solve problems such as making health care affordable, we need to also be able to say how these solutions are to be financed.

It might be easier to ignore such problems, as well as the deficit, but we already have the Republicans for that. We need leadership to explain to the voters why they come out ahead financially if they pay a little more in taxes (assuming they make over $200,000) but in return will have affordable health care, and will not see the value of their retirement funds eroded by inflation due to the deficit. This might increase the chances of losing, as in 2004, but getting this country back on track is a mission for more than one election cycle. We need people like John Kerry who will tell the voters the way it is, and over time an increasing number of people may be receptive to their message.

Update: Warner Admits Kerry Was Right on Tax Cuts

Number of Uninsured Rises Again

American Medical News reports that the number of uninsured has climbed to 46.6 million, up 1.3 million last year primarily due to the loss of employer-based coverage. Those who are insured are also finding that their benefits have decreased. The number of uninsured has steadily increased under George Bush, up from 41.2 million in 2001.

Many of the uninsured are working but make too little to handle medical expenses. Of the 37.8 million of working age people who lacked insurance in 2005, 27.3 million worked at some time during the year. Looking at household income, 24.4% of the uninsured make less than $25,000 and 20.6% make $25,000 to $49,999. Children account for 11.2% of the uninsured.

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Keith Olbermann Cuts Through Republican Rhetoric of Supporting Freedom

Keith Olbermann calls on George Bush to apologize to the nation, not just for his failed policies but for violating the principles the principles of freedom which this country represents:

In a larger sense, the President needs to regain our confidence, that he has some basic understanding of what this country represents — of what it must maintain if we are to defeat not only terrorists, but if we are also to defeat what is ever more increasingly apparent, as an attempt to re-define the way we live here, and what we mean, when we say the word “freedom.”

Because it is evident now that, if not its architect, this President intends to be the contractor, for this narrowing of the definition of freedom.

Olbermann reminds viewers that George Bush has violated the principles of the Founding Fathers of this nation:

“Governments are instituted among men, deriving their just powers from the consent of the governed. That whenever any form of government becomes destructive of these ends, it is the right of the people to alter or to abolish it, and to institute new government.”

Those incendiary thoughts came, of course, from a prior holder of your job, Mr. Bush.

They were the words of Thomas Jefferson.

He put them in the Declaration of Independence.

Mr. Bush, what would you say to something that anti-thetical to the status quo just now?

Would you call it “unacceptable” for Jefferson to think such things, or to write them?

Between your confidence in your infallibility, sir, and your demonizing of dissent, and now these rages better suited to a thwarted three-year old, you have left the unnerving sense of a White House coming unglued – a chilling suspicion that perhaps we have not seen the peak of the anger; that we can no longer forecast what next will be said to, or about, anyone who disagrees.

Or what will next be done to them.

The present crisis in our democracy reminds us a lot of Watergate with one important difference. During Watergate the media frequently reported on Richard Nixon’s crimes until he was forced to resign. Since then the fairness doctrine has been eliminated and the media has been consolidated under generally conservative ownership, quieting most voices of dissent in the media. The supposedly liberal media reported every step of the Monica Lewinsky scandal, but until recently kept quiet about Bush’s misdeeds.

I am pleased to see that Keith Olbermann is not only speaking out about the specifics of Bush’s actions, but the general principles which have been violated. Far too often, liberals have allowed the right wing noise machine to use words like freedom in an Orwellian fashion as they have violated. It is important that supporters of freedom stand up to show that the Republicans have fallen under the control of authoritarians who have no support for freedom. Similarly we must show that, despite their rhetoric, Republican support for corporate welfare is opposite to the prinicples of capitalism, and that the Republicans are the ones who have cut and run every step of the way, refusing virtually every Democratic recommendation, to keep the country safe from terrorism.

McCain Defies Bush on Treatment of Detainees

I’m no fan of John McCain, but sometimes it is only fair to give the other side credit. McCain ran as the outsider in 2000 and found that is a dead end in the GOP. He has been trying to run as Bush’s heir in 2008 and has been photographed being as cuddly with Dubya as Joe Lieberman. Politically the smart thing to do would be to go along with the Bush Administration, including on detainees, but McCain is sticking to principle here.

This may only remind Repubicans of why they opposed him in 2000. The Washington Post notes, “In a reprise of criticism showered on McCain during his 2000 campaign, some prominent conservatives are branding him a disloyal Republican and an unreliable conservative because of his assertiveness on the detainee issue.”

Perhaps McCain can afford to stick to his principles on this issue. It is unlikely to hurt him in New Hampshire. The big question is South Carolina, where disagreeing with Bush might not be as dangerous as we’d first think. South Carolina Senator Lindsey Graham, a former military lawyer, joins McCain in opposing the Bush Administration on treatment of detainees:

In a telephone interview from South Carolina yesterday, Graham said: “What I hear is, people respect the commitment of the president to the [CIA interrogation] program, and they respect my commitment and Senator McCain’s commitment to the troops.”

Graham added: “Every editorial in the state has understood Senator McCain’s and my concerns, and believe they are legitimate.” The Geneva Conventions say wartime detainees must be “treated humanely.” Bush says the United States complies so long as CIA interrogators abide by a 2005 law barring “cruel, inhuman, or degrading” treatment of captives. McCain and his allies say that the requirement is too narrow, and that they are concerned Bush’s approach would invite other nations to interpret the conventions in lax ways that could lead to abusive treatment of captive U.S. troops.

Update: The Los Angeles Times looks at how this stand may hurt McCain among conservatives. Sorry John–don’t let them torture people and they won’t want to play with you.
A few older posts on John McCain are under the fold–two of which include the picture of him hugging George Bush.